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Public health approach needed in suicide prevention

The current approach commonly used in suicide prevention, which focuses on mental health treatment, is insufficient, and should be bolstered via a comprehensive public health approach that can reach at-risk individuals who haven’t received psychiatric help, according to CDC researchers.

In a CDC Grand Rounds report published in Morbidity and Mortality Weekly Report, the researchers stated that mental health treatment approaches to suicide prevention only reach individuals who have identified risk factors, and those who have or can overcome barriers such as the stigma and limited availability of treatment services. However, a public health approach, they argue, would cast a much wider net.

“The overall suicide rate is increasing, with a 27% increase from 2000 (12.1 per 100,000 population) to 2014 (15.4 per 100,000),” Corinne David-Ferdon, PhD, of the CDC National Center for Injury Prevention and Control, and colleagues wrote. “… Suicide data severely underestimate the extent of the problem, with many more persons experiencing suicidal thoughts and making suicide plans and nonfatal suicide attempts.”

The researchers note several “promising models” using comprehensive approaches, including the U.S. Air Force Suicide Prevention Program, which, when fully implemented, had 11 components that increased community awareness, provided personnel training, encouraged people to seek and accept help, strengthened confidentiality policies, sought to reduce the stigma of seeking mental health care and created organizational accountability for implementation. This model was associated with a 33% reduction in suicide rates, a 51% reduction in homicides, an 18% decrease in accidental death and a 54% decrease in severe family violence.

Another model, called Together for Life, which targeted police officers in Montreal, includes a publicity campaign, suicide risk and support training for all units and supervisors, and a telephone helpline. This program was associated with a 79% reduction in suicide rates over 12 years, while officers in a comparison group experienced no statistically significant changes.

The Good Behavior Program, a classroom-based strategy for elementary schools, teaches students to better control their emotions and how to work well with others through classroom rules, team activities and positive reinforcement. As a prevention strategy, the program has reported reductions in antisocial behavior, smoking, drug and alcohol use, and significant decreases in suicide ideation and attempts throughout childhood, adolescence and adulthood.

Another school-based model, Sources of Strength, is designed to reach all students regardless of apparent risk. Through connections with trained peer leaders and trusted adults, the program aims to increase students’ acceptance of seeking help and communication, while reducing the perceived acceptability of suicidal and other harmful behaviors.

In addition, the researchers said that the infrastructure for a public health approach to prevention has been growing, noting the CDC-funded Injury Control Research Center for Suicide Prevention (ICRC-S). A collaboration between the University of Rochester Medical Center and the Education Development Center, the ICRC-S enhances access to data to inform prevention activities at the state, regional and national levels.

In addition, the Colorado Department of Public Health and Environment is advocating both research and practice to reach vulnerable groups, using its statewide public and private Suicide Prevention Commission and a collaboration with the ICRC-S.

“A public health approach adds a complementary, wider and prevention-oriented focus that increases attention to the many factors across the lifespan that contribute to circumstances that promote suicidal thinking and suicide attempts,” David-Ferdon and colleagues wrote. “This approach offers opportunities to foster protective factors throughout a person’s life, supporting ongoing prevention well before the prospect of suicide is imminent.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.