The
period of highest risk is during the first six months after the onset of a
physical or mental illness
By Jitender
Sareen
Expert Advisor EvidenceNetwork.ca
WINNIPEG, MB/ Troy
Media/ - The death of comedian Robin Williams last month sparked a worldwide
discussion about suicide, its underlying causes and how it might be
prevented.
And, with World
Suicide Prevention Day taking place Sept. 10, the subject is certain to generate
more debate as people seek to understand this important health issue.
Having spent 10 years
researching the subject while working as a professor of psychiatry, I believe
there are things we can do as a community to tackle this problem. With that in
mind, I thought it might be helpful to reflect on what researchers have learned
over the years about strategies for preventing suicide.
First, it is
important to understand suicide, like other medical conditions such as cancer
and heart disease, is complex. There is no singular cause of suicide. People who
attempt or die by suicide often have stories of adverse childhood experiences,
onset of depression, anxiety, substance use problems, loss of social support,
financial stress, medical problems and impulsive/aggressive personality style.
Our work in First Nations communities has also demonstrated the importance of
loss of culture, residential school trauma and racism as a risk for suicide
behaviour.
Yet, the majority of
people who experience many of these issues do not die by suicide or attempt
suicide. Why does one person attempt suicide while another person with the same
stressor does not? This question remains unanswered.
Generally speaking,
most suicide prevention programs take a broad public-health approach with a view
to reducing everyone's risk for suicide.
For example,
increasing awareness of suicide and the importance of getting appropriate
treatment to reduce suicidal behaviour is an important goal of World Suicide
Prevention Day. Other promising community level initiatives include
positive-parenting programs and school-based programs such as the Good Behaviour
Game, which involves teams of students competing for points based on how they
act in class.
Reducing access to
lethal means such as firearms, pesticides, carbon monoxide and quantities of
medications has been shown to be associated with reduced suicide. Fifteen years
ago, the United Kingdom moved to limit acetaminophen to 28 tablets per bottle.
Since then, there has been a reduction in overdose death related to
acetaminophen in the UK, without a commiserate increase in suicide with another
method. In Manitoba, researchers are examining whether similar action may reduce
the risk of suicide and unintentional overdose deaths in this
province.
There is a strong
adverse relationship between childhood experiences (sexual abuse, physical
abuse) and suicidal behaviour. Thus, positive-parenting programs, and
culturally-grounded interventions to improve parent-child relationships are
important.
Families bereaved by
suicide often struggle with guilt, anxiety and depression. Interventions to help
families cope with family members who are struggling with suicidal behaviour are
required. I have always been surprised that a public health nurse comes to the
new mother's home to ensure that the mom and baby are doing well. But when there
is a suicide in a family, there is no outreach to see how the family is doing
after this awful event. We are considering pilot testing the utility of such an
outreach program.
At the individual
level, the period of highest risk for suicide is during the first six months
after the onset of a physical or mental illness. Increasing access to crisis
services and evidence-based treatments for depression, anxiety, psychosis and
substance use disorders have shown to be associated with reductions in suicide.
There is strong evidence improving primary-care physician education in the
assessment and treatment of depression reduces suicide. Specialized
mental-health teams that focus on mental-health problems and addictions are
extremely important in suicide prevention.
In short, there is
rapid advancement in the knowledge of suicide prevention and there is a need for
an evaluation of promising new programs for suicide prevention.
Dr. Jitender
Sareen is an expert advisor with EvidenceNetwork.ca, professor of psychiatry at
the University of Manitoba and team leader of the Manitoba Population Mental
Health Research Group. |
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Wednesday, September 10, 2014
How communities can work together to prevent suicide
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