Suicide Outbreak Prompts CDC Assessment

Community education and availability of mental health resources are called essential in efforts to limit suicidal behavior.

By Christopher White
Psychiatric News
Originally published September 21, 2012

In the first five months of this year, 11 young people completed suicide in Kent and Sussex counties in Delaware, an increase from the yearly average of four in those aged 12 to 21 from 2009 to 2011.

Reflecting the state’s concern about this troubling development, the Delaware Department of Health and Human Services asked the federal Centers for Disease Control and Prevention (CDC) to conduct an epidemiological study to determine the rates of fatal and nonfatal suicide behaviors in the area, analyze risk factors, and recommend strategies to prevent future suicides.

Of the 11 decedents, four were students at the same high school, two were students at other local high schools, one was a student at a middle school, one had dropped out of high school, two had graduated from area high schools and were still living in Sussex County, and one was an adult with unknown education history.


The entire story is here.

Suicide, Not Car Crashes, #1 Cause of Injury Death

By Jennifer Warner
WebMD Health News
Originally published September 20, 2012

Suicide has overtaken car crashes as the leading cause of injury-related deaths in the U.S.

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The top five leading causes of injury-related deaths were:

1. Suicide
2. Motor vehicle crashes
3. Poisoning
4. Falls
5. Homicide

Researchers say the findings demonstrate that suicide is now a global public health issue.

"Our finding that suicide now accounts for more deaths than do traffic crashes echoes similar findings for the European Union, Canada, and China," they write.

Researchers say deaths from unintentional poisoning rose, in part, because of a sharp rise in prescription drug overdoses.

The entire article is here.

President Obama orders VA to expand suicide prevention services

By Rebecca Ruiz
MSNBC.com
Originally published September 1, 2012

President Obama issued an executive order Friday tasking the Department of Veterans Affairs to expand its suicide prevention and mental health services.

Under the order, VA is expected to increase its veteran crisis line by 50 percent by the end of the year; ensure that a veteran in distress is given access to a trained mental health worker in 24 hours or less; and launch a national 12-month suicide prevention campaign to educate veterans about available mental health services.

The order reinforces some initiatives that VA has already undertaken.


In April, VA announced that it would hire 1,600 mental health clinicians to meet surging demand, and the order instructs the agency to use loan repayment programs and scholarships, among other strategies, to recruit those professionals by June 2013.

The entire story is here.

U.S. officials launch new strategy to prevent suicide

Reuters
Originally published September 10, 2012

A new nationwide strategy to prevent suicides, especially among U.S. military veterans and younger Americans, is tapping into Facebook, mobile apps and other technologies as part of a community-driven push to report concerns before someone takes his own life.

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The initiative includes $55.6 million in grant funding for suicide prevention programs.

Suicide is a growing concern and results in the deaths of more than twice as many people on average as homicide, officials said.

On average, about 100 Americans die each day from suicide, officials said. More than 8 million U.S. adults seriously thought about suicide in the last year, according to the Substance Abuse and Mental Health Services Administration.

The entire story is here.

Preventing Suicides in US Service Members and Veterans: Concerns After a Decade of War

By Charles W. Hoge, MD, & Carl A. Castro, PhD
JAMA. 2012;308(7):671-672. doi:10.1001/jama.2012.9955

Before the wars in Iraq and Afghanistan, the incidence of suicide in active duty US service members was consistently 25% lower than that in civilians, attributable to "healthy-worker" effects from career selection factors and universal access to health care.

Between 2005 and 2009, the incidence of suicide in Army and Marine personnel nearly doubled.
From 2009 through the first half of 2012, the incidence of suicide among Army soldiers remained elevated (22 per 100 000 per year), with the number dying of suicide each year exceeding the number killed in action.

High rates of suicide have also been reported for US veterans, although incidence studies in veteran populations have drawn conflicting conclusions.

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"Examining communication strategies is also critical. Stigmatizing attitudes may be unwittingly reflected in cliches, such as 'zero tolerance' or 'one suicide is one too many,' expressed by well-intentioned VA or military leaders.  These slogans convey an implicit message: suicides are different from any other medical condition, the result of a bad 'choice' by the individual or negligence by peers or leaders.  These types of communications would not be used to describe attitudes toward depression, PTSD, or cancer."

The entire article is here.

Thanks to Ken Pope for this information.

U.S. Army suicides reached record monthly high in July

By Collen Jenkins
Reuters
Originally published August 17, 2012

Twenty-six active-duty soldiers are believed to have committed suicide in July, more than double the number reported for June and the most suicides ever recorded in a month since the U.S. Army began tracking detailed statistics on such deaths.

During the first seven months of this year, there were 116 suspected suicides among active-duty soldiers, compared to 165 suicides for all of last year, the Army said. The military branch reported 12 likely suicides during June.

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"Suicide is the toughest enemy I have faced in my 37 years in the Army," General Lloyd J. Austin III, vice chief of staff of the Army, said in the report released on Thursday.

"To combat it effectively will require sophisticated solutions aimed at helping individuals to build resiliency and strengthen their life coping skills," he said.

The entire story is here.

Means restriction for suicide prevention

The Lancet, Volume 379, Issue 9834, Pages 2393 - 2399, 23 June 2012

doi:10.1016/S0140-6736(12)60521-2

By Yip, et. al

Summary

Limitation of access to lethal methods used for suicide—so-called means restriction—is an important population strategy for suicide prevention. Many empirical studies have shown that such means restriction is effective. Although some individuals might seek other methods, many do not; when they do, the means chosen are less lethal and are associated with fewer deaths than when more dangerous ones are available. We examine how the spread of information about suicide methods through formal and informal media potentially affects the choices that people make when attempting to kill themselves. We also discuss the challenges associated with implementation of means restriction and whether numbers of deaths by suicide are reduced.

Self-harm and suicide in adolescents

The Lancet, Volume 379, Issue 9834, Pages 2373 - 2382, 23 June 2012
by K. Hawton, K. Saunders, and R. O'Connor
Originally published June 23, 2012

Summary

Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Important contributors to self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors. The effects of media and contagion are also important, with the internet having an important contemporary role. Prevention of self-harm and suicide needs both universal measures aimed at young people in general and targeted initiatives focused on high-risk groups. There is little evidence of effectiveness of either psychosocial or pharmacological treatment, with particular controversy surrounding the usefulness of antidepressants. Restriction of access to means for suicide is important. Major challenges include the development of greater understanding of the factors that contribute to self-harm and suicide in young people, especially mechanisms underlying contagion and the effect of new media. The identification of successful prevention initiatives aimed at young people and those at especially high risk, and the establishment of effective treatments for those who self-harm, are paramount needs.

Suicides Outpacing War Deaths for Troops

by Timothy Williams
The New York Times
Originally published on June 8, 2012

The suicide rate among the nation’s active-duty military personnel has spiked this year, eclipsing the number of troops dying in battle and on pace to set a record annual high since the start of the wars in Iraq and Afghanistan more than a decade ago, the Pentagon said Friday.

Suicides have increased even as the United States military has withdrawn from Iraq and stepped up efforts to provide mental health, drug and alcohol, and financial counseling services.
      

The military said Friday that there had been 154 suicides among active-duty troops through Thursday, a rate of nearly one each day this year. The figures were first reported this week by The Associated Press.

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Mr. Rieckhoff attributed the rise in military suicides to too few qualified mental health professionals, aggravated by the stigma of receiving counseling and further compounded by family stresses and financial problems. The unemployment rate among military families is a particular problem, he said.

The entire story is here.

Examination of the Effectiveness of the Mental Health Environment of Care Checklist in Reducing Suicide on Inpatient Mental Health Units

Archives of General Psychiatry
Bradley V. Watts, MD, MPH; Yinong Young-Xu, ScD, MA, MS; Peter D. Mills, PhD, MS; Joseph M. DeRosier, PE, CSP; Jan Kemp, RN, PhD; Brian Shiner, MD, MPH; William E. Duncan, MD, PhD
Arch Gen Psychiatry. 2012;69(6):588-592. doi:10.1001/archgenpsychiatry.2011.1514

Abstract

Objective  To evaluate the effect of identification and abatement of hazards on inpatient suicides in the Veterans Health Administration (VHA).

Design, Setting, and Patients  The effect of implementation of a checklist (the Mental Health Environment of Care Checklist) and abatement process designed to remove suicide hazards from inpatient mental health units in all VHA hospitals was examined by measuring change in the rate of suicides before and after the intervention.

Intervention  Implementation of the Mental Health Environment of Care Checklist.

Results  Implementation of the Mental Health Environment of Care Checklist was associated with a reduction in the rate of completed inpatient suicide in VHA hospitals nationally.

Conclusions  Use of the Mental Health Environment of Care Checklist was associated with a substantial reduction in the inpatient suicide rate occurring on VHA mental health units. Use of the checklist in non-VHA hospitals may be warranted.

The entire article is free here.

Thanks to Ken Pope for this information.

An article about psychologists using checklists to reduce treatment  failure is here.

GPs Reminded to Regularly Assess Depressed Patients for Risk of Suicide

Originally Published on May 4, 2012

The Medical Defence Union

GPs are being advised to ensure patients with depression are regularly assessed for a risk of suicide. The Medical Defence Union (MDU) issued the advice after being notified of a small number of complaints in which GPs were criticised for failing to appreciate that the patient was a suicide risk.

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The MDU's advice for GPs to help them avoid such problems includes:

• Be aware of the current guidance on the treatment of depression, including the role of non-drug interventions.
• Ensure patients understand what is being prescribed and have been warned about the risks involved, any side-effects and alternatives to treatment.
• Have a system in place to review patients on long-term medication.
• All patients who present with depression need to be assessed regularly for risk of suicide.
• Be prepared to refer patients for specialist treatment where necessary and have a system to track referrals.
• Take care with prescriptions for drugs with similar names and with dosages.

The entire story is here.

A Spate of Teenage Suicides Alarms Russians

By Glenn Kates
The New York Times
Originally published April 19, 2012

Russia has been hit with a wave of copycat teenage suicides so pronounced that President Dmitri A. Medvedev felt compelled on Thursday to warn news media outlets against making too much of the deaths, for fear of attracting more imitators.

“It is indeed very alarming and serious, but it does not mean that it is a snowball that will become bigger and bigger every year,” Mr. Medvedev said. “This must be treated extremely gently.”

The spike in teenage suicides began in February, when two 14-year-old girls jumped hand in hand from the 16th-floor roof of an apartment building in suburban Moscow. Afterward, a series of apartment jumps attracted national attention.

Over 24 hours starting on April 9, there were at least six deaths. A girl, 16, jumped from an unfinished hospital in Siberia, while five others hanged themselves: a boy, 15, who died in the city of Perm two days after his mother found him hanging; another 15-year-old, who killed himself on his birthday, in Nizhny Novgorod, a city on the Volga River; teenagers in the northern city of Lomonosov and in Samara; and a 16-year-old murder suspect who used his prison bedsheet to kill himself in Krasnoyarsk.

The entire story is here.

Suicides Highlight Failures of Veterans' Support System

By Aaron Glanz
The New York Times
Originally published March 24, 2012

Francis Guilfoyle, a 55-year-old homeless veteran, drove his 1985 Toyota Camry to the Department of Veterans Affairs campus in Menlo Park early in the morning of Dec. 3, took a stepladder and a rope out of the car, threw the rope over a tree limb and hanged himself.

It was an hour before his body was cut down, according to the county coroner's report.

"When I saw him, my heart just sank," said Dennis Robinson, 51, a formerly homeless Army veteran who discovered Mr. Guilfoyle's body.

"This is supposed to be a safe place where a vet can get help. Something failed him."

Mr. Guilfoyle's death is one of a series of recent suicides by veterans who live in the jurisdiction of the Department of Veterans Affairs Palo Alto Health Care System.

The Palo Alto V.A. is one of the agency's elite campuses, home to the Congressionally chartered National Center for Post-Traumatic Stress Disorder.

The poor record of the Department of Veterans Affairs in decreasing the high suicide rate of veterans has already emerged as a major issue for policy makers and the judiciary.

On Wednesday, the V.A. Inspector General in Washington released the results of a nine-month investigation into the May 2010 death of another veteran, William Hamilton.

The report said social workers at the department in Palo Alto made "no attempt" to ensure that Hamilton, a mentally ill 26-year-old who served in Iraq, was hospitalized at a department facility in the days before he killed himself by stepping in front of a train in Modesto.

The story is here.

Preventing Suicide on Campus May Mean Fences and Nets as Well as Counseling

Chronicle of Higher Education

By Michael Stratford

Originally published March 25, 2012

The families of students who die by suicide often seek to hold colleges responsible.

Lawsuits typically claim that an institution failed to pick up on warning signs or to adequately protect a student whom campus officials knew to be suicidal.

Far less often does a legal action cite, say, the absence of fences on a bridge.

But a lawsuit now pending against Cornell University in federal court takes that approach: It argues that the institution didn't do enough to restrict access to a particular means of suicide.

Specifically, Howard I. Ginsburg alleges that Cornell was negligent for not having installed barriers on the campus bridge where, in February 2010, his son, Bradley, jumped to his death.

A judge this month rejected the university's effort to have the suit dismissed, ruling that the case could continue.

Limiting access to certain methods of suicide, a strategy known as means restriction, has been gaining traction among mental-health researchers.

Some suicides can be prevented, the logic goes, if it's more challenging for an impulsive individual to harm himself.

But on most campuses, that strategy has not taken hold.

 Instead, counseling and education tend to be the centerpiece of suicide-prevention efforts.

 Only at a few institutions, mainly where students' suicides have made headlines in recent years--like Cornell, New York University, and the Massachusetts Institute of Technology--have administrators acted, beyond locking doors to roofs, to significantly alter physical elements of the campus in the name of prevention.

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For not taking steps to block bridge suicides, the lawsuit says, both Cornell and the city were "negligent, careless, and reckless in failing to provide for safety and protection for vulnerable or impulsive individuals."

University and city officials, Mr. Ginsburg argues, knew that area bridges were a recurring site of suicides and therefore had an obligation to restrict access to them.

Cornell says it is "vigorously" fighting the suit, which Mr. Ginsburg filed in November.

The entire story is here.

A subscription to Chronicle of Higher Education is needed for the full article.

Thanks to Ken Pope for this information.

Counseling Conflict

By Allie Grasgreen
Inside Higher Ed
Originally published March 26, 2012

Georgia State University’s decision this month to replace its counseling center staff with outsourced employees is worrying those in the field, who say such moves are extremely rare and will likely prove detrimental to the mental health services available to students.

The shift is doubly troubling because a number of former staff members (as well as others in the field) are accusing the university of outsourcing services as a retaliation for their complaints that some university policies involving the counseling center had the potential to hurt students. While the outsourcing was announced shortly after the complaints were made, the university says there was no relationship between the two developments. The director and two associate directors will stay on as full-time employees of Georgia State, spokeswoman Andrea Jones said.

The university says it replaced its nine counseling center clinical positions (three of which were vacant) with contracted employees “in order to increase institutional effectiveness in delivering mental health services to students.”

Because the staff were eliminated through a “reduction in force” process, which is done without regard to an employee’s performance, the change could not have been retaliatory, Jones said. The new model will mimic that of Georgia State’s psychiatry services and health center (both of which commonly use independent contractors).

The entire story is here.

Suicide, Mental Illness Climb in Military

By Kristina Fiore, Staff Writer

MedPage Today

Published: March 07, 2012

Just one ambulatory visit for a mental health disorder may warn that a soldier is at risk for suicide, researchers said.

Those who sought such help were about four times more likely to commit suicide than those who had not made any mental health visits (RR 3.9, 95% CI 3.0 to 4.9), Michelle Canham-Chervak, PhD, of the Injury Prevention Program of the U.S. Army Public Health Command, and colleagues reported online in Injury Prevention.

Patients who were hospitalized with mental illness had more than a 15-fold higher risk of suicide than those not hospitalized (RR 15.5, 95% CI 11.2 to 21.5).

"Soldiers seeking treatment for mental disorders and substance abuse should be a focus for suicide prevention," they wrote.

Soldier suicides have been on the rise since 2004, a trend that has been paralleled by increases in mental illness. In 2008, suicide rates among soldiers surpassed civilian rates that were adjusted for characteristics of a military population, including male gender and younger age (20 per 100,000 versus 18 per 100,000).

Although suicide has long been one of the leading causes of death among those in the military, army operations between 2004 and 2008 -- including the major commitment of troops to Iraq as well as continuing operations in Afghanistan -- likely affected the nature and extent of mental health problems, the researchers said.

To assess the associations between suicide and mental health disorders, Canham-Chervak and colleagues looked at U.S. military data from 2007-2008, during which time 255 soldiers committed suicide.

Factors associated with a higher suicide risk included being male, younger, and Caucasian, as well as having a lower enlisted rank.

The entire story is here.

Suicidal Ideation and Self-Harm in LGBT Youth

Medical News Today
Originally published February 16, 2012

What protects lesbian, gay, bisexual and transgender (LGBT) youths from considering suicide and, conversely, what makes them most vulnerable to it?

The question is of paramount concern because these youths are at least twice as likely to attempt suicide than heterosexual youths, prompting the national "It Gets Better Project" with encouraging video messages from such public figures as Lady Gaga and President Barack Obama.

Now the first longitudinal study to look at suicide ideation and self-harm in this population shows support from friends and family offers the most protection in preventing youths from thinking about suicide. Adolescents who know they can talk to their parents about problems and know they have friends who care about them are less likely to consider ending their lives, according to new Northwestern Medicine research.

Adolescents most likely to consider killing themselves and engage in self-harm behaviors are those who feel victimized for being gay. About 94 percent of LGBT youths have had at least one experience in which people said cruel things to them, spit on them, destroyed their property and threatened or assaulted them - all related to them being gay, according to prior Northwestern research.

Suicidal thoughts are a key predictor of a suicide attempt. Cutting behaviors also are a risk factor.

Previous studies of LGBT adolescents looked at their risk of making suicide attempts, not predictors that make them vulnerable to it or protect them from it.

"Our research shows how critical it is for these young people to have social support and for schools to have programs to reduce bullying," said Brian Mustanski, associate professor of medical social sciences at Northwestern University Feinberg School of Medicine. "We believe this will help save young lives."

The entire story is here.

The research article is here.

Marine Fights Conviction for Suicide Attempt

Pvt. Lazzaric T. Caldwell

Associated Press
Originally Published February 3, 2012

HAGERSTOWN, Md. - A discharged Marine private who slit his wrists in a suicide attempt is fighting his military conviction for deliberately injuring himself, arguing the punishment is inconsistent with the armed forces' efforts to battle a rise in suicides during the wars in Iraq and Afghanistan.

It's not clear how often the Marines or any other service branch prosecute active duty members for trying to kill themselves. But the defense lawyer for Pvt. Lazzaric T. Caldwell says it's wrong to punish service members with mental health problems for genuine suicide attempts. Suicide prevention has become a priority across the military as numbers climbed in the past decade with the increasing stress of combat and multiple deployments in the wars.

Caldwell, 25, of Camp Pendleton, Calif., never deployed to a war zone but was diagnosed in 2009 with post-traumatic stress disorder and a personality disorder, according to court records. In 2010, he slashed his wrists in his barracks at Camp Schwab in Okinawa, Japan.

He pleaded guilty at a court-martial that year to "intentional self-injury without intent to avoid service," a criminal charge that the government says helps maintain good order and discipline in the armed forces. The charge is sometimes used in self-injury cases when there isn't enough evidence to prove malingering, military justice experts say.

Caldwell was sentenced to 180 days in jail and a bad conduct discharge. Military rules allow an appeal after a guilty plea in some cases, but Caldwell's initial appeal to the Navy-Marine Corps Court of Criminal Appeals was denied in December. His lawyer, Navy Lt. Mike Hanzel, said this week he will ask the military's highest court, the U.S. Court of Appeals for the Armed Forces in Washington, to hear the case.

"I think it definitely touches important issues which are affecting all the branches of the armed forces right now," Hanzel said in a telephone interview from Bremerton, Wash.

Military prosecutors didn't immediately respond to requests for comment on the case. In an appellate brief, the government stated that Caldwell "was not charged with, or convicted of, attempting suicide. He was charged with, and properly convicted of, intentionally injuring himself to the prejudice of good order and discipline or the discredit of the service."

The entire story is here.

Facebook aims to help prevent suicide

By BROOKE DONALD
The Associated Press

A program launching Tuesday (December 13, 2011) enables users to instantly connect with a crisis counselor through Facebook's "chat" messaging system.

The service is the latest tool from Facebook aimed at improving safety on its site, which has more than 800 million users. Earlier this year, Facebook announced changes to how users report bullying, offensive content and fake profiles.

"One of the big goals here is to get the person in distress into the right help as soon as possible," Fred Wolens, public policy manager at Facebook, told The Associated Press.
Google and Yahoo have long provided the phone number to the National Suicide Prevention Lifeline as the first result when someone searches for "suicide" using their sites. Through email, Facebook also directed users to the hotline or encouraged friends to call law enforcement if they perceived someone was about to do harm.

The new service goes a step further by enabling an instant chat session that experts say can make all the difference with someone seeking help.

"The science shows that people experience reductions in suicidal thinking when there is quick intervention," said Lidia Bernik, associate project director of Lifeline. "We've heard from many people who say they want to talk to someone but don't want to call. Instant message is perfect for that."

How the service works is if a friend spots a suicidal thought on someone's page, he can report it to Facebook by clicking a link next to the comment. Facebook then sends an email to the person who posted the suicidal comment encouraging them to call the hotline or click on a link to begin a confidential chat.

Facebook on its own doesn't troll the site for suicidal expressions, Wolens said. Logistically it would be far too difficult with so many users and so many comments that could be misinterpreted by a computer algorithm.

"The only people who will have a really good idea of what's going on is your friends so we're encouraging them to speak up and giving them an easy and quick way to get help," Wolens said.

The entire story can be found here.

Many Suicidal Teens Make First Try Before High School

By Molly McElroy

News and Information

University of Washington

Thoughts about killing oneself and engaging in suicidal behavior may begin much younger than previously thought. While about one of nine youths attempt suicide by the time they graduate from high school, new findings reveal that a significant proportion make their first suicide attempt in elementary or middle school.

In a study published in the November issue of the Journal of Adolescent Health, nearly 40 percent of young adults who said they had tried suicide said that they made their first attempt before entering high school.

The researchers also found that suicide attempts during childhood and adolescence were linked to higher scores of depression at the time of the attempts, validating for the first time that young adults can reliably recall when they first attempted suicide.

“Young adults who end up having chronic mental health problems show their struggles early,” said James Mazza, lead author and professor of educational psychology at the University of Washington. “This study suggests that implementation of mental health programs may need to start in elementary and middle schools, and that youth in these grades are fairly good reporters of their own mental health.”

Adolescence can often be a struggle for some youth with ongoing pressures of drugs, alcohol, sexual relationships and sexual orientation. At the same time, they’re becoming more autonomous.

The entire press release is here.