Hard Truths About Suicide Prevention

By Roy H. Perlis; Stephan D. Fihn: For Entire Post, Go Here…

Suicide accounts for nearly 50 000 deaths annually in the US, making it the second leading cause of death among persons 10 to 34 years of age.1 Although psychiatric illness is associated with elevated rates of death from a range of causes, from cardiovascular disease to cancer,2 suicide stands out: it occurs precipitously, disproportionately involves younger individuals, and is generally viewed as more preventable.

Suicide represents a particular challenge in the military because soldiers are placed in extremely stressful situations, often without adequate physical or emotional support. Their risk remains elevated even after they leave active service and attempt to reenter a society ill-equipped to acknowledge their special needs. For this reason, the US Department of Defense and the US Department of Veterans Affairs (VA) have invested billions of dollars to reduce the incidence of suicide. Every VA secretary for the past 15 years has made suicide prevention a top priority and vowed to eliminate suicide. They have launched initiatives that included hiring more than 400 suicide counselors; establishing hotlines that receive more than 600 000 calls per year; screening patients for depression and posttraumatic stress disorder at nearly 60 million primary care, emergency, and mental health visits each year; and ensuring that every person discharged from the military is contacted personally. Despite these heroic efforts, the number of veterans who die by suicide every year has actually increased during the past decade.3

These circumstances highlight how difficult and complex a task it is to prevent suicide more broadly and why limiting interventions to the moment when individuals present with suicidal thoughts does not suffice. (N)early two-thirds of veterans who die by suicide have not sought any type of health care from the VA.3 Thus, even in a perfect world of optimal screening and intervention by the VA, two-thirds of suicide deaths among veterans would not be prevented.

In aggregate, these 3 articles highlight the major obstacles in suicide prevention: whether automated or not, screens pose problems both of false-positive and false-negative results, and well-documented, specific, and scalable interventions remain elusive. Like most serious public health problems related to chronic illness, a multipronged approach will be necessary.

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