Suicide prevention
Encyclopedia
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.
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. 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.
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.
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). The document also outlines 11 specific objectives, listed below :
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 epidemic
s, and avoiding presenting authorities or sympathetic, ordinary people as spokespersons for the reasonableness of suicide.
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.
There are various screening tools in the form of self-report questionnaire
s 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. 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. 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. Asking about or screening for suicide does not appear to increase the risk.
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.
For years, researchers and health policy planners have theorized and demonstrated that restricting lethal means helps reduce suicide rates. 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.
In the United States, numerous studies have concluded that firearm access is associated with increased suicide risk. 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.
The conservative estimate is that 10% of individuals with psychiatric disorders may have an undiagnosed medical condition causing ther symptoms, upwards of 50% may have an undiagnosed medical condition which if not causing is exacerbating their psychiatric symptoms. Illegal drugs and prescribed medications may also produce psychiatric symptoms. Effective diagnosis and if necessary medical testing which may include neuroimaging 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.
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. Lithium has also proven effective in lowering the suicide risk in those with unipolar depression as well.
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. Cognitive Behavior Therapy for Suicide Prevention (CBT-SP) is a form of DBT adapted for adolescents at high risk for repeated suicide attempts.
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"
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.
Journals of suicide prevention research
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
.
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.
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. 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.
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.
Strategies
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). The document also outlines 11 specific objectives, listed below :
- Promote awareness that suicide is a public health problem that is preventable
- Develop broad-based support for suicide prevention
- Develop and implement strategies to reduce the stigma associated with being a consumer of mental health, substance abuse and suicide prevention services
- Develop and implement community-based suicide prevention programs
- Promote efforts to reduce access to lethal means and methods of self-harm
- Implement training for recognition of at-risk behavior and delivery of effective treatment
- Develop and promote effective clinical and professional practices
- Increase access to and community linkages with mental health and substance abuse services
- Improve reporting and portrayals of suicidal behavior, mental illness and substance abuse in the entertainment and news media
- Promote and support research on suicide and suicide prevention
- Improve and expand surveillance systems
Specific strategies
Various specific suicide prevention strategies have been used:- Selection and training of volunteer citizen groups offering confidential referral services.
- Promoting mental resilience through optimismOptimismThe Oxford English Dictionary defines optimism as having "hopefulness and confidence about the future or successful outcome of something; a tendency to take a favourable or hopeful view." The word is originally derived from the Latin optimum, meaning "best." Being optimistic, in the typical sense...
and connectedness. - Education about suicide, including risk factors, warning signs and the availability of help.
- Increasing the proficiency of health and welfare services at responding to people in need. This includes better training for health professionals and employing crisis counseling organizationsCrisis hotlineA crisis hotline is a phone number people can call to get immediate emergency telephone counseling, usually by trained volunteers. Such hotlines have existed in most major cities of the United States at least since the mid-1970s. Initially set up to help those contemplating suicide, many have...
. - Reducing domestic violenceDomestic violenceDomestic violence, also known as domestic abuse, spousal abuse, battering, family violence, and intimate partner violence , is broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, or cohabitation...
and substance abuseDrug abuseSubstance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent. The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts...
are long-term strategies to reduce many mental healthMental healthMental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
problems. - Reducing access to convenient means of suicideSuicide methodsA suicide method is any means by which one or more persons purposely kill themselves. Suicide methods can be classified according to two modes of interrupting life processes: physical or chemical. Physical modes of interruption typically act by incapacitating the respiratory system or the central...
(e.g. toxic substances, handguns). - Reducing the quantity of dosages supplied in packages of non-prescription medicines e.g. aspirin.
- Interventions targeted at high-risk groups.
- Research. (see below)
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 epidemic
Suicide epidemic
A suicide epidemic is an epidemic of suicides. Such epidemics have occurred in the former Soviet Union in the 1990s; among police officers; on Indian reservations; in Micronesia; The Werther effect occurs when suicides that are made publicly known encourage others to imitate them...
s, and avoiding presenting authorities or sympathetic, ordinary people as spokespersons for the reasonableness of suicide.
Screening
Assessment of suicide risk
Suicide risk assessment is ethically complex: the concept of "imminent suicide" is a legal construct in a clinical guise, which can be used to justify rationing of emergency psychiatric resources or intrusion into patients' civil liberties...
may be one of the most effective means of preventing suicide in children and adolescents.
There are various screening tools in the form of self-report questionnaire
Questionnaire
A questionnaire is a research instrument consisting of a series of questions and other prompts for the purpose of gathering information from respondents. Although they are often designed for statistical analysis of the responses, this is not always the case...
s to help identify those at risk such as the Beck Hopelessness Scale
Beck Hopelessness Scale
The Beck Hopelessness Scale is a 20-item self-report inventory developed by Dr. Aaron T. Beck that was designed to measure three major aspects of hopelessness: feelings about the future, loss of motivation, and expectations...
and Is Path Warm?
Is Path Warm?
Is Path Warm? is an acronym utilized as a mnemonic device. It was created by the American Association of Suicidology to help assess the risk of suicide.IS PATH WARM?I Ideation...
. A number of these self-report questionnaires have been tested and found to be valid for use among adolescents and young adults. 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. 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. Asking about or screening for suicide does not appear to increase the risk.
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.
Lethal means reduction
Means reduction, reducing the odds that a suicide attempter will use highly lethal means, is an important component of suicide prevention.For years, researchers and health policy planners have theorized and demonstrated that restricting lethal means helps reduce suicide rates. 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.
In the United States, numerous studies have concluded that firearm access is associated with increased suicide risk. 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.
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 pharmacological and psychotherapeutic talk therapies.The conservative estimate is that 10% of individuals with psychiatric disorders may have an undiagnosed medical condition causing ther symptoms, upwards of 50% may have an undiagnosed medical condition which if not causing is exacerbating their psychiatric symptoms. Illegal drugs and prescribed medications may also produce psychiatric symptoms. Effective diagnosis and if necessary medical testing which may include neuroimaging 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.
Recent research has shown that Lithium
Lithium
Lithium is a soft, silver-white metal that belongs to the alkali metal group of chemical elements. It is represented by the symbol Li, and it has the atomic number 3. Under standard conditions it is the lightest metal and the least dense solid element. Like all alkali metals, lithium is highly...
has been effective with lowering the risk of suicide in those with bipolar disorder to the same levels as the general population. Lithium has also proven effective in lowering the suicide risk in those with unipolar depression as well.
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. Cognitive Behavior Therapy for Suicide Prevention (CBT-SP) is a form of DBT adapted for adolescents at high risk for repeated suicide attempts.
Respect of self esteem
World Health OrganizationWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
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
Self-esteem
Self-esteem is a term in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. Self-esteem encompasses beliefs and emotions such as triumph, despair, pride and shame: some would distinguish how 'the self-concept is what we think about the self; self-esteem, the...
" 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
Violence
Violence is the use of physical force to apply a state to others contrary to their wishes. violence, while often a stand-alone issue, is often the culmination of other kinds of conflict, e.g...
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
Intolerance
-Medical/biological:*Intolerance, a synonym of sensitivity **Drug intolerance**Food intolerance**Lactose intolerance**Hereditary fructose intolerance**Sucrose intolerance**Lysinuric protein intolerance**Citric acid intolerance...
. and as well "to de-stigmatize mental illness"
Support groups
Many non-profit organizations exist, such as the American Foundation for Suicide PreventionAmerican Foundation for Suicide Prevention
The American Foundation for Suicide Prevention was founded in 1987 by a group of experts on suicide who wanted to create a 5013 organization to fund research in suicide prevention....
in the United States, which serve as crisis hotlines. In addition, some groups like To Write Love on Her Arms
To Write Love on Her Arms
To Write Love on Her Arms is an interfaith, American non-profit organization which aims to present hope for people struggling with addiction, depression, self injury, and thoughts of suicide while also investing directly into treatment and recovery...
have been promoted using social media
Social media
The term Social Media refers to the use of web-based and mobile technologies to turn communication into an interactive dialogue. Andreas Kaplan and Michael Haenlein define social media as "a group of Internet-based applications that build on the ideological and technological foundations of Web 2.0,...
to reach more people.
External links
Agencies and organizations- CDC website on Suicide Prevention
- The Suicide Prevention Resource Center (SPRC) provides prevention support, training, and resources to assist organizations and individuals to develop suicide prevention programs, interventions and policies, and to advance the National Strategy for Suicide Prevention.
- Stamp Out Suicide!
- The JED Foundation is the leading nonprofit organization working to reduce the rate of suicide and the prevalence of emotional distress among college students.
- Suicide Prevention:Effectiveness and Evaluation A 32-page guide from SPAN USA, the National Center for Injury Prevention and Control, and Education Development Center, Inc.
- American Association of Suicidology is a membership organization for all those involved in suicide prevention and intervention, or touched by suicide.
- American Foundation for Suicide Prevention is the leading not-for-profit dedicated to preventing suicide through research, education and advocacy.
- Suicide Prevention Action Network USA
- International Association for Suicide Prevention Organization co-sponsors World Suicide Prevention DayWorld Suicide Prevention DayWorld Suicide Prevention Day is an awareness day observed on September 10 every year, in order to provide worldwide commitment and action to prevent suicides, with various activities around the world...
on September 10 every year with the World Health Organization (WHO). - U.S. Surgeon General - Suicide Prevention
- Suicide.org
- Samaritans of Singapore is a non-profit and non-religious organisation which aims to provide 24-hour confidential emotional support to people in crisis, thinking of suicide or affected by suicide.
Journals of suicide prevention research