NIH Panel Unveils New Plan to Stop Youth Suicide

Megan Brooks

October 06, 2016

Advancing youth suicide prevention in the United States will take improved data systems, enhanced data collection and analysis methods, and better coordination between researchers and clinicians, says a National Institutes of Health (NIH) working group.

Providers and stakeholders need to "partner with the research community to provide the data that they need and partner with the greater community to open communication among all agencies from schools, to churches, to police stations, to after school programs, to social programs," Todd D. Little, PhD, of Texas Tech University in Lubbock, and member of the working group, told Medscape Medical News.

"A coordinated and concerted effort to tie all data sources together will give us the information we need to identify those at risk and ways to intervene," Dr Little added.

The report was published online October 4 in Annals of Internal Medicine.

A Leading Cause of Death

Suicide is the second leading cause of death in young people aged 10 to 24 years and young adults aged 25 to 34 years. In 2014, more than 12,000 persons in these age brackets died by suicide.

"Although prevention is daunting, the obstacles created by the complex factors involved in suicide are surmountable. New coordinated research strategies that embrace this complexity are necessary," the working group writes.

To address these issues, the NIH convened in March 2016 the Pathways to Prevention Workshop: Advancing Research to Prevent Youth Suicide. The panel of independent experts summarized youth suicide prevention efforts and explored strategies to guide future research.

The working group's recommendations include the following:

  • Developing and implementing standardized measures generalizable across settings, communities, and cultures to identify high-risk persons.

  • Mandating use of cause-of-injury codes to identify suicides and suicide attempts that require medical attention.

  • Expanding surveillance of suicide and suicide attempts by linking data from multiple sources, including state all-payer databases, emergency departments, electronic health records, health information exchanges, accountable care organizations, and the research setting.

  • Encouraging and facilitating efforts to document implementation and measurement details (code books and data dictionaries).

The working group also provides recommendations for improving how studies are designed and results analyzed. They advocate cross-sector collaboration, as well as education, training, and dissemination of research findings, to build and strengthen the research and clinical care communities.

"As researchers and practitioners, we must unite to stop youth suicide in order to circumvent its associated economic cost and devastating pain and suffering," Dr Little and colleagues write.

"We must build and strengthen both coordination and collaboration among all members of the larger policy, practice, and research communities. We need to improve and coordinate the various surveillance and administrative data systems across these sectors. We must also elevate the level of rigor and breadth of methods used in studies of suicidal behavior," they add.

The recommendations of the NIH workshop provide "a roadmap to our ultimate goal — eliminating suicide," they conclude.

Untapped Potential

In a companion article, Holly C. Wilcox, PhD, of Johns Hopkins School of Medicine in Baltimore, Maryland, and colleagues report results of a systematic review conducted for the NIH Pathways to Prevention Workshop.

Their goal was to provide an objective assessment of the "state of the science" on data linkage strategies for suicide prevention research as well as identify barriers, gaps, and opportunities for future data linkage approaches.

Among 47 suicide prevention studies they identified, only six were already linked to data systems. Among 153 unique and potentially linkable data systems, only 66 were classified as "fairly accessible" and had data dictionaries available.

Overall, 19% of the data systems were developed primarily for research, 11% for clinical care or operations, 29% for administrative services (such as billing), and 52% for surveillance.

Thirty-seven percent provided national data, 12% provided regional data, 63% provided state data, and 41% provided data below the state level.

"There is untapped potential to evaluate and enhance suicide prevention efforts by linking suicide prevention data with existing data systems," Dr Wilcox and colleagues conclude. "However, sparse availability of data dictionaries and lack of adherence to standard data elements limit this potential."

They suggest that a national suicide outcomes data repository be created that combines data from several sources to achieve better coverage of suicidal ideation, suicide attempt, and suicide on a national level; that guidelines on data linkage methods and procedures as well as technical and legal aspects of data linkage be developed to facilitate the linkage of prevention data with external data systems; and that a technical support center be established to assist researchers, health systems, states, and others with methods and procedures for data linkage.

Sound Guidance

"We applaud this effort to address potential approaches to studying suicide," Jill Harkavy-Friedman, PhD, vice president of research for the American Foundation for Suicide Prevention, told Medscape Medical News.

"Suicide is a complex behavior that has been difficult to predict and prevent. These papers highlight the value of large data sets for understanding and preventing suicide," she said.

"Large data sets linked together offer a unique view of longer-term and short- term risk. In the US, we could do a better job of developing a national infrastructure for gathering information and examining suicide," Dr Harkavy-Friedman said.

"The guidance offered in these papers is sound and, if implemented, will improve our ability to prevent suicide. We need more and better research to save lives, and these papers identify some ways in which to engage in the needed research for suicide prevention," she added.

"These papers codify much of what we know and the need for future research. They provide a framework for approaching research. Our efforts will need to be broader than those outlined in the papers, but it's a start. We have more work to be done."

The workshop was cosponsored by the NIH Office of Disease Prevention, the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Center for Complementary and Integrated Health. The systematic review was prepared by the Johns Hopkins Evidence-Based Practice Center under contract to the Agency for Healthcare Research and Quality. The authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online October 4, 2016. Little et al, Full text; Wilcox et al, Full text

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