Prevention and the YSR Project

Prevention and the Youth Suicide Rise Project

Note: this is part of the Youth Suicide Rise project.

One topic that has been raised repeatedly by medical practitioners in the news media coverage of the increasing rates of youth suicide last year was the importance of prevention.

Here are some excerpts:


NY Times Dec 02:
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“We’re at a point now where this issue really can’t be ignored,” said John P. Ackerman, clinical psychologist and coordinator of suicide prevention at Nationwide Children’s Hospital in Columbus, Ohio. “We invest heavily in crisis care, which is the most expensive and least effective means of preventing suicide.”

He proposed instead that more time and money be spent “on identifying kids who are most vulnerable, helping them respond effectively to stress, and teaching them what they can do in a crisis. And we need to start early, in the elementary grades. We haven’t even begun to use the resources that we know work. We have to be proactive.”
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CNN March 25:
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Moreover, suicide can be preventable -- death should not be an acceptable outcome of depression, said Dr. Jeffrey Lieberman, professor and chairman of the Department of Psychiatry at Columbia University's Vagelos College of Physicians and Surgeons.
[...]
"There's four disorders that have greatest increased risks of suicide: bipolar, depression, psychotic disorders like schizophrenia, and PTSD. Drug abuse or addiction is a potential complicating factor in all of them -- and in all of these conditions, death by suicide should never be an outcome," he said. "But when they don't get treated, some small proportion of them have the potential to harm themselves or will end their lives by suicide."
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CBS News Oct 17:
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[Dr. Victor Fornari, vice chairman of child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y] said at an annual meeting of the American Academy of Child and Adolescent Psychiatry, in Chicago, that plans are afoot for a major study of ways to prevent teen suicide.

"We have to be able to identify vulnerable youth, and strategies are being developed to try to screen," he said. "In the same way we screen for cholesterol and blood pressure, we have to screen for suicidal thoughts and then have targeted interventions for youth identified as being at risk."
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More recently, psychiatrist Richard A. Friedman asked in a NY Times Opinion column:
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How is it possible that so many of our young people are suffering from depression and killing themselves when we know perfectly well how to treat this illness? 
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John Ackerman has expressed a similar sentiment in an email to me last year:

To be perfectly honest, we know much more about what we can do to prevent youth suicide than why it is increasing at such a concerning rate.


That this emphasis on prevention comes from practitioners rather than academicians does not surprise -- for those dealing with suicide up close, practical issues are more pressing than theoretical ones.

This is all the more true in the present situation, given that

a) it seems unlikely that researchers can discern the reasons for the rise in youth suicides any time soon, and if they do, that this will necessarily be of much help.

b) much more could be done in properly applying what is already known about suicide.


In view of the above, it is fair to ask if the current project -- the critical review of theories explaining the increases in youth suicides -- can be of any benefit at all to practitioners.

There are three reasons why I hope it might be of some value:

1) Improved clarity regarding data and evidence can help improve suicide prevention, for example by appropriately adjusting emphases on risk factors when data shows that firearms and prescription pills are increasingly (or decreasingly) involved in suicide deaths.

2) Critical evaluations of plausibility can improve the efficiency of applying research resources and thus prevent needless waste that could eventually impact prevention areas as well.

3) Decreasing public misinformation, say by providing easily understood explanations of flaws in invalid arguments, in data misinterpretations, or in common misconceptions, can also help improve the effectiveness of suicide prevention.

It is therefore my intent to occasionally produce articles dedicated specifically to content potentially useful to prevention efforts.  Ideally this would be on single pages with info encapsulated for ease-of-use by journalists and others who might be referred there by practitioners.

Somewhat paradoxically, even if this project concludes that there is very little we can assert with confidence about the reasons youth suicide rates have been soaring, this could still be of use to suicide prevention practitioners.  To understand this, note that 3 out of 4 letters in response to Friedman's NY Times opinion column criticized him for supposedly ignoring the causes of the suicide increases -- and promptly informed him with certitude what these were, though each writer offered different ones.

Once the project is substantially completed, I also plan to ask practitioners to contribute some thoughts on how prevention efforts can be further aided by society, and to provide a summary of, and further links to, such content -- so that the project ends with a reminder of the ultimate goal of trying to prevent suicide.