Suicides and suicide attempts have a ripple effect that impacts on families, friends, colleagues, communities and societies.
- Macro Trading and Investment Strategies: Macroeconomic Arbitrage in Global Markets (Wiley Trading).
- Turkey ‘bans cyanide’ after spate of mass suicides linked to poverty?
- Samaritans Media Guidelines.
- SANE on Suicide;
- Tricolor Over the Sahara: The Desert Battles of the Free French, 1940-1942 (Contributions in Womens Studies).
Suicides are preventable. Much can be done to prevent suicide at individual, community and national levels. Suicide occurs throughout life. It is the second leading cause of death among year-olds globally. Suicide occurs in all regions of the world. While the link between suicide and mental disorders in particular, depression and alcohol use disorders is well established, many suicides happen impulsively in moments of crisis. Further risk factors include experience of loss, loneliness, discrimination, a relationship break-up, financial problems, chronic pain and illness, violence, abuse, and conflict or other humanitarian emergencies.
The strongest risk factor for suicide is a previous suicide attempt. Much can be done to prevent suicide. WHO recommends four key interventions which have proven to be effective:. However, many prevention programs do not have the long-term funding that would allow them to assess reduction in the completion of suicide as an endpoint. The low base rate of suicide, combined with the short duration of assessment and the relatively small populations under study make it difficult to acquire sufficient power for such trials. As described in Chapter 10 , to assess the incidence of suicide in a general population where the rates are between 5 and 15 per , with a 90 percent confidence requires almost , participants.
These populations can only be recruited through large nationally coordinated efforts. Extensive epidemiological data describe the suicide rates among various populations. The rates of suicide in the United States are exceptionally high in white males over 75 years of age, Native Americans, and certain professions, including dentists. Studies from across the world find higher rates of suicide in rural areas as compared to urban ones. Much is known about the general trends, but no data set provides a picture of evolving risk and protective factors at the national level.
Globally, a million suicides are estimated to occur each year, but there is no coordinated effort to understand responsible factors or reduce the death toll. Major changes in rates of youth suicide remain unexplained. Population laboratories could provide data on a much larger population.
While each center might be able to obtain a sufficiently large sample for studies in the general population, a consortium of centers will be necessary to fully explore differences based on region, economic environment, culture, urbanization, and other factors that vary across the country. Furthermore, certain subpopulations may be sufficiently small or low risk to require broader recruitment than one center could access. For these. The integration of data across laboratories can provide an ongoing picture of the key factors influencing national suicide rates such that studies of risk and protective factors can be optimized, and permit rational prevention and treatment planning.
The national impact of treatment and prevention interventions shown to be effective within a network can be estimated. This will permit translation into national implementation, and with systematic cross-cultural comparisons, global extension of United States studies would become more feasible. To obtain optimal data for the understanding, prevention, and treatment of suicide and suicidal behavior, a large population base is essential.
The committee proposes a coordinated network of Population Laboratories that would allow stratified and repeated longitudinal surveys to provide more accurate data on rates of suicidal behavior, as well as long-term data on ethnographic, social, psychiatric, biological, and genetic measures necessary for increased success in prevention. Data on diagnoses associated with suicides would be obtained through the psychological autopsy method by the population laboratories for all suicides within their population, which would be enriched by highly focused ethnography. Similarly, data would be obtained on suicide attempts in the course of stratified population surveys that would be more complete than that obtained from reports generated from emergency rooms or health care providers.
Thus, the population laboratory rates would correct underestimations of national rates through these registries of suicides and attempted suicides. The population laboratories would be the source of data on rates of suicidal ideation. Accurate ascertainment is essential for measurement of relative impact of risk and protective factors, and of preventive interventions. Drawing smaller samples from these large population centers will allow the examination of risk and protective factors in far greater specificity.
Multiple risk factors must be measured in the same high-risk group by multi-disciplinary groups of scientists to determine their interaction as well as their relative importance.
This differs from the overwhelmingly typical approach of measuring only a few risk or protective factors in unrepresentative convenience samples. Sampling from within population laboratories allows measurement of generalizability. Deliberate sampling within ethnic and social subgroups as well as from groups with specific mental disorders can generate data applicable to at-risk groups all over the United States.
In the course of obtaining data on completed suicides, the population laboratories can collect tissue samples from each indi-.
Finally, data on treatment utilization and barriers to treatment can be obtained at a population level and related to those considered to be at risk for suicidal behavior. A longitudinal data gathering strategy will be more powerful than a cross-sectional approach. A population-based approach is well suited for testing public health interventions.
A sub-population high-risk group is best suited for randomized treatment studies that test efficacy at the level of the individual patient, and such studies can be feasibly extended to comparison studies in the developing world. To address the problem of suicide effectively will require an integrated approach in which experts from many disciplines come together to tackle the problem.
Only with such an interdisciplinary effort can a full understanding of the complex nature of suicide be obtained. And only through this full understanding can effective interventions be designed. A coordinated network of laboratories provides the infrastructure in which the many disciplines can be united. An interdisciplinary center also provides a opportunities for training new scientists to think broadly about suicide and b incentives to recruit established scientists to apply their expertise to this important area.
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Because of the multidisciplinary nature of research on suicidal behavior, multiple federal agencies, foundations, and the pharmaceutical industry have a stake in enhancing the science and reducing the risk of suicide. The public health significance of suicidal behavior has been underscored by the World Health Organization and the United States Surgeon General and validates a substantial financial commitment to fostering biomedical research and improving the health of the public.
The committee believes that, to have a large public health impact, a network of Population Laboratories in the United States will be necessary. The longitudinal dimension of the proposed studies, necessary to provide a picture of the evolving rates of suicidal behaviors and of risk and protective factors, requires a year funding period.
The National Institute of Mental Health in collaboration with other agencies should develop and support a national network of suicide research Population Laboratories devoted to interdisciplinary research. The network of Population Laboratories should be administered by NIMH and funded through partnerships among federal agencies and private sources, including foundations. Very large study samples of at least , are necessary because of the relatively low frequency of suicide in the general public. A number of Population Laboratories e.
Extending the efforts into the international arena where cultural differences are large may provide new information and can be fostered and guided by such global organizations as the World Health Organization and the World Bank and by the Fogarty International Center at NIH. The network should be equipped to perform safe, high-quality, large-sample, multi-site studies on suicide and suicide prevention. Each Laboratory would have a population base of approximately , At a base-rate of 10—12 suicides per , people, this population base of the network would significantly improve the available data for estimates of suicide incidence, capacity for longitudinal studies, development of brain repositories, access to representative samples for prevention and intervention studies, and studies of genetic risk for suicide.
Several such laboratories would provide adequate data to assess the numerous and complex interacting variables including the profound effects of demographics, regions, culture, socioeconomic status, race, and ethnicity. Coordination and collaboration among centers should be encouraged to further enhance the breadth of the database. The laboratories would cover an ethnically and socially diverse and representative population and would recruit higher risk individuals and subgroups in communities within the population laboratories for longitudinal and more detailed studies.
Treatment and prevention studies would be carried out in high-risk patients recruited from within the population laboratories. With these defined populations, the centers would conduct prospective studies—integrating biological, psychosocial, ethnographic, and ethical dimensions—that would be of great importance in advancing science and meeting public health needs.
These studies would include such initiatives as identified in the committee report:. Testing of promising programs at multiple sites with long term follow-up.
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It is critical to determine whether an intervention can be gen-. Long-term assessments are important for evaluation of the impact of interventions on suicide and suicide attempts rather than more proximal measures. Intervention studies to evaluate means and effectiveness of promoting greater continuity of care, treatment adherence, and access to emergency services because patients recently discharged from inpatient care are among those at highest risk for suicide.
Descriptive studies to identify markers for increased risk should aid in the design of intervention studies to decrease risk. Clinical trials on the specific effects of reducing hopelessness on suicide.