Reducing Suicide A National Imperative (2002) / Chapter Skim
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11 Findings and Recommendations
11 Findings and Recommendations
Pages 423-438
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From page 423... ...
To make fundamental advances requires a different scientific approach that will ensure a higher level of scientific rigor, integrate multiple levels of research, provide reliable national and international data on current rates of suicidal behavior and key risk and protective factors, and create the infrastructure for testing treatment and preventive interventions and implementing and institutionalizing the effective strategies. The following sections will briefly 423
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From page 424... ...
Risk factors associated with suicide include serious mental illness, alcohol and drug abuse, childhood abuse, loss of a loved one, joblessness and loss of economic security, and other cultural and societal influences. Resiliency and coping skills, on the other hand, can reduce the risk of suicide.
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From page 425... ...
However, psychological autopsy studies and toxicological analyses indicate that many people who complete suicides are not under treatment for mental illness at the time of death. Accurate information on treatment utilization by persons at risk for suicidal behavior, efficacy or effectiveness of existing interventions and cost of treatment are not possible without accurate assessment of suicidal behaviors.
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From page 426... ...
Data on diagnoses associated with suicides would be obtained through the psychological autopsy method by the population laboratories for all suicides within their population, which would be enriched by highly focused ethnography. Similarly, data would be obtained on suicide attempts in the course of stratified population surveys that would be more complete than that obtained from reports generated from emergency rooms or health care providers.
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From page 427... ...
The longitudinal dimension of the proposed studies, necessary to provide a picture of the evolving rates of suicidal behaviors and of risk and protective factors, requires a 10-year funding period. The committee believes that population laboratories will eventually provide models of "reduced-suicide zones" that will have great benefit to public health.
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From page 428... ...
At a base-rate of 10-12 suicides per 100,000 people, this population base of the network would significantly improve the available data for estimates of suicide incidence, capacity for longitudinal studies, development of brain repositories, access to representative samples for prevention and intervention studies, and studies of genetic risk for suicide. Several such laboratories would provide adequate data to assess the numerous and complex interacting variables including the profound effects of demographics, regions, culture, socioeconomic status, race, and ethnicity.
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From page 429... ...
Psychological Risk and Protective Factors Clinical trials on the specific effects of reducing hopelessness on suicide. Hopelessness is related to suicidality across age, diagnoses, and severity of disorder, yet the field lacks research on the pathways to hopelessness, interrelationships between hopelessness and other psychological aspects of suicide risk, and on the specific effects of reducing hopeless.
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From page 430... ...
Clinical Epidemiology Prospective studies of populations at high risk for the onset of suicidal behavior, such as the offspring of suicide completers or attempters, can allow for studies of neurobiologic, genetic, and non-genetic factors that predict the onset of suicidal behavior. Interdisciplinary research that weaves together biological, cognitive, and social effects of trauma to elucidate the complex pathways from childhood trauma to mental illness and/or suicidality and thereby elucidate multiple possibilities for intervention.
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From page 431... ...
ENHANCING THE DATABASE ON SUICIDE Because suicide is a low base-rate event, special efforts are needed to ensure collection of sufficient data to allow meaningful analysis of risk factors and interventions. Long-term studies of suicidal behavior are potentially uniquely informative.
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From page 432... ...
Including suicidal participants in clinical trials is a critical step to improving the outcome of suicidal individuals by providing an evidencebase for treatment protocols. Such studies should be conducted with research designs and measures that touch on the etiopathogenesis of suicidal behaviors, as described throughout this report.
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From page 433... ...
It might be developed as part of a broader injury reporting database. Modeled after Oregon's program for the reporting of adolescent suicide attempts and the HIV/AIDS registry, pilot programs should be developed, tested, and implemented as soon as feasible.
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From page 434... ...
Suicide can be considered an expected outcome of a significant subgroup of mentally ill patients who experience accumulative life stresses, just as cardiac infarction is an expected outcome of untreated high blood cholesterol. The committee finds that mental illnesses are potentially fatal and that suicide is the most common cause of premature mortality in this group.
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From page 435... ...
Recommendation 3 Because primary care providers are often the first and only medical contact of suicidal patients, tools for recognition and screening of patients should be developed and disseminated. Furthermore, since over half of suicides occur in populations receiving treatment for mental disorders, it is critical to enhance the capacity of mental health professionals to recognize and address both chronic and acute suicide risk factors.
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From page 436... ...
Programs that integrate prevention at multiple levels are likely to be the most effective. Comprehensive, integrated state and national prevention strategies that target suicide risk and barriers to treatment across levels and domains appear to reduce suicide.
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From page 437... ...
School-based Programs emulovin~ a health uromo . ~ , 1 1 tJ 1 J tJ lion approach have been shown to effectively prevent and/or reduce suicide risk factors and correlates like adolescent pregnancy, delinquency, substance abuse, and depression.
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From page 438... ...
· Programs that have shown success within select populations should be expanded. For example, the Air Force program should be adopted by hierarchical organizations that employ groups with increased suicide rates, including police and rescue workers.
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