The stunning death by suicide of designer Kate Spade, followed just days later by the death of celebrity chef and author Anthony Bourdain, highlights the lingering stigma of anxiety, despair and depression, even among the seemingly most upbeat and successful among us.

Chicago experts say the tragedy also points to women’s and middle-age people’s increasing rates of suicides.

Suicide rates for U.S. adults ages 45-64 had the largest absolute rate increase (to 19.2 per 100,000 people in 2016 from 13.2 per 100,000 in 1999), and the greatest number of suicides (232,108) during the same period, according to Centers for Disease Control and Prevention data released Thursday. Previous studies showed the percent increase in the age-adjusted suicide rate was greater for women (45 percent increase) than for men (a 16 percent increase) from 1999-2014, and women ages 45-64 had the second-largest percentage increase in suicide rates (63 percent) during the time period. Nearly 45,000 suicides occurred in the United States in 2016, making it the 10th-leading cause of death.

Women ages 45 to 64 not only experience increased depression and suicide because of midlife hormone flux, but also because middle age comes with extra and new stress. That includes becoming caregivers to aging parents, coming to grips with children moving out of the house, or either being devalued or taking on new responsibilities at work, said Tory Eisenlohr-Moul, associate director of translational research in women’s mental health and an assistant professor of psychiatry at the University of Illinois at Chicago.

Other factors that can cause depression are genetic predispositions and how much abuse or stress a woman has endured across her lifetime, Eisenlohr-Moul said.

Yet the stigma surrounding anxiety, depression and suicide — for both men and women — is still deeply embedded in our culture, the experts say.

“People feel ashamed, embarrassed and alone,” said Alexa James, executive director of the Chicago affiliate of the National Alliance on Mental Illness (NAMI). “People are afraid of the derogatory labels — like ‘crazy’ — associated with mental illness.”

Yet 20 to 25 percent of the U.S. population annually meets the criteria of living with some kind of mental health condition.

“We know people suffer in isolation because many don’t know where to go for help, and the people around them may not feel equipped to provide the support the (people suffering) need and deserve,” James said.

That’s especially devastating because depression, whether unipolar or bi-polar, can be treated successfully, and efforts are gaining traction to support suicide prevention and research.

For example, women with longstanding depression who get hormone stabilization treatment show reduced depression and suicidal thoughts, Eisenlohr-Moul’s research shows. She has been awarded a $750,000 grant from the National Institutes of Health to find out which specific hormones can be stabilized to reduce depression and suicidal thoughts or actions.

The number of “Out of the Darkness” community walks to raise funds for suicide prevention has grown to over 400 plus another 150 on college campuses, compared with just four such walks when the effort started 14 years ago, said Jill Harkavy-Friedman, vice president of research at the American Foundation for Suicide Prevention (AFSP). The foundation will invest $5.3 million this coming year for research and will invest in educational programs, public policy advocacy and support for survivors of suicide loss.

NAMI’s Chicago affiliate (NAMIChicago.org) helps people cut through the complicated system of getting help, finding the right healthcare provider and figuring out insurance coverage. (The help line is 312-563-0445).

“If you’re suffering, anxious and depressed, the energy required to negotiate the system can be a significant barrier,” James said.

Another barrier is recognizing when someone is suicidal, since some people experience a jovial or uplifted mood and feel calm, relaxed and relieved when they decide to die by suicide, James said.

Dr. Pedro L. Dago, medical director of the psychiatric emergency department at Northwestern Memorial Hospital in Chicago, said other suicide-risk factors include history of trauma, substance abuse, alcohol abuse, unstable relationships and illnesses – especially those involving chronic pain – as well as recent losses such as with a job, a divorce or life status. Anxiety, hopelessness and psychotic symptoms are other red flags, Dago said.

For some, suicide can be an impulsive act, while for others, it’s the result of weeks or months of consideration, he said.

People considering suicide may also:
— Say they feel like they’re a burden to their families or significant others.
— Become increasingly isolated.
— Exhibit greater than usual anxiety.
— Feel paralyzed by chronic pain.
— Show increased anger or irritability or a sense of shame and humiliation.
— Sleep or eat more or less than usual.
— Talk about wanting to die.
— Plan ways to carry out suicide.

What should friends and loved ones do?

Any threats to a person at risk should be taken seriously.

“If someone is reaching out and threatening suicide, call 9-1-1,” Northwestern’s Dago said.

“If someone is in a lot of distress, a lot of turmoil emotionally, alcohol is involved and they’re becoming more and more withdrawn, try to get that person to the emergency room for an evaluation,” he said. “I would try to get that person seen immediately.”

People can also request a police officer trained in crisis intervention (a CIT officer) by calling 9-1-1, said James.

Suicide prevention hotlines are also available, such as the National Suicide Prevention Lifeline at 1-800-273-8255, which provides free and confidential support 24 hours a day, seven days a week.

If a friend is increasingly withdrawn and hopeless, reach out, said Harkavy-Friedman.

“People [suffering depression] can put on a good face,” she said. “They think they have to. Sometimes it’s best to be there, listen and let them know someone cares.”

Sandra Guy is a local freelance writer.