Forging an Agenda for Suicide Prevention in the United States

Abstract

Suicide prevention must be transformed by integrating injury prevention and mental health perspectives to develop a mosaic of common risk public health interventions that address the diversity of populations and individuals whose mortality and morbidity contribute to the burdens of suicide and attempted suicide. Emphasizing distal preventive interventions, strategies must focus on people and places--and on related interpersonal factors and social contexts--to alter the life trajectories of people before they become suicidal. Attention also must be paid to those in the middle years--the age with the greatest overall burden. We need scientific and social processes that define priorities and assess their potential for reducing what has been a steadily increasing rate of suicide during the past decade.

Comprehensive, integrated approaches to suicide prevention: practical guidance

“…In addition to past tendencies to implement one-by-one interventions rather than a group of interlaced programmes that constitute a mosaic of actions,8 there are inherent barriers to effective prevention,9 especially as programmes have focused on seeking to detect persons at high risk as they enter perisuicidal periods and approach the precipice of death. These include: an inability to discriminate the relatively few true cases from the large number of false positive cases, that is, the preponderance of persons suffering severe psychological distress with diagnosed psychiatric disorders who, even while suicidal, neither attempt nor die by suicide; the large number of false-negative cases that escape preventive detection, that is, persons who seemed ‘normal’ but killed themselves or whose long-standing condition appeared no worse to family, friends or providers during the days immediately before their death; the inability of clinical and social services to reach many individuals who have serious suicidal intent; a continuing paucity of knowledge about fundamental biological, psychological, social and cultural factors that contribute to fatal suicide attempts among diverse populations and groups who have been labelled at-risk; and the lack of coordinated strategies for suicide prevention that can deal effectively with myriad local, regional, state and national agencies and organisations that could, in theory, play a role in preventing suicide.…”

“…Upstream prevention efforts reach beyond perisuicidal periods to times when no suicidal thinking or behaviours may be apparent; while this may not seem to be suicide prevention to some observers because vulnerable persons have yet to reach symptomatic states, efforts to prevent fatal cardiac events or challenging-to-treat cancers often begin decades before their apparent onset with efforts to stop smoking, reduce high blood pressure and promote a healthy lifestyle. Added to these challenges, past prevention efforts understandably have tended to reflect the priorities of focused interest groups that have driven agendas based on their personal experiences rather than assessing the greatest potential contributions to reducing the collective suicide burden 8. The challenge now for the field is to build partnerships encompassing a broader range of interest groups to foster priority settings across the prevention spectrum.…”

CDC Grand Rounds: Preventing Suicide Through a Comprehensive Public Health Approach

“…NVDRS data show that most suicides have multiple precipitating conditions, such as depression, intimate partner problems, physical health conditions, financial challenges, and legal problems (7). Suicide risk factors also include personal or family experiences of violence (e.g., child abuse and neglect or family history of suicide) and broader community conditions, such as high crime rates, easy access by persons at risk to lethal means (e.g., large amounts of medication or unlocked firearm), and limited access to health and social services (7,8). NVDRS data underscore that mental health treatment should not be the only prevention strategy; approximately 70% of suicide decedents were not receiving mental health services at the time of their death, and approximately 80% did not have a known history of previous suicide attempts (7).…”

Why an alternative to suicide prevention gatekeeper training is needed for rural Indigenous communities: presenting an empowering community storytelling approach

“…The community training focuses on generating ideas and readiness of participants to help others who may need some extra caring as well as those who may be suicidal. In broadening the scope, CARES aligns well with recent calls in the suicide literature (Caine, 2013). Focusing on vulnerability (not suicide) makes it appropriate for natural helpers of all kinds: youth, family members, and typical gatekeepers who come in contact with youth regularly.…”