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NIH issues report on optimizing youth suicide prevention efforts

Based on findings from its Pathways to Prevention Workshop, the NIH has issued a final report that offers strategies for youth suicide prevention in the Annals of Internal Medicine.

Bolstering data systems, methods for data collection and analysis and both the research and practice community can help in suicide prevention, Todd D. Little, PhD, from the Institute for Measurement, Method, Analysis, and Policy at Texas Tech University, and colleagues wrote.

"Suicide is the second leading cause of death in youth (aged 10 to 24 years) and young adults (aged 25 to 34 years) and claimed the lives of 12,073 persons in these age brackets in 2014," Little and colleagues wrote. "Many risk factors (for example, depression, mental disorders, substance abuse, prior suicide attempts, family history of suicide, family violence, exposure to suicidal behavior, or incarceration), precipitating events (such as shame, loss, or relationship disruption), and environmental circumstances (for example, access to lethal means) contribute to suicidal behavior. Although prevention is daunting, the obstacles created by the complex factors involved in suicide are surmountable. New coordinated research strategies that embrace this complexity are necessary."

They recommended developing standardized measures to identify high-risk individuals, linking data from various sources and encouraging the documentation of implementation to improve data systems.

In addition, Little and colleagues suggested study designs and data collection efforts that incorporate various settings and times, employ missing data techniques, promote data linkage and expand methods for deriving conclusions to advance data collection and analysis.

Finally, to strengthen the practice and research community, the researchers recommended cross-sector collaboration and increased education, training and research sharing.

"As researchers and practitioners, we must unite to stop youth suicide in order to circumvent its associated economic cost and devastating pain and suffering," Little and colleagues concluded. "We must build and strengthen both coordination and collaboration among all members of the larger policy, practice, and research communities. We need to improve and coordinate the various surveillance and administrative data systems across these sectors. We must also elevate the level of rigor and breadth of methods used in studies of suicidal behavior. Adherence to the recommendations summarized herein provides us with a roadmap to our ultimate goal — eliminating suicide."

In an accompanying evidence review, researchers called for suicide prevention data to be linked to current data systems.

Holly C. Wilcox, PhD, from the department of psychiatry and behavioral sciences at Johns Hopkins School of Medicine, and colleagues noted that their association represents "untapped potential to evaluate and enhance suicide prevention efforts."

"Linkage to external data systems could allow for longer-term assessment of suicide outcomes from prevention programs," they wrote. "Data system linkage is underutilized in suicide prevention studies. Although we identified 153 unique data systems, we found only six studies that assessed outcomes by linking their prevention data to external data systems at the individual or ecological level."

Wilcox and colleagues noted that 94% of the systems they identified continuously gathered data or were consistently updated, indicating that linkage would be beneficial.

They wrote that data linkage could include health care delivery systems, health insurance systems and population-wide data systems, as well as other sources such as electronic health records and state health information exchanges. The authors detailed the logistics of linking data.

"A national suicide outcomes repository that combines data from several sources to achieve better coverage of suicidal ideation, suicide attempt, and suicide on a national level could be created," Wilcox and colleagues concluded. "Guidelines on data linkage methods and procedures as well as technical and legal aspects of data linkage could be developed to facilitate the linkage of prevention data with external data systems. A technical support center could be established to assist researchers, prevention scientists, health systems, states, and others with methods and procedures for data linkage." – by Chelsea Frajerman Pardes

Disclosure: Little reports personal fees, royalties and consulting fees from Yhat Enterprises outside the submitted. No other authors reported any relevant financial disclosures.