National Suicide Prevention Month: Update 2015

September 28, 2015 • Science Update

In 2014, the National Action Alliance for Suicide Prevention’s  Research Prioritization Task Force released a Prioritized Research Agenda for Suicide Prevention , which emphasized the importance of targeting interventions to specific risk groups as well as vulnerable times and settings. Broad measures and messages aimed at whole populations, as well as an expanding repertoire of treatments, haven't had a measurable impact on the national suicide rate—41,149 in 2013, the most recent year for which we have data.¹ In an effort to change that, the agenda clearly laid out the potential for identifying approaches that could lead to the greatest reductions in suicide by, for example, reducing lethal means, or identifying interventions for specific at-risk subgroups such as jail and prison inmates and people seen in emergency departments in the last year. In this way, the Agenda argued, we could make a real dent in the suicide rate, which has remained depressingly stable for 50 years.

NIMH’s efforts in 2015 in suicide prevention are in keeping with the Agenda’s approach; a grant awarded this month is a good example and is notable for the population that is the focus of the project. The National Institute of Justice, a component of the Justice Department, is joining NIMH in funding a $6.8 million study called Suicide Prevention for at-Risk Individuals in Transition, or “SPIRIT. Suicide rates in jails exceed that in the overall population (46 vs. 13 per 100,000), but research suggests the suicide rate is even higher in the year following release.^{2, 3} Investigators at Michigan State University and Brown University will test an intervention to lower the risk of suicide among just-released jail detainees. The safety planning intervention that SPIRIT will compare with standard care involves a brief intervention to develop a safety plan during jail detention followed by phone calls after release to review the plan and address any problems.

Beyond the SPIRIT study, described above, NIMH also posted a “concept” this year aimed at preventing suicide in the juvenile justice system. This concept aims at encouraging research on how to detect and prevent suicidality in youth who come into contact with the juvenile justice system, including ensuring their safety while in the system and after they transition out. The components of the justice system in this country—police, jails, and prison—have become the de facto institutions for handling and housing large numbers of those with mental illness; efforts directed at the port of entry—the juvenile justice system—target a large population for whom effective mental health interventions could be life saving.

The need for health care providers to be able to identify those at risk and intervene is another target of research. Analysis of the 2008-2012 National Survey on Drug Use and Health  found that 29 percent of adults who attempted suicide in the past year (an estimated 1.3 million Americans) received at least one night of inpatient mental health care that year. The National Action Alliance launched the Zero Suicide  initiative in 2011, aimed at preventing suicides in health care. Earlier this year, NIMH issued a request for information  (RFI) soliciting input on approaches that could be used to understand what components of inpatient care are safe and effective in reducing suicide risk; identify effective alternatives to inpatient care (for example telephone counseling, home visits, intensive day/residential treatment, respite care); and to determine how those alternatives can be broadly implemented. Another 2015 NIMH concept—soon to be posted on the Institute website—focuses on research to expand the number of “learning health care systems” in the U.S. that incorporate reduction in the number of suicide events as part of their business model.  Zero Suicide includes a number of “practice-to-science” prevention efforts that are ripe for empirical investigation; research funding could accelerate the rapid testing of these approaches.

Other efforts are aimed at particular at-risk groups. Another concept and RFI  this year affirmed NIMH’s interest in research aimed at a group with a particularly high risk of suicide: Alaska Native communities. Surveys suggest that the suicide rate among young Alaskan Native people (younger than 44) is five times that of white Americans in the U.S. Elements such as geographic isolation, cultural diversity, and small, localized populations present challenges for intervention; funding could support the development of culturally sensitive approaches to suicide prevention.

Research on suicide is generating results to guide future efforts. This year has seen a series of new papers adding to the data already reported from the NIMH-Army collaboration Army STARRS . One thing Army STARRS has shown is that there will be no easy answers to predicting who is at risk for suicide in the military. Nonetheless, the findings on the characteristics associated with risk—rank, occupation, sex, length of service, age at entering service, deployment history, and mental health history, among others—will all contribute to creating a means to identify personnel likely to be an elevated risk, and help direct interventions to them.

Everyone can participate in suicide prevention. Research, however, can show the way by demonstrating what will be the most effective strategies for preventing suicide, for the greatest number of people.

References

¹ National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System, Fatal Injury Reports , National and Regional, 1999-2013.

² Noonan M, Rohloff H, Ginder S. Mortality in local jails and state prisons, 2000-2013 – Statistical Tables.  Bureau of Justice Statistics. Washington, DC. U.S. Department of Justice, 2015.

³ Zlodre J, Fazel S. All-cause and external mortality in released prisoners: systematic review and meta-analysis.  Am J Public Health. 2012 Dec;102(12):e67-75. doi: 10.2105/AJPH.2012.300764. Epub 2012 Oct 18.