Post by Former NIMH Director Thomas Insel: A New Research Agenda for Suicide Prevention
More than 38,000 Americans died by suicide in 2010, the most recent year for which we have national data. This makes suicide, once again, the tenth leading cause of death for all ages; the second leading cause of death for young adults ages 25 to 34.1 Despite changes in recent decades that might reasonably have been expected to reduce suicide rates—increased awareness about mental disorders, the availability of treatment, and community-based public health efforts aimed directly at preventing suicide—U.S. rates of suicide deaths have not decreased. In fact, suicide has proven stubbornly difficult to understand, to predict, and to prevent.
This grim reality contrasts with the successes achieved in other areas of medicine and prevention. Death rates from heart disease, cancer, traffic accidents, and homicides are all declining. For heart disease and cancer, research has identified risk factors as well as new pathways to prevention and treatment. Changes in automobile design along with road safety measures have contributed to an ongoing reduction in traffic deaths. Homicides now number less than half the annual total of deaths by suicide in this country.
Why is suicide different? There are a number of public health approaches, from redesigned bridges and buildings to firearm safety, that need the kind of aggressive engineering and policy approaches we have seen with automobile safety. And, learning from heart disease and cancer, we can do better detecting and helping individuals at risk. Despite our best efforts, it remains very difficult to predict who will attempt suicide and, thus, difficult to intervene. The presence of mental illness is a risk factor, but it is not universally present or identified in those who attempt suicide. Treatment can be effective, but too many high-risk individuals are not getting the effective care they need. Suicide remains one of the top five sentinel events (unanticipated events resulting in serious injury or death) for health care systems.2 To reduce suicide, we need to know how to target our efforts: to be able to reliably identify who is at risk, how to reach them, and how to deter them from acting on suicidal thoughts.
In a blog post last September, I talked about a newly updated National Strategy for Suicide Prevention and the research agenda being developed by a task force of the National Action Alliance for Suicide Prevention. This week, the Research Prioritization Task Force (RPTF) released A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives. (pdf)
The stated goal of the Research Agenda is to reduce suicides by 20 percent in five years and 40 percent in the next ten (assuming all recommendations are fully implemented). The Research Agenda bases its recommendations on the impact of currently known interventions and the potential number of suicide attempts and deaths prevented. For instance, it was estimated that in 2010 there were 735 suicides from motor vehicle carbon monoxide inhalation.3 One model illustrated the hypothetical effect of shut-off devices in cars linked to carbon monoxide sensors, a technology that could be inexpensive per vehicle and is currently feasible. The results suggest that installing devices the way we install seat belts could prevent most suicides from carbon monoxide poisoning in automobiles.
What are we doing to jumpstart this agenda? Two new initiatives will focus on priorities of the Research Agenda. First, NIH recently announced funding opportunities calling for research on violence with particular focus on firearm violence. This call for proposals was developed in response to the Presidential memorandum in January 2013 directing science agencies within the U.S. Department of Health and Human Services to fund research into the causes of firearm violence and ways to prevent it. The resulting research will help us understand the risk factors for firearm violence and prevention opportunities, directed at self as well as others.
In 2010, suicide was the third leading cause of death for adolescents. It remains a challenge to predict individual risk, and once a young person screens positive for suicide risk, there are few, if any, strategies to guide matching of individuals to the appropriate intervention. As a second initiative, NIMH released a request for applications to support research that addresses both issues: developing and testing screening approaches for use in emergency departments (EDs) to identify children and adolescents at risk for suicide; and developing methods to help assign youth who screen positive to appropriate interventions. Given the numbers of young people who may be at risk, and the high number of them who visit the ED, developing effective screening and assessment approaches to gauge the level of risk can give providers the tools they need to better use limited resources.
A friend who lost his son to suicide told me that every suicide has at least 11 victims: the person who dies and at least ten others who will never be the same. This is a problem that sooner or later, unfortunately, touches us all. Developing the Research Agenda was a 3-year effort by the RPTF, chaired by Phillip Satow, chair of the board at the Jed Foundation, and myself. The RPTF called on more than 60 national and international research experts and more than 700 individuals representing stakeholders in this research to identify priorities. We believe the Research Agenda gives us a roadmap to save lives.
1 Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System, http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html.
2 The Joint Commission. Sentinel Event Alert. Issue 46, November 17, 2010. http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html.
3 National Action Alliance for Suicide Prevention: Research Prioritization Task Force. (2014). A prioritized research agenda for suicide prevention: An action plan to save lives. Rockville, MD: National Institute of Mental Health and the Research Prioritization Task Force.