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Reducing Suicide: A National Imperative
Treatment and Prevention
Pharmacotherapy and psychotherapy can be effective in preventing suicide. Continued contact with a health care provider has been shown to be effective in reducing the risk of suicide, especially in the early weeks after discharge from a hospital. However, psychological autopsy studies and toxicological analyses indicate that many people who complete suicides are not under treatment for mental illness at the time of death. Accurate information on treatment utilization by persons at risk for suicidal behavior, efficacy or effectiveness of existing interventions and cost of treatment are not possible without accurate assessment of suicidal behaviors. Data on the reasons for under-treatment must be used to design corrective programs.
Several prevention programs have been developed that look promising. However, many prevention programs do not have the long-term funding that would allow them to assess reduction in the completion of suicide as an endpoint. The low base rate of suicide, combined with the short duration of assessment and the relatively small populations under study make it difficult to acquire sufficient power for such trials. As described in Chapter 10, to assess the incidence of suicide in a general population where the rates are between 5 and 15 per 100,000 with a 90 percent confidence requires almost 100,000 participants. These populations can only be recruited through large nationally coordinated efforts.
Extensive epidemiological data describe the suicide rates among various populations. The rates of suicide in the United States are exceptionally high in white males over 75 years of age, Native Americans, and certain professions, including dentists. Studies from across the world find higher rates of suicide in rural areas as compared to urban ones. Much is known about the general trends, but no data set provides a picture of evolving risk and protective factors at the national level. Globally, a million suicides are estimated to occur each year, but there is no coordinated effort to understand responsible factors or reduce the death toll. Major changes in rates of youth suicide remain unexplained. Population laboratories could provide data on a much larger population.
While each center might be able to obtain a sufficiently large sample for studies in the general population, a consortium of centers will be necessary to fully explore differences based on region, economic environment, culture, urbanization, and other factors that vary across the country. Furthermore, certain subpopulations may be sufficiently small or low risk to require broader recruitment than one center could access. For these