Another Day in Paradise?

Another Day in Paradise?

Summer DeBastiani, Ph.D. in Nursing from the SONHS and former 3MT 2018 competitor, researched suicide risk in the Florida Keys.
By Mike Clary and additional reporting by Robin Shear

Summer DeBastiani, Ph.D. in Nursing from the SONHS and former 3MT 2018 competitor, researched suicide risk in the Florida Keys.

Another Day in Paradise?

By Mike Clary and additional reporting by Robin Shear
Though many see the Keys as an idyllic place to live, a SONHS researcher tracks a link between access to housing and the area’s high suicide rates.

Original article published in the Spring 2018 edition of the SONHS’ Heartbeat magazine, pages 16-17: https://news.miami.edu/sonhs/publications/heartbeat/heartbeat_spring_2018.pdf.

Soon after moving to Islamorada in 2015, Summer DeBastiani, Ph.D. ’18, M.P.H., began seeing local media reports about startlingly high suicide rates among her fellow Keys residents. Beyond the news, it was personal for her. “I’ve lost friends,” says the UM School of Nursing and Health Studies (SONHS) doctoral candidate.

The statistics seemed especially mystifying for a place many consider a tropical paradise. DeBastiani, a former health scientist with the Centers for Disease Control and Prevention (CDC), turned her attention to the topic, contacting the Florida Department of Health in Monroe County to collaborate on research.

At her urging, questions from the Suicidal Behavior Questionnaire were added to the 2016 Monroe County Behavioral Risk Factor Surveillance Survey “to estimate suicide risk, elucidate some of the risk factors associated with suicidal ideation in the county, and begin to explore potential interventions,” according to DeBastiani’s resulting “Suicide Risk Report,” distributed by the health department this past December.

Among other findings, the research revealed an intriguing link between housing issues and the risk of suicide.

Monroe County, with a population of about 77,500, has some of the highest suicide rates in Florida annually, according to the state Department of Health. With 66 suicides between 2013 and 2015, the county’s death rate from suicide hit a peak of 27.7 per 100,000 residents—nearly twice as high as the state rate of 14.1 suicide deaths per 100,000 residents for that same period. In the Keys, where tourism is the dominant industry, those suicide rates are often thought to be associated with alcohol and drug use.

But the Monroe County survey showed a stronger correlation between suicide risk and those who rent as compared to those who own their homes in the Keys. “And that,” says DeBastiani “came as a surprise.”

“We knew we had some of the highest suicide rates,” she adds, “but we didn’t know what the risk profile looked like.” The findings form the basis of DeBastiani’s doctoral dissertation, “A Population-based Assessment of Suicide Risk.”

The 2016 Monroe County data set contained 528 respondents who were 18 years and older. Of those who responded, 7.34 percent were at risk for suicide. Those respondents reported significantly more depression, less exercise, more inability to work, and poorer mental health, physical health, and general health, as well as more activity limitation due to health, than those not at risk for suicide.

Most notably, DeBastiani found, people at risk for suicide were more likely to be renters than those not considered suicide risks. In the suicide risk category, 63.5 percent rent or have other arrangements while 36.5 percent own homes. In the no-risk category, it’s the other way around: 35.9 percent were renters while 64.0 percent owned homes.

As a measure of socioeconomic status, housing “tenure,” whether one rents or owns, has been emerging in the suicide literature as a stronger predictor of suicide than income, employment, or education, DeBastiani explains.

In association with its higher percentage of suicide rates, she adds, Monroe County has a higher percentage of renters than the rest of Florida. Further, the percentage of residents paying more than 30 percent of their income for rent or mortgage exceeds statewide estimates by 8 percent. In Monroe County, more than 19 percent of households pay more than half of their income for housing.

Hurricane Irma only exacerbated matters. When Irma barreled through the Florida Keys in September 2017, it destroyed 25 percent of the region’s housing stock, particularly low-income housing.

“Our biggest issue down here, and it’s gotten almost as much attention as the suicide rate, is that we don’t have affordable housing for people,” DeBastiani says. “My research found a link showing people struggling to pay their rent are actually more at risk for suicide.”

DeBastiani presented her findings at a February meeting of the Florida State Suicide Prevention Coalition in Tallahassee and in April at the CDC’s 2018 Behavioral Risk Factor Surveillance Survey Training Conference in Atlanta. Her work will also be included in the next Monroe County Community Health Almanac. She represented the SONHS at UM’s Three Minute Thesis competition and has been interviewed on US1 Radio in the Florida Keys.

Now, having successfully defended her dissertation and graduated, DeBastiani says her research is just beginning on the ways in which housing in a particular population area relates to health.

She will collaborate with Monroe County’s health department again next year to ask the same suicidal behavior questions. “It’s going to be interesting what we find pre- and post-Irma,” she says. “The mental health repercussions for some people are really, really hard.”