Franklin James Cook

Archive for the ‘Research’ Category

Attachment-Based Therapy Promising for Suicidal Youth

In Prevention, Research on February 24, 2010 at 7:30 pm

According to a news release from the Children’s Hospital of Philadelphia, a study has shown that “adolescents with suicidal thoughts and elevated depression had stronger and faster reduction of symptoms when treated with family therapy than with standard treatment.”

In this study, Attachment-based Family Therapy (ABFT), found that patients with severe suicidal thinking were at least four times more likely to have no suicide thinking at the end of the treatment or three months after treatment, than patients treated in the community. Patients in ABFT also showed a more rapid decrease in depression symptoms and were retained in treatment longer than in community care … This is the first treatment study for teen suicidal ideation to show robust and statistically significant improvement over treatment as usual.

“Family conflict, chaos, and strife can contribute to youth suicide, while at the same time family love, trust, and communication can buffer against it,” [says Dr. Guy Diamond of the hospital’s Center for Family Intervention Science, who directed the study]. “This therapy aims to resolve family conflicts and promote family strengths so that the appropriate bond of attachment can protect youth from self harm.”

The research report appears in the Journal of the American Academy of Child and Adolescent Psychiatry.

Dr. Diamond is delivering a workshop for clinicians in Attachment-based Family Therapy at Children’s Hospital of Philadelphia on April 9-10.

[The abridged URL for this post is http://tinyurl.com/AttachmentTherapy .]

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Study Shows Link between Child Sex Abuse and Suicide

In Research on February 14, 2010 at 1:01 pm

A news release today from the Medical Journal of Australia describes a recent research study showing that “victims of child sexual abuse are at increased risk of suicide and accidental fatal drug overdose later in life.”

[Researchers] found significantly higher rates of suicide and accidental fatal drug overdose in the CSA [child sex abuse] cohort compared with age-limited national data for the general population …

“Depression and psychosis have been consistently shown to be strong predictors of suicide; however, most of the CSA victims in our study who died from self-harm had a recorded diagnosis of anxiety disorder,” [writes the lead author of the study, Dr. Margaret Cutajar, a psychologist at Monash University in Melbourne]. “These findings suggest that victims of CSA who die from self-harm have a different psychopathological profile to non-abused individuals who die from self-harm.”

Interestingly, the research shows a significant gap in time between identification of the abuse and a person’s death by suicide.

On average, almost 20 years had passed from examination for CSA to death, indicating that CSA was not an immediate precipitant to fatal self-harm. An accompanying editorial in the journal, by Professor Ross Kalucy, Director of Emergency Mental Health at Flinders Medical Centre, states

“Although child sexual abuse is a marker for later psychosocial problems, it may not be the critical formative experience. The complex psychopathological conditions that are associated with disorders of adolescence and young adulthood need more investigation, and their association with child sexual abuse needs explanation.”

[The abridged URL for this post is http://tinyurl.com/CSA-suicide .]

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Preventing Suicide by Train Gets Attention of Research

In Prevention, Research on February 10, 2010 at 7:31 am
Dad at Train Tracks

Steve Vale, whose daughter killed herself in 2008 on these tracks in Mansfield, Mass., watches a train speed by. (John Tlumacki, Boston Globe)

In “Striving To Prevent Suicide By Train,” Boston Globe reporter Noah Bierman introduces an ongoing research study about suicide using trains as a means of death.

The Federal Railroad Administration has funded an effort, the first of its kind, to tally train suicides as part of a study into whether and how more of them could be prevented. The study, now in its fourth year and set for release next year, looks more closely at fences and other barriers, which are often low and rickety, if they exist at all, along the nation’s rail beds.

Preliminary findings from the study suggest that there are about 300 to 500 suicides per year in the United States involving a train. One of the questions under consideration is whether better barriers limiting people’s access to train tracks would prevent such suicides. This approach to prevention, called “means restriction,” is one of the proven ways to reduce suicide.

“When you reduce access to a highly lethal method, overall, suicide rates go down,” said Matthew Miller, a Harvard professor and specialist in suicide prevention.

For example, the presence of a gun in the home multiplies the risk that people will kill themselves by a factor of as much as 10, with the highest risk found in homes where children and teenagers have access to loaded, unlocked guns. And instances of bridge suicide drop substantially when engineers build architectural barricades to prevent jumps.

With 215,000 miles of train track in the United States and in the absence of studies assessing the effectiveness of track barriers in preventing suicide, “some in the industry worry that finding a solution means adding more cost and responsibility,” according to Dr. Alan Berman, executive director of the American Association of Suicidology, who is leading the team that is conducting the federal rail suicide study.

Putting up barricades all over the country would not be feasible, he said, but the [team] may suggest testing barriers in targeted areas where prevention is most likely to be successful.

In addition to documenting [train-related] suicides for the first time, Berman’s team is in the midst of conducting 60 psychological autopsies of train suicide victims in an effort to learn about their lives and motivation, to gain insight about how their actions might have been prevented.

The Boston Globe report is framed by the story of 21-year-old Elizabeth Mary Vale, a college student who died by suicide on train tracks in Mansfield, Mass., in September 2008.

[Steve] Vale said his daughter’s suicide note, and attempts she made that day to reach her therapist, indicated she was wavering. Vale has no proof a better barrier would have deterred her.

“We’re not saying it definitely could have,” he said, “but we believe she would not have.”

Related SPNAC posts:

[The abridged URL for this post is http://tinyurl.com/TrainResearch .]

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New Therapy for Suicidal Teenagers Shows Promise

In Prevention, Research on February 5, 2010 at 10:07 pm

In a pilot study, a therapy called Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) showed that “the rate of suicidal events among participants who chose the new therapy was lower than rates typically found in surveys of suicidal teenagers” according to a Jan. 31 news release from Columbia University Medical Center. The news release suggests that CBT-SP merits more rigorous research.

Because of the pilot study’s design (the participants chose their own treatment among three choices: talk therapy, antidepressants, or both), the therapy’s effectiveness is still uncertain, and a randomized, controlled clinical trial is needed.

“Our pilot study was really just step one,” [Barbara Stanley, a Columbia clinical psychologist] says, “but it showed us that research with these kids is feasible, not futile.”

The therapy could be especially important because it is designed for use with teens who have made a nonfatal suicide attempt, which is one of the highest-risk groups for suicide. It is also an approach that can go hand-in-hand with medical treatment for depression, and there is evidence that medicine in combination with “talk therapy” is an effective approach to treating suicidal patients.

“The brains of depressed people who attempt suicide are different from those that do not,” Dr. Stanley says. “Our point of view is that while they need treatment for depression, they also need therapy tailored to help with their suicidal thoughts and behaviors.”

Because most suicidal teenagers are depressed, researchers believed that successful treatment of depression would also eliminate suicidal thoughts. But recent studies — including analyses of brain chemistry by Columbia neuroscientist J. John Mann — suggest there is something different about being suicidal.

CBT-SP addresses teenagers’ suicide attempts very directly, giving them a chance to talk frankly about what led to the attempt so the therapist and the youth can develop a customized strategy that “heads off” as early as possible the kinds of reactions in the teen’s life that might lead to suicidal behavior.

“From the moment they come through the door, we talk about the attempt. We put that time period under a microscope to understand all the thoughts, feelings, and behaviors that led up to it,” [says Stanley]. “Then we identify what skills they lack that could prevent them from attempting suicide again.”

With CBT-SP, the therapist not only helps them understand their feelings and behaviors, but also teaches them specific skills they can use to enhance their capabilities to cope.

The report on the study of CBT-SP are published in the October 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

[The abridged URL for this post is http://tinyurl.com/TeenTherapy .]

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KEY QUOTE — Yeates Conwell, Feb. 1, 2010

In Key Quote, Prevention, Research on February 3, 2010 at 9:05 am
YeatesConwell-Photo_Mug

Yeates Conwell

In “Genetic Variants in Depressed People Raise Suicide Risk,” by HealthDay reporter Amanda Gardner, Yeates Conwell, co-director of the Center for the Study and Prevention of Suicide at the University of Rochester Medical Center in New York, gives some important context for biomedical research on suicide:

“Suicide is a pretty intransigent problem. It’s a very difficult, complex behavior that, despite many years of study, we have to acknowledge that suicide rates haven’t changed a great deal,” said Dr. Yeates Conwell … “We have a long way to go to understand the mechanisms of suicide, so this kind of work is very hopeful, and findings like this that identify some significant associations between genetic patterns and a lifetime history of suicidal behavior are certainly intriguing and potentially important, [but] they have a long way to go to translate to suicide preventive interventions.

That said, Conwell added, the best way to look at suicide is in the interactions between genes and environment, and the variability in suicidality explained by genetic profiles is relatively small.

[Editor’s note: I’ve highlighted elements of Dr. Conwell’s quote to emphasize an idea that lies at the heart of the suicide prevention field’s overall mission, which is developing an interdisciplinary approach to the problem (i.e. “to look at suicide” with a focus on “the interactions between genes and the environment”). In my opinion, this is a critical challenge that has gone substantially unanswered by the field and which, therefore, deserves much more serious attention. FJC]

[The abridged URL for this post is http://tinyurl.com/YeatesConwell020110 .]

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Blue Lights: Suicide Prevention or Marketing Ploy?

In Research on November 11, 2009 at 9:42 am
BlueLights-TokyoTrains

Keihin Electric Express Railway trains arrive at Gumyoji Station in Yokohama, Japan. (Itsuo Inouye, The Associated Press)

By Franklin Cook, SPNAC Editor

East Japan Railway has installed blue lights in all of its Tokyo central loop train stations because, according to a Nov. 4 Associated Press story “they hope [the lights] will have a soothing effect and reduce suicides.”

Here’s the interesting thing:

There’s no scientific proof that the lights actually reduce suicides.

No scientific proof. Zero. None.

The rationale for installing blue lights, according to a spokesman from another train company that did so on a smaller scale several years ago, was “‘we thought we had to do something to save lives.'”

“We know there is no scientific proof that blue lights will help deter suicides. But if blue has a soothing effect on the mind, we want to try it to save lives,” [said Keihin Railway spokesman Osamu Okawa].

In other words, they did something (whether or not it might be effective) because they had to do something.

Here’s how it works:

The lights, which are brighter than standard fluorescent bulbs, bathe the platform below in an eerie blue light. They hang at the end of each platform, a spot where people are most likely to throw themselves in front of a speeding train.

Using the same “logic,” wouldn’t we be “doing something about suicide” if we treated suicidal people by having them sit in a blue-lit room? Or how about if we start carrying anti-suicide flashlights that cast a strong beam of blue light with which we could “bathe” any suicidal person we encountered with the soothing effect caused in humans by their exposure to the color blue?

Not only is there no evidence now that the train station lights might work, but isn’t it true that there is no way to conduct a future study of their effectiveness in such a large-scale environment? I’m not a scientist, but eight million people use the railway system in question every day, and I don’t see a way to demonstrate — even if fatalities suddenly decreased by a dramatic number — that other factors other than the lights might be the cause of the reduction. (There were 68 fatalities in Tokyo stations operated by East Japan Railway in the most recent year reported.)

It makes me wonder if East Japan Railway spent $165,000, the cost of installing the blue lights in Tokyo, simply to demonstrate that the train company is “doing something” about suicide fatalities on its tracks (but without regard to the plan’s effectiveness).

Even more importantly, shouldn’t this make us all wonder about how many activities in the suicide prevention field overall are being done simply because we think “we have to do something to save lives.” How many programs and practices ostensibly designed to prevent suicide are in place now that lack scientific evidence about their effectiveness? How many are implemented that don’t include a reliable way to measure their effectiveness? The “blue light suicide prevention program” now in use in Tokyo certainly deserves scrutiny. Which suicide prevention programs elsewhere deserve the same scrutiny?

[The abridged URL for this post is http://tinyurl.com/BlueLights .]

[Editor’s note: A substantive comment (click on the red “Responses” link below) was posted on Nov. 23 by a psychologist working in Japan, which includes …

Useful telephone numbers and links for Japanese residents of Japan who speak Japanese and are feeling depressed or suicidal:
Inochi no Denwa (Lifeline Telephone Service):
Japan: 0120-738-556
Tokyo: 3264 4343
Tokyo Counseling Services:
http://tokyocounseling.com/english/
http://tokyocounseling.com/jp/
http://www.counselingjapan.com

… and it should be noted that the “Need Help?” tab above gives English-speaking readers guidance on what to do if they or someone they know is having thoughts of suicide. FJC]

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A Life Saved Connects the Dots on Data from Hotline Study

In Intervention, Research on November 3, 2009 at 10:00 pm

By Franklin Cook, SPNAC Editor

In March 2005, at the inaugural meeting of the Consumer Survivor Subcommittee of the National Suicide Prevention Lifeline, a troupe of the finest researchers in the field unveiled the results of several key studies of the operations and effectiveness of suicide prevention hotlines, and I was fortunate to be among the newly recruited committee members in attendance.

Of all the things I learned during that meeting at the headquarters of the Substance Abuse and Mental Health Services Administration (SAMHSA) in Rockville, Md. — much of which has continued to guide the committee’s work and the overall development of the Lifeline network of crisis centers — one bit of data stands out to me with utmost clarity: In a relatively larger study, 11 percent of hotline callers said that “the call prevented them from killing or harming themselves.”

Eleven percent! More than one in every 10 people who reached out to a suicide hotline said the call prevented them from making a suicide attempt.

That bit data came to mind today when I read a story from WYFF Television in Greenville, S.C.

On Saturday in the little town of Travelers Rest, a police officer shot a gun right out of the hand of a suicidal man.

The police officers spoke with [Jeffrey] Simpson for more than an hour as Simpson held a gun to his head. The officers said Simpson repeatedly waved the gun around and pointed it directly at the officers, refusing repeated commands to put it down. The officers said as Simpson extended his arm and pointed the gun at an officer, another officer fired, hitting the pistol.

It seems to me as if a life was miraculously saved (especially when one considers how many times incidents such as this end with police killing the gun-wielding suicidal person).

And here’s what brought to mind for me the data about hotlines:

Police said the man … had called the national suicide hotline, who in turn contacted the sheriff’s office. The officers quickly requested assistance from the sheriff’s office SWAT team. The police chief and captain both responded from home to the scene.

Who knows what the long-term story will be in this case (or in any case involving a starkly suicidal person who is rescued), but this much is clear: The man was ambivalent about dying, and he called for help. The people he called sent someone to him who was able to help. And the man lived another day, with a brand-new chance to recover from whatever it is that is causing him pain.

See all five articles related to crisis hotlines from the June 2007 issue of Suicide and Life-Threatening Behavior.

[The abridged URL for this post is http://tinyurl.com/HotlineStudy .]

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Study Gives 1st Picture of Suicide Attempts in U.S.

In Prevention, Research on September 17, 2009 at 6:49 am

A news release today from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) “provides important insights into the nature and scope of suicidal thoughts and behaviors.”

Nearly 8.3 million adults (age 18 and older) in the U.S. (3.7 percent) had serious thoughts of committing suicide in the past year according to the first national scientific survey of its size on this public health problem. The study … shows that 2.3 million adult Americans made a suicide plan in the past year and that 1.1 million adults–0.5 percent of all adult Americans–had actually attempted suicide in the past year.

The study also uncovered a strong relationship between substance abuse disorders and having thoughts of suicide or making a suicide attempt.

People experiencing substance abuse disorders within the past year were more than three times as likely to have seriously considered committing suicide as those who had not experienced a substance abuse disorder (11.0 percent versus 3.0 percent). Those with past year substance abuse disorders were also 4 times more likely to have planned a suicide than those without substance abuse disorders (3.4 percent versus 0.8 percent), and nearly seven times more likely to have attempted suicide (2.0 percent versus 0.3 percent).

Dr. Eric Broderick, SAMHSA Acting Administrator, framed the study results as a call to action for establishing suicide prevention as a national priority:

“While there are places that people in crisis can turn to for help like the National Suicide Prevention Lifeline 1-800-273-TALK (8255), the magnitude of the public health crisis revealed by this study should motivate us as a nation to do everything possible to reach out and help the millions who are at risk–preferably well before they are in immediate danger.”

The study, titled “Suicidal Thoughts and Behaviors among Adults,” uses data from the 2008 National Survey on Drug Use and Health, and the full report is available online from SAMHSA.

[The abridged URL for this post is http://tinyurl.com/AttemptsInUS .]

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Anti-Depressant Use Doubles; Joint Psychotherapy Decreases

In Mental Illness, Research on August 3, 2009 at 11:16 pm

According to an article in USA Today by reporter Liz Szabo, “the number of Americans using antidepressants doubled in only a decade, while the number seeing psychiatrists continued to fall.” The article is based on a “study of nearly 50,000 children and adults,” which appears in the current issue of Archives of General Psychiatry.

According to the USA Today report,

About 10% of Americans — or 27 million people — were taking antidepressants in 2005, the last year for which data were available at the time the study was written. That’s about twice the number in 1996 … Yet the majority weren’t being treated for depression. Half of those taking antidepressants used them for back pain, nerve pain, fatigue, sleep difficulties, or other problems, the study says.

Among users of antidepressants, the percentage receiving psychotherapy fell from 31.5% to less than 20%, the study says. About 80% of patients were treated by doctors other than psychiatrists …

Olfson says his study shows that doctors need more training in mental health. And he says he’s concerned about the decline in patients receiving psychotherapy. Patients who receive only medication may not get the help they need, he says.

[The abridged URL for this post is http://tinyurl.com/AntiDepressantUse .]

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Wednesdays and July, August Most Likely Times for Suicide

In Research on July 8, 2009 at 9:32 pm

A USA Today story by Sharon Jayson covers a University of California, Riverside study showing that, regarding when suicides occur in the United States, “summer is the most common season and Wednesday the most likely day.”

Common beliefs about suicide being more likely on Mondays and during the winter aren’t really true … July and August are the most common months for suicide … [and] 24.6% of suicides were on Wednesdays.

The study was recently published online in the journal Social Psychiatry and Psychiatric Epidemiology.

It is based on data on almost 132,000 suicides from 2000-2005, from the U.S. Multiple Cause of Death Files, at the National Center for Health Statistics.

“What people believe to be the case — in sociology, frequently you find it is not the case,” says [the study’s co-author, Professor Augustine Kposowa]. “People believe because the weather is cold and people are depressed in the winter, there are more suicides, but in sociology, what we find is that the highest number of suicides are in spring and summer.”

[The abridged URL for this post is  http://tinyurl.com/SuicideTimes .]

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CBT Shown To Be Preventative with Teen Depression

In Mental Illness, Prevention, Research on July 7, 2009 at 6:52 am

A post by Nancy Shute last month in her U.S. News & World Report “On Parenting” blog covers a study showing that “cognitive behavioral therapy can prevent teenagers from becoming clinically depressed.”

That’s great news, because serious depression afflicts 2 million teenagers each year and puts them at greater risk of suicide and depression throughout life.

The findings of the study were published in the Journal of the American Medical Association.

Half of the 316 teenagers in the study, led by Vanderbilt University psychology professor Judy Garber, took part in eight weekly, 90-minute group sessions, in which they were taught problem-solving skills and practiced them. Cognitive behavioral therapy isn’t traditional, long-term “talk therapy”; it’s a short-term treatment, usually lasting no more than 20 sessions, based on the idea that people’s thoughts cause their feelings and behaviors. Thus if people change how they think about a situation and how they respond to it, they can feel better, even if the situation hasn’t changed.

Shute notes that “finding cognitive behavioral therapy can be tricky, because it’s advertised more than it’s actually delivered” and gives a description of CBT, from the Association for Behavioral and Cognitive Therapies, which she points out, “also has a decent online therapist finder”:

In cognitive therapy, a person learns to:

  • Distinguish between thoughts and feelings.
  • Become aware of how thoughts can influence feelings in ways that sometimes are not helpful.
  • Learn about thoughts that seem to occur automatically and how they can affect emotions.
  • Evaluate critically whether these “automatic” thoughts and assumptions are accurate or perhaps biased.
  • Develop the skills to notice, interrupt, and correct these biased thoughts.

[The abridged URL for this post is http://tinyurl.com/CBT-Preventative .]

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1/4 of Suicides in Large Study Exceeded Legal Alcohol Limit

In Research on June 23, 2009 at 10:51 pm

Staff writer Kristina Fiore reports in MedPage Today on a study from the Centers for Disease Control and Prevention (CDC) showing that almost one-fourth of suicide fatalities in a large database “had a blood alcohol level above the legal limit for driving a car.” The findings are especially significant because they are based on data from almost 19,000 suicides in 17 states over a two-year period, 70% of which included toxicology results for alcohol.

The percentage of suicides with high blood alcohol levels was greatest among American Indian/Alaska Natives at 37%, followed by 29% for Hispanics — findings that hold implications for culturally specific intervention programs, [said Dr. Alex Crosby of the CDC’s National Center for Injury Prevention and Control].

“Alcohol is connected to suicides across all [racial and ethnic] groups,” he said. “When programs try to address suicide prevention, they should definitely include alcohol as one component.”

The findings aren’t a surprise, since alcohol is a known risk factor in suicide, said Eric D. Caine, MD, chair of psychiatry at the University of Rochester Medical Center.

But the study is unique because it examines the role of alcohol in suicides across all ethnic groups — data that has been limited in prior studies, Dr. Crosby said.

“This is a really important paper because it underscores how much a common risk factor such as drinking contributes to something like suicide,” Dr. Caine said. “Here’s more data on how something like alcohol is fuel on the fire, and we need to ask ourselves what we are going to do about it.”

The paper by Dr. Crosby and his colleagues appears in the June 19 issue of “Morbidity & Mortality Weekly Report.” SPNAC readers may download a copy of the paper.

The data are from the National Violent Death Reporting System, which “collects data on violent deaths from a variety of sources, including death certificates, police reports, medical examiner and coroner reports, and crime laboratories,” according to the NVDRS website.

Individually, these sources provide fragmented data that explain violence only in a narrow context. Together, these sources offer a more comprehensive picture of the circumstances surrounding a homicide or suicide. As a result, NVDRS provides insight into the optimal points for intervention, thus improving violence prevention efforts.

Because of its importance in making suicide prevention efforts in the United States more strategic and more effective, expanded funding for the NVDRS is one of the current public policy priorities of the Suicide Prevention Action Network (SPAN USA).

[The abridged URL for this post is  http://tinyurl.com/SuicidesAlcohol .]

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Research on Meds Must Safely Include Suicidal People

In Research on May 18, 2009 at 5:03 pm

[Editor’s note: It is my pleasure to share with SPNAC readers the first guest article to be posted on Suicide Prevention News and Comment. Several other noteworthy authors have been invited to make contributions, and I am hopeful that items such as this will become a regular feature. FJC]

By DeQuincy A. Lezine, Ph.D.

Patients in antidepressant drug trials are not representative of patients in the United States who might need antidepressant medication. That is the conclusion of a recent study by Dr. Madhukar Trivedi of the University of Texas Southwestern Medical Center and colleagues appearing in the May issue of the American Journal of Psychiatry. The report comes from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, funded by the National Institute of Mental Health (NIMH). The $35 million study included 2,855 patients with depression and lasted six years.

MedPage Today senior editor John Gever writes in a May 14 article that pharmaceutical drug trials for antidepressants generally exclude many potential participants, such as those with “more than one concurrent general medical condition or Axis I psychiatric disorder in addition to depression, or current episodes lasting more than two years.” A May 12 article in The Medical News notes that potential participants “who have previously tried treatment, have suicidal thoughts or have other psychiatric illnesses” would have been excluded. In fact, nearly 80 percent (4 out of 5) of the patients included in STAR*D would have been excluded from other antidepressant clinical trials.

The problem of excluding suicidal individuals from research studies has been noted for some time, with some solutions initially covered in a 2001 article by Jane Pearson (NIMH) and colleagues. This research issue will only intensify as we continually recognize and treat depression and other mental illnesses earlier, especially if we continue to find that comorbidity is the norm rather than the exception.

While prior studies have noted that patients in drug trials differed from other patients based on demographics and clinical characteristics, the current study also documented differences in outcomes. According to the MedPage Today article, findings from drug trials probably “paint a rosier picture than should be expected in ordinary practice” because patients who would have been excluded from drug trials

  • were less likely to respond well to the antidepressants (39%) compared to those included in drug trials (52%) …
  • were less likely to achieve remission from depression (25%) compared to those included in drug trials (34%) …
  • were more likely to require psychiatric hospitalization (2.5%) compared to those included in drug trials (0.3%) …
  • were more likely to experience severe or intolerably intense side effects compared to those included in drug trials.

These findings call into question whether the information provided to patients who receive antidepressant medications overstates the potential benefits, including response rates, and understates the potential side effects and risks. Can patients truly give informed consent without accurate information?

According to Dr. Trivedi, “We are basing our judgment of clinical care in the United States on samples of patients that are totally different than the patient population actually treated in primary care and mental health facilities.” The patients who would have been included in drug trials had “shorter bouts of depression, quicker response to medication, less severe side effects and fewer adverse events compared with those people with depression who would have been excluded from such a trial” [continued … read the full article here].

[The abridged URL for this post is http://tinyurl.com/SafelyInclude .]

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U.S. Suicide Prevention Oblivious to Working-Age Men

In Policy, Research on May 11, 2009 at 4:02 pm

By Franklin Cook, SPNAC Editor

Men and Mental Health: Get It Off Your Chest,” a study just released by Mind, the leading mental health charity in England and Wales, deserves attention in the United States, where what is known about suicide and men lines up very well with what is known in Great Britain.

Here’s what the study, in which 2,000 men and women were surveyed about their mental health, says about men and suicide. These survey results explain some of the reasons why 75 percent of suicide fatalities are men in England and Wales (79 percent of suicides in the United States are men).

When it comes to risk factors and thoughts of suicide:

  • Men are twice as likely as women to have suicidal thoughts when they are worried (seven times more likely for men age 45 to 54).
  • Young men (18 to 24) are five times as likely to take recreational drugs when worried as young women, and almost twice as many men overall as women drink alcohol to cope with feeling down.
  • Almost twice as many men as women get angry when they are worried.
  • Forty-five percent of men think they could fight off feeling down by themselves.

When it comes to getting help:

  • Only one-fourth of all men would see their physician if they felt “low” for more than two weeks, and only 14 per cent of men age 35 to 44 would do so.
  • Men are half as likely as women to go to a counselor or therapist to talk about their feelings.
  • Men are also about half as likely to talk to friends about their problems as women, and only about three out of 10 men are likely to talk to a friend about feeling low (and young men are the most likely to tell a friend to “pull themselves together”).

The Mind report makes several specific recommendations that address the mental health and government institutions in Great Britain, and several more general recommendations that could be translated to U.S. suicide prevention efforts for men:

  • Commissioners of health services should identify the need for and plan accordingly for male-specific mental health services.
  • The criteria used by health professionals for diagnosing mental health problems should include all indicators of a condition, including the more traditional male symptoms of “acting out.”
  • Health professionals should take gender into account when discussing treatment options with men.
  • Employers should learn to recognise the symptoms of men’s mental distress and introduce mental well-being policies.
  • Core education/training and continuing professional development of health and social services professionals should cover the relationship between gender, sexuality, and mental well-being.
  • Race equality and the needs of black and minority ethnic men should be made a priority …
  • Commissioners of mental health services and public health professionals should take into account the different needs men can have at different ages and plan services accordingly.

Most importantly, the leadership of the suicide prevention movement in America ought to be asking (and answering) these questions:

  • Since four out of five U.S. suicide deaths are by men, what is being done to institute a public health strategy for suicide prevention that specifically targets that obviously high-risk group (including in the areas referenced by the recommendations above)?
  • Since nearly two-thirds of all suicides in the United States are by men between the ages of 20 and 64 (precisely during their working years), shouldn’t suicide prevention for those people be one of the highest health-care priorities for employers and the institutions supporting employees throughout the country (such as the Department of Labor and the AFL-CIO, just to name a few)?

These questions are–and have been for a long time–knocking about in the background of  discussions about suicide prevention in the U.S., but developing the strategic answers is on no one’s radar that I know of. Yet there are a number of realities that indicate the need and opportunity for action:

  • The National Strategy for Suicide Prevention marked its eighth year in existence on May 1st, and while it still is an excellent blueprint for the public health response to suicide in America, it is now unquestionably overdue for an overhaul.
  • The national coordinating body intended to help guide the suicide prevention movement that was called for in the NSSP (which was to be instituted by 2002, in fact) is still not in place (although the Substance Abuse and Mental Health Services Administration, SAMHSA, several years ago indicated it was taking steps to organize such a group under the name “Action Alliance”).
  • The lessons being learned from four years of community-level suicide prevention work targeting youth and college students with funding from the Garrett Lee Smith Memorial Act are ripe for translation into programs for suicide prevention across the lifespan.

If suicide prevention is to be effectively based on the public health model, then the highest number of individuals in the population identified as a group that is most affected by the malady ought to be reached through intensive preventative measures. The time for making suicide prevention a priority in the United States among working-age men has come.

[The abridged URL for this post is http://tinyurl.com/ObliviousToMen .]

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Alcohol Screening Linked to Youth Suicide Prevention

In Prevention, Research on May 9, 2009 at 6:52 am

In a May8 Reuters article, reporter Joene Hendry summarizes findings from a University of Connecticut Health Center study that demonstrates “adolescents who drink alcohol while sad or depressed have an increased risk of attempting suicide, whether or not they have previously had suicidal thoughts.”

The findings have implications for screening adolescents for suicide, especially when suicide might be impulsive.

Among adolescents not reporting prior suicidal thoughts, “drinking while ‘down’ was associated with a 3-fold increase in risk,” said [Dr. Elizabeth] Schilling.

Suicide prevention is challenging when youths do not show suicidal ideas before attempting suicide … so screening young people to see if they tend to drink alcohol while depressed may provide “an alternative avenue for identification and early intervention.”

As the study itself points out, “the absence of suicidal thoughts may signify the absence of depression or less severe depressive symptomatology that may evade detection through commonly used screening instruments, which typically include questions about suicidal thoughts and previous suicidal behavior.”

The full text of the study is available from the Journal of Adolescent Health. The study concludes that “the use of alcohol while sad or depressed [is] a marker for suicidal behavior in adolescents who may not engage in planning or ideating prior to an attempt, and hence, may not be detected by current strategies for assessing suicide risk.”

Although problematic use of alcohol among adolescents is readily detectable using current screening approaches … routine screening for adolescent alcohol use by pediatricians and family practitioners is not universally practiced despite the recommendations of the American Academy of Pediatrics, the American Medical Association, and the Society for Adolescent Medicine. Findings from this study should provide further impetus for alcohol and drug screening among pediatricians and family practitioners beyond that motivated by concerns about alcohol and substance use.

[The abridged URL for this post is http://tinyurl.com/AlcoholScreening .]

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Finland: 2007 Suicides 1/3 Fewer than in 1990

In Prevention, Research on April 23, 2009 at 2:55 pm

 A woman in Helsinki, Finland attends a 1995 in memory of suicide victims. (Helsingin Sanomat   photo by Jarmo Matilaine)

A woman in Helsinki, Finland attends a 1995 ceremony in memory of suicide victims. (Helsingin Sanomat photo by Jarmo Matilaine)

ORIGINAL REPORT — The Scandinavian newspaper Helsingin Sanomat, in a report yesterday on a recent decrease in suicide in Finland, gives a glimpse of international suicide statistics.

In 2007, 995 deaths in Finland were determined to be suicides. The number has declined by one-third from the record year of 1990, when 1,520 people in Finland took their own lives.

Concerning countries with high suicide rates, the report references a 2005 paper that states “about 60 per cent of the world’s suicides take place in Asia, where it is a major public health problem … [and] one-fifth of all suicides in Asia do not make it into the statistics.”

According to a [2004] article in the medical journal The Lancet, suicides are most common in Lithuania. Kazakhstan is in second place, followed closely by Hungary. They are followed by Latvia, and three Asian countries, Japan, China, and Sri Lanka. Next on the list is Finland … Since then, suicides by men, and especially women have decreased in Finland.

Countries with the lowest rates of suicide include Greece, Israel, and Mexico.

A decrease of one-third in the United States (where more than 30,000 people die by suicide annually) would r esult in 10,000 fewer lives lost , so it would be interesting to learn if Finland’s reduction is a trend or an anomaly and, if it is a trend, whether prevention practices there are duplicable in the U.S. and elsewhere.

[The abridged URL for this post is  http://tinyurl.com/FinlandSuicides .]

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78% of Male Suicides/Attempts Showed Psych Problems at Age 8

In Research on April 6, 2009 at 10:14 pm

ORIGINAL REPORT — According to a report in Science Daily, in a study involving more than 5,000 subjects, a high proportion of men who, by their mid-20s, died by suicide or attempted suicide and were hospitalized had psychiatric problems when assessed at the age of 8, while the same was not true of women.

Andre Sourander, M.D. … and colleagues studied 5,302 Finnish individuals born in 1981. Eight years later, information about psychiatric conditions, school performance and family demographics was gathered from children, parents and teachers. Participants were then tracked through national registers through 2005.

Between ages 8 and 24, 40 participants died, including 24 males and 16 females. Of those, 13 males and two females died from suicide. A total of 54 males and females (1 percent) either completed suicide or made a suicide attempt serious enough to result in hospitalization.

Of the 27 males who either seriously attempted or completed suicide, 78 percent screened positive for psychiatric conditions at age 8, compared with 11 percent of 27 females who had serious or completed suicide attempts.

The study is published in the current issue of Archives of General Psychiatry (abstract).

It also showed a number of other indicators at age 8 associated with suicide and life-threatening attempts in males later in life, namely not living “in a family with two biological parents, [having] psychological problems … reported by a teacher, or [having] conduct, hyperactive or emotional problems.” Again, the same was not true for females.

Interestingly, however, when it comes to depression, the study showed that “depression at age 8 was not associated with suicide attempts for either sex.”

[The abridged URL for this post is  http://tinyurl.com/PsychProblems .]

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Research Points to PTSD as a “Predictor of Attempted Suicide”

In Research on March 3, 2009 at 6:53 pm

ORIGINAL ARTICLE — Rick Nauert, Senior News Editor for PsychCentral, reports that “new research suggests development of posttraumatic stress disorder (PTSD) may be associated with subsequent attempted suicide in young adults.” According to the abstract of the study, which appears in the current issue of the Archives of General Psychiatry, “posttraumatic stress disorder is an independent predictor of attempted suicide.”

The research involved nearly 1,700 subjects “who had been tracked since entering the first grade in Baltimore public schools” and who were interviewed 15 years later “to assess the occurrence of traumatic experiences, suicide attempts and the development of PTSD.”

Of the participants interviewed, 1,273 (81 percent) had been exposed to a traumatic event and 100 (6 percent, or 8 percent of those exposed to trauma) developed PTSD. Suicide had been attempted by 10 percent of those with PTSD, compared with 2 percent of those who were exposed to trauma but did not develop PTSD and 5 percent of those who had never been exposed to traumatic events.

Further research is needed, the authors write, to learn more about whether “there could be a common pre-existing predisposition to PTSD and suicide attempts that was present before the trauma occurred.” They note, as well, that their findings are in line with “previous research [that] has found that up to 20 percent of suicide attempts in young people are attributable to sexual abuse during childhood.”

“Although we did not focus explicitly on child sexual abuse, our results point to the need to base risk estimates of attempted suicide on data that take into account the psychiatric response to the trauma.”

[The abridged URL for this post is http://tinyurl.com/PTSD-Predictor .]

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Childhood Abuse Can Alter the Brain and Increase Suicide Risk

In Research on February 26, 2009 at 6:29 am

ORIGINAL REPORT — According to a Canadian Press report, research shows that “childhood trauma can alter the way genes in the brain work, potentially putting an individual at increased risk for suicide later in life.”

A team of scientists from McGill University analyzed brain tissue from 12 suicide victims who had been abused as children and compared them to the tissue of 12 suicide victims who had not been traumatized and 12 people who died from other causes. They found that the brain tissue from the abused group showed “epigenetic” changes that affect a person’s response to stress, which is known to increase the risk of suicide.

An article about the study is published in the current issue of Nature Neuroscience (see an abstract of the article). In the Canadian Press report, the scientists who completed the research say that “identifying epigenetic changes in abuse victims could one day pave the way for drugs that would reverse the damage.”

“The implications at this stage are you want to identify these people and then probably offer them some sort of intervention,” said [Moshe] Szyf, an epigeneticist in McGill’s department of pharmacology and therapeutics.

Any practical application of the study’s findings is not likely to be available anytime soon, for “researchers would have to find similar epigenetic makings in the DNA of a person’s blood, since brain tissue can only be analyzed after death” and then researchers would have to “find drugs that could reverse the epigenetic changes,” which are both steps not yet accomplished.

Dr. John Strauss, a child psychiatrist at the Centre for Addiction and Mental Health in Toronto, said the McGill study is important because it brings to “psychiatric disorders a way of explaining potential gene-environment interactions.”

The difficulty is translating the method into subjects that are living, he said. “Obviously, if there were some kind of marker that you could check in individuals to see if they are more at risk (for suicide), it might aid identification.”

The findings are also an example of how basic research on brain function might lead to medical or other interventions that would prevent suicide, specifically in the emerging field of epigenetics. For more about epigenitics, see the Public Broadcasting Service feature on Nova or Science magazine’s web page on the topic.

Szyf said the optimistic message from the [McGill] study is that changes in the function of genes transformed by environmental factors are potentially reversible.

“I think what’s nice about the study is we can see marks of early life in the genes of older people,” he said. “And that illustrates the power of epigenetics because it serves as a memory of environmental exposure.”

For instance, it’s known that toxic chemicals like lead, mercury and PCBs can alter the function of a person’s genes and result in disease, including some cancers. “But it seems that social exposures are as toxic and can cause exactly the same kind of changes,” Szyf said. “And we should be aware of the impact a bad social environment can have on our health.”

[The abridged URL for this post is  http://tinyurl.com/AbuseCanAlter .]

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Juvenile Justice Suicide Report’s Delay Called “Public Disservice”

In Prevention, Research on February 16, 2009 at 10:43 pm

ORIGINAL REPORT — According to a report by staff writer John Kelley in Youth Today, a national newspaper for professionals in the youth service field, “the author of a recent U.S. Office of Juvenile Justice and Delinquency Prevention report on suicides in juvenile facilities says that, despite the major findings it produced, the agency sat on the report for five years for reasons that have never been disclosed to him.”

Lindsay Hayes, a project director for the NCIA [National Center on Institutions and Alternatives], told Youth Today he handed in the report [titled “Characteristics of Juvenile Suicide in Confinement“]  during the winter of 2004. OJJDP published the study and made it available on its website [on February 9, 2009].

Kelley also posted a companion story on Youth Today’s blog, summarizing the findings of the study, including that

  • more than a third of the 110 suicide deaths that occurred between 1995 and 1999 were not known to the supervising or licensing state agency …
  • many of the suicides were not known to child advocacy agencies, and nearly a sixth of the deaths were learned about through newspaper articles and conversation despite surveys sent to almost 4,000 public and private juvenile facilities …
  • more than two-thirds of private facilities did not respond to survey requests …
  • more than 70 percent of the victims were between the ages of 15 and 17 …
  • more than half of juveniles who killed themselves in detention did so in the first six days …
  • only 35 percent of them had received a mental health assessment at the time of their death … [and]
  • only 17 percent of the victims were on suicide watch at the time of their deaths.

The report recommends that juvenile facilities have written suicide prevention policies, and create and maintain effective training programs.

Pro Publica’s A.C. Thompson also reported on the OJJDP study in an article a few days after Youth Today broke the story, suggesting that the department’s delay of the report might have been strategic and questioning the actions of J. Robert Flores, who was chief of DOJ’s juvenile justice office at the time.

Dan Macallair, executive director of the Center on Juvenile and Criminal Justice, a San Francisco nonprofit, said the report would have made headlines had it been released in a timely fashion. “It would have been huge,” [he] said. “It would have led to legislative hearings, newspaper articles … It would have sparked an outcry.”

Over the years, Hayes said, the Justice Department vacillated on the status of the document, saying first that it was fast-tracked for publication and later that it had been rejected and “unapproved.” Last fall, Hayes complained about the delay to [Flores]. “I wrote kind of a nasty letter to Mr. Flores saying I was extremely frustrated that this report didn’t come out — that there are youth dying,” recalled Hayes.

This isn’t the first time controversy has found Flores, who has been the subject of congressional hearings. In June he was questioned by the House Oversight and Government Reform Committee about millions of dollars in grant spending, with then-Chair Henry Waxman (D-CA) describing Flores’ grant-making process as “neither fair nor transparent.” [SPNAC readers can read Flores’s statement to the House committee.]

That same month, the Washington Post reported that Flores was the subject of a criminal probe into his “alleged use of government funds for personal travel expenses and his hiring of a politically well-connected contractor who allegedly performed little work in a high-paying job.”

In a column yesterday in the St. Paul Pioneer Press, Ruben Rosario writes that the delay in the report’s release was “a public disservice.”

The findings and recommendations from this unprecedented study could have saved lives while it sat gathering dust.

Rosario goes on to further implicate Flores, quoting “a former high-ranking OJJDP staffer [who] publicly accused Flores of steering OJJDP grant money to programs that had ‘religious, social or political’ connections to the Bush administration.”

One substantial grant was awarded to a juvenile golf foundation whose honorary chairman is George H.W. Bush, even though the program ranked 47th out of 104 grant bidders in an OJJDP funding priority report.

Best Friends, a teen-abstinence program ranked 57th and run by Bush family pal and former drug czar Bill Bennett, was awarded $1.1 million — twice the federal funds it requested.

Flores, who left with the recent change in administration, told ABC News’ Brian Ross that he was free to ignore OJJDP staff recommendations but denied playing favorites.

[The abridged URL for this post is  http://tinyurl.com/ReportDelay .]

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