COMMENTARY

Stepping Up Suicide Prevention

Alexander E. Crosby, MD, MPH

Disclosures

August 31, 2018

Editorial Collaboration

Medscape &

My name is Alex Crosby. I am a medical epidemiologist at the Centers for Disease Control and Prevention (CDC). I am pleased to join you as part of the CDC Expert Commentary Series on Medscape. I would like to talk today about suicide prevention. Nearly 45,000 lives are lost in the United States each year to suicide; that's about one person every 12 minutes. More than 1 million people have attempted suicide in the past year. Over the past 15 years, suicide rates in the United States increased nearly 30%, while most other leading causes of death have declined. Suicide and suicide attempts cost more than $69 billion annually in direct medical and work-loss costs.[1]

Suicidal behavior affects all segments of our society—all ages, from children to older adults, and all races and ethnicities. This means that clinicians in all specialties have a role to play in prevention.

Suicide is preventable. CDC's Division of Violence Prevention developed a technical package to help healthcare providers understand effective approaches to prevent suicide. This package compiles the best available evidence on strategies that can increase factors that protect against suicide and decrease factors that put people at risk for suicide. I'll talk about four approaches you can take that can make a difference in your practice.

Screening, assessment, and support. Ascertain whether systems are in place to screen, assess, and support people at risk for suicide. Make sure your staff members are trained in suicide care practices and protocols, including safety planning. Put evidence-based treatments into practice. In many cases, such as rural and underserved areas, primary care providers may be the only clinician a patient sees.[2] Even in urban and suburban settings, primary care providers often see patients first before making referrals to a specialist. Below, you will find resources that outline important steps that different types of healthcare providers can take to asses and screen for suicide risk.[3,4]

Limit access to lethal means. Another approach is to create protective environments that address risk factors where people live, work, and play. One way to do this is reducing access to lethal means for people at risk for suicide. For example, you can offer education and counseling to people who may be at risk, or who have made previous attempts, about how to keep medicines in a locked cabinet or how to store their firearms safely. The Community Guide and the Guide to Clinical Preventive Services provides proven strategies to adopt.

Risk for suicide. Another way to prevent suicide is to identify and support patients at risk. While no one tool or assessment will accurately screen everyone at risk for suicide, some patients are at higher risk than others. In particular, this includes people living with a mental illness; people who have previously attempted suicide; and veterans and active-duty military personnel. Specific approaches include referral agreements with mental health providers in your area, and making sure that there is continuity of care and ensuring the sharing of information among all of the patient's different providers. Following up with at-risk patients by phone between visits can help prevent repeated suicide attempts.

Suicide prevention. Healthcare providers play a critical role in "postvention." Interventions after a suicide may include debriefing sessions, counseling, and/or bereavement support groups for surviving friends, family members, or other close contacts.

Suicide is a serious public health problem. Rates of suicide have been on the rise for more than a decade. Suicide has a far-reaching ripple effect. Families of those who die of suicide often have higher rates of depression and anxiety. To prevent suicide, we must work to support people at high risk and their families. Clinicians have an important and influential role in preventing suicide in the first place and in lessening the immediate and long-term harms of suicidal behavior by helping those in times of crisis access the services and support they need. CDC has new information about suicide data at the state level in a recently released Vital Signs and other links and resources for healthcare providers. Visit the resources at the bottom of this page for more information. Thank you.

Web Resources

Centers for Disease Control and Prevention. Suicide Prevention

Suicide Prevention Resource Center

National Suicide Prevention Lifeline

National Action Alliance for Suicide Prevention. Recommended standard care for people with suicide risk: making health care suicide safe.

Agency for Healthcare Research and Quality. Guide to Clinical Preventive Services, 2014.

The Community Guide

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