More investment needed for suicide research
The National Institutes of Health allocates an average of $304 million annually for research on hypertension, which kills 56,000 Americans each year.
But the amount of money dedicated to researching suicide, the 10th leading cause of death in the U.S., lags far behind other such high-profile conditions.
More than 41,000 Americans died by suicide in 2013, according to the U.S. Centers for Disease Control’s National Vital Statistics Report. Yet only $72 million per year is spent on suicide research, despite it being one of the most preventable causes of death, according to a new report from the National Action Alliance for Suicide Prevention.
Seventy percent of suicide studies conducted during the six-year span covered by the report, “U.S. National Suicide Prevention Research Efforts: 2008-2013 Portfolio Analyses,” were funded by the federal government with the remainder supported by private foundations.
Top funding agencies were the NIH, Department of Defense and the Department of Veterans Affairs. The American Foundation for Suicide Prevention funded about 25 percent of the research examined in the alliance’s report.
Of 383 studies identified in the report, the largest proportion – about 41 percent – aimed to better understand why people become suicidal. About a third examined interventions to prevent suicidal behavior.
A lack of empirically tested intervention methods poses a challenge for those who administer resources for suicide prevention efforts. Just ask Alan Holmlund, director of the Massachusetts Department of Health’s Suicide Prevention Program and Injury Prevention and Control Program. In fiscal 2015, Holmlund’s office awarded $1.24 million to community-based organizations that provide trauma-informed and culturally appropriate suicide prevention services in the Bay State.
“We spend a lot of resources in the area of education and training,” Holmlund said. “I think we know that it increases knowledge and it increases people’s confidence in approaching someone that they feel is suicidal but I do think we need more research in that area. What works best? What training works best? Are we talking an hour? Are we talking a half-day? Are we talking, for instance, an emphasis on mental illness in general or should we be concentrating more on signs of suicide?”
The alliance’s report acknowledged “thoughtful investments by funders” resulting in 26 studies on ways to detect or predict suicide risk.
“To date, the research that I’m aware of basically says that mental health clinicians don’t predict much better than chance so what we do in general is over predict risk,” said Christopher Matkovic, M.D., director of psychiatric emergency services at Rhode Island Hospital in Providence and a clinical assistant professor of psychiatry and human behavior at Brown University’s Warren Alpert Medical School.
Half of the nearly 4,000 adult patients referred to Rhode Island Hospital’s psychiatric emergency services last year exhibited suicidal ideation, Matkovic said.
“We’re aware of risk factors. Those are easy to collect, such as age, sex, social context, psychological context, psychiatric diagnosis. So we wind up holding people inpatient probably more than people need to be, disrupting their lives in the ways that holding someone in an inpatient unit would,” Matkovic said.
“I would love to see or have some tool at my disposal that would tell me with greater accuracy whether or not what I’m doing is necessary and even helpful.”
Risk is not static, said psychologist Shirley Yen, Ph.D., associate professor in the department of psychiatry and human behavior at Brown University’s Warren Alpert Medical School, and a principal investigator for two National Institute of Mental Health funded studies of interventions for suicidal adolescents who have been admitted to an inpatient psychiatric unit because of suicide risk.
“We can identify the individuals who might be at high risk but someone at high risk is not always at high risk,” Yen said.
Yen said a large proportion of people who die by suicide were not known to have made a previous attempt and thus were not identified by the mental health system.
“We are in a system where we wait for people to come to us. There are many people who have died of suicide, who were not identified as at-risk individuals, and in which there were no evident warning signs,” Yen said.
Holmlund would like to see more research on what interventions are most effective in preventing suicidal behavior, especially among white, middle-age men, who are driving the rise in suicide deaths. From 2006-2010, the average annual age-adjusted suicide rate in Massachusetts was 13.4 per 100,000 among white, non-Hispanic males, compared to the overall rate of 8.3 per 100,000 people. Most suicides occurred among individuals aged 34-44 and 45-54.
“We have some indications that there are psychological therapies like cognitive behavior therapy and dialectical behavior therapy that are quite effective with people who are feeling suicidal, and that’s useful,” Holmlund said. “But in order to get people to that point where they are receiving services, how do you get them there?”
Holmlund continued: “The white middle aged males, they’re too independent. They’re too, ‘I can get through this myself. I don’t need help’ kind of thing and we’re looking for ways to look at that.”
Yen said she was pleased to see the alliance’s report draw public attention to the low funding suicide receives relative to other mortality causes.
“I think we need to have a balanced portfolio so we don’t overinvest in one area at the expense of another area,” Yen said.