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Summer/Fall 2002 Vol. 2 No. 2

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©West Stock Inc. Suicidal Tendencies

Curbing the Nation's Suicide Rate

In popular culture, suicide is sometimes romanticized as the tragic result of a broken heart or troubled spirit. It is even portrayed as gutsy, as in the movie "Thelma and Louise" when the lead characters decide to drive off a cliff rather than face the police.

However, suicide is anything but fictional melodrama. Every year about 30,000 Americans kill themselves -- more than the average number of homicides. Overall, suicide is the 11th-leading cause of death for Americans, and the third-leading cause of death for those between the ages of 15 and 24, government statistics show. Emergency rooms annually treat 650,000 people after they attempt to take their own lives. But despite its prevalence and impacts, efforts to reduce suicide have lacked the serious national attention afforded other major public health issues.

Research efforts and prevention programs have offered some insights into factors that increase or decrease the risk of suicide, but a dearth of information hampers the nation's ability to fully understand the problem and craft solutions. To that end, a new report from the Institute of Medicine puts forth a blueprint for research designed to fill in the data gaps. Many questions about suicide remain unanswered because the appropriate infrastructure to adequately address them is lacking. The report calls for the creation of a national network of laboratories geared to perform large-sample studies through a multidisciplinary approach. A consortium of labs would allow exploration of differences in risk and protective factors across regions, economic classes, and other variables, and would serve as a central repository of suicide data. Similar approaches already have been taken with cancer and Alzheimer's disease research, both of which have benefited from dedicated research centers.

What existing data do show is that the majority of suicidal people visit a doctor in the months or weeks before their deaths. Physicians and nurses often are these individuals' first and only medical contact. Primary care providers could serve as a front-line intervention force to steer at-risk patients into treatment. Reluctance among primary care providers to discuss suicide risk factors with patients could be eased through training that incorporates study of suicidal behavior.

Few treatment and prevention programs have had the capacity to conduct long-term evaluations of their efficacy. However, the report highlights examples of prevention programs that seem to be effective. The U.S. Air Force's program, for example, appears to have reduced suicide rates in its community by increasing access to treatment and support and reshaping attitudes about suicide. More work needs to be done to determine whether programs like this can be expanded to other populations.    --Christine Stencel

Reducing Suicide: A National Imperative. Committee on Pathophysiology and Prevention of Adolescent and Adult Suicide, Board on Neuroscience and Behavioral Health, Institute of Medicine (2002, 516 pp.; ISBN 0-309-08321-4; available from the National Academies Press, tel. 1-800-624-6242; $59.95 plus $4.50 shipping for single copies).

The committee was co-chaired by William E. Bunney Jr., Della Martin Chair of Psychiatry, department of psychiatry and human behavior, University of California, Irvine; and Arthur M. Kleinman, Maude and Lillian Presley Professor of Medical Anthropology, Harvard University School of Medicine. The study was sponsored by the U.S. Department of Health and Human Services and the U.S. Department of Veterans Affairs.

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Copyright 2002 by the National Academy of Sciences