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Can we prevent suicide?

It’s fair to say that in the U.S., our attempts to prevent suicide thus far have failed—the rate of deaths by suicide has been constant for decades. In 2013, over 41,000 people died by suicide in the U.S. For Americans, suicide is the 10th leading cause of death (homicide is 16th). It is the second leading cause of death for 15 – 24 year olds in the U.S. and the third leading cause of death in that age group worldwide. September is National Suicide Prevention Month. Are we learning anything that could help us prevent suicide?

Can we prevent suicide? Chart of US suicide deaths by year

U.S. suicide rates by year (1981-2013). This and other facts and figures can be seen on the American Foundation for Suicide Prevention website.

 

So what is research telling us?

Research has given us a pretty good picture of risk factors for suicide, and not much more at this point. We still know very little about why people attempt suicide under conditions where others do not. Nor do we have a very good sense of which interventions work best to prevent suicide attempts, whether first or additional attempts.

For example, for most people who complete suicide—nine out of ten—mental illness is a factor, often undiagnosed or not adequately treated. To determine this, in some cases an intensive retrospective analysis of the person’s activities and behavior (reported by family and friends) has enabled a diagnosis after death. Depression is the most common mental illness associated with suicide, but bipolar disorder, borderline personality disorder, and schizophrenia also increase the risk of suicide.

We also know that one suicide attempt is a risk factor for future attempts. Although many who attempt suicide fortunately survive and go on to live full and satisfying lives, we need to know more about how to help people who have previously attempted suicide.

Other risk factors include a family history of suicide, family history of child abuse, alcohol and substance abuse, and not surprisingly, access to lethal means, especially firearms. A more complete list of know risk factors is available on the Centers for Disease Control website.

An interesting preventive tool that research has suggested is appropriate media reporting on suicide. When sensationalized, reporting can in fact lead to “copycat” suicides, it would seem; however reporting that is factual, not dramatized, and not extensive has been shown to avoid “suicide contagion” and perhaps even decrease suicide in the immediate aftermath of the reporting.

Another factor in suicide is that rates vary between different countries, as well as between different cultures within a country. While there is some association between poverty or unemployment and suicide that can account for part of the variation, cultural understandings of suicide also vary–in some cultures it is viewed as more shameful than in others. These differences have to be taken into account when developing prevention strategies.

Can we prevent suicide? Global map of suicide rates

Is there a biological basis of suicide?

Family history of suicide is a known risk factor, suggesting that there may be something genetic that could be identified. Researchers are looking for biomarkers for suicidal behavior. The fact that the drug ketamine (primarily used as an anaesthetic) has been found to reduce suicidal thoughts dramatically and almost instantly in people who are depressed also points to underlying biological mechanisms of suicidal thoughts and behavior (see our post on ketamine). And recently, a blood test was developed that has been shown to help in predicting suicide risk. The clinical usefulness of such a test remains to be seen, but it does show that our thoughts and emotions are not independent of our bodies.

Are we doing enough research on suicide?

In a word, no! Even among mental illness research, which is underfunded as a whole, suicide research is too small a part. A report released in March 2015 analyzed all the research on suicide in the US (both public and private funding), and concluded that research on suicide is “meager,” given its prevalence as a cause of death. As NIMH director Tom Insel points out, substantial research investments in other leading causes of death (notably heart disease and cancer, still the first and second leading causes of death) have dramatically reduced death rates. Research leading to policy changes has led to fewer deaths by accident (the 4th highest cause of death)—for example, improving product safety and requiring seat belt use. There is every reason to think that more investment in research can help us decrease deaths by suicide.

Can we prevent suicide with what we know now?

We can. The best hope for preventing suicide comes from the fact that it’s been done. There are interventions that work, and more research can help us understand better which ones work best and under what circumstances. Appropriate and effective treatment for mental illnesses protects against suicide, as does a family or community support system. And broader awareness of suicide, risk factors, and available resources is essential.

If you are in crisis, or think you may know someone who is, please reach out:

1-800-273-TALK (8255) National Suicide Prevention Lifeline

Or to chat online:

National Suicide Prevention Hotline

I’m Alive

7 Cups of Tea

For college students

More Reading

American Foundation for Suicide Prevention

National Institute of Mental Health

Suicide Awareness Voices of Education

Centers for Disease Control: Suicide Prevention

Suicide Prevention Apps

 

 

 

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