Which Suicide Prevention Strategies Work?
A new study from Columbia University Vagelos College of Physicians and Surgeons has found that suicide mortality can be reduced by a Federally coordinated approach employing scientifically proven options.
Columbia researchers J. John Mann, MD, Christina A. Michel, MA and Randy P. Auerbach, PhD conducted a systematic review, determining which suicide prevention strategies work, and are scalable to national levels.
The study, “Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review,” was published in the American Journal of Psychiatry.
The researchers found that screening school children or the general population for those at risk for suicide, the tenth leading cause of death in the U.S. with 48,344 suicide deaths in 2018, have generally not reduced suicide rates. The outstanding exception is training primary care physicians in depression recognition and medication treatment. That approach prevents suicide, often halving the risk.
While educating the public about depression and suicidal behavior has not been shown to prevent suicidal behavior in adults, educating high school students prevents suicidal behavior, however, educating their teachers or parents does not.
“Timing is everything,” said Dr. Mann. “Active outreach to psychiatric patients after discharge or following a suicidal crisis, both prevent suicidal behavior.”
Although medication treatment of depression is subject to a black box warning by the FDA, meta-analyses of FDA and NIMH-funded study data find antidepressants prevent suicide attempts. But standard antidepressants take weeks to work, which has led to increased interest in intravenously administered ketamine, a promising treatment to reduce suicidal ideation in hours, yet this is still untested for suicidal behavior prevention.
The study found that the final line of defense in suicide prevention is reducing access to the most lethal methods for suicide. In the U.S. half of all suicides involve a firearm that was mostly purchased years earlier, telling us that improved gun safety in the home should be a national priority.
Combinations of these approaches in health care systems show promise in reducing suicide rates in the U.K., Denmark and even parts of the U.S. “It is time to use this knowledge and implement a national suicide prevention plan,” said Dr. Mann.
The Columbia University Department of Psychiatry is among the top ranked psychiatry departments in the nation and has contributed greatly to the understanding and treatment of brain disorders. Co-located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Irving Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at the Columbia University Vagelos College of Physicians and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, substance use disorders, and childhood psychiatric disorders.
Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cuimc.columbia.edu or columbiadoctors.org.