From the Archives: Seeking to Stem Suicide

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Nearly 45,000 people in the US kill themselves each year (probably an underestimate, given the stigma still attaching to suicide), and there may be 25 attempts for each death, according to the US Centers for Disease Control & Prevention. A news story we published in January reported on a few of the many avenues of research trying to help doctors and caregivers predict who is at risk and how to better help them.

“Suicide is one of the few medical conditions in which the doctor and patient have different goals—the patient may be highly motivated not to reveal what he or she is thinking,” psychiatrist Maria Oquendo says in the story. “We need biological markers so we can identify those at risk.”

In an article for Cerebrum in 2012, “Suicide and the United States Army,” psychiatrist Elspeth Cameron Ritchie, a retired Army colonel, explained how the military collects data on suicides and recommended  ways to put that data to use through strategies such as means restriction and service animals, aiming to reduce the high suicide rate in the military.

Searching for answers, the US Army started its yearslong Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Its first reports, in 2014, found that “the rise in suicide deaths from 2004 to 2009 occurred not only in currently and previously deployed soldiers, but also among soldiers never deployed; nearly half of soldiers who reported suicide attempts indicated their first attempt was prior to enlistment; and soldiers reported higher rates of certain mental disorders than civilians, including attention deficit hyperactivity disorder (ADHD), intermittent explosive disorder (recurrent episodes of extreme anger or violence), and substance use disorder.” (Find up-to-date reporting on STARRS and its follow-on project, STARRS-LS, at the Center for the Study of Traumatic Stress.)

In a Cerebrum article a decade earlier, psychiatrist and author Kay Redfield Jamison focused on suicide in the young. Unlike those in the military, who usually have not been diagnosed with a mental illness (although they may have substance-abuse issues), more than 90 percent of civilians who kill themselves had a major psychiatric or addictive illness, severe anxiety disorder, or borderline or antisocial personality disorder. “Most people who were depressed will not kill themselves. But of those who do, the majority were profoundly depressed,” she wrote.

We are fortunate today to have effective ways to treat the psychiatric illnesses most commonly associated with suicide: a range of antidepressant medications, lithium, anticonvulsant medications, psychotherapy, drugs to treat anxiety, and drugs to ameliorate and prevent psychosis. Of all these, lithium is the most persuasively tied to the actual prevention of suicide. But not everyone will respond to lithium, and not everyone who needs it will take it as prescribed. Other medications—such as the antipsychotic clozapine, and the antidepressants—can also help prevent suicidal behavior. Most of these medications have troublesome side effects, but the research literature is consistent in showing that patients at high risk for suicide are in great danger if undertreated—as many still are.

If someone you know talks to you about suicide, take them seriously. Call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

– Nicky Penttila

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