U.S. Suicide Rate Increases

The rate of suicide in the United States is increased for the first time in a decade, according to a new report from the Johns Hopkins Bloomberg School of Public Health’s Center for Injury Research and Policy. The increase in the overall suicide rate between 1999 and 2005 was due primarily to an increase in suicides among whites aged 40-64, with white middle-aged women experiencing the largest annual increase.

Whereas the overall suicide rate rose 0.7 percent during this time period, the rate among middle-aged white men rose 2.7 percent annually and 3.9 percent among middle-aged women. By contrast, suicide in blacks decreased significantly over the study’s time period, and remained stable among Asian and Native Americans. The results are published online at the website of the American Journal of Preventive Medicine and will be published in the December print edition of the journal.

The researchers also conducted a detailed analysis of suicide methods across specific population groups. While firearms remain the predominant method, the rate of firearm suicides decreased during the study period. Suicide by hanging or suffocation increased markedly with a 6.3 percent annual increase among men, and a 2.3 percent annual increase among women.

Hanging/suffocation accounted for 22 percent of all suicides by 2005, surpassing poisoning at 18 percent.

“The results underscore a change in the epidemiology of suicide, with middle-aged whites emerging as a new high-risk group,” said study co-author Susan P. Baker, MPH, a professor with the Bloomberg School’s Center for Injury Research and Policy. “Historically, suicide prevention programs have focused on groups considered to be at highest risk—teens and young adults of both genders as well as elderly white men. This research tells us we need to refocus our resources to develop prevention programs for men and women in their middle years.”

Baker along with colleagues Guoqing Hu, PhD, Holly Wilcox, PhD, Lawrence Wissow, MD, MPH, analyzed data from the Web-based Injury Statistics Query and Reporting System (WISQARS) mortality reports, which provides data on deaths according to cause and intent of injury by age, race, gender and state. WISQARS mortality data are based on annual data files of the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC).

The reasons for the increase in the suicide rate are not fully understood. “While it would be straightforward to attribute the results to a rise in so-called mid-life crises, recent studies find that middle age is mostly a time of relative security and emotional wellbeing,” said Baker. “Further research is warranted to explore societal changes that may be disproportionably affecting the middle-aged in this country.”

The research was funded by the Center for Injury Research and Policy.

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Burst Appendix or Stomach Flu? Hopkins Children’s Experts Say Doctors and Parents Can Sort Out Symptoms with a Checklist

A young child arrives at the emergency room after several days of abdominal pain, vomiting, diarrhea and is sent home with a diagnosis of viral gastritis and treatment for the symptoms. The child seems better for a while, only to return to the ER with worse symptoms and a ruptured appendix, a life-threatening complication of appendicitis.

The scenario is not uncommon, experts say, because children with appendicitis don’t usually have the classic symptoms of the condition, but pediatricians at the Johns Hopkins Children’s Center say there are ways for doctors and parents to tell the difference early on between a potentially deadly burst appendix – which can kill in a matter of days, even hours – and a stomach bug.

Past research has found that half of appendicitis cases are misdiagnosed when they first present at the emergency room or the doctor’s office, and that up to 80 percent of appendicitis cases in children younger than 4 years of age end up in rupture.

Says emergency room pediatrician Jennifer Anders, M.D., of Hopkins Children’s, who has seen her fair share of burst appendices, “appendicitis should always be near the top of the list of potential culprits when a child has ANY abdominal pain, vomiting, and malaise,” keeping in mind that many children don’t have fever or lose appetite the way adults might.

Doctors recommend that children with prolonged or severe abdominal symptoms that do not go away or improve should be evaluated for ruptured appendix. Consider the following questions:

Do blood tests indicate elevated white cell count?
Was there sharp pain in the lower right portion of the abdomen, which later subsided and became dull and spread across the abdominal area? Paradoxically, as appendicitis worsens and the appendix ruptures, the acute pain is alleviated and transformed into more diffuse abdominal pain.
“It’s counter-intuitive, but if that sharp pain improves or subsides and becomes more generalized, it’s actually a bad sign,” Anders says. “As the severely inflamed appendix ruptures, the acute pain is alleviated and transformed into more diffuse abdominal pain.”

Does the child have diarrhea? Diarrhea, which can be a marker of bowel inflammation, resulting from the infection caused by the burst appendix, often distracts doctors and puts them on a different track. Diarrhea may not be a classic sign of appendicitis, it may signal a ruptured appendix.

Did the child have vomiting, which later stopped?

The appendix is a small tube extending from the large intestine, and infections and inflammation of the organ can be dangerous. The only absolute way to diagnose the condition is surgery, and each year, appendicitis sends 77,000 American children to the hospital. An estimated one-third of them suffer a ruptured appendix before they reach the OR.

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