Reducing Suicide A National Imperative (2002) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-16
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presented a comprehensive assessment of future goals and objectives to combat suicide. Several federal agencies (the National Institute of Mental Health, the National Institute of Drug Abuse, the Veterans Administration, the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, and the National Institute on Alcohol Abuse and Alcoholism)
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The report reviews many of these risk factors individually, but the Committee emphasizes the need for an integrated understanding of their influence. Over 90 percent of suicides in the United States are associated with mental illness and/or alcohol and substance abuse.
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Since the fall of the Soviet Union and its Eastern European satellite states much of East Europe has reported worsening health statistics, including adult mortality, alcohol and drug abuse, and some of the highest suicide rates in the world today. Here suicide is correlated with societal breakdown, severe economic dislocation, major cultural change and new political systems.
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, and a decline in suicide rates in a number of countries. However, randomized clinical trials with antidepressants have failed to reveal significant differences versus placebo, perhaps due to methodological limitations.
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There are significant barriers to receiving effective mental health treatment. About two-thirds of people with diagnosable mental disorders do not receive treatment.
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interventions attempt to address risk factors and to enhance protective factors. Programs that integrate prevention at multiple levels are likely to be the most effective.
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and improving our capability for assessment in prevention programs. ADDITIONAL CHALLENGES IN SUICIDE RESEARCH Reporting Problems Because suicide has a low base-rate, studies need large populations to yield significant results.
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NEXT STEPS To effectively study suicide requires a large population base, better reporting of completed and attempted suicide, careful control and analysis of risk and protective factors, common databases, and banks of biological tissues for analysis. Because of its low base rate, the difficulties in assessment, and the long-term nature of the risk and protective factors, the optimal approach to suicide is to use large populations with cultural and genetic diversity for long-duration, interdisciplinary studies.
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In recognition of the current funding and research shortage in the area of suicide, the committee provides the following recommendation for establishing population research centers that will integrate the talents of experts from many disciplines and will draw upon a large population base with continuity over a long duration to improve prevention and treatment interventions. In addition, the recommendations aim to improve the monitoring of suicide, to increase the recognition and consequently the treatment of the primary risk factors in primary care, and to expand the efforts in prevention.
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A number of Population Laboratories (e.g., 5-10) are necessary to capture the data for numerous and complex interacting variables including the profound effects of demographics, region, culture, socioeconomic status, race, and ethnicity.
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Brain mapping studies on biological predictors of suicidal behavior. The relationship between genetic markers and suicidal behavior and between suicide and aggression/impulsivity.
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· Statistical cores to manage the databases on risk and protective factors including genetic markers and cultural contexts. · Clinical cores to recruit patients and to ensure their safe and ethical treatment.
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· NIMH and other funding agencies should provide funds to clinical researchers to develop and evaluate screening tools that assess risk factors for suicide such as substance use, history of abuse and/or trauma, involvement with the criminal justice system, mental illness, psychological and personality traits such as impulsivity and hopelessness, abnormal neurobiology or genetic markers, employment problems, bereavement and other relationship stresses, etc. Funding agencies should issue program announcements to encourage efforts in this area.
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Recommendation 4 Programs for suicide prevention should be developed, tested, expanded, and implemented through funding from appropriate agencies including NIMH, DVA, CDC, and SAMHSA. · Partnerships should be formed among federal, state, and local agencies to implement effective suicide prevention programs.
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For example, the Air Force program should be adopted by hierarchical organizations that employ groups with increased suicide rates, including police and rescue workers. Gatekeeper training programs and screening programs for youth and elderly should be implemented more broadly within work and educational settings to identify and intervene with those at suiciderisk.
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