Introduction
Each year, approximately 30,000 Americans die by suicide — outnumbering homicides and deaths from HIV/AIDS. Suicide is the leading cause of violent death in the world, claiming almost a million lives each year, more than homicide and armed conflict combined. In the United States, suicide is the third-leading cause of death for individuals between the ages of 10 and 24. It claims more than 4,000 young lives annually.
During the last 10 years, significant headway has been made in drawing attention to this public health problem and garnering support for prevention initiatives.
Suicide has been recognized as a serious public health problem in a number of reports, including:
In 1997, the U.S. Congress passed resolutions in both chambers recognizing suicide as a national problem and priority. These resolutions led to a number of suicide prevention initiatives on the part of the federal government led by the Centers for Disease Control and Prevention (CDC), the National Institute of Mental Health (NIMH), the Indian Health Service (IHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
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Resources for physicians
Physicians can find a range of resources to help them recognize and respond when a patient is exhibiting early warning signs of a tendency toward suicide. One of the best such resources is the Suicide Prevention Resource Center, the federally-funded center that provides technical assistance to states and communities engaged in suicide prevention.
Primary care physicians and other health care providers are highly likely to see patients who are depressed and may be at risk of suicide. Most people who complete suicide signal their intention to do so before ending their lives, and they often display these distress signals to their doctors. A substantial number of elderly people who die by suicide contact their primary care physicians within a month before their death.
Successful intervention by a physician depends on the physician's ability to recognize the warning signs of suicide and to make sure that the patient receives immediate and appropriate care.
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Risk factors
Biopsychosocial risk factors
- Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders, and certain personality disorders
- Alcohol and other substance use disorders
- Hopelessness
- Impulsive or aggressive tendencies
- History of trauma or abuse
- Some major physical illnesses
- Previous suicide attempt
- Family history of suicide
Environmental risk factors
- Job or financial loss
- Relational or social loss
- Easy access to lethal means
- Local clusters of suicide that have a contagious influence
Socialcultural risk factors
- Lack of social support and sense of isolation
- Stigma associated with help-seeking behavior
- Barriers to accessing health care, especially mental health and substance abuse treatment
- Certain cultural and religious beliefs (for instance, the belief that suicide is a noble resolution of a personal dilemma)
- Exposure to, including through the media, and influence of others who have died by suicide
Protective factors against suicide
- Effective clinical care for mental, physical, and substance use disorders
- Easy access to a variety of clinical interventions and support for help-seeking
- Restricted access to highly lethal means of suicide
- Strong connections to family and community support
- Support through ongoing medical and mental health care relationships
- Skills in problem solving, conflict resolution, and nonviolent handling of disputes
- Cultural and religious beliefs that discourage suicide and support self-preservation
(Source: National Strategy for Suicide Prevention: Goals and Objectives for Action. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 2001.)
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Prevention programs
At their most basic, prevention programs attempt to address and mitigate risk factors while enhancing protective factors.
Those programs that best integrate prevention at the multiple levels of universal, selective, and indicated intervention have demonstrated the most success. Yet, it is essential to note that some programs may succeed only with certain types of populations and under certain circumstances.
For example, the Air Force has established a widely-praised model program that has been quite successful in removing barriers to treatment, enhancing knowledge, attitudes and community competencies, and increasing access to support for those at risk. However, it has been implemented within a select and well-defined military community.
A reduction in the availability or lethality of a suicidal method does result in a decline in suicide incidence by that method. Comprehensive school-based programs have also demonstrated some success in overall suicide rate reduction.
The lack of longitudinal and prospective studies, however, are a critical barrier to a better understanding and prevention of suicidal behavior.
To learn more about prevention programs, visit the Evidence-Based Practices Registry of the Suicide Prevention Resource Center.
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Mobilizing support for suicide prevention
Despite the tragic impact of suicide on our nation, suicide prevention has received little attention and funding when compared to many other public health problems.
The Suicide Prevention Action Network USA (SPAN USA) is a nonprofit organization dedicated to preventing suicide through public education, community action, and federal, state, and local grassroots advocacy.
Formed in 1996 to mobilize support for the development of a national strategy to address suicide in the United States, SPAN USA is the nation's only suicide prevention organization dedicated to leveraging grassroots support among those touched by suicide to advance public policies that help prevent suicide.
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