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Suicide Prevention

Dec 31, 2015

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Suicide Prevention. Saving Lives One Community at a Time. America Foundation for Suicide Prevention Dr. Paula J. Clayton, AFSP Medical Director 120 Wall Street, 29th Floor New York, NY 10005 1-888-333-AFSP www.afsp.org. Facing the facts an overview of suicide. Facing the Facts. - PowerPoint PPT Presentation

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Suicide Prevention Saving Lives One Community at a TimeAmerica Foundation for Suicide PreventionDr. Paula J. Clayton, AFSP Medical Director120 Wall Street, 29th FloorNew York, NY 100051-888-333-AFSPwww.afsp.orgFacing the factsan overview of suicide2Facing the FactsIn 2010, 38,364 people in the United States died by suicide. About every 13.7 minutes someone in this country intentionally ends his/her life.

Although the suicide rate fell from 1992 (12 per 100,000) to 2000 (10.4 per 100,000), it has been fluctuating slightly since 2000 despite all of our new treatments.

3From the studies of committed suicide, about 50% of men who died were not in treatment and 75% of the men who died had no medications in their systems at the time of their deaths, so even if they were in treatment, they were not taking the medications.The data on whether treatments will help decrease suicide rates are also controversial. There is only one study (Angst et al, JAD (2002), Angst et al, Arch.Suic.Res. (2005) that indicates, in a naturalistic study (e.g. the patients were sent to their local physicians for treatment after they were discharged from the psychiatric hospital) from Switzerland, if patients with either major depression or bipolar illness were treated with antidepressants, neuroleptics and lithium their suicide rates and deaths from other causes were markedly decreased. There are also three studies that showed that treatment with Lithium, usually in patients with bipolar disease, also helps decrease the suicide and overall death rate significantly. However, many studies have shown, even patients in treatment or patients who have been hospitalized after a suicide attempt, that the treatment is not adequate.The conclusion is that there are many factors that contribute to the suicide rates, and we must work to change all of them to have an impact.

In 2010, there were 38,364 suicides, the rate is 12.4 per 100,000.3Facing the FactsSuicide is considered to be the second leading cause of death among college students.

Suicide is the second leading cause of death for people aged 25-34.

Suicide is the third leading cause of death for people aged 10-24.

Suicide is the fourth leading cause of death for adults between the ages of 18 and 65.

Suicide is highest in white males over 85. (51/100,000, 2010)

4The first and second leading causes of deaths in young adults (18-24) are accidents and homicides. Since the CDC does not collect data on men and women who are specifically in college, we assume, since homicide is low in this group, it may be the second leading cause of death.Although suicide rates in the US are highest in the very elderly, because there are so many other reasons why men die at this age, it is not a "leading" cause of death.Data on this can best be obtained through the CDC website www.cdc.gov or NIMH website www.nimh.nih.gov.

4Facing the FactsThe suicide rate was 12.4/100,000 in 2010.

It greatly exceeds the rate of homicide. (5.3/100,000)

From 1981-2010, 939,544 people died by suicide, whereas 479,471 died from AIDS and HIV-related diseases.

5Facing the FactsDeath by Suicide and Psychiatric DiagnosisPsychological autopsy studies done in various countries over almost 50 years report the same outcomes:90% of people who die by suicide are suffering from one or more psychiatric disorders:Major Depressive DisorderBipolar Disorder, Depressive phaseAlcohol or Substance Abuse*SchizophreniaPersonality Disorders such as Borderline PD*Primary diagnoses in youth suicides.

6Psychological autopsies (detailed interviews with the families, physicians, therapists, clergy and anyone close who knew the person who died by suicide usually done on a consecutive group in people who have died by suicide and are chosen from the coroners office) have shown that most of those who suicided were suffering from major mental illnesses as described above. These are a few such studies: Completed Suicides and Psychiatric DiagnosesPsychological Autopsy StudiesRobins et al, 1959: 94% psychiatrically ill, 68% depressive or alcoholicDorpat and Ripley, 1960: 100% psychiatrically ill, 57% depressive or alcoholic Baraclough et al, 1974: 93% mentally ill, 79% depressive or alcoholicBeskow, 1979: 98% mentally ill, 59% depressiveChynoweth et al, 1980: 89% mentally ill, 76% depressive or alcoholicRich et al, 1988: 92% mentally ill, 96% depressive or alcoholic Arato et al, 1988: 82% mentally ill, 66% depressive or alcoholicOf note, Dr. Mann, AFSP Scientific Council member, has developed an assessment battery for doing such studies that makes it possible to do such studies with the same method throughout the world.

6Facing the FactsSuicide Is Not Predictable in IndividualsIn a study of 4,800 hospitalized vets, it was not possible to identify who would die by suicide too many false-negatives, false-positives.

Individuals of all races, creeds, incomes and educational levels die by suicide. There is no typical suicide victim.

7A prospective research study attempted to identify persons who would subsequently commit or attempt suicide. The sample consisted of 4,800 patients who were consecutively admitted to the inpatient psychiatric service of a Veterans Administration hospital. They were examined and rated on a wide range of instruments and measures, including most of those previously reported as predictive of suicide. Many items were found to have positive and substantial correlations with subsequent suicides and/or suicide attempts. However, all attempts to identify specific subjects were unsuccessful, including use of individual items, factor scores, and a series of discriminant functions. Each trial missed many cases and identified far too many false positive cases to be workable. Identification of particular persons who will commit suicide is not currently feasible, because of the low sensitivity and specificity of available identification procedures and the low base rate of this behavior. Pokorny AD. Arch Gen Psychiatry. 1983. Data from a 1983 prospective study of suicide in a cohort of 4800 psychiatric inpatients were reanalyzed using logistic regression, which is more appropriate for a binary outcome. The results were the same as in the previous study: too few of the subsequent suicides were identified and there were too many false positives to make this procedure useful. Several additional "artificial" logistic regression analyses were done: one series randomly removed increasing numbers of nonsuicide cases to increase the base rates; another series added an increasingly powerful hypothetical "test." Both of these maneuvers helped, but fell well short of perfection. Pokorny AD. Suicide Life Threat Behav. 1993Five year follow-up of 4154 patients presenting with deliberate self harm showed that the predictive powers of Beck's Suicidal Intent Scale (SIS) was low (meaning they couldn't predict suicide). Harriss and Hawton, JAD 20057Facing the FactsSuicide Communications Are Often Not Made to ProfessionalsIn one psychological autopsy study, only 18% told professionals of intentions*

In a study of suicidal deaths in hospitals:77% denied intent on last communication28% had no suicide contracts with their caregivers **

Research does not support the use of no-harm contracts (NHC) as a method of preventing suicide, nor from protecting clinicians from malpractice litigation in the event of a client suicide***

*Robins et al, Am J Psychiatry, 1959 **Busch et al, J Clin Psychiatry, 2003 ***Lewis, LM, Suicide & Life Threat Beh, 2007

88Facing the FactsSuicide Communications ARE Made to OthersIn adolescents, 50% communicated their intent to family members*

In elderly, 58% communicated their intent to the primary care doctor**

*Robins et al, Am J Psychiatry, 1959 **Busch et al, J Clin Psychiatry, 2003

9Facing the FactsResearch shows that during our lifetime:20% of us will have a suicide within our immediate family.

60% of us will personally know someone who 10This is from a Canadian study. It involves life time exposure, so the suicide could be a relative who had died before the living person knew him or her. Ramsay, R and Bagley, C. Suic and Life Threat Beh (1985).A more recent study showed that in the last year, 7% of the population knew a person, mainly a friend or acquaintance who killed himself and 1.1% of the population had a family member or relative who killed himself (or herself) Crosby and Sacks, Exposure to Suicide, Suic and Life Threat Beh (2002).

10Annual Deaths, by Cause

11Spending for Medical Research

12Facing the FactsPrevention may be a matter of a caring person with the right knowledge being available in the right place at the right time.13Myths versus factsabout suicide14Most of these facts are taken from psychological autopsy reports.

1415

Myths versus FactsMYTH: People who talk about suicide don't complete suicide.

FACT: Many people who die by suicide have given definite warnings to family and friends of their intentions. Always take any comment about suicide seriously.15Robins, E 1981: 50% to spouses, 40% to coworkersReuneson, B, Suicide Life Threat Beh 199216

Myths versus FactsMYTH: Suicide happens without warning.

FACT: Most suicidal people give clues and signs regarding their suicidal intentions.1617

Myths versus FactsMYTH: Suicidal people are fully intent on dying.

FACT: Most suicidal people are undecided about living or dying, which is called suicidal ambivalence. A part of them wants to live; however, death seems like the only way out of their pain and suffering. They may allow themselves to "gamble with death," leaving it up to others to save them.1718

Myths versus FactsMYTH: Men are more likely to be suicidal.