Preventing Suicide Among Veterans and Other Vulnerable Groups

Experts on suicide, particularly among veterans, led a wide-ranging conversation about risk factors and effective interventions at an event hosted by UCLA Luskin Social Welfare. Professor Mark S. Kaplan shared insights from his extensive research of at-risk populations with the gathering of students and social workers. “What many vulnerable young veterans returning from places like Afghanistan and Iraq needed more than anything else was not a psychiatrist but a social worker, somebody who could help them with that transition into civilian life, somebody who could help them with their family and their community,” he said. “It was really a challenge of reintegration that mattered most; it wasn’t a psychiatric problem.” The Nov. 6, 2018, panel included Susan Pindack, a social worker with the Veterans Affairs Greater Los Angeles Healthcare System; Sam Coleman, a lecturer at Cal State Long Beach and coordinator of the Veterans for Peace PTSD Working Group; and Carolyn Levitan, director of the crisis line at Didi Hirsch Mental Health Services’ Suicide Prevention Center. The panel’s broad experience led to an expansive discussion that touched on Civil War fighters who took their own lives, firearm use among female soldiers, the role of pain management in preventing suicide and the impact of the Netflix series “13 Reasons Why.” Students from the Mental Health Caucus at UCLA, one of several event co-sponsors, led a question-and-answer session after the panel presentations. — Mary Braswell

View a Flickr album from the event here.


 

 

Kaplan Discusses CDC Report About Suicide Rates Rising Across U.S. 

New CDC figures documenting the growing rate of suicide may not reflect the full scope of the problem, said Mark S. Kaplan, professor of social welfare at UCLA Luskin. Many suicides are actually classified as ”accidental deaths,” Kaplan, a noted suicide prevention researcher, told WebMD. “Some are classified as unintentional self-injury when, in fact, if you take a closer look, they look more like suicide,” he said. “The true incidence of suicide is unknown.” Kaplan said the Great Recession from 2007 to 2009 contributed to what he terms ”deaths of despair” by suicide. Some people, he said, never recovered economically.


 

The Connection Between Poverty, Inequality and Firearm Violence UCLA Luskin’s Mark Kaplan explains how circumstances in U.S. urban centers go hand in hand with gun violence

By Stan Paul

A fatal gunshot wound. This is a slide that Mark Kaplan, professor of Social Welfare at the UCLA Luskin School of Public Affairs, shows early in his presentation on gun violence.

As he recites annual gun death statistics in the United States, the vivid and unsettling scene serves as a backdrop.

“This might have been a suicide, this might have been a homicide; we’re not exactly sure. All I can tell you is that it was a fatal gunshot wound,” said Kaplan who spoke on “Poverty, Inequality and Firearm Violence,” Jan. 26, 2017 at the Luskin School as part of the Public Child Welfare Seminar series.

“The reason for putting this up is because quite often the discussion about guns is sanitized.” Kaplan explained, “We often treat the issue of gun violence as an abstraction but when you talk to people who are working in emergency departments, when you talk to coroners and medical centers, this is what people tell you. This is the net effect of guns.”

Across the nation, that net effect amounts to more than 33,000 similar scenes recorded each year on average, and more than 36,000 for 2015, Kaplan reported as the latest available data. What stands out for Kaplan is that two-thirds are suicides, his area of research. Kaplan, who holds adjunct appointments in psychiatry at the Oregon Health & Science University and in epidemiology and community medicine at the University of Ottawa, focuses on using population-wide data to understand suicide risk factors and firearm violence among vulnerable populations.

“So, the problem of gun violence in this country is primarily a suicide problem, less so a homicide problem,” said Kaplan to the audience, which included future social workers who are students in the master of social welfare (MSW) program. While recognizing the spike in gun deaths in cities such as Chicago – more than 50 in January in that city alone — Kaplan said that over the past 10-15 years there has been an overall national decline in the rate of gun deaths.

Kaplan said gun ownership in the U.S. is at more than 300 million and growing, and the death rate is only part of the story. He pointed out that for all of the recorded deaths by guns, there were more than 81,000 people – more than 200 per day – injured nationwide by guns in 2014.

“There are a lot of individuals who are shot, who survive, who wind up in emergency departments, are hospitalized and often disabled for life.”

A relationship exists between the high rate of guns and gun ownership and the number of homicides, suicides and injuries. Kaplan said that work is needed “on the ground” in America’s cities, such as limiting access to guns that would “go a long way to reducing some of the fatalities that we’re experiencing both in the homicide and suicide.”

He pointed to the work of one of his doctoral students that showed almost 90 percent of suicides involved guns in some parts of the country. California is an exception, according to Kaplan, who credited the state’s stringent gun control measures.

“California is an outlier. There aren’t many states like us,” he noted, suggesting that California could serve as a role model for the rest of the country. Unfortunately, two-thirds of states fall into the quadrant with both high rates of gun violence and lax restrictions on gun ownership, he said. “We are a gun-toting, gun-culture nation, and that’s going to make things a little bit challenging.”

The U.S. stands out among industrialized nations, Kaplan said. Gun homicides in the U.S. are 25 times higher than the average of other high-income countries. Factors such as poverty and inequality are contributing factors, he said.

“You all hear about poverty, but inequality is another measure of economic well-being. And there is a strong correlation between homicide per million and income inequality,” said Kaplan, pointing out that countries that are most equal have the lowest rates of gun-related homicides.

In terms of race and ethnicity, Kaplan said that 77 percent of white gun deaths in the U.S. are suicides, while less than 1 in 5 (19 percent) is a homicide. The figures are nearly opposite for African Americans, for which only 14 percent are suicides.

African American males in the 20-29 age group have the highest risk (89 per 100,000) in terms of the firearm homicide rate, a figure that is comparable with Honduras (90.4 murders per 100,000 people).

“In many ways we look like what some developing or Third World countries are experiencing,” Kaplan said.

Citing recent scholarship published by the Brookings Institution, he said that people who witness gun violence are also at increased risk for a variety mental health issues that can manifest as post traumatic stress disorder (PTSD), depression, poor academic performance, substance abuse, risky sexual behavior, delinquency and violent behavior – a “constellation of interconnected pathologies.”

Cities such as Los Angeles and New York have been stereotyped as “dangerous big cities,” Kaplan said, but both have benefitted from gun control measures. “Look how well we do in Los Angeles. New York is another place where the homicide rate has declined quite dramatically in the past 10-15, maybe 20, years.”

In contrast, Philadelphia today still has a high homicide rate, he said. And Texas, which has some of the least restrictive gun law on the books (with both Dallas and Houston appearing close to the bottom), has among the highest rates of gun deaths in the United States.

UCLA Luskin’s Mark Kaplan talks about a spike in gun violence in Chicago, a topic that has been much discussed by President Donald Trump and others. Photo by Stan Paul

Kaplan, who was born in Chicago, spoke about that city’s spike in murders in the past few years – nearly 300 shootings this January. One of Kaplan’s slides showed a recent tweet by President Trump about gun homicides in Chicago.

“We don’t know what [Trump] is going to do, but he is reacting to something legitimate” that is not occurring randomly, Kaplan said in reference to the accuracy of the numbers.

“You can approach this problem as a criminal justice problem … or approach it as a public health or social welfare or social justice problem, and that’s was missing in the discussion,” Kaplan said. Social inequality and income inequality are to some extent fueling the gun violence epidemic in Chicago, he noted.

Over the long term, however, little has really changed in Chicago, which has concentrated areas of poverty and racial segregation. Some areas are 90 percent African American. “Neighborhoods still look the same way as they did 10, 15, 20, maybe even 30, years ago. Chicago is a very divided city socio-economically,” Kaplan said.

The addition of guns increases violence. “The more guns, the more lethal the assault. When guns are absent, people are more likely to survive an assault,” said Kaplan. “If we could just tamp down the levels of gun ownership, that might – might – be the first step in trying to reduce the rate of gun violence.”

Compared to other leading causes of death in the U.S., the national investment in trying to understand and prevent gun deaths “pales by comparison” to what is spent on other causes of death and other major health problems, he said. A prohibition in the United States related to research on firearms doesn’t help.

“There is so much we need to know,” Kaplan said. “That’s what depresses me and keep me up at night.”

 

 

 

 

Studying the Link Between Poverty and Suicides New research shows that poverty may have a greater effect on suicide rates than do unemployment or foreclosures

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Mark S. Kaplan

County-level suicide rates in the United States had a strong positive relationship with county poverty rates, while no relationships were found between county measures of unemployment or foreclosures when poverty rates were controlled, according to a new study from the Alcohol Research Group (ARG), a program of the Public Health Institute, in collaboration with the UCLA Luskin School of Public Affairs, Oregon Health and Science University, Prevention Research Center and the Centre for Addiction and Mental Health in Toronto.

The study, published in the American Journal of Preventive Medicine, analyzed data over a six-year period from 2005 to 2011 that includes the major U.S. economic downturn from 2007 to 2009. The study also found that for men 45 to 64 years old, the proportion of alcohol-related suicides and poverty rates were positively associated. This working-age group was a key demographic in rising suicide rates during the recession.

This is the first study to try to unravel how different features of such a downturn affect suicide rates and alcohol-related suicides in particular. It is also the first study to suggest that unemployment’s role may not be as significant as poverty.

“Our finding suggests that the consequences of unemployment were more important than being unemployed during this period,” said ARG senior scientist and lead author William C. Kerr. “These results are consistent with what we see in countries that have strong unemployment support systems — where being out of a job doesn’t increase your risk for suicide.”

Poverty was also found to mediate unemployment’s effect on suicide rates, which suggests that policies should focus directly on reducing poverty as well as on supporting people who are unemployed.

“The analysis also draws attention to the importance of targeting suicide prevention efforts in economically disadvantaged communities and incorporating alcohol control policies, abuse prevention and treatment for alcohol misuse into such efforts,” said Mark S. Kaplan, co-author and professor in UCLA Luskin’s Department of Social Welfare.

“County-level poverty rates reflect what’s happening at an individual and family level as well as across the entire area,” Kerr added. “It speaks to a lack of resources for people who are struggling. It’s possible that some people were already at a breaking point when the recession hit — it’s difficult to know for sure. But the results do tell us that we need better mechanisms in place to help the people who need it the most.”

The study analyzed data from 16 states included in the National Violent Death Reporting System during the study period. This system links data from coroner/medical examiner records, police reports, death certificates and crime laboratories.

Support for this paper was provided by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health under award number R01 AA021791.

Study Explains Link Between Heavy Alcohol Use and Suicides During Economic Downturns Social Welfare professor Mark Kaplan and colleagues found that increase in high-risk drinking during the Great Recession may explain rise in alcohol-related suicides by men — but not women — during period of overall decline in alcohol use

By Stan Paul

While economic downturns have been linked previously to increased suicide risk in the United States, new research from the UCLA Luskin School of Public Affairs sheds light on the role alcohol use may play in the complex relationship between economic conditions and suicide.

UCLA Social Welfare professor Mark Kaplan is lead author and principal investigator of a new study funded by the National Institutes of Health (NIH) and released online today. The report, “Heavy Alcohol Use Among Suicide Decedents Relative to a Nonsuicide Comparison Group: Gender Specific Effects of Economic Contraction,” will be published in the July issue of the journal Alcoholism: Clinical and Experimental Research.

In conducting the study, specifically on the contribution of alcohol to suicide during the 2008-09 recession period, Kaplan and colleagues used data from the U.S. National Violent Death Reporting System from 16 participating states and supplemented with data from the Behavior Risk Factors Surveillance System for the same states, which was used as the nonsuicide comparison group. Blood-alcohol levels in suicide decedents were compared to heavy alcohol use in the nonsuicide comparison group in the years 2005-07 (before), 2008-09 (during), and 2010-11 (after the recession).

Kaplan and colleagues noted that, in general, economic recessions have been associated with declines in overall alcohol consumption but at the same time with increases in heavy alcohol use, particularly among those directly affected by the contraction. In their current work, Kaplan and colleagues showed that the percentages of suicide decedents who were intoxicated at the time of death increased during the recent economic recession. What is unknown is whether this change in alcohol use prior to suicide mirrored patterns of heavy drinking in the general population.

In this new study, Kaplan’s findings show that, for men, alcohol involvement increased among decedents beyond what was observed in the general population, emphasizing the “heightened importance” of acute alcohol use as a risk factor for suicide among men during times of severe economic hardship. “Surprisingly, there is evidence that individuals intoxicated at the time of death did not necessarily have a history of alcohol abuse prior to suicide,” said Kaplan.

But similar results were not found for women who died by suicide. Kaplan suggests women may show resilience to the interaction of alcohol and financial crises, reporting that heavy alcohol use by women mirrored consumption in the general population.

He further explains how creative control policies have been shown to reduce the risk. Among those policies, Kaplan cites research on pricing strategies, including raising taxes and pricing beverages according to alcohol content. Also, easy access to alcohol — longer hours for alcohol sale or high density of alcohol outlets — may create more opportunity for impulse buying and thus contribute to suicide during economic downturns, Kaplan concluded.

And, citing recent research, Kaplan explains, “Not only are alcohol control policies important, but equally so is investing in the public health and social welfare infrastructure to minimize the adverse effects of future economic downturns, such as high unemployment and associated material deprivation.”

The full study may be found online at http://onlinelibrary.wiley.com/doi/10.1111/acer.13100/abstract

The findings are part of a three-year study funded by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health. Kaplan is the principal investigator of the project, which is a collaboration between UCLA, Oregon Health and Science University, Pacific Institute for Research and Evaluation (Oakland, CA), Centre for Addiction and Mental Health  (Toronto, ON), and the Pacific Health Institute (Emeryville, CA).

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Mark S. Kaplan, Dr.P.H., is professor of Social Welfare at the UCLA Luskin School of Public Affairs. He holds an adjunct appointment in psychiatry at the Oregon Health & Science University. His research focuses on using population-wide data to understand suicide risk factors among veterans, seniors and other vulnerable populations. He is the recipient of a Distinguished Investigator Award from the American Foundation for Suicide Prevention and has contributed to state and federal suicide prevention initiatives.

Examining the Link Between Gun Laws and Suicides Luskin professor and his student find that states with most-restrictive gun laws have a reduced rate of firearm suicides among older males

By Adeney Zo and Stan Paul

In April, the Centers for Disease Control and Prevention (CDC) released a study showing that, from 1999 to 2014, the rate of suicides in America rose nearly 25 percent, with a marked increase after 2006. And, in this election year, gun control remains one of the most heated topics in the nation.

Researchers at the UCLA Luskin School of Public Affairs have been taking a close look at the role firearms play in suicides — specifically among older adults — and the effect that gun law environment and gun control policies can have on reducing firearm suicides among this age group.

UCLA Social Welfare professor Mark Kaplan and Social Welfare doctoral student Carol Leung’s work on this issue has been presented at conferences across the U.S.  Results from their research and presentations were recently published in the study “Deploying an Ecological Model to Stem the Rising Tide of Suicide in Older Age” in the Journal of Aging & Social Policy.

While gun control laws generally can reduce the risk of suicide, few studies exist showing what laws are the most effective in curbing firearm suicides in older males.

“Suicide research is a small niche, but it’s such an important topic,” Leung said. “Two-thirds of all gun deaths are suicides, and 80 percent of older males who complete suicide will use a firearm.”

Among the key results of their study on older men and suicide, Kaplan and Leung found:

  • Older men have a higher suicide rate and a higher proportion of suicides involving firearms compared to their younger counterparts.
  • States with the most restrictive gun laws (California) have proportionately fewer suicides involving the use of firearms.
  • Two out of the six gun policies (“gun owner accountability” and “regulation of sales and transfers”) explained more than half (53 percent) of the variation in the fraction of suicides involving firearms among older men.
  • “Gun owner accountability” (i.e., licensing of gun owners and purchases, registration of firearms, and reporting of stolen firearms) accounted for the largest share of the explained variance (50 percent).

“I found a very linear relationship,” said Leung. “States without these policies have the highest rate of firearm-related suicide. The states with the lowest rate of firearm-related suicide have the strictest gun laws.”

As an example, California received an A- on “The 2013 State Scorecard: Why Gun Laws Matter,” produced by the Law Center to Prevent Gun Violence and the Brady Campaign to Prevent Gun Violence, whereas nearly two-thirds of the states received a D or F on the scale.

In addition, Kaplan explained that, in the context of health and older adult suicides, 70 percent of older adults will visit their primary care physician prior to completing suicide.

“We hope to influence health-care providers to be more attentive to anything that seems to be associated with pending suicide attempts,” said Kaplan. “This includes probing for gun availability. The mere presence of a gun matters; their chances of dying by firearm-related accident or suicide increase.”

The researchers know that change doesn’t happen overnight. “Suicide prevention starts with advocacy work that involves collaboration between policy makers, professors and clinicians,” said Leung.

Kaplan and Leung, who also presented at the 49th annual American Association of Suicidology Conference, strongly urge that clinicians and policy makers need to become stronger advocates for a more restrictive gun law environment. Overall, their research demonstrates the important role a “gun law environment” and specific gun control policies can play in reducing firearm suicides among older adults. Their most recent work will contribute to a study to be conducted this summer.

“We strive to harmonize policies and clinical practice with preventing firearm suicides among older adults, particularly older men,” said Leung.

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Mark S. Kaplan, Dr. P.H., is professor of Social Welfare at the UCLA Luskin School of Public Affairs. He holds an adjunct appointment in psychiatry at the Oregon Health & Science University. His research focuses on using population-wide data to understand suicide risk factors among veterans, seniors and other vulnerable populations. He is the recipient of a Distinguished Investigator Award from the American Foundation for Suicide Prevention and has contributed to state and federal suicide prevention initiatives.

Carol Leung, LMSW, is a doctoral student in the Department of Social Welfare at the UCLA Luskin School of Public Affairs.

Recent Findings Concerning Alcohol Abuse and Suicide Policies minimizing harmful alcohol use are essential for suicide prevention.

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By UCLA Luskin School of Public Affairs

Recent studies conducted by UCLA professor Mark Kaplan and a team of researchers shed light on the association between alcohol abuse, racial-ethnic demographics, and suicide. The study, funded by the National Institute on Alcohol Abuse and Alcoholism, reveals patterns between heavy alcohol use immediately prior to suicide with certain demographic groups, notably 43 percent of American Indian/Alaskan Native men and 35 percent of women demonstrated heavy alcohol use (defined as postmortem blood alcohol level at or above .08) at the time of suicide.

Other particularly vulnerable groups (demonstrating high alcohol use prior to suicide) include:

  • Latinos — 30.6 percent of men and 25 percent of women.
  • American Indian/Alaska Native — 43 percent of men and 35 percent of women.
  • White men — demonstrated 24.4 percent rate of heavy alcohol use.

“Using the 2005-11 National Violent Death Reporting System (n=52,276) and the 2001-02 National Epidemiologic Survey on Alcohol and Related Conditions (n=43,093), we examined odds of heavy alcohol use among suicide decedents relative to living respondents across racial-ethnic groups after stratifying by gender and then adjusting for age and alcohol dependence,” wrote Kaplan, lead author of the study and Social Welfare professor at the UCLA Luskin School of Public Affairs.

The paper “Heavy Alcohol Use Among Suicide Decedents: Differences in Risk Across Racial-Ethnic Groups” appears in the January 2016 online issue of the journal Psychiatric Services published by the American Psychiatric Association and emphasizes the markedly elevated risk of suicide associated with heavy alcohol use across all racial-ethnic groups and especially so for Hispanic women. According to Kaplan and colleagues, “Policies minimizing harmful alcohol use are essential for suicide prevention, particularly for the most vulnerable.”

 

Mark S. Kaplan

Mark S. Kaplan, Dr.P.H., is professor of Social Welfare at the UCLA Luskin School of Public Affairs and holds adjunct appointments in psychiatry at the Oregon Health & Science University and in epidemiology and community medicine at the University of Ottawa. He received his doctorate in public health from the University of California, Berkeley and holds master’s degrees in social work and public health with postdoctoral training in preventive medicine at the University of Southern California. His research, funded by the National Institutes of Health and private foundations, has focused on using population-wide data to understand suicide risk factors among veterans, seniors and other vulnerable populations.

Dr. Kaplan is the recipient of a Distinguished Investigator Award from the American Foundation for Suicide Prevention. He has contributed to state and federal suicide prevention initiatives. Dr. Kaplan testified before the Senate Special Committee on Aging at its hearing on veterans’ health and was a member of the Expert Panel on the VA Blue Ribbon Work Group on Suicide Prevention in the Veteran Population. He serves as a scientific advisor to the American Foundation for Suicide Prevention.

Currently, he is principal investigator on two National Institute on Alcohol Abuse and Alcoholism funded projects: “Acute alcohol use and suicide” and “Economic contraction and alcohol-associated suicides: A multi-level analysis.”

Mark Kaplan Says There is Lack of Analysis of the Military as a Social Setting The social welfare professor discussed mental health and suicide prevention for veterans on NPR.

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By Alejandra Velarde-Reyes
UCLA Luskin student writer

According to an NPR radio broadcast on Thursday morning, 22 veterans commit suicide every day, or about one every hour. The broadcast invited experts in mental health and veteran services, including social welfare professor Mark Kaplan to address the problem of suicide risk among returning veterans.

In 2007, Kaplan was part of one of the first groundbreaking research studies to reveal that veterans were at higher risk of suicide than the general public, a study that followed thousands of veterans over a 12 year period. Gaining national attention by the media and by congress, the study prompted increased action toward suicide prevention for veterans, Kaplan said in the broadcast.

Since then, new studies have been conducted revealing more detailed information and Kaplan has become more involved in the issue of veteran suicide risk. He expressed concern over gun access, higher risk women in the military, and what factors really contribute to suicide and mental health problems for veterans.

“We’ve assumed many suicides were associated with trauma from deployment but a recent study found that…the risk of suicide among veterans who were deployed and those who were not, were not significantly different,” Kaplan said.

The broadcast explored the reasoning for such evidence, suggesting that it is military service itself rather than exposure to war that causes higher suicide risk.

Though the military attempts to increase resilience in soldiers individually, Kaplan said there is a lack of analysis of the military as a social setting.

“What about the psycho-social environment of the military? What role that may be contributing is pretty much unknown,” Kaplan said. “The military has been resistant to looking at itself as an institution and instead focused on individuals and defines the problem in purely psychiatric and therapeutic ways.”

Kaplan suggested that other factors such as family crisis and financial problems that have little to do with military service precipitate events that lead to suicide.

The segment also addressed the problem of veterans’ access to guns, a central element in suicide risk among veterans.

“There are many veterans who still sleep with a gun under there pillow. This is not uncommon. Many find it difficult, whether they are at risk or not, to part with their guns. We need to do a much better job at probing for gun access and doing something about it,” Kaplan said.