Physicians, public health officials and mental health advocates hope the death of Robin Williams will bring new attention to suicide, the little-discussed and less-understood phenomenon that now ranks among the top 10 causes of death in the United States.
The public might consider it a concern chiefly for teens and the elderly. But adults ages 45 to 64 — the Academy Award-winning actor was 63 — now account for the largest number of suicides and have the fastest-growing suicide rate.
Williams was found dead Monday in his Marin County home. A county coroner said Tuesday that he appeared to have hanged himself. Friends and associates said he had struggled for decades with depression, and the coroner said he had been seeking treatment.
Suicide-prevention advocates hope Williams' death makes more people aware of the risk factors, and said they would be on heightened alert for those who might harm themselves in the days and weeks to come. Depression is a leading cause of suicide.
"People have to realize it could happen to anybody," said Dr. Steven Sharfstein, CEO of the Sheppard Pratt Health System in Towson. "Depression is a very common human experience."
The 45-to-64 age group has accounted for much of an increase in the nation's overall suicide rate, according to the federal Centers for Disease Control and Prevention. That rate rose more than 18 percent from 2000 to 2011, from 10.4 deaths per 100,000 people to 12.3 deaths.
That age group made up nearly 19 percent of suicides in the United States in 2011, more than any other bracket. In 2000, the group trailed those 25 to 44, 65 to 84, and 85 or older.
Dr. Adam Kaplin, a professor of psychiatry at Johns Hopkins Medicine, said studies have linked much of the increase to the economic dislocations of the Great Recession, which for many baby boomers have meant the loss of jobs and retirement savings.
Shame about seeking mental health treatment, gaps in psychiatric diagnosis and care, and access to guns can also be factors — not just for older adults but for all age groups, according to professionals.
"It's very possible that a lot of people in that demographic, specifically, would be afraid or ashamed to ask for help," said Caitlin Mulrine, a Baltimore-based spokeswoman for the National Alliance on Mental Illness. "Within the media and within society, there's such a stigma that surrounds seeking help for mental illness."
Some say the health care system does a poor job of connecting patients at risk of suicide to treatment.
The number of people ages 45 to 64 who visited hospital emergency rooms after suicide attempts more than doubled from 2005 to 2011, according to the federal Substance Abuse and Mental Health Services Administration. But fewer than one in 10 of them were referred to mental health services, the agency reported.
"We're still not thinking of these diseases as illnesses," Kaplin said. "Mood disorders are the elephant in the room."
Linda Raines, CEO of the Mental Health Association of Maryland, said there are major gaps in the system: a dearth of child psychiatrists, the absence in some jurisdictions of round-the-clock crisis-response teams and a shortage of support services for people suffering with mental illness in the community.
In addition, she said, many poor and disabled residents lack access to even basic health services.
"Since we closed hospitals and state psychiatric facilities in the 1950s — dumped people out on the streets without a support system — it's been a piecemeal effort to really get the services back in place," she said.
It is often left to family members and friends to spot warning signs. They might be the first to notice when someone suffers symptoms of depression, which can include fatigue, insomnia or excessive sleeping, anxiety or feelings of hopelessness.
The National Alliance on Mental Illness offers courses on suicide risk and prevention both for the mentally ill and for their family members, Mulrine said. One recent workshop focused on how to persuade someone that he or she needs to seek mental health treatment.
"Sometimes it does really take the family member taking that first step to get information and resources," she said.
In Maryland, 481 people committed suicide in 2010, the most recent year for which numbers are available.
On Tuesday, state police tweeted dashboard video of a trooper stopping a man Saturday from jumping off the Millard E. Tydings Memorial Bridge between Cecil and Harford counties.
A state commission on suicide prevention formed by Gov. Martin O'Malley in 2009 focused on the needs of high-risk groups, such as military veterans, members of the lesbian, gay, bisexual and transgender community, bullied youth, the unemployed and those who have previously attempted suicide.
Cyntrice Bellamy, chief of community care and suicide prevention at the state's Behavioral Health Administration, said the state is working with the Mental Health Association of Maryland to provide "mental health first aid" training to people who may come into contact with vulnerable populations. These include college counselors, school administrators, law enforcement officers and administrative law judges.
Bellamy said that effort has helped push the state into the bottom 15 for suicide rates. Still, Maryland has seen an increase in suicide attempts in recent years, which some link to the economy.
Adults between the ages of 25 and 64, and particularly men, generally are more likely to be successful in their suicide attempts, Bellamy said, in part because they have "greater means," including more access to firearms.
Following Williams' death, Bellamy said, hot line operators and other behavioral service providers in the state will be on "heightened alert."
In the days after a high-profile death, she said, officials will try to pinpoint trends — particularly increases in call volume at individual call centers — and then staff up to respond to any increase in demand for services that is identified.
Advocates said they hope that will mean more opportunities to raise awareness about suicide prevention.
Williams' death inspired discussions of mental health and suicide Tuesday on air, in print and social media. Sites such as Facebook and Reddit posted telephone numbers and links for help, and television and radio programs called on psychiatrists and other mental health professionals to answer questions.
"You never want to feel like you are taking advantage of a tragedy" said Raines, of the Mental Health Association of Maryland. "But if there is something good that can come out of a tragedy and it can ease the pain of the tragedy a little bit, I guess that is good."