Suicide prevention

Suicide prevention is an umbrella term for the collective efforts of local citizen organizations, mental health practitioners and related professionals to reduce the incidence of suicide.

Such efforts include preventive and proactive measures within the realms of medicine and mental health, as well as public health and other fields – since protective factors such as social support and connectedness, as well as environmental risk factors such as access to lethal means, appear to play significant roles in the prevention of suicide, suicide should not be viewed solely as a medical or mental health issue.[1][2]

In the U.S., suicide prevention efforts are guided by the National Strategy for Suicide Prevention, published by the Department of Health and Human Services in 2001.[3] Suicide prevention interventions fall into two broad categories: prevention targeted at the level of the individual and prevention targeted at the level of the population.[4]

The Best Practices Registry (BPR) For Suicide Prevention is a registry of various suicide intervention programs maintained by the American Association of Suicide Prevention. The programs are divided, with those in Section I listing evidence-based programs: interventions which have been subjected to indepth review and for which evidence has demonstrated positive outcomes. Section III programs have been subjected to review.[5][6]

Contents

Strategies

In recognition of the need for comprehensive approaches to suicide prevention, various strategies have been put forth in the last decade.

In 2001, the U.S. Department of Health and Human Services, under the direction of the Surgeon General, published the National Strategy for Suicide Prevention, establishing a framework for suicide prevention in the U.S. The document calls for a public health approach to suicide prevention, focusing on identifying patterns of suicide and suicidal behavior throughout a group or population (as opposed to exploring the history and health conditions that could lead to suicide in a single individual).[3] The document also outlines 11 specific objectives, listed below :

  1. Promote awareness that suicide is a public health problem that is preventable
  2. Develop broad-based support for suicide prevention
  3. Develop and implement strategies to reduce the stigma associated with being a consumer of mental health, substance abuse and suicide prevention services
  4. Develop and implement community-based suicide prevention programs
  5. Promote efforts to reduce access to lethal means and methods of self-harm
  6. Implement training for recognition of at-risk behavior and delivery of effective treatment
  7. Develop and promote effective clinical and professional practices
  8. Increase access to and community linkages with mental health and substance abuse services
  9. Improve reporting and portrayals of suicidal behavior, mental illness and substance abuse in the entertainment and news media
  10. Promote and support research on suicide and suicide prevention
  11. Improve and expand surveillance systems

Specific strategies

Various specific suicide prevention strategies have been used:

It has also been suggested that news media can help prevent suicide by linking suicide with negative outcomes such as pain for the suicide and his survivors, conveying that the majority of people choose something other than suicide in order to solve their problems, avoiding mentioning suicide epidemics, and avoiding presenting authorities or sympathetic, ordinary people as spokespersons for the reasonableness of suicide.[7]

Interventions

Screening

The U.S. Surgeon General has suggested that screening to detect those at risk of suicide may be one of the most effective means of preventing suicide in children and adolescents.[8] There are various screening tools in the form of self-report questionnaires to help identify those at risk such as the Beck Hopelessness Scale and Is Path Warm?. A number of these self-report questionnaires have been tested and found to be valid for use among adolescents and young adults.[9] There is however a high rate of false-positive identification and those deemed to be at risk should ideally have a follow-up clinical interview.[10] The predictive quality of these screening questionnaires has not been conclusively validated so it is not possible to determine if those identified at risk of suicide will actually commit suicide.[11] Asking about or screening for suicide does not appear to increase the risk.[12]

In approximately 75 percent of completed suicides the individuals had seen a physician within the year before their death, including 45 to 66 percent within the prior month. Approximately 33 to 41 percent of those who completed suicide had contact with mental health services in the prior year, including 20 percent within the prior month. These studies suggest an increased need for effective screening.[13][14][15][16][17]

Lethal means reduction

Means reduction, reducing the odds that a suicide attempter will use highly lethal means, is an important component of suicide prevention.[18]

For years, researchers and health policy planners have theorized and demonstrated that restricting lethal means helps reduce suicide rates.[19] One of the most famous historical examples of this is that of coal gas in the United Kingdom. Until the 1950s, the most common means of suicide in the UK was poisoning by gas inhalation. In 1958, natural gas (virtually free of carbon monoxide) was introduced, and over the next decade, comprised over 50% of gas used. As carbon monoxide in gas decreased, suicides also decreased. The decrease was driven entirely by dramatic decreases in the number of suicides by carbon monoxide poisoning.[20][21]

In the United States, numerous studies have concluded that firearm access is associated with increased suicide risk.[22] Because guns are quick and more lethal than other suicide means (about 85% of attempts with a firearm are fatal, a much higher case fatality rate than for other methods), they are often a major driver of suicide rates.[23][24]

Treatment

There are various treatment modalities to reduce the risk of suicide by addressing the underlying conditions causing suicidal ideation, including, depending on case history, medical[25] pharmacological[26] and psychotherapeutic talk therapies.[27]

The conservative estimate is that 10% of individuals with psychiatric disorders may have an undiagnosed medical condition causing ther symptoms,[28] upwards of 50% may have an undiagnosed medical condition which if not causing is exacerbating their psychiatric symptoms.[29][30] Illegal drugs and prescribed medications may also produce psychiatric symptoms.[31] Effective diagnosis and if necessary medical testing which may include neuroimaging[32] to diagnose and treat any such medical conditions or medication side effects may reduce the risk of suicidal ideation as a result of psychiatric symptoms, most often including depression, which are present in up to 90-95% of cases.[33]

Recent research has shown that Lithium has been effective with lowering the risk of suicide in those with bipolar disorder to the same levels as the general population.[34] Lithium has also proven effective in lowering the suicide risk in those with unipolar depression as well.[35]

There are multiple evidence-based psychotherapeutic talk therapies available to reduce suicidal ideation such as dialectical behaviour therapy (DBT) for which multiple studies have reported varying degrees of clinical effectiveness in reducing suicidality. Benefits include a reduction in self-harm behaviours and suicidal ideations.[36][37] Cognitive Behavior Therapy for Suicide Prevention (CBT-SP) is a form of DBT adapted for adolescents at high risk for repeated suicide attempts.[38]

Respect of self esteem

World Health Organization states that "worldwide, suicide is among the top five causes of mortality in the 15-to 19-years age group and in many countries it makes first or second as a cause of death among both boys and girls in this age group." and recommends "strengthening student's self-esteem" to protect children and adolescents against mental distress and dependency, and enables them to cope adequately with difficult and stressful life situations. and "prevention bullying and violence at school" that specific skills should be available in the education system to prevent bullying and violence in and around the school promises in order create a safe environment free of intolerance. and as well "to de-stigmatize mental illness"[39]

Support groups

Many non-profit organizations exist, such as the American Foundation for Suicide Prevention in the United States, which serve as crisis hotlines. In addition, some groups like To Write Love on Her Arms have been promoted using social media to reach more people.

See also

References

  1. ^ Maine Suicide Prevention Website
  2. ^ http://www.medterms.com/script/main/art.asp?articlekey=11613
  3. ^ a b National Strategy for Suicide Prevention
  4. ^ Suicide Prevention: at what level does it work?, Bertolote, Jose. Suicide prevention: at what level does it work? World Psychiatry. 2004 October; 3(3): 147-151.
  5. ^ Best Practices Registry (BPR) For Suicide Prevention
  6. ^ Rodgers PL, Sudak HS, Silverman MM, Litts DA (April 2007). "Evidence-based practices project for suicide prevention". Suicide Life Threat Behav 37 (2): 154–64. doi:10.1521/suli.2007.37.2.154. PMID 17521269. 
  7. ^ R. F. W. Diekstra. Preventive strategies on suicide. 
  8. ^ Office of the Surgeon General:The Surgeon General's Call To Action To Prevent Suicide 1999 [1]
  9. ^ Rory C. O'Connor, Stephen Platt, Jacki Gordon: International Handbook of Suicide Prevention: Research, Policy and Practice, p. 510 [2]
  10. ^ Rory C. O'Connor, Stephen Platt, Jacki Gordon, International Handbook of Suicide Prevention: Research, Policy and Practice, p.361; Wiley-Blackwell (2011), ISBN 0470683848
  11. ^ Alan F. Schatzberg: The American Psychiatric Publishing textbook of mood disorders, p. 503: American Psychiatric Publishing; (2005) ISBN 158562151X
  12. ^ Crawford, MJ; Thana, L, Methuen, C, Ghosh, P, Stanley, SV, Ross, J, Gordon, F, Blair, G, Bajaj, P (2011 May). "Impact of screening for risk of suicide: randomised controlled trial.". The British journal of psychiatry : the journal of mental science 198 (5): 379–84. PMID 21525521. 
  13. ^ Depression and Suicide Andrew B. Medscape
  14. ^ González HM, Vega WA, Williams DR, Tarraf W, West BT, Neighbors HW (January 2010). "Depression Care in the United States: Too Little for Too Few". Archives of General Psychiatry (1): 37–46. doi:10.1001/archgefall into his hands I will kill. PMC 2887749. PMID 20048221. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2887749. 
  15. ^ Luoma JB, Martin CE, Pearson JL (June 2002). "Contact with mental health and primary care providers before suicide: a review of the evidence.". The American journal of psychiatry 159 (6): 909–16. PMID 12042175. 
  16. ^ Lee HC, Lin HC, Liu TC, Lin SY (June 2008). "Contact of mental and nonmental health care providers prior to suicide in Taiwan: a population-based study.". Canadian Journal of Psychiatry 53 (6): 377–83. PMID 18616858. 
  17. ^ Pirkis J, Burgess P (December 1998). "Suicide and recency of health care contacts. A systematic review.". The British journal of psychiatry : the journal of mental science 173: 462–74. PMID 9926074. 
  18. ^ Means Matter Campaign
  19. ^ Suicide Prevention Resource Center - Lethal Means
  20. ^ Means Matter Campaign - Coal Gas Case
  21. ^ The Coal Gas Story, Kreitman, N. The Coal Gas Story: United Kingdom suicide rates, 1960-1971. Br J Prev Soc Med. 1976 Jun;30(2):86-93.
  22. ^ Means Matter - Risk
  23. ^ http://www.hsph.harvard.edu/means-matter/means-matter/risk/index.html#What%20is%20it
  24. ^ CDC MMWR
  25. ^ Randolph B. Schiffer, Stephen M. Rao, Barry S. Fogel, Neuropsychiatry: Neuropsychiatry of suicide, pp. 706-713, (2003)ISBN 0781726557
  26. ^ Cipriani A, Pretty H, Hawton K, et al. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry. 2005 Oct;162(10):1805-19. PMID 16199826
  27. ^ Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006 Jul;63(7):757-66. PMID 16818865
  28. ^ Hall RC, Popkin MK, Devaul RA, et al. Physical illness presenting as psychiatric disease. Arch Gen Psychiatry. 1978 Nov;35(11):1315-20. PMID 568461
  29. ^ Chuang L., Mental Disorders Secondary to General Medical Conditions; Medscape;2011 [3]
  30. ^ Felker B, Yazel JJ, Short D.;cMortality and medical comorbidity among psychiatric patients: a review. Psychiatr Serv. 1996 Dec;47(12):1356-63.PMID 9117475
  31. ^ Kamboj MK, Tareen RS.; Management of nonpsychiatric medical conditions presenting with psychiatric manifestations. Pediatr Clin North Am. 2011 Feb;58(1):219-41, xii. PMID 21281858
  32. ^ Andreas P. Otte, Kurt Audenaert, Kathelijne Peremans, Nuclear medicine in psychiatry: Functional imaging of Suicidal Behavior, pp.475-483, Springer (2004);ISBN 3540006834
  33. ^ Patricia D. Barry, Suzette Farmer; Mental health & mental illness,p.282, Lippincott Williams & Wilkins;(2002) ISBN 0781731380
  34. ^ Baldessarini RJ, Tondo L, Hennen J. Lithium treatment and suicide risk in major affective disorders: update and new findings. J Clin Psychiatry. 2003;64 Suppl 5:44-52.PMID 12720484
  35. ^ Coppen A. Lithium in unipolar depression and the prevention of suicide. J Clin Psychiatry. 2000;61 Suppl 9:52-6. PMID 10826662
  36. ^ Canadian Agency for Drugs nd technology in Health: Dialectical Behaviour Therapy in Adolescents for Suicide Prevention: Systematic Review of Clinical-Effectiveness, CADTH Technology Overviews, Volume 1, Issue 1, March 2010 [4]
  37. ^ National Institute of Mental Health: Suicide in the U.S.: Statistics and Prevention [5]
  38. ^ Stanley B, Brown G, Brent DA, et al. (October 2009). "Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability". J Am Acad Child Adolesc Psychiatry 48 (10): 1005–13. doi:10.1097/CHI.0b013e3181b5dbfe. PMC 2888910. PMID 19730273. http://linkinghub.elsevier.com/retrieve/pii/S0890-8567(09)60165-9. 
  39. ^ Preventing Suicide, a resource for teachers and other school staff, World Health Organization, Geneva 2000

External links

Agencies and organizations

Journals of suicide prevention research