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.”

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Community-Driven Initiatives Aim to Stem Suicides Among Arctic Peoples

Guest Post by Brenda Patoine

Image courtesy of Stacy Rasmus

Image courtesy of Stacy Rasmus [click to see bigger]

In some of the most remote areas of Alaska, the suicide rate is seven times the national average, soaring to almost 18 times the U.S. average among Alaskan Native youth, where the suicide rate is 124 per 100,000 people aged 15-24, compared with 7 per 100,000 for that age group in the U.S. overall.

While it is not unusual for rural communities where people live in relative isolation to have higher-than-average rates of substance abuse, depression, and suicide, remote Arctic villages may represent a worst-case scenario. Far removed from population centers, these villages are located in some of the harshest environments in North America, are typically inaccessible by highways, and the closest hospitals are a plane ride away. Medical care is limited and mental health resources are typically nonexistent.

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From the Archives: Suicide Prevention

In this month’s Cerebrum article, “Suicide and the United States Army,” Dr. Elspeth Cameron Ritchie, a retired Army colonel, explains how the U.S. Military now collects data on suicides. She recommends ways to put that data to use through new strategies—like means restriction and service animals—that could bring down the high suicide rate in the military.

In July of 2011, Kay Redfield Jamison wrote the Cerebrum article “Suicide in the Young: An Essay.” She said:

“We know, first, that suicide is a terrible killer of the young. In the United States, suicide is the third major cause of death in 15-to-19-year-olds and the second leading cause of death in college-age students. In 1996, more teenagers and young adults died from suicide than from cancer, heart disease, AIDS, stroke, and lung disease combined. Suicide kills the young dreadfully and disproportionately. And, across the world, in those between the ages of 15 and 44, suicide is the second leading killer of women and the fourth of men.”

These numbers have not changed much. According to the CDC, suicide is still the third leading cause of death for 15-24 year olds, and for every completed suicide in this age range, there are 100-200 unsuccessful suicide attempts.

Dr. Ritchie says in her new article that military suicide differs from civilian suicide in part due to the role of mental illness. Most soldiers who commit suicide have not been diagnosed with a mental illness, although substance abuse issues can be a factor. She writes that an accumulation of stressors, like pain, disability, and estrangement from friends and family are more common risk factors among active duty personnel.

In contrast, in the civilian population, writes Dr. Jamison:

“We have compelling evidence from a large number of studies that the single most important factor in suicide is psychopathology: More than 90 percent of all people who kill themselves suffered from a major psychiatric or addictive illness (depression, manic-depression, schizophrenia, or alcohol and drug abuse), a severe anxiety disorder, or borderline or antisocial personality disorder. Those who are victims of both depression and alcohol or drug abuse are especially at risk. Most people who were depressed will not kill themselves. But of those who do, the majority were profoundly depressed.”

This, too, remains true today.

So what can be done to prevent suicide in the civilian population? The National Institute for Mental Health recommends treating underlying disorders, like depression and substance abuse, while addressing suicide risks. Studies have shown that cognitive behavior therapy can effectively reduce the number of suicide attempts. A combination of medication and therapy may be even more effective. In addition, primary care physicians should be better trained to recognize warning signs of suicide.

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

–Johanna Goldberg

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