A Better Strategy for Suicide Prevention

July 21, 2014
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To meet new ambitious national targets for reducing suicide, public health officials may need to focus on periods of high risk.

Earlier this year, the National Action Alliance for Suicide Prevention, a public-private partnership formed by the federal government in 2010, set its most ambitious suicide prevention goal ever: decrease the number of deaths by suicide in the United States by 20 percent over the next five years and 40 percent over the next decade.

Those targets won’t come easy. While public health officials have enjoyed success in other areas in recent years, suicide rates have risen from 10.4 per 100,000 people in 2000 to 12.1 per 100,000 in 2010, according to a commentary published in The Journal of the American Medical Association in March. “We haven’t really addressed suicide as a public health problem in the way that we’ve done with smoking or cancer,” says Jeffrey Bridge, PhD, a principal investigator in The Research Institute at Nationwide Children’s Hospital and a coauthor of the JAMA article.

To that end, Bridge and his coauthors — Mark Olfson, MD, MPH, of Columbia University and the New York State Psychiatric Institute and Steven Marcus, PhD, of the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center — have suggested a key first step in tackling this difficult health issue, the third leading cause of death for young people between the ages of 10 and 24, according to the Centers for Disease Control and Prevention.

They advocate focusing on “periods of high risk.” In particular, they identified two populations — patients who’ve just been discharged from psychiatric hospitals and patients with deliberate self-harm injuries who seek emergency care — who need more attention. By offering better intervention programs for these groups, healthcare providers “could go a long way toward lowering suicide risk during these critical periods,” says Dr. Bridge, also an associate professor of pediatrics at The Ohio State University.

To be sure, the approach faces obstacles, and it’s not enough to meet the ambitious national suicide prevention targets alone, experts say. A lack of mental health specialists in hospital emergency rooms, for instance, remains a problem. “One of the greatest areas of shortage are child psychiatrists and psychologists,” says Christine Moutier, MD, the chief medical officer for the American Foundation for Suicide Prevention. And the stigma associated with suicide continues to prevent some families from getting their loved ones proper care. “When a young person makes a suicide attempt, there is still the phenomenon of not recognizing it as an actual suicide attempt,” Dr. Moutier says.

In an era of limited resources, one of the best strategies may be “more aggressive case finding,” Dr. Bridge says. “Pediatricians have an important role in identifying and managing youth at risk of suicide,” he says. “Engaging in the conversation is probably the most important thing that a pediatrician can do.”