Monday, May 5, 2003
By GI SMITH
TR Staff Writer
ZANESVILLE -- Frustrated, feeling out of control, feeling alone and that you don't matter to anyone anymore, afraid of becoming a burden -- sometimes that's when the choice is made.
For one local woman, who requested anonymity for this article, there were no obvious signs that a female relative was contemplating suicide. Those around her never considered that the woman would take her own life -- mostly because she didn't fit the commonly perceived "profile" of someone likely to kill herself. She was a 71-year-old widow who had a part-time job.
It was two days after Easter a few years ago when the woman's grandson went to her home to check on her. He found her in her favorite chair, feet propped up and dead of a self-inflicted gunshot wound. Two days earlier she was celebrating the end of Lent with her family, apparently happy.
But in hindsight, her actions -- before, during and after the suicide -- would fit an all-too-common profile often overlooked in society.
Most think suicidal people are tormented young men reacting in a heated moment. But the national numbers show a more likely suicide candidate. Of all the various age groups, the suicide rate among people 65 years and older is 50 percent higher than any other age group in the country. Experts agree that the suicide death rate for that age group is often overshadowed by teen suicide rates.
The most recent local statistics provided by the Center for Health Data and Statistics and the Ohio Department of Health regarding Muskingum County show that from 1996 to 1998 there were six suicides within the 65+ age group. That number was down from the 1990 to 1992 statistics, where nine senior citizens took their own lives. However, during the 1996 to 1998 time frame, more people from the 35 to 64 age group and the 15 to 34 age group killed themselves, which is not in keeping with the national average.
With the baby boomer population embarking on the "golden years," the senior citizen population is expected to double to 70 million by the year 2030 -- and the numbers of seniors who commit suicide is likely to jump as well. In Ohio, the suicide risk for people over the age of 80 is three to four times higher than for other age groups.
According to Ohio's Suicide Prevention Plan, which was prepared by the Ohio Department of Health in collaboration with the Ohio Coalition for Suicide Prevention, some factors that make the elderly prone to killing themselves are "social isolation, significant losses (death of spouse, loss of home, family and friends), illness, disability, chronic pain, depression and, oftentimes, hidden alcoholism."
One common characteristic of senior citizen suicide is how thoroughly planned the act is.
"It did seem thoroughly planned," the victim said. "In fact, the depth of her planning was really quite astonishing to me. She typically depended on me and my family (following her husband's death) to help her plan things. She had been a very dependent person and did not like to make decisions on her own. She had obviously given this a lot of thought and put a lot of energy into putting things in place prior to her death."
The plans included leaving several notes to her family and her workplace. The notes to her family members included additional instructions to her estate will, an explanation that she didn't want to become a burden to her family and special messages to each of her sons commenting on what she expected from them as a result of her death.
As a librarian at a school, she left notes to teachers that would help prepare them for upcoming events.
"Since she committed suicide over Easter break from school, she had left notes prior to the break in the school library for several teachers who depended on her to have materials ready for them at certain times of the year," she said. "The notes provided detailed instructions to each one. She also mailed a note to the school principal apologizing for leaving her work unfinished for the year."
Because the woman worked at the school, the family chose not to identify her in the article because it might cause psychological harm to the students.
The victim, who is a social worker, said the woman often confided in her and had lengthy discussions about her feelings for a period after becoming widowed.
"She had definitely been suffering with depression since her husband died. I had urged her on several occasions to seek professional help or at the very least, have her family doctor prescribe an antidepressant. She was taking something for anxiety. She was a devout Catholic and believed strongly in the power of prayer ... She used me as a sounding board and support person. I thought that she was getting a handle on her depression several months prior to her death. She had stopped talking so much about her feelings and seemed to be getting back into a more independent routine of activity with friends and co-workers. In hindsight, I realize that I was probably less attentive to her as well...I missed all the typical signs of impending suicide."
Recognizing the signs
Dr. Frank LoSchiavo, professor of psychology at Ohio University-Zanesville, said there are warning signs that may precede suicide but sometimes those signs are just not visible to others.
"There are some signs (of an upcoming suicide) but I think that it is really important to note that there is no definitive measure to foresee (someone will commit) suicide," LoSchiavo said.
Some people contemplating suicide exhibit mental illness, depression, have abused alcohol or drugs or have talked about committing suicide. Sometimes, suicidal people begin to settle their estate while they're still alive.
"She had been making contact with distant friends and relatives to 'catch them up on our lives.' She had completed several overdue projects like photo albums, scrapbooks, etc. On the Sunday before her death, she gave my mother some 'special' pictures she had reproduced of my children and she made an extra trip back to my house to give my husband his favorite Easter candy -- not typical for her behavior," the victim said.
Another surprising characteristic was uncovered regarding senior citizen suicide.
"Coming from the (National Institute of Mental Health), of the older adults who have committed suicide, many of them have visited their primary care physician," LoSchiavo said. Further examination of events surrounding senior citizen suicide show that 70 percent of those who took their life had visited a physician within a month of their death, according to NIMH.
In the victim's case, her relative had recently visited her doctor.
"We were not aware of any chronic illness other than hypertension and arthritis that she had been treated for over the past several years," she said. "However, in a diary we found when distributing her belongings, there was reference to a belief that she and my 18-year-old (at the time) son both had cancer and that she did not want to face dealing with the consequences of that belief. We checked with all physicians that we knew she had contact with and were never able to confirm her belief. My son had recently been told that he had a benign tumor on his shoulder...it was not cancerous and we had reassured her of that at the time."
Tom Quinn, president of the National Alliance for the Mentally Ill (NAMI)-Six County, said help is available for people of any age considering suicide and that friends and family members should seek immediate professional help if they suspect a loved one may be contemplating death.
"We need to get the word out to everyone (about immediate resources available)," he said. "There are all kinds of signs (someone is considering suicide) and we as a society need to be able to recognize those signs."
He added that victims of suicide also have resources available to them to help cope with their loss.
Sandra Harstine, managed care coordinator for the Mental Health and Recovery Services Board, said they are currently working on several initiatives around suicide awareness and intervention. Though the board doesn't actually provide mental health services, they do plan, manage and monitor the public system of care by contracting a network of service providers.
What's being done
More than a year ago, the Ohio Coalition for Suicide Prevention convened leaders in public health, mental health, academics, faith and survivor communities. In the six meetings across the state, more than 300 experts in their fields outlined the characteristics of an effective suicide prevention plan in the state. Those traits included being:
Focused on adolescents and young adults first, then on other priority groups (middle-aged white males and the elderly)
Public health focused
Appropriate for a community-based mental health system
Built on data, research and best practices
Able to address statewide needs
The plan states:
"Selective prevention is dedicated to prevent the onset of suicidal behavior in priority risk groups. These strategies may include screening and assessments, training of natural community gatekeepers (people who can recognize life-threatening distress in individuals or families), and community-based mental health treatment."
The plan includes an Awareness Goal under which there are five objectives including developing local, broad-based support for prevention, a partnership with Ohio's media to further prevention, a push to inform policy makers, develop and implement public awareness campaigns and encourage the use of evidence-based prevention and awareness programs in schools.
Also in the plan is an Intervention Goal, under which are five objectives that include strengthening crisis response and building community capacity to serve people at risk and in need of treatment, increase the number and quality of key gatekeepers, increase the ability of health care professionals and the clergy to intervene and to promote and support the presence of protective factors.
Finally, the plan includes a Methodology Goal that consists of three objectives that target the development of state and county surveillance systems, an increase in scientific knowledge by advancing research, outcome evaluations and knowledge transfers, and the promotion of a research agenda.
"This death was devastating to my family," the victim said. "After the initial grief, there was so much anger and confusion among the immediate family. All of the 'what ifs' and the 'should haves' really ate at family and friends. We sought and received excellent support from professionals at Six County for the adults and children in the family. There were, in my opinion, however, long range effects...All (family members) have related part of their symptoms to guilt, fear, anger and confusion about her death. There will forever be a shadow over our Easter celebrations and an underlying uneasiness about how a family member will react to trauma."
Originally published Sunday, May 4, 2003