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September 29, 2014

World Suicide Prevention Day

Reuel S. Amdur

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September 10 was World Suicide Prevention Day. On that occasion, Dr. Ian Colman of the University of Ottawa, Canadian Research Chairman in Mental Health Epidemiology, spoke before a gathering sponsored by the Ottawa Suicide Prevention Coalition.

If one looks at potential years of life lost, the rates for suicide and heart disease are similar, but the resources allocated to suicide prevention are far less, he pointed out.

Studies, he reported, find that 30% of adolescents have thought of taking their own lives, and a tenth have actually made a suicidal effort. 

The National Longitudinal Survey of Children and Youth, looking at those from 12 to 15, surveyed around 10,000 children, from 1998 to 2007. 

The good news is that there has been a decline in those who have seriously considered suicide in the last 12 months and a significant decline in the number of attempts. 

However, a British study found a problem, significant underreporting of suicidal thoughts and attempts.  It found that people asked face-to-face are less likely to report such things than those who fill out written questionnaires.  There is also underreporting of suicide itself.  For example, a death may be listed as due to drug overdose.  Was it suicide or an accident?  Often the cause of death will be listed as accidental.

Mood disorders are a major factor in suicide and suicidal thoughts and attempts.  An American study found that people experiencing depression were 21 times as likely to think about taking their own lives or attempting to do so.

What characteristics make people prone to suicidal thoughts and behaviors? 

Among them are feelings of hopelessness.  A family history of suicide, loss of a parent, and a history of physical or sexual abuse are all factors.  Sexual minorities and First Nations people are also more likely to be implicated.  Availability of means to kill oneself is another consideration.  Stressful events are an important factor.

Looking at the problem from the other angle, there are things that serve to protect people from suicide, such as support from family, school, and community and religious belief. 

I am a social worker, and when I used a depression scan in interviewing a Muslim woman, a question about suicide elicited the response that suicide is haram, not permitted.  Methods of limiting means to commit suicide can be helpful, such as putting barriers on bridges and on the roofs of tall buildings, as well as limiting access to guns.

Suicides sometimes occur in clusters, due to contagion.  13% of teen suicides in the United States appear to be of this sort, and contagion-related suicides are more common among teens than in other age groups.  Contagion may involve a personal connection with the perpetrator or media influence.  Around a quarter of teens are exposed to suicide before graduating from high school.

One study attempted to identify children at risk at the time of school entry, using a list of 75 factors.  One, for example, was a girl experiencing a stressful life event, with mother under 25 and the death of a family member.  However, this screening device over-predicted and in fact was more predictive of other problems: anti-social behavior, substance abuse, poor physical and emotional health, and poor academic performance. 

Trying to deal with all of the children identified as at risk as being at risk for suicide would, Colman argued, overwhelm available resources.  Surveying people in schools and places like doctors’ waiting rooms identifies many people with symptoms, but there are many false positives, as with the 75-factor device, again leading to the danger of overwhelming the resources available if all are included in programs.  However, the other problems besides suicide that are identified raise the question of the need for enrichment programs of a variety of types or of a general program.  If resources are overwhelmed, is the message that we need to increase the resources?

Colman spoke of ways of addressing the problem of suicide. 

He identified three target groups: the general public, family physicians, and ‘gatekeepers.’  There has, he said, been limited success in improving the general public’s understanding of causes and risk factors. Yet, it is important to work on reducing the stigma of mental illness and suicide.

There has been much more success with programs to educate family physicians.  They do not get much training about suicide and often do not ask patients pertinent questions.  Asking a person about suicide does not promote it. 

Promoting better understanding among ‘gatekeepers’ has also been positive to some extent.  The category includes pharmacists, clergy, and school personnel.  He feels that more study is needed to determine effectiveness with these groups.

Drug treatment for depression has been an important factor in the significant drop in the suicide rate, and psychotherapy, especially cognitive behavioral therapy, “may be as effective as psychopharmacology,” he observed.  While there have been efforts at follow-up care for people who attempt suicide, there is a need to identify the best approach, he said.   

Newspapers have been encouraged to be more circumspect when reporting suicide. 

Journalists are now often aware of how to present suicide in ways less likely to be contagious.  It is recommended that, in the case of a teen, the story should not be page one and should not display a photo of the person.  The word “suicide” should not appear in the headline, and it is best not to mention the method used.  The piece might also serve an educational purpose by listing available resources and warning signs.  The internet, being less tamed, presents a bigger problem in that regard.

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