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ST. LOUIS COUNTY • One victim, a 49-year-old woman, was found lying on a living room sofa with photos of her children and a row of empty medicine bottles.

Another was a pretty high school girl who, at 17, already was rubbing elbows at a black-tie fundraiser but struggling away from the spotlight.

Then there was the doctor who spent a career trying to preserve life before taking his own.

These stories are just a few ripples in a wave of suicides that has quietly swelled in recent years. There are scores of other cases in the diverse neighborhoods in the St. Louis region.

In St. Louis County alone, there were 130 suicides in 2011, accounting for more deaths than fatal motor vehicle accidents and homicides combined.

There are more than 38,000 suicides in the U.S. each year. The national rate has risen in recent years and surpassed traffic wrecks as the leading cause of injury mortality, according to a study published last month in the American Journal of Public Health.

And the numbers could be higher. The author of the report, Ian Rockett, said the suicide rate was "very seriously undercounted." Suicides by drug overdose, for example, are often logged as poisonings, he said.

The numbers also don't include all the attempts. Dispatchers for St. Louis and St. Louis County police combined have responded to more than 18,000 attempted-suicide calls since 2005.

Though suicides happen among all age groups, middle-age white males now have the highest rate of suicide nationally, surpassing the elderly. Geographically, rural areas tend to have the highest rates, partly because of less access to mental health services.

While shootings, homicides and wrecks are routinely reported by media outlets, suicides typically are not noted out of fear of copycats and respect for survivors. Only family members, neighbors and close friends may find out. And they are often reluctant to talk about it.

A suicide gets attention only when somebody disrupts the general flow of the populace, such as the 76-year-old woman who jumped from a downtown Clayton high-rise in 2010. Or when a public figure is involved. Or when it's a horrifying murder-suicide, where cameras zoom in on yet another teddy bear left at a crime scene.

But even in those cases, the full story is rarely told.

Sometimes multiple suicides shock individual neighborhoods, such as the three suicides this spring and summer involving young women in Kirkwood. One family that lost a 21-year-old now tries to remember her life, not her decision to hang herself one night after downing bourbon. She had also battled mental illness and drug addiction.

When the mother navigates grocery store aisles, she sometimes sees people drop their heads or turn away, unsure what to say.

"You kind of feel like — you don't want to say celebrity, probably more of a freak," the mother said.

As fresh as the Kirkwood cases are, others continue to fester many years later.

"It's a long recovery process," said Darwyn Walker, executive director of the St. Louis chapter of the National Alliance on Mental Illness, which works with families affected by suicide. "When you start talking about death that isn't planned, like a suicide, or an accident, you start thinking what should have been done to prevent it. There is a kind of a guilt factor."

In Missouri, rural Mercer County, near the Iowa border, has the state's highest suicide rate. Only 3,800 people live in the county. Between 1990 and 2009, there were 27 suicides, nearly three times the national rate.

Longtime Mercer County Coroner Mike Greenlee is unsure why the rate is highest there. But he usually knows the victims, because the community is so small.

"Suicide is a very selfish act," he said. "Not always, but most of the time. Most of the people they hurt are their loved ones, because they have to live with it."

MULTIPLE FACTORS

There isn't a single cause of suicide, which can stem from a combination of depression, mental illness, health issues, addiction or numerous other factors. Suicides have been gradually rising nationally since 2005, and though experts concede that the recession — with the unemployment and foreclosures it brought — might be a factor, they also say it's hard to pinpoint reasons.

Public and mental health experts, however, say the majority of suicides are preventable.

Restricting access to firearms, or reducing access to alcohol and drugs among those at risk, can help. So can knocking down the stigma of mental illness, which tends to be viewed as a weakness.

More than 90 percent of people who die by suicide have a diagnosable mental disorder, yet fewer than a third of adults and only half of children with a mental disorder receive needed services each year, according to federal agencies.

"Talking about it is a start," said Lanny Berman, executive director of the American Association of Suicidology. "It moves it from darkness into the light. But that in and of itself won't stop the problem. It takes action. It takes involvement. It takes the willingness to approach somebody who is psychologically distressed and say, 'I am concerned, how can I help?' and then getting them to effective sources of help."

Charlotte Tate's case speaks to those challenges.

Tate, 53, was uprooted by divorce and unemployment. She didn't have a place of her own and moved back to Black Jack in north St. Louis County last year after a failed romance in Memphis, Tenn., with an old friend with whom she had reconnected on Facebook.

She briefly lived with one of her brothers, but that wasn't working well, so she moved in with her other brother, Mervin Davis, his wife and their mother. Davis said his sister seemed confused and complained about her head hurting.

She tried to get help at a few hospitals, but he said she never offered details. Then, during a family meeting, Davis asked what he suspected.

"I asked her, 'Charlotte, have you ever thought about committing suicide?'" Davis recalled. "She said, 'No, no, I've never thought about suicide.' And that's how we left it."

The next morning, Tate stayed home from church. When the rest of the family got back, Davis found his sister had hanged herself.

Later, he started calling numbers on her cellphone. One man told Davis that she'd asked him for a gun. The man told her to get help instead. He didn't tell anybody else.

Davis said he provided his sister with a peaceful place to stay, but now he wonders if he should have done more.

"I am sorry I wasn't there for my sister when she really needed me," he said.

Looking back, nearly a year later, Davis said mourning a suicide victim started with anger. "And then you are sad because she got tricked out of her life."

He believes he'll see his sister again in heaven.

"The first thing I am going to do is slap her face and say, 'What in the heck were you thinking, girl?'" he said. "Then I might hug her."

TAKING ACTION

While many people try to move on after suicide wracks a family, some take a dramatically different approach.

The parents of Chad McCord decided to form the nonprofit CHADS Coalition — Communities Healing Adolescent Depression and Suicide.

Chad killed himself two weeks after becoming an Eagle Scout in 2004 and a month before graduating from Oakville High School. He had competed in the Junior Olympics, but there was an obstacle he couldn't clear, despite treatment: depression. It wasn't a secret that he had considered suicide.

"He was a high achiever, as are many people who die by suicide," said Chad's mother, Marian. "They are used to rising above and being the best of the best. In Chad's case, he couldn't beat his depression. He felt that he should have been able to fix it. He felt like it was a character flaw within himself."

The nonprofit group named after him raises money for research and holds programs in schools and community centers. Last week, CHADS Coalition was at Ferguson Middle School, teaching seventh-graders how to look for suicide warning signs and what to do after spotting them.

"It's one thing to say, 'I have cancer,' and another to say, 'I have mental illness, I have depression.' There is a certain shame," Marian McCord said. "If you have mental illness, you are treated differently. You are not surrounded by the same support, compassion and understanding. It's a very isolating illness."

The parents of Andrew Engster decided to take action, too. Andrew, 17, was on the Clayton High School rowing team, played saxophone and earned A's. His family had no clue he was in trouble.

In a funk over a breakup, he was found dead two days after a 1999 Valentine's Day rave party at which he took drugs. A computer consultant hired by his family found that he'd searched for 'suicide" on the Internet two days before the rave.

In the wake of his death, his parents, Mitch and Karen Margo, wrote a four-page letter addressed to Clayton High School students and parents. It was mailed to all of them and published in the school newspaper.

"Andrew sounds like many other teenagers — curious, bright but not street-wise, open to new ideas, eager to experience life," they wrote.

The parents also wrote that they took comfort in what a rabbi said at their son's memorial service: "If there is one person who will not be lost to the same darkness Andrew knew, because of his life and because of him, then that person can provide some hope and healing to Andrew's family for the blessings of Andrew's life."

HOLDING ON

One afternoon in the summer of 2011, a 74-year-old woman in an apartment complex in south St. Louis County called 911 threatening to kill herself. She talked about how lonely she was, how she felt abandoned by her family. The dispatcher tried to buy time until police arrived by telling the woman to think about her grandchildren. Twelve minutes into the call, a shot rang out.

Two months later, a 41-year-old man in a neighboring building hanged himself from a balcony.

He lived across the street from where Stacy Fuller and her pregnant daughter, Hailey, 21, lived.

The duo decided to move a few weeks ago. Not because of the suicides. They couldn't afford $495 a month rent at the building.

Stacy Fuller is no stranger to struggle. She'd been homeless before. Her daughter spent years in foster care. She's been disabled.

She's also no stranger to suicide. In 1991, her father, 54, a tool-and-die maker, took his own life. She said cancer on her father's face had grown like an angry hand with fingers, reaching into his jaw, eye, ear, brain and mouth. He'd wanted to hold Hailey, who was just months old at the time, but was scared, as if the cancer could jump.

Fuller keeps his suicide note in her jewelry box.

"The tumor has eaten half of my face away and it's hurting more every day," wrote her father, Robert Richey. "I would try to hold out longer, but I've almost went deaf in my right ear and my sinus has rotted through and I can't do anything but sit around. ... It's in my mouth now and I can't eat."

Hailey, his now grown-up granddaughter, dismisses suicide.

"If you want to find a solution and you go to suicide, you're just taking the coward's way out," she said.

Her mother said it was more complex than that. She thinks her dad, for example, can be described as a "very strong person."

But for now, she had more urgent issues to debate. She needed to move. She talked about potential job leads at the Waffle House and an auto parts store. Her daughter's baby was due in a few weeks.

"I try to take each day at a time, but sometimes several days hit me at once," Fuller said with a smile. "I'll figure it out. Figure it out as you go."

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