Suicide Research: Let’s Fund The Agenda To Reduce Suicide
What can suicide research tell us? Ultimately, we want research to tell us how to reduce suicide and suicide attempts.
A lot of approaches exist for preventing suicide—some we’ve tried and some are just proposals or ideas. But which ones work best? Better guardrails on bridges? Better training for emergency room personnel? What other places in the healthcare system are the best intervention sites? What about the purported wonder drug ketamine, which still carries a lot of question marks?
There actually exists a strategic plan for answering these and other questions.
A national strategy and a research agenda
The U.S. Surgeon General and the National Action Alliance for Suicide Prevention (a public-private organization) developed a National Strategy for Suicide Prevention, including goals and objectives that dictate actions. The first national strategy document was created in 2001 and the second (most recent) one came out in 2012. One of the goals of the National Strategy is to “promote and support research on suicide prevention.” To this end, the National Action Alliance for Suicide Prevention produced a research agenda establishing priorities for suicide prevention research, released in 2014.The research agenda developed six “key questions” that research should be trying to answer:
- Why do people become suicidal?
- How can we better/optimally detect/predict risk?
- What interventions are effective? What prevents individuals from engaging in suicidal behavior?
- What services are most effective for treating the suicidal person and preventing suicidal behavior?
- What other types of preventive interventions (outside health care systems) reduce suicide risk?
- What new and existing research infrastructure is needed to reduce suicidal behavior?
Finding answers to these questions will require a range of types of research—from evaluating the effectiveness of different interventions to basic neuroscience that might help us understand suicidal feelings. One of the most important overall elements of both the National Strategy document and the Research Agenda is the need to change perceptions of suicide from something inevitable to something that can be prevented through changes in policies and systems—healthcare, prison, education, and others.
That’s where advocates come in: We are the people who can tell our elected officials that there is a strategy and it’s time to implement it.
It’s worth mentioning that suicide rates in the US have not decreased in many decades, and have actually increased rather steadily since about 2000, so creating plans and strategies is clearly not enough to actually decrease suicide. Strategies have to be implemented, and in order to know which ones to implement, it’s useful to know which are the most effective—that’s what research is for.
As an example, in the United Kingdom, paracetamol (called acetaminophen in the US, the active ingredient in Tylenol) has been packaged in blister packs since 1998 and studies have shown that both intentional and accidental poisonings with paracetamol declined. A similar measure for acetaminophen and perhaps other medications is worth consideration in the U.S. as well. But perhaps other measures would be more effective with less overall cost. Since firearms are responsible for most suicide deaths in the U.S. (partly because suicide attempts with firearms are more likely to result in death), policies that address access to firearms could have a large impact on the suicide rate in the U.S. The right research could help guide us in these policy decisions.
Assessing where we are now
After the Research Agenda was released, the same group took a look at the actual research being done on suicide prevention and in March 2015 released an analysis of research efforts from 2008 to 2013. Their overall conclusion was that funding for suicide prevention research is “meager,” and had decreased over the past decade while suicide mortality was increasing. Clearly, that needs to change.
- The ArmyStudy To Assess Risk and Resilience in Servicemembers (Army STARRS) program provided a huge one-time injection of funding into suicide research, all falling under the category of Question 1—why people become suicidal.
- During the 6 years this report looks at, funding for suicide research averaged $71.6 million per year, including Army STARRS ($60.8 million excluding Army STARRS). To put that in context, in 2013 the National Institutes of Health spent over $5 billion per year on cancer research, $240 million on tuberculosis research, and $78 million on cystic fibrosis research. Cystic fibrosis is a terrible disease, but only affects about 30,000 Americans total (about 1,000 new cases per year). https://www.cff.org/What-is-CF/About-Cystic-Fibrosis/
- While private foundations funded about thirty percent of the studies identified (116 studies of a total of 383), in terms of dollars spent, the federal government provided 98 per cent of the total funding, and private foundations only 2 per cent.
- Not including the Army STARRS funding, the most well-funded question was Question 3—examining which interventions work best to prevent suicidal behavior (see the chart above).
- The panel listed short-term and long-term objectives for each of the six questions; most of the research being done addresses short-term objectives. In fact several of the long-term objectives had no studies at all addressing them (see Appendix A of the report).
We at Cure Alliance would like to see more funding for research in all six questions. Given limited funds, an emphasis on questions 1 and 3 seems appropriate, but we’d like to see more funding in all areas and on the long-term objectives of each question. And we’d add that by itself, all the research funding in the world won’t decrease deaths by suicide. As a society, we then need to take action to implement strategies shown to work—that might also mean more funding in areas where interventions and treatment take place.
Note: As we were writing this blog, the National Institute of Mental Health (the world’s largest funder of mental health research) was writing an update on the suicide initiatives it is undertaking—some is research already underway and some is exploratory activities for new kinds of research. There’s a lot going on—read more on its website.