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Suicide is a major mental health concern that devastates lives and causes unimaginable pain. In fact, in 2020, suicide was the 12th leading cause of death in the U.S., with nearly 46,000 people dying this way. What can we as mental health professionals do to help conquer this issue? 

We need to understand better the clinical reasons behind the decision to commit suicide. Suicide doesn’t have a clear etiology, and many factors influence whether a person will become suicidal, including their neurobiology, personal and family history, stressful events they may have experienced, and sociocultural environment. However, suicide can be viewed as “a behavior motivated by the desire to escape from unbearable psychological pain.” Psychological factors, including personality and emotions, also contribute. Interestingly, decision-making impairment seems to be an increasingly important influence. 

It's critical that we promote within our own organizations and communities the fact that suicide is preventable. Years ago, researchers found that almost half of people who commit suicide visit a primary care doctor within 1 month of death but don’t admit to or consult with the doctor about any suicide intent or ideation. Many people who commit suicide are social and active—they are struggling under the surface and do not seek help.  

September 5–11 is National Suicide Prevention Week. This week, the Substance Abuse and Mental Health Services Administration (SAMHSA) encourages everyone to put the topic of suicide prevention top of mind. Make sure your patients, clients, and students know about suicide risk factors, warning signs, and what they can do to prevent suicide. And be sure to emphasize the new three-digit phone number for the Suicide Prevention Lifeline—made active across the country in July: 988. 

For more information about what you can do this week to promote suicide prevention, visit this site.  

If you are treating patients and need more information about tools you can use for assessing suicide intent, visit our mental health resources page. 

If you or someone you know is considering suicide, you are not alone. Dial 988 to reach the Suicide Prevention Lifeline for immediate help, 24/7. 

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Suicide is one of the leading causes of death in the U.S. Yet, 93% of adults in the U.S. think suicide can be prevented. The week surrounding September 10—World Suicide Prevention Day—is hailed as National Suicide Prevention Week. Here are some ways you can get involved with suicide prevention: 

Learn the 5 steps and share them with others. The National Suicide Prevention Lifeline (NSPL) breaks down 5 ways anyone can help someone who may be suicidal. Although clinicians are trained in suicide prevention, most individuals don’t know where to begin. Share these steps so more people have awareness. NSPL even offers graphics that you can use to share on your social channels. 

Add a square to this virtual memory quilt. The American Foundation for Suicide Prevention (AFSP) offers a digital memory quilt. Whether you add a square for a lost loved one or simply view the stories and photos, this online remembrance is a powerful reminder of the impact of suicide. 

Participate in an Out of the Darkness walk. AFSP holds community walks across the country—more than 400 are currently planned for this fall.   

Ask for support! The National Alliance on Mental Illness provides extensive resources via phone or chat. Though not a crisis line, they offer a nationwide peer-support service that offers referrals and support. This page also offers a list of resources that can be used in an emergency. 

Take part in an online training session. The American Association of Suicidology offers a listing of clinical trainings and online events intended for professionals. 

Show support online. You can find prewritten social posts, graphics, and videos that you can use on your own social media accounts, as well as digital banners and Zoom backgrounds here.  

Researchers at Johns Hopkins University have discovered a chemical alteration in a single human gene that is linked to the risk of a suicide attempt. According to study leader Zachary Kaminsky, PhD, an assistant professor of psychiatry and behavioral sciences at the JHU School of Medicine, the results of this study could be a first step in developing a simple blood test that will help doctors predict suicide risk.

Described in The American Journal of Psychiatry, the study suggests that chemical changes in a gene involved in the function of the brain’s response to stress hormones plays a significant role in suicide risk. These changes can turn a normal reaction to everyday stress into suicidal thoughts and behaviors.

“Suicide is a major preventable public health problem, but we have been stymied in our prevention efforts because we have no consistent way to predict those who are at increased risk of killing themselves,” explains Kaminsky in a press release from Hopkins Medicine. “With a test like ours, we may be able to stem suicide rates by identifying those people and intervening early enough to head off a catastrophe.”

A blood test that accurately predicts suicide risk would be good news for the U.S. military, which has experienced an alarming increase in the number of suicides among veterans over the past few years, particularly males under the age of 30.

“What we envision, potentially, is using this test in psychiatric emergency rooms. For example, it could dictate closeness of monitoring and treatment options, and drive potentially more fast acting treatment in someone who is really high risk,” said Kaminsky in an interview with The Huffington Post.

To read the abstract or to download the full article, visit the American Journal of Psychiatry Web site.
Last month, major news outlets reported that a new study had linked concussions to a higher suicide risk among adolescents—but did the media get the story right?

In April, headlines such as “Concussions make young people more likely to attempt suicide” (U.S. News and World Report) and “Once-concussed teenagers found to be at higher risk for bullying, suicide” (Education Week) began to appear. Each source referenced a study by Dr. Gabriela Ilie, a post-doctoral fellow at St. Michael’s Hospital in Toronto. Ilie’s study, which was published on April 15 in the science journal Plos One, looked at data from 4,685 surveys administered to adolescents in grades 7 through 12 as part of a 2011 drug use and health survey in Ontario.

In the weeks since, however, there has been some criticism, not of the study itself but of the way it was covered by the media. In her April 22 article “The press release that fell and hit its head,” Brenda Goodman, a health writer for the Association of Healthcare Journalists, followed up with Ilie about the study. One of Goodman’s criticisms is that the media coverage—including St. Michael’s own press release—used the word “concussion” to describe the brain injuries that were associated with suicide risk, even though the study itself does not use that word. Instead, the study refers to a narrower band of more traumatic brain injuries, defined as “head injury that resulted in being unconscious for at least 5 minutes or being retained in the hospital for at least one night.”

Why is that distinction so important? Goodman points out that more serious brain injuries are likely to be the result of car accidents or assaults; sports-related concussions, while still serious, result in loss of consciousness only about 10 percent of the time.

So what did the study actually say about TBI and suicide risk? “When holding constant sex, grade, and complex sample design,” according to Ilie’s findings, “students with TBI had significantly greater odds of reporting elevated psychological distress (AOR = 1.52), attempting suicide (AOR = 3.39), seeking counselling through a crisis help-line (AOR = 2.10), and being prescribed medication for anxiety, depression, or both (AOR = 2.45).” The study goes on to say that students with TBI had higher odds of being bullied or threatened with a weapon at school, compared with students who did not report a TBI. Ilie recommends that physicians screen for potential mental health and behavioral problems in adolescent patients with TBI.

This study demonstrated a correlation between some types of TBI and suicide risk in adolescents; it did not, however, show a causal relationship between concussion and suicide. Brenda Goodman and health writers like her remind us that when it comes to psychology news, it’s important to go beyond the headlines and look at the original research.
PAR author Lisa Firestone will be presenting two continuing education workshops in Boston, Massachusetts in December.

The workshops are sponsored by the Massachusetts School of Professional Psychology and highlight the topics of suicide treatment and prevention and working with high conflict couples.

“The War Within: Working with Suicidal Individuals” will be held December 6, from 9 a.m. to 4:30 p.m. This course focuses on giving more extensive training to practitioners in the treatment of suicidal clients.

“Transforming War Between Intimates: Working with High Conflict Couples” will be held December 7, from 9 a.m. to 4:30 p.m. Focusing on Gottman’s research on the predictors of longevity in a relationship, this course will discuss styles of relating and how couples can challenge behaviors that interfere with closeness and longevity.

For more information or to register, click on the course descriptions above.
According to a new survey by the Iraq and Afghanistan Veterans of America (IAVA), suicide is one of the most important issues facing this generation of veterans, with 37 percent of respondents saying they know a veteran who has committed suicide and 45 percent know of an Iraq/Afghanistan war veteran who has attempted suicide.

Furthermore, nearly one in three veterans have considered taking their own life and 63 percent of vets say they have a friend who they feel needs mental health care. Half of respondents have had people close to them suggest they seek mental health care (19 percent of those individuals did not seek care, with most of those people stating that they were concerned it would affect their career or would make their peers perceive them in a different light).

On a positive note, 93 percent of individuals know that the Department of Veteran’s Affairs offers a suicide helpline, and 91 percent of vets say they have recommended that their friends seek out mental health treatment.

In an unrelated study published in The Journal of the American Medical Association (JAMA), researchers from the Naval Health Research Center found that the rising number of suicides in the military may not be caused by deployments to Iraq and Afghanistan. Instead, they believe that untreated depression, manic-depressive disorder, and alcohol abuse are much stronger indicators that an enlisted individual will commit suicide. For more information about the study, visit JAMA.
The Centers for Disease Control and Prevention (CDC) is calling painkiller use in the U.S. a “public health epidemic.”

A new study found that non-medical drug abuse is linked to depression and suicide in college students. Keith Zullig, PhD, from West Virginia University and Amanda Divin, PhD, from Western Illinois University conducted a study analyzing non-medical drug use among college students and its relationship to symptoms of depression.

Zullig and Divin analyzed data from the 2008 American College Health Association National College Health Assessment (ACHA-NCHA). ANCHA-NCHA asked 26,000 randomly selected college students from 40 campuses in the U.S about their non-medical drug use including painkillers, stimulants, sedatives, and antidepressants, along with their overall mental health in the last year.

The study, entitled “The Association between Non-medical Prescription Drug Use, Depressive Symptoms, and Suicidality among College Students” appears in the August 2012 issue of Addictive Behaviors: An International Journal. Authors reported that 13 percent of respondents who felt hopeless, sad, depressed, or were considered suicidal were using non-medical prescription drugs. The results were especially apparent in college females who reported painkiller use. Authors suggest that these findings are the result of college students self-medicating to mask their psychological distress.

“Because prescription drugs are tested by the U.S. Food and Drug Administration and prescribed by a doctor, most people perceive them as ‘safe’ and don't see the harm in sharing with friends or family if they have a few extra pills left over,” Divin said in a news story  from Western Illinois University. “Unfortunately, all drugs potentially have dangerous side effects. As our study demonstrates, use of prescription drugs—particularly painkillers like Vicodin and Oxycontin—is related to depressive symptoms and suicidal thoughts and behaviors in college students. This is why use of such drugs need[s] to be monitored by a doctor and why mental health outreach on college campuses is particularly important.”

The U.S. Department of Education’s Higher Education Center for Alcohol, Drug Abuse, and Violence Prevention says, “Before choosing a prevention strategy, you must start with assessment—the same as you would when addressing high-risk alcohol abuse or violence on campus.” The Center’s suggestions included surveys such as the NCHA, environmental scanning, including physical and online social networking environments, and increased faculty-student contact and mentoring.

What do you think? Should colleges do more to address non-medical prescription drug abuse as part of mental health and suicide prevention programs for their students? We would love to hear from you and keep the conversation going!

Editor’s note: This week, PAR is pleased to welcome guest blogger Grace Gardner. A recent graduate of the University of South Florida with a B.A. in Mass Communication, Grace is working as an editorial assistant this summer in the production department at PAR.

 
The Department of Veterans Affairs is working to address the growing problem of suicide among members of the military, using technology to strengthen communication between active-duty troops or veterans and the mental health professionals who can help them. VA Secretary Eric Shinseki says that the VA will be making greater use of videoconferences between doctors and their patients, according to a June story from the Associated Press.

Suicides this year among active-duty military personnel now outnumber battle deaths, according to Pentagon statistics (New York Times, June 8). Between January 1 and June 8, 2012, there were 154 suicides—an average of one per day and an 18 percent increase over the number of suicides during the same period in 2011.

The VA is planning to use videoconferencing to eliminate some of the barriers that prevent members of the military from seeking help for feelings of distress or suicidal thoughts. Videoconferencing can reduce the amount of time patients spend traveling, making it more convenient to meet with a health care provider. Shinseki said that members of today’s military are comfortable with online chats, and working with them in this way can help reduce some of the stigma that patients feel about their mental health concerns. ‘‘Shame keeps too many veterans from seeking help,’’ Shinseki said.

The VA is also stepping up its use of electronic health records, according to the AP story. In recent months, Congress has criticized Shinseki about the length of time that some veterans have had to wait before receiving a full mental health evaluation from the VA. By integrating electronic health records among departments, the VA hopes to expedite treatment for veterans who need immediate attention.

VA officials estimate that up to two-thirds of all veterans who commit suicide have never asked for the VA’s help, a reality that Shinseki called frustrating and disheartening. “We know when we diagnose and treat, veterans get better,” he told the audience at a recent veterans suicide prevention conference, “but we can’t influence and help those we don’t see” (Stars and Stripes digital edition).

What do you think? Is videoconferencing a viable option for improving the responsiveness of mental health services for active-duty personnel or veterans? Do you use technology to communicate with clients—military or otherwise—in your practice? PAR wants to hear from you, so leave a comment and join the conversation!
PAR author Lisa A. Firestone, PhD will be presenting “Suicide: Treating the Self-Destructive Client” through live CE workshops in Minnesota, Pennsylvania, and New Jersey as well as an online during February and March. These workshops will be helpful for users of the Firestone Assessment of Violent Thoughts™ (FAVT™) ,  the Firestone Assessment of Violent Thoughts-Adolescent (FAVT-A), and the Firestone Assessment of Self-Destructive Thoughts and Firestone Assessment of Suicide Intent (FAST-FASI).

For more information or to register, visit The Glendon Association.
A new Facebook initiative attempts to prevent more suicides by allowing users to report comments under a new “Report Suicidal Content” link. The person who posted the concerning comment will immediately receive an e-mail from Facebook that encourages them to call the U.S. National Suicide Prevention Lifeline or to click on a chat session with a crisis counselor.

The Lifeline, which is funded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), has answered more than 3 million calls since its inception in 2005. Before this initiative began, the Lifeline was responding to dozens of individuals every day who had expressed suicidal thoughts on Facebook, so this new service is simply an extension of that work. As many suicidal individuals do not want to pick up the phone, this online chat service allows them another way to get the help they need and enables friends to intervene immediately and help identify those who may be in urgent need of help.

Approximately 36,000 individuals commit suicide in the U.S. every year – twice the number of murders in the country. Do you think this initiative will help to lower that number in the coming years?

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