Editorial: Making Suicide Prevention Part of the National Conversation

Dr. Regina Benjamin, the U.S. surgeon general, recently released a statement about the urgency of addressing suicide prevention in this country. Her message is important, and discussing these issues is in everyone’s best interests.

The most valuable resources on suicide prevention came from an Institute of Medicine report about 10 years ago. The report, by the IOM’s Committee on Psychopathology and Prevention of Adolescent and Adult Suicide, is called "Reducing Suicide: A National Perspective." Like all IOM reports, the science was culled from all the rigorous science in Western literature. Unfortunately, like most IOM reports, this one had too much science and was too scholarly to be read by the public or most people interested in suicide prevention.

This report highlighted two important points that should have directed the field of suicide prevention. First, epidemiologic studies indicate that 20,000/100,000 people get depressed; second, we have recently learned that about 5,000/100,000 people attempt suicide; and finally, the suicide rates run about 11/100,000 people, and 20/100,000 adolescents. In addition, 65/100,000 white males over 85 complete suicide.

Thus, we have a huge paradox: – Suicide is the third-leading cause of death in teens, but how do we identify the 20/100,000 teens who will tragically kill themselves out of the 5,000 attempters, much less the 20,000 depressed youth?

Because suicide is such a "rare event," the report notes that in order to have any solid scientific evidence that suicide prevention interventions work, we would need to test the intervention in a population of 600,000 people – and that study has yet to be done.

The other important point from the decade-old IOM report is that we should be paying more attention to what is protecting the majority of 5,000 people who have attempted suicide from completing suicide, which illustrates what I consider to be one of the most valuable concepts in preventive medicine: "risk factors are not predictive factors due to protective factors."

Furthermore, it makes sense that, while we are looking for the "needle in the haystack," we also need to explore how to strengthen protective factors around vulnerable people. Dr. Benjamin notes the most vulnerable – people who have signs and symptoms of depression, bipolar disorder, anxiety disorders, and substance abuse – do not receive help. While I agree, it is also abundantly clear to me that we now have solid evidence showing that many of these problems can be prevented ("Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities") [Washington: National Academies Press, 2009]. We need to realize this as well.

These newer ways of looking at the issue of suicide prevention and these concepts are beginning to gain traction. The Substance Abuse and Mental Health Services Administration "gets it" and is taking steps to put this knowledge into practice – despite the National Institute of Mental Health’s lack of serious attention to prevention ("NIMH Needs Stronger Prevention Focus," Clinical Psychiatry News, February 2011, p. 19).

Dr. Benjamin also highlighted the role of the media in reporting on suicide, and I also applaud her for making that point. The research is clear: If the mainstream media glamorizes suicide, the risk of contagion, or "copy cat" suicides, is heightened. However, I wish the science were clear enough to also show that the media’s coverage of "suicide preceded by mass murder" also is prone to contagion. My impression is that many of the mass murders we have been seeing in schools and other highly populated sites actually are suicide missions designed to capture the media’s attention. Thus, these incidents are driven by the same phenomena of contagion. Unfortunately, because media is now so omnipresent, it is scientifically difficult to prove contagion like sociologist David P. Phillips, Ph.D., did in the 1970s, when print dominated the media landscape (Am. Sociol. Rev. 1974;39:340-54).

Of course, the other problem is that the public is charmed by "media epidemiology." Thus, the public does not understand that when the media catastrophizes a tragic event like a suicide, it encourages contagion. Furthermore, if the event is a disaster (natural or man-made), hope, resiliency, and protective factors can be dampened because of the mainstream media’s "if it bleeds, it leads" marketing approach to news. So the media focuses on getting high Nielsen ratings and ranking high in Google search results – instead of making sure that stories provide a scientific context and that the public is engaged to find proactive solutions to problems.

Western medicine and public health need to begin to study what makes most of us – despite our depression – resistant to suicide. As Dr. Benjamin is leading the nation’s first National Prevention, Health Promotion, and Public Health Council, I suspect that she is very aware of this need. Kudos.