Psy-World

The Cost of Suicide in the USA
by
Gemma Fox

Suicide is a devastating event for friends and families of victims, yet we often fail to discuss the economic ramifications for the nation when someone takes their own life. The most recent figures show that the cost of suicide and suicide attempts amounted to $58.4 billion in 2013, based on reported acts. Indirect costs brought about by lost productivity are responsible for almost the entirety (97.1%) of this cost. However, adjusting this figure due to under-reporting of suicides and suicide attempts, sets the total cost much higher – at around $93.5 billion. Suicide is the 10th leading cause of death in the United States.

Previously, the exact economic burden posed by both suicides and attempts remained unascertained. However, data presented in the paper Suicide and Suicidal Attempts in the United States: Costs and Policy Implications provides quite detailed information, which is compiled in Table 3 of the Report. Thus the economic cost, as well as normal health considerations, have influenced the country’s plan of action when it comes to suicide, as contained in the National Strategy for Suicide Prevention.

In America, suicides are recorded in the Injury Statistics Query and Reporting System (WISQARS), run by the Centers for Disease and Control Prevention (CDC). These statistics show that in 2013 (the most recent year in which official data have been compiled), some 41,149 individuals died by taking their own lives intentionally. Additionally, 395,000 people purposely inflicted injuries upon themselves. The CDC additionally indicated that in recent years, the number of suicides has continued to rise.

The researchers also found that between 10 and 15% of patients who make a serious suicide attempt will die from suicide within a decade. Additionally, around 14% of those who make a serious attempt will be hospitalized for the same reason within one year and their risk of being readmitted for yet another attempt amounts to 28.1% within a 10-year period.

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides additional information: in 2012, an estimated 2.7 million adults made a suicide plan and around 1.3 million attempted suicide.

The costs of suicide are both direct (related to treatment) and indirect (mainly covering indirect productivity costs from early death or from recovery time owing to injuries sustained in a suicide attempt). Of course, costs are also incurred by families, and the insurance industry is also affected by this manner of death. If in the UK, suicide does not necessarily negate the validity of an insurance plan, in the United States, most policies include a ‘suicide clause’, which states that no death benefit is paid if the person insured commits suicide within two years of signing the policy.

Interviews with hospital representatives highlight three key issues. The first is the lack of expertise and staff required to assess the risk of suicidal behavior and self-harm in patients admitted into hospital and into emergency wards. The second issue involves a lack of resources (including a lack of qualified staff to deal with patients at a risk of suicide and self-harm). The third problem is the lack of continuous care for at-risk patients.

Researchers made specific recommendations to cut down costs involved with suicide and self-harming behaviors. These include addressing the issue from a multi-faceted perspective, which includes greater involvement from education institutions, communities, and the health industry. Previous studies have shown that continuous care within hospitals and between hospitals and the community can lower the suicide rate. Statistics indicate that patients make almost 10 suicide attempts before they actually commit suicide, meaning that hospitals and health care professionals have many opportunities to prevent many deaths.

It is also recommended that all patients who enter a trauma unit for attempted suicide have a suicide risk assessment carried out, to determine if they need to be hospitalized. A safety plan should be made for them before they are discharged if doctors deem that hospitalization is unnecessary. Secondly, all patients who are hospitalized should continue to have access to behavioral and social services after they are discharged. Finally, communities, emergency departments and inpatient centers should create a list of experts who can help those considering suicide – the list may include psychiatrists providing counselling via telephone. Those in need should be referred to specific services where necessary. Finally, follow-ups should be provided to all patients admitted to hospitals for suicide attempts.

Family doctors can also play an important role in recognizing the risk of suicide in their patients, by being more aware of the signs and symptoms of suicidal behavior. If suicidal intentions are suspected, tools such as the SSI (Scale of Suicidal Ideation) can be used to evaluate more precisely the patient’s intentions, or to monitor their response to interventions over time. This test evaluates items including the patient’s will to live, wish to die, and reasons for living/dying. Higher scores indicate a greater intent to end one’s life.

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Gemma Fox is a freelance writer
She can be contacted through the editor.

 


Updated April 2017
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