WHAT CAN WE DO ABOUT SUICIDE?

Dr. Igor Galynker, who is the director of the Galynker Suicide Research Laboratory at the Icahn School of Medicine at Mount Sinai in NYC was quoted in Clinical Psychiatry News [Vol 46 No 8 August 2018] stating that "using suicidal ideation as a risk factor [for suicide] is flawed" as this will miss 75% of people who end up dying by suicide. He recommends using the patient's feeling entrapped and the clinicians own sense of the patient being at risk, instead. Dr. Galynker also noted that while hospitalizing suicidal patients can help them to feel more in control and mobilize support systems there is still a spike in suicides after hospitalization [250 x for women and 100 x for men]. Dr. Galynker also notes that according to the CDC, the suicide rate has been increasing since 2000 and has been increasing by 2% per year from 2006-2016. Additionally, Dr. Galynker also notes that suicide intent was disclosed by less than 25% of people who completed suicide. However, Dr. Galynker does see a benefit for safety planning such as limiting access to firearms, nets under bridges and smaller quantities of medications. He also mentions risk factors such as romantic rejection, terminal illness and humiliating failures in buisiness.

David Brent, M.D. in a paper entitled "Preventing Youth Suicide: Time to Ask How" in the Journal of the American Academy of Child Psychiatry.2010.09.017 identifies several risk factors for youth to become suicidal. These include: mood disorder, especially if linked with non-affective comorbidities [conduct disorder; substance abuse; etc.]; a previous suicide attempt, especially if the child is still depressed and suicidal; suicidal ideation combined with alcohol or substance abuse; other family members having been suicidal or completed suicide; family adversity such as abuse; and parental criticism for youth that are already self-critical [work by Wedig and Nock in the Journal of the American Academy of Child and Adolescent Psychiatry. 2007;46[9]:1171-1178 and in the same journal Nock. 2009;48:237-239].

Also, in the AACAP News [September/October 2018. Volume 49; Issue 5] Tracy Asamoah, M.D. writes about "Suicide in African Americans." She indicates that the rate for suicide in African American children had increased from ages 5-11 while it had decreased for white children [JAMA Pediatrics. 2012;169;673-677]. Also, the CDC Data and Statistics Fatal Injury Report for 2016 showed that while suicide rates for African American youth was less than that for white youth, the rate of increase in suicides was greater for African American youth. Primary factors for this include the under recognition of mental illness in these youth as problem behaviors are more likely to be punished versus treated, and the lack of resources for these youth in underserved communitieis.   

Wedig and Nock identified a risk factor and the possibility of an interventional approach to reduce the risk. Clearly reducing risk for suicide is important as well as efforts that focus on prevention of suicidal behaviors. Access to mental health treatment can reduce the risk of suicide. This will require that mental illness in African-American youth be recognized instead of seeing their behaviors as criminal and requiring punishment. In addition, access to preventative mental health services and screening tools can help reduce the suicidal behavior.  Unfortunately, these services are less available in underserved communities that have a higher percentage of African-American youth.

Finally, a study from 2016 [Walker R, et al. A Longitudinal Study of Racial Discrimination and Risk for Death Ideation in African American Youth. Suicide and Life-Threatening Behavior. 2016; 47: 86-102] found that experiencing racial discrimination was correlated with death ideation and depressive and anxiety symptoms. Therefore, it is important to be aware of the impact of racial discrimination and disenfranchisement on risk for suicidal thought and also on the access to mental health services. This highlights the critical role that supporting families and extended families and local communities as they will help to empower youth, who are at risk for suicidal behavior, to seek and make use of treatments.

What do you think?