Advocacy Forum 2011 Dr. Paula J. Clayton, Medical Director American Foundation for Suicide Prevention 120 Wall Street, 22nd Floor New York, NY 10005 1-888-333-AFSP.

Advocacy Forum 2011Advocacy Forum 2011

Dr. Paula J. Clayton, Medical DirectorDr. Paula J. Clayton, Medical Director

American Foundation for Suicide PreventionAmerican Foundation for Suicide Prevention120 Wall Street, 22nd Floor120 Wall Street, 22nd FloorNew York, NY 10005New York, NY 100051-888-333-AFSP1-888-333-AFSPwww.afsp.orgwww.afsp.org

Facts about SuicideFacts about Suicide

3333

FactsFacts More than 34,598 people in the United States died by suicide in 2007. More than 34,598 people in the United States died by suicide in 2007.

About every 15 minutes someone in this country intentionally ends his/her About every 15 minutes someone in this country intentionally ends his/her life.life.

Although the suicide rate fell from 1992-1999, it was steady for 5 Although the suicide rate fell from 1992-1999, it was steady for 5 consecutive years despite all of our new treatments. The number of deaths consecutive years despite all of our new treatments. The number of deaths rose by 955 in 2004, by 118 in 2005, by 663 in 2006 and rose even more, rose by 955 in 2004, by 118 in 2005, by 663 in 2006 and rose even more, by 1298, in 2007.by 1298, in 2007.

Although the rate in adolescents and the elderly is falling, alarmingly, the Although the rate in adolescents and the elderly is falling, alarmingly, the rate in middle age men and women (46-64) is rising.rate in middle age men and women (46-64) is rising.

4444

U.S. Suicide Rates by Gender & Age(with special attention to those 65+)

Centers for Disease Control, WISQARS.http://www.cdc.gov/injury/wisqars/index.html

0

5

10

15

20

25

30

35

40

45

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

Rate

per 10

0,0

00

Males65+

Male AllAges

Total 65+

All Ages&GenderFemaleAll Ages

Females65+

PreventionPrevention

6666

Prevention Prevention

AWARENESSAWARENESS

SCREENINGSCREENING

EDUCATIONEDUCATION

MEANS RESTRICTIONMEANS RESTRICTION

MEDIA GUIDELINESMEDIA GUIDELINES

SIMPLE INTERVENTIONSSIMPLE INTERVENTIONS

TREATMENTTREATMENT

7777

AwarenessAwareness Primary risk factor for suicide is psychiatric illness: “depression can be Primary risk factor for suicide is psychiatric illness: “depression can be

lethal”lethal” Depression is treatableDepression is treatable Destigmatize the illnessDestigmatize the illness Destigmatize the treatmentDestigmatize the treatment Encourage help-seeking behaviors and continuation of treatmentEncourage help-seeking behaviors and continuation of treatment Proposed: Proposed:

Billboard campaignBillboard campaign AFSP: Depression and Bipolar Awareness: From Diagnosis to RemissionAFSP: Depression and Bipolar Awareness: From Diagnosis to Remission

Civnar, JG, Perspectives in Psychiatric Care, 2005Civnar, JG, Perspectives in Psychiatric Care, 2005

8888

Professional EducationProfessional Education

One of 3 StudiesOne of 3 Studies

In the Swedish county of Jämtland the use of antidepressants in 1994In the Swedish county of Jämtland the use of antidepressants in 1994was 25% below the Swedish average and the average suicide ratewas 25% below the Swedish average and the average suicide rateduring 1970-1994 was 10% above the national average. during 1970-1994 was 10% above the national average.

From 1995 to 2005, GPs were offered a two day seminar on treating depression which From 1995 to 2005, GPs were offered a two day seminar on treating depression which consisted of lectures, case discussions, and videotape presentations. There was an consisted of lectures, case discussions, and videotape presentations. There was an option to continue one day seminars in future years.option to continue one day seminars in future years.

Suicide rates per 100,000Suicide rates per 100,000 JämtlandJämtland SwedenSweden

1974-19941974-1994 27.7 27.7 25.0 25.01995-20021995-2002 17.3 17.3 17.6 17.6

Decrease seen mostly in womenDecrease seen mostly in women

Henriksson S, Isacsson G, Acta Psychiatr Scand, 2006Henriksson S, Isacsson G, Acta Psychiatr Scand, 2006

9999

Professional EducationProfessional Education

Sales of antidepressants in Jämtland, SwedenSales of antidepressants in Jämtland, Sweden

10101010

Suicide Prevention Strategies: Suicide Prevention Strategies: A Systematic Review (2005)A Systematic Review (2005)

InterventionIntervention Suicides, % Decline in Annual Rates Suicides, % Decline in Annual Rates

EducationEducationPublicPublic Not availableNot availablePrimary care physicianPrimary care physician 22-73 22-73 GatekeeperGatekeeper

US AirforceUS Airforce 4040Norwegian ArmyNorwegian Army 3333Increasing antidepressant prescriptions*Increasing antidepressant prescriptions* 3.23.2Chain of careChain of care Not availableNot availableRestricting lethal meansRestricting lethal means

GunsGuns 1.5-9.51.5-9.5Domestic gasDomestic gas 19-3319-33BarbituratesBarbiturates 2323Vehicle emissionsVehicle emissions Not availableNot availableAnalgesicsAnalgesics Not availableNot available

Media blackoutsMedia blackouts Not availableNot available

*There was a 414% increase in antidepressant prescriptions 1987 – 1999*There was a 414% increase in antidepressant prescriptions 1987 – 1999

Mann J, et al, JAMA, 2005Mann J, et al, JAMA, 2005

Treatment and DisseminationTreatment and Dissemination

National Network of Depression National Network of Depression CentersCenters

2929 Plymouth Rd., Suite 3002929 Plymouth Rd., Suite 300

Ann Arbor, MI 48105Ann Arbor, MI 48105

www.nndc.org

PurposePurposeNNDC’s MissionNNDC’s MissionTo conquer depressions, bipolar illnesses and related To conquer depressions, bipolar illnesses and related

diseases so millions can live better lives by developing, diseases so millions can live better lives by developing, disseminating and translating standardized, disseminating and translating standardized, sustainable, evidence-based, large-sample research sustainable, evidence-based, large-sample research advances into clinical care via a national networkadvances into clinical care via a national network

Four INTEGRATED domainsFour INTEGRATED domains Research TranslationResearch Translation Clinical CareClinical Care Education of a New GenerationEducation of a New Generation Public PolicyPublic Policy

1204/18/23

Timeline and ProgressTimeline and Progress

Center of Excellence Center of Excellence MembershipMembership

1404/18/23

1. Columbia University2. Duke University3. Emory University4. Brigham & Women’s

Hospital, Partners Healthcare & Harvard

5. Johns Hopkins University6. Massachusetts General

Hospital, Partners Healthcare & Harvard

7. McLean Hospital, Partners Healthcare & Harvard

8. Stanford University9. University of California Los

Angeles10. University of California San

Francisco Depression Center

The nation’s leaders in depression & bipolar care, research and education

11. University of Cincinnati & Lindner Center of HOPE

12. University of Colorado Denver Depression Center

13. University of Iowa14. University of Louisville

Depression Center15. University of Michigan

Depression Center16. University of Pennsylvania17. University of Texas

Southwestern Medical Center

18. Weill Cornell Medical College

Vision and Roadmap

Our Clinical ReachOur Clinical Reach

1604/18/23

Patients Treated Annually• Outpatient ~ 526,000• Inpatients ~ 29,000

Current Staffing• Clinical Psychiatrists ~ 1,000+• Clinical Psychologists – 336• Social Workers – 300• Nurses – 600

Current Facilities• Inpatient Beds – 1023+• Child/Adolescent Beds – 276+• 1028+ treatment rooms

available for adult outpatient• 298+ treatment rooms

available for child/adolescent outpatient

Opportunities

and plans to

reach many more

Committees & Task GroupsCommittees & Task Groups

• Clinical CareClinical Care

• EducationEducation

1704/18/23

• Women & Mood Disorders

• Primary Care Outreach

• Bipolar Disorder

• rTMS (repetitive Transcranial Magnetic Stimulation)

• Biosignatures & Pharmacogenetics

• School-Community Depression & Suicide Prevention

Domain Committees • Research

• Public Policy

Task Groups Underway• Child & Adolescent Mood

Disorders

• Suicide Prevention

• Health Services & Intervention Dissemination

• Electroconvulsive Therapy

• Geriatric Depression & Bipolar

• College Mental Health

Over 400 individual members from multiple disciplines participating

Board of DirectorsBoard of DirectorsOfficers Officers Founding Chair: Founding Chair: John F. Greden, M.D., John F. Greden, M.D., University of Michigan Depression CenterUniversity of Michigan Depression CenterVice Chair: Vice Chair: J. Raymond DePaulo, Jr., M.D.,J. Raymond DePaulo, Jr., M.D., Johns Hopkins University Johns Hopkins UniversityTreasurer: Treasurer: Frank deGruy, M.D., M.S.F.W., Frank deGruy, M.D., M.S.F.W., University of Colorado Denver Depression Center University of Colorado Denver Depression Center Secretary: Secretary: Terence Ketter, M.D., Terence Ketter, M.D., Stanford University Stanford University

1804/18/23 *The NNDC Executive Committee includes members who are starred (*), in addition to officers.

Selected ProjectsSelected Projects

Research & Clinical CareResearch & Clinical Care• Common Assessment Package: Common Assessment Package: providing standardized providing standardized

assessments for depression (“vital signs” of Psychiatry)assessments for depression (“vital signs” of Psychiatry)• Women & Mood Disorders Registry, Database, & Pending Women & Mood Disorders Registry, Database, & Pending

Clinical Trial (10 member sites)Clinical Trial (10 member sites)• Bipolar Genetic Repository (6 sites)Bipolar Genetic Repository (6 sites)• rTMS Dose Enhancement/Outcome Project & rTMS Dose Enhancement/Outcome Project &

communication with FDA (14 sites)communication with FDA (14 sites)• Intervention Dissemination Task Group for Evidence-Intervention Dissemination Task Group for Evidence-

Based Chronic Care For Bipolar Disorders (8 sites)Based Chronic Care For Bipolar Disorders (8 sites)• NNDC Data Coordinating Center (DaCC)NNDC Data Coordinating Center (DaCC)• NNDC Data RegistryNNDC Data Registry• Joint research recruitment program with DBSAJoint research recruitment program with DBSA

2004/18/23

Collaborative Grant Projects Collaborative Grant Projects or Submissions Involving or Submissions Involving

NNDC CentersNNDC Centers• EMBARC (Establishing Moderators/Mediators for EMBARC (Establishing Moderators/Mediators for

a Biosignature of Antidepressant Respeonse in a Biosignature of Antidepressant Respeonse in Clinical Care) – NIMH-funded U-01 (contract) Clinical Care) – NIMH-funded U-01 (contract) involving Columbia, Michigan, UT Southwestern, involving Columbia, Michigan, UT Southwestern, and Mass General-Fundedand Mass General-Funded

• RAPID (Rapidly Acting Treatments for RAPID (Rapidly Acting Treatments for Treatment Resistant Depression ); NIMH-funded Treatment Resistant Depression ); NIMH-funded U01 to develop truly innovative treatments U01 to develop truly innovative treatments capable of improving Treatment Resistant capable of improving Treatment Resistant Depression within 72 hours-SubmittedDepression within 72 hours-Submitted

2104/18/23

Education and Public PolicyEducation and Public Policy

EducationEducation Moodbook – a clearinghouse providing up-to-date, Moodbook – a clearinghouse providing up-to-date,

evidence-based information on mood disordersevidence-based information on mood disorders Adolescent Depression Awareness Program Adolescent Depression Awareness Program

(ADAP)(ADAP) College Mental Health Task ForceCollege Mental Health Task Force

Public PolicyPublic Policy White Paper produced for U.S. SenateWhite Paper produced for U.S. Senate Consultation with U.S. Senator to write legislationConsultation with U.S. Senator to write legislation Support funding for the ENHANCED ActSupport funding for the ENHANCED Act Position Statements from the NNDCPosition Statements from the NNDC

2204/18/23