Why US suicide rate is on the rise

A new government study released reveals that suicide has been on the rise nationwide since 1999. The figures were released in the week when the deaths of designer Kate Spade and celebrity chef Anthony Bourdain brought the issue to the fore.

In the days following Spade's death, the US suicide prevention hotline - 1-800-273-8255 - saw a 25% spike in calls, the Wall Street Journal reported.

International research has shown an apparent "contagion" effect after high-profile suicides.

But what has spurred such a steady increase in American suicides?

In 17 years, 30%

That's how much the overall suicide rate has increased in more than half of US states in that time, according to the US Centers for Disease Control and Prevention (CDC). The overall rise nationwide is about 25%.

It means that around 16 out of every 100,000 Americans will take their own life.

Nearly 45,000 Americans took their own life in 2016 alone.

According to CDC data, suicide increased among all sexes, ages, races and ethnic groups.

Lead researcher Dr Deborah Stone told the BBC that the agency had been tracking the rise for some time.

"Knowing the rates were increasing, we [wanted to] look at state level increases and contributing factors," Dr Stone says.

"There were 25 states that had increases of more than 30% - that was a new finding for us."

Nearly all of those states are in the western and Midwestern regions of the US.

Why are suicide rates increasing?

While there is no single factor that leads to suicide, Dr Stone says relationship issues and financial troubles tend to be top factors contributing to suicide across the country.

She also notes that some western states have some of the highest rates of suicide historically, which could be related to the fact that they tend to be more rural.

Rural states, she explained, are still recovering from economic downturns. People also tend to be more isolated, without access to proper care. And, these states have been hit hard by the opioid epidemic.

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Prof Julie Cerel, president of the American Association of Suicidology, noted that having better reporting standards could account for some of the increase, but also pointed to a lack of adequate funding for mental health research and preventative care.

"Our mental health systems are just really struggling across the country," Prof Cerel says. "In terms of training mental health professionals, we're not doing a great job."

As of 2018, only 10 states mandate suicide prevention training for health professionals.

And Prof Cerel raised another related, though often sidelined, public health issue - firearms.

"The gun debate in the US has been about the horrific school shootings, and we want to prevent those, but the vast majority of deaths from firearms are suicides," she says.

In fact, two-thirds of gun-related deaths in America are suicides, according to the CDC.

"We just don't talk about that in the US because there are stigmas against mental health. People think suicides are different - why should they want gun control? Nobody in their family is going do that."

Fruit and vegetables: are you getting your 5 A Day?

Eating a balanced diet

What is an NHS Health Check?

Middle age health crisis' warning

Unfit in middle age

After accounting for other factors (including socio-economic status, a number of long-term conditions, smoking, alcohol and BMI), researchers found men between the ages of 37 and 45 were over two-and-a-half times more likely to die than non-frail people of the same age.

The figures were similar in all the other age groups (45-55, 55-65, and 65-73).

Similar associations were found in women who were judged to be frail and were 45 or older.

Frail people were also far more likely to have conditions such as multiple sclerosis and chronic fatigue syndrome.

Lead author of the study, Prof Frances Mair, from the University of Glasgow, said the findings suggested there was a need to both identify and treat frailty much earlier in life.

So what can we do?

Dr Peter Hanlon, a co-author on the frailty study, said the good news is that frailty might be reversible in people, particularly if it is identified early.

The key for those who are unfit in middle age is making healthy changes "as soon as possible", says Ilaria Bellantuono, professor of musculoskeletal ageing at the University of Sheffield.

"The key is a healthy diet and exercise. It's the only thing we know that works," she says.

Losing weight, stopping smoking, cutting back on alcohol, exercising regularly and eating less salt are just some of the things you can do to lower your blood pressure.

And similar advice applies to reducing your risk of dementia and helping to keep your brain healthy as you age, says Dr Laura Phipps from Alzheimer's Research UK.

But the million pound question is how do you get people to change their habits?

Prof Bellantuono said that for some, health warnings won't be enough.

Instead, finding an "internal motive that speaks to them" will be key to getting some people to exercise and be healthier.

"That could be picking up the grandchildren or going to watch the football," she adds.

The UK health tax hurting foreign nurses

When a Kenyan nurse took up a job in the UK a few years ago, he felt his family's future had been secured.

But now the distraught father-of-three is struggling financially to reunite his family.

Ken, not his real name, lives with his wife and daughter.

But his twin children, a boy and a girl, remain in Kenya where they live with relatives.

That's because Ken is unable to raise enough money to cover a British health tax, known as the immigration health surcharge (IHS).

'Struggling to stay afloat'

Migrant workers coming to the UK from outside the European Economic Area (EEA) and their dependents have to a pay an annual fee of £200 ($268) each.

Ken is also required to have £2,185 in his account for three months before he can apply to bring his twins into the country - on top of the £400 he will need for their health tax.

"It's very difficult to explain to them when they ask me when they will join me here.

"Ideally, every parent would love to be with all their children."

Top five nationalities of non-EEA NHS staff in England

1. Indian - 18,348
2. Filipino- 15,391
3. Nigerian - 5,405
4. Zimbabwean - 3,899
5. Pakistani - 3,375

One in eight National Health Service (NHS) England staff are not British nationals, and people from a total of 201 foreign nationalities work for NHS England.

Source: House of Commons Library

The time difference and the nature of his job also make it difficult for him to give the twins the attention they need.

"Sometimes when you're at work, they call and you cannot speak with them as you'd love to, since you're really busy," he says.

The health surcharge was introduced in 2015 to boost funding for the National Health Service (NHS) and as a way to discourage health tourism.

Later this year, the annual charge is to be doubled from £200 to £400, with the discounted rate for students set to increase from £150 to £300.

A double tax?

A Home Office spokesperson reiterated that the government was aware of the "contribution" made by international professionals "to the UK and to our health service".

But it said the surcharge offered access to healthcare that was "far more comprehensive and at a much lower cost than many other countries".

"The income generated goes directly to NHS services, helping to protect and sustain our world-class healthcare system for everyone who uses it," the spokesperson said.

Prostate cancer spit test is trialled

A spit test to detect men at increased risk of prostate cancer has started early trials.

The new DNA test looks for high-risk genes that are thought to affect one in every 100 men.

Three hundred men are taking part in the trials, from three London GP surgeries.

Developing better diagnostic tests that could be used as part of a nationwide screening programme is a research priority for prostate cancer.

At present, there is no single, reliable test for prostate cancer. The PSA blood test, biopsies and physical examinations are all used.

But the PSA can give false positives and sometimes misses more aggressive cases.

The new DNA test was created by a group of international scientists based at the Institute of Cancer Research (ICR) in London.

They studied more than 140,000 men and identified 63 new genetic variations that can increase the risk of prostate cancer.

The DNA test combines those variants with more than 100 others previously linked to prostate cancer.

Ros Eeles, professor of oncogenetics at the ICR, said the study was "very significant".

"By looking at the DNA code of tens of thousands of men in more depth than ever before, we have uncovered vital new information about the genetic factors that can predispose someone to prostate cancer, and, crucially, we have shown that information from more than 150 genetic variants can now be combined to provide a readout of a man's inherited risk of prostate cancer."

Only those men found to be at higher risk of prostate cancer would then be scanned and have a prostate biopsy, so researchers hope it could prevent unnecessary procedures.

"It could have a substantial impact on how we actually manage those at increased risk because if you find the disease earlier it's much easier to treat it and much more easy to cure," says Prof Elees.

The trial will be expanded to 5,000 men next year.

Prof Paul Workman, chief executive of the Institute of Cancer Research, said the study also provided important information about the causes of prostate cancer and the potential role of the immune system "which could ultimately be employed in the design of new treatments".

The study is published in the journal Nature Genetics and was funded by the the National Cancer Institute in the US, with additional support from the European Research Council, Cancer Research UK and Prostate Cancer UK.

Dr Iain Frame, director of research at Prostate Cancer UK said: "This new research could help men to understand their individual genetic risk of prostate cancer, which could prompt them to speak to their GP about the disease.

"Given that one in eight men will be diagnosed with prostate cancer in their lifetime, we urgently need more accurate diagnostic tests which are suitable for use in a nationwide screening programme."

Carl Alexander from Cancer Research UK, said the study was "an exciting example" of how research can find clues in our genes to help us uncover those more likely to develop the disease.

"The next steps should be to understand how this research can be developed into tests which could identify men who might be more likely to develop aggressive cancers, and how this could be rolled out to patients.

Smoked mackerel pilau rice

This is a great one-pan family meal that’s tasty and healthy too. If you like more spice, add some ginger and chilli to the vegetables at the start. You can also add boiled eggs at the end too bulk it out.

Ingredients

• 1 tsp rapeseed oil
• 1 onion, roughly chopped
• 1 garlic clove, finely chopped
• 1 tbsp medium curry powder
• 250g/9oz basmati rice
• 500ml/18fl oz vegetable or chicken stock
• 200g/7oz smoked mackerel or smoked peppered mackerel, skin removed and flaked into large pieces
• 80g/3oz frozen peas
• 1 lemon, juice only, plus wedges to serve
• 2 tbsp roughly chopped flatleaf parsley (optional)
• sea salt and freshly ground black pepper

How-to-videos

Method

1. Heat a large saucepan until medium hot, add the oil and onion and stir well. Cover with a lid and leave to cook gently for 10 minutes, until softened.
2. Add the garlic and curry powder and stir fry for 1 minute. Add the rice and stir, then add the stock. Stir well and cover with a lid.
3. Bring to the boil, then turn the heat down and simmer gently with the lid on for about 15 minutes, checking that it doesn’t dry out. When the rice has absorbed all the stock it should be tender. If not, add a splash of boiling water then cook for a further 5 minutes and check again.
4. Stir in the flaked mackerel, peas, lemon juice and parsley and mix carefully, as you don’t want the mackerel to break up too much. Season to taste with salt and pepper and cook for 1 more minute to make sure it’s hot through, then serve.

Student mental health 'failing a generation'

British universities say they risk "failing a generation" unless students get better mental health care.

A Universities UK report found some students risked "slipping through the gaps" due to a lack of co-ordination between the NHS and universities.

The most up-to-date statistics show 146 students killed themselves in 2016. At Bristol, three students have died suddenly in the past month alone.

An NHS official said local services should collaborate with universities.

Henry Curtis-Williams, a photography student, took his own life in 2016, aged 21.

"He had lost weight, he had dark shadows under his eyes, he was clearly in crisis," said his mother Pippa Travis-Williams.

"He changed from being that super-confident person to [becoming] just a shell of a person."

The number of deaths in 2016 was higher than the 134 students who killed themselves in 2015 - which in turn was the highest total since 2006.

Universities UK said that over the past five years, 94% of universities had seen a "sharp increase" in the number of people trying to access support services.

Some institutions noticed a three-fold increase.

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The report said data on students was rarely shared fully between universities and local health services, which could lead to students accessing "treatment and support with incomplete information, or not accessing it at all".

The report added students leaving their family homes to attend university often enrolled with a new GP.

They would then return home during holidays, meaning they were without their bespoke GP care for several weeks or months.

What is Universities UK suggesting?

• Universities and local NHS services should communicate more about students who may need mental health services
• Local services and universities should assess the need for mental health services for students in specific towns and cities
• Institutions should promote positive mental health, make reasonable adjustments for students with pre-existing conditions, and reduce the stigma of mental health
• Create "student mental health teams" with NHS providers to improve referrals to specialist services