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Additional Questions and Answers about Suicide Prevention

Time constraints prevented the panelists from answering all of the submitted questions about suicide. Below are answers to the questions that we were unable to address during the live event.

  1. I would like to know what is being done about the prevalence of suicide amongst Latinas in the 15-24 age group. Secondly, what is being done to address/prevent suicide outside of mainland U.S? I understand there are also similar issues among the Pacific jurisdictions; particularly, Guam.

    According to SAMHSA's National Household Survey on Drug Abuse in 2000, Latina youth are at higher risk for suicide attempts compared to non-Hispanic white and black females. Hispanic female youths born in the United States were at higher risk than Hispanic female youths born outside the United States.  But rates of suicide risk were similar among Hispanic female youths across regions and ethnic subgroups (e.g., Mexican, Puerto Rican, Central or South American and Cuban). For more information, see http://www.oas.samhsa.gov/2k3/LatinaSuicide/LatinaSuicide.cfm .

    Some federally funded research is underway to understand the role of family dynamics in the higher attempt rate.  See http://www.hindawi.com/journals/drt/2011/403602/ref/  for more information.
    Information about suicide rates in Guam is available here: http://www.sprc.org/stateinformation/PDF/stateplans/plan_guam.pdf .



  2. Is suicide higher in same-sex relationships than in traditional relationships?

    Unfortunately, there are no known statistics of this because sexual identity is not a question on the standard death certificate.



  3. Can you address suicide in adults over 65 that have been diagnosed with a mental illness?  What are the statistics (if known)?  Are there any resources for professionals that serve this population?

    A comprehensive list of resources addressing suicide prevention in older adults can be found here: http://library.sprc.org/browse.php?catid=21 



  4. Please discuss suicide in the U.S. as it relates to minority elders and older adults of varying ethnicities.

    You can search the CDC’s National Center for Injury Prevention and Control database for the statistics on suicide among minority older adults:  http://webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html 

    This article, which describes a treatment protocol that specifically addressed the barriers that disproportionately affect ethnic minority elderly at risk for suicide, may also be of interest:

    Bao Y, Alexopoulos GS, Casalino LP, Ten Have TR, Donohue JM, Post EP, Schackman BR, Bruce ML. Collaborative depression care management and disparities in depression treatment and outcomes. Arch Gen Psychiatry. 2011 Jun;68(6):627-36



  5. I am interested in the suicide rates among minorities, e.g., African American, Hispanic, Asians, and blacks from the Caribbean.

    You can search for suicide rates among Hispanics, African Americans and other ethnic minorities at http://webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html  In addition, the Suicide Prevention Resource Center has fact sheets on suicide among several minority groups, including Hispanics ; African Americans ; American Indians/Alaska Natives ; and Asians, Pacific Islanders and Native Hawaiians .

    Regarding suicide attempts among African Americans, this article may be of interest:  Joe S, Baser RE, Breeden G, Neighbors HW, Jackson JS.  Prevalence of and risk factors for lifetime suicide attempts among blacks in the United States. JAMA. 2006 Nov 1;296(17):2112-23.



  6. Could you please address any suicide data specific to tribal communities and how that data relates to prominent risk and protective factors that are associated with multiple problem outcomes such as substance abuse?

    The Indian Health Service, part of the Department of Health and Human Services, provides information on suicide deaths and other health factors by regions, through their reports called Trends in Indian Health .



  7. How and why has suicide remained the 2nd leading cause of death for Native American children ages 15-24 for over 20 years, particularly when we see an overall decrease in the general U.S. population incident of suicide, in the same age group? What do we know about these communities that have extremely high rates of suicide at approximately 100 per 100,000, in terms of risk and/or protective factors?

    The National Action Alliance for Suicide Prevention has developed several task forces for addressing suicide among specific populations. The Alliance’s American Indian/Alaska Native Task Force would be a good resource to learn about current private-public plans to address this very high risk group. See http://actionallianceforsuicideprevention.org/?page_id=7 

    Also, NIH recently released a funding opportunity that supports research on suicide prevention with Native Americans. See http://grants.nih.gov/grants/guide/pa-files/PAR-11-346.html  for more information.



  8. What are the stats for law enforcement, probation and parole officers and suicide? Stats for suicide by their own firearm? Are there programs available for officers?

    Information about law enforcement’s role in preventing suicide among others, as well as programs and information about how to prevent suicide among officers, can be found here: http://www.sprc.org/featured_resources/customized/lawenforcementpersonnel.asp 



  9. What portion of suicide attempts and/or actual suicides do you believe might be related to either diagnosed or undiagnosed traumatic brain injuries (TBI)?

    Research into how traumatic brain injury (TBI) may increase risk for suicide is in the beginning stages, with most research focusing on veterans at this time. TBI, post traumatic stress disorder, and depression often co-occur, so it is difficult to attribute suicide risk only to TBI.   However, it may be good clinical practice to assess TBI patients for suicidal risk.



  10. Can you speak to suicide prevention for women in the perinatal period?

    These 2 studies provide overviews on this topic:

    Comtois KA, Schiff MA, Grossman DC.  Psychiatric risk factors associated with postpartum suicide attempt in Washington State, 1992-2001. Am J Obstet Gynecol.  2008 Aug;199(2):120.e1-5.

    Lindahl V, Pearson JL, Colpe L .  Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health.  2005 Jun;8(2):77-87.



  11. Please address suicide risk among teens, especially with regard to cultural issues, drugs and alcohol use, LGBTQ issues.  Can you also address prevention efforts?

    For the basics about suicide risk among youth, please see  http://www.sprc.org/suicide_prev_basics/youth.asp 

    For more information about LGBTQ see http://library.sprc.org/browse.php?catid=32 

    This article also gives a good overview of the subject, as well as information about preventive interventions:
    Gould MS, Greenberg T, Velting DM, Shaffer D.  Youth suicide risk and preventive interventions: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry.  2003 Apr;42(4):386-405.



  12. Bullying. How are suicide and bullying linked? How can awareness and responsiveness to bullying prevention be improved?  What sources and organizations are best equipped to address bullying, teen depression and risk for suicide? How can parents help their children who are struggling with bullying, depression, and suicide?

    Please see  http://library.sprc.org/item.php?id=859  for information addressing all of these questions about bullying.



  13. Could you talk about suicide crisis response in adolescents versus adults – differences, legality issues, prevention options available (hotlines?).  How are Internet resources involved?

    For information about the suicide crisis response line, please see http://www.suicidepreventionlifeline.org/ 



  14. There are so many issues with the mental health safety net (e.g., accessibility of mental health system, physicians' screening practices, lack of psychiatrists). What are some practical strategies that community members can use to strengthen the safety net in their community?

    This document highlights many problems as well as opportunities to improve continuity of care in communities: http://library.sprc.org/item.php?id=858 



  15. What are your thoughts on computerized self assessment?

    Research is being conducted in this area, such as this on-line assessment  supported by the American Foundation for Suicide Prevention .



  16. Do you feel self-harming behaviors (cutting, biting, burning) are a gateway or a connection to a suicide attempt? Where does non-suicidal self injury fit in with suicide prevention?

    Unlike suicide attempts, self-harming behaviors generally do not stem from a desire to die. However, some self-harming behaviors may be life threatening. In most cases, intent appears to differentiate self-harm/non-suicidal self-injury from suicidality.

    These studies would be of interest:

    Wilkinson P, Kelvin R, Roberts C, Dubicka B, Goodyer I. Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT). Am J Psychiatry. 2011 May;168(5):495-501.

    Lewis SP, Santor DA Self-harm reasons, goal achievement, and prediction of future self-harm intent. J Nerv Ment Dis. 2010 May;198(5):362-9. NIMH is currently supporting research to test or develop therapies and medications that can reduce self-harm.



  17. We are part of a county suicide prevention coalition. We are looking for initiatives to follow and resources to promote suicide prevention. At present we are a group of nonprofit county agencies and individuals and are not incorporated as an entity at this time.

  18. You might consider starting here with your efforts:  http://www.sprc.org/taking_action/index.asp 



  19. How are peer specialists used in the US especially for warmlines? How would a community get a warmline started?

    We are only aware of the Veterans Administration peer support programs. This could be a starting point:  http://www.ncbi.nlm.nih.gov/books/NBK49132/ 



  20. What do we know about the effect of place, specifically neighborhood planning, on suicide?

    Civically strong communities have been found to have lower suicide rates.  Community connectedness has been found to be related to “reasons for living,” which are protective against suicide.  
    Some studies that may be of interest:
    Cutlip AC, Bankston WB, Lee MR..Civic community and nonmetropolitan White suicide. Arch Suicide Res. 2010 Jul;14(3):261-5.

    Wexler L, Goodwin B. Youth and adult community member beliefs about Inupiat youth suicide and its prevention. Int J Circumpolar Health. 2006 Dec;65(5):448-58



  21. [Is] there is an explanation for a domestic violence aggressor to kill the victim and after that, commit suicide? 

    There are hypotheses that suggest different processes for different age groups.  When this occurs in older couples, a husband often sees homicide/suicide as an act of taking care of desperate circumstances (e.g., anticipated mental or physical incapacity, or being alone).   In younger couples, it is more often a result of anger, control and/or revenge in the context of interpersonal violence.

    Some studies that might be of interest:
    Salari S. Patterns of intimate partner homicide suicide in later life: strategies for prevention. Clin Interv Aging. 2007;2(3):441-52.

    Malphurs JE, Cohen D. A statewide case-control study of spousal homicide-suicide in older persons. Am J Geriatr Psychiatry. 2005 Mar;13(3):211-7.

    Galta K, Olsen SL, Wik G. Murder followed by suicide: Norwegian data and international literature. Nord J Psychiatry. 2010 Dec;64(6):397-401. Epub 2010 Apr 9.



  22. As someone who has volunteered in this field for many years I am concerned about the lack of progress in reducing suicides. Please address what we are going to do differently to try and address this.

    The National Action Alliance for Suicide Prevention  is one effort that is trying to do something different to change the numbers.



  23. Any empirical data showing that suicide prevention actually works?  Any studies to show a Return on Social Investment - money spent and lives saved? Any ratio?

    For costs of attempts and deaths, see:  
    Corso PS , Mercy JA , Simon TR , Finkelstein EA , Miller TR . Medical costs and productivity losses due to interpersonal and self-directed violence in the United States. Am J Prev Med.  2007 Jun;32(6):474-482.

    Evidence-based programs can be found at http://www2.sprc.org/bpr/section-i-evidence-based-programs .

    To understand a return on investment, one would need to calculate the costs of an effective preventive intervention, compared to the costs of suicide attempts and deaths averted.



  24. What are military leaders doing to learn more about and address the causes of suicide, rather than just looking out for symptoms of someone who may commit suicide?

    The War Within: Preventing Suicide in the U.S. .Military , is a RAND report that summarizes suicide prevention efforts across all military services in the United States.

    In addition, the U.S. Army and NIMH have partnered to conduct the Army Study to Assess Risk and Resilience among Servicemembers (Army STARRS) , the largest study of mental health risk and resilience ever conducted among military personnel.
    Army STARRS investigators are looking for factors that help protect a soldier’s mental health and those factors that put a soldier’s mental health at risk, Research findings will be applied to ongoing health promotion, risk reduction, and suicide prevention efforts. The findings from Army STARRS will benefit not only servicemembers but the nation as a whole.



  25. What preventative tasks or resiliency models do you recommend to family members of active duty members who have a history of depression and challenges with stress management?

    It is best to seek behavioral health counseling sooner than later, before a problem escalates.  It is easier to treat mild problems, and plan for recurring problems, than it is to treat a more severe condition.



  26. It has been difficult to get data on suicide because of privacy issues. We need data by age; gender; ethnic background; rate of attempts; and if illicit drugs, alcohol, or prescription drugs were involved. The ER and Coroner data is very vague and do not always list the death as a suicide or include the fact that substance abuse was involved. Without specific data, how can we get the help that is needed in our community? Are there any national mandates for the collection of data on suicide?

    The CDC’s National Violent Death Reporting System  is a good start for developing richer data to inform suicide prevention efforts.



  27. How do you currently utilize survivors in the work of prevention beyond parent-to -parent support? What focus and development is underway to address the needs of sibling survivors? How are those siblings involved in the development and evaluation of current practices? Where and how are the populations with the most disparities being addressed and what measurement is being used to assess beyond death report data and awareness levels?

    Suicide survivors are often the ones who advocate for state suicide prevention plans.  Most public and private funders involve family advocates in setting priorities for research. Disparities in excess causes of death, such as firearm deaths, have been documented for life expectancy and life insurance costs (e.g., http://www.upenn.edu/ldi/issuebrief8_8.pdf ).



  28. I’m curious about life insurance policies and if they still have a clause regarding suicide?  I always thought that weird.  Where does that come from? It’s almost like the family suffering the loss, get a double blow by not getting that life insurance.

    Most standard life insurance policies cover death by any cause at any time in any place, except for death by suicide within the first two policy years (one year in some states).