The alarming increase in suicide rates in the United States over the past two decades is unprecedented and beyond disturbing. The Centers for Disease Control and Prevention just released research reporting “suicide increased by 25 percent across the United States from 1999 to 2016 and a shocking 45,000 Americans age 10 or older died by suicide in 2016.”
The American Psychological Association calls suicide prevention a public health priority and supports a multifaceted public health approach. A new statement from the APA president reads, “the science and practice of psychology play an essential role in both understanding and addressing the biopsychosocial underpinnings of this issue. This crisis affects people both with and without diagnosed mental health conditions. Suicide is often an act of desperation brought on by an inability to cope with life’s stressors. Addressing the source of those stressors is vital.”
So what are the sources for those stressors? The 2017 Stress in America survey conducted annually for the past decade by the APA, found that the most common sources of stress were: the future of our nation, money, work, the current political climate, and crime and violence. While the public’s overall stress level remains the same, on average, compared to 2016, Americans were more likely to report symptoms of stress, which include anxiety, anger and fatigue.
Another source of stress are Adverse Childhood Experiences (ACEs), or childhood trauma. A large body of scientific research that began with a study conducted by the CDC and Kaiser Permanente in 1998 found that childhood trauma causes toxic stress that affects not only the function and structure of the developing brains of young children, but also the physical and emotional well-being of individuals throughout their entire lifetime. Alarmingly, historical and generational trauma (epigenetic consequences of toxic stress) can alter how our DNA functions, and that can be passed on from generation to generation. ACEs include in the study were: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, a family member sent to prison, a mother treated violently, substance misuse within a household, household mental illness, and parental separation or divorce. A subsequent questionnaire added questions about bullying, racism, witnessing violence outside the home, poverty and food insecurity.
The ACE Study revealed six main discoveries:
- ACEs are common…nearly two-thirds (64 percent) of adults have at least one.
- ACEs don’t occur alone. If you have one, there’s an 87 percent chance that you have two or more.
- There is a direct correlation between the number of ACEs a person has and the adult onset of chronic disease, such as cancer, diabetes and heart disease, as well as the likelihood of mental illness, alcoholism, drug addition, violence, and being a victim of violence.
Among people having four ACEs, it doesn’t matter which ones; the harmful consequences are the same. The brain cannot distinguish one type of toxic stress from another; it’s all toxic stress, with the same impact.
You can think of an ACE score as like a cholesterol score for childhood trauma. For example, people with an ACE score of four are twice as likely to be smokers, and seven times more likely to be alcoholic. Having an ACE score of four increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and attempted suicide by 1,200 percent.
A 2001 study found that an ACE score of seven or more increased the risk of suicide attempts 51-fold among children or adolescents, and 30-fold among adults. People with high ACE scores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, and more autoimmune diseases. People with an ACE score of six or higher are at risk of their lifespan being shortened by 20 years.
As a nation, we face significant daily stress such as political strife, mass shootings, violence, and a rising opiate epidemic that continues to plague our young. We are exposed to greater levels of trauma and related symptoms of PTSD and stress exposure with information relayed around our planet at cyberspeed. Just consider adding daily stressors on top of chronic, toxic stress from ACEs and therein lies a formula for understanding most of the maladies afflicting our society.
There is a growing understanding of the need for a comprehensive approach to suicide prevention that includes both upstream and downstream prevention. Currently, most efforts to prevent suicide take place downstream and at the individual or family/relationship levels of the social ecology.
It is time that the field of suicide prevention collaborate with other sectors, including education, business, health care, and faith-based communities to reduce children’s exposure to adverse experiences. Fortunately, many people, organizations, agencies, systems and communities are beginning to implement trauma-informed, resilience–building practices based on ACEs science.
Janet Cox is a licensed clinical psychologist in Buckhead, with a 27-year career in treating substance use disorder.