Hard Truths About Suicide Prevention

Abstract

Suicide accounts for nearly 50 000 deaths annually in the US, making it the second leading cause of death among persons 10 to 34 years of age. 1 Although psychiatric illness is associated with elevated rates of death from a range of causes, from cardiovascular disease to cancer, 2 suicide stands out: it occurs precipitously, disproportionately involves younger individuals, and is generally viewed as more preventable. Suicide represents a particular challenge in the military because soldiers are placed in extremely stressful situations, often without adequate physical or emotional support. Their risk remains elevated even after they leave active service and attempt to reenter a society ill-equipped to acknowledge their special needs. For this reason, the US Department of Defense and the US Department of Veterans Affairs (VA) have invested billions of dollars to reduce the incidence of suicide. Every VA secretary for the past 15 years has made suicide prevention a top priority and vowed to eliminate suicide. They have launched initiatives that included hiring more than 400 suicide counselors; establishing hotlines that receive more than 600 000 calls per year; screening patients for depression and posttraumatic stress disorder at nearly 60 million primary care, Author affiliations and article information are listed at the end of this article.

Comparing the predictive value of screening to the use of electronic health record data for detecting future suicidal thoughts and behavior in an urban pediatric emergency department: A preliminary analysis

“…The positive predictive value across all our models was quite low (e.g., 0.04-0.05). This is consistent with a recent systematic review by Belsher et al (2019) focused on predictive models, findings from screening studies, and is reflective the key challenge in suicide risk screening-suicide is a low base rate problem (Perlis & Fihn, 2020). Predictive accuracy can vary by the rarity of the behavior selected for the outcome, with lower PPVs observed for deaths, but higher PPVs possible with relatively more outcomes such as suicide-related ED visits or suicide attempts.…”

Comparing the predictive value of suicide risk screening to the detection of suicide risk using electronic health records in an urban pediatric emergency department

“…This is consistent with a recent systematic review by Belsher et al 23 focused on predictive models, findings from screening studies, and is reflective of the key challenge in suicide risk screening – suicide is a low base rate problem. 45 Our false positive rates were considerably lower than those found in previous studies, 46 but still represent potential inappropriate use of resources and/or a potential source of distrust or source of fatigue in procedures. 47 While our work and the work of others show suicide risk models can accurately identify risk, depending on how they are operationalized, these models can generate additional workload for clinicians by necessitating response to false positives and strategies for responding to alerts on patients.…”

Prevalence of Firearm Ownership Among Individuals With Major Depressive Symptoms

“…Such a focus may be critical given the challenges in developing reliable risk stratification and effective suicide prevention strategies. 10 Indeed, a study 11 of 135 US Army soldiers who died of suicide found that firearm ownership and modifiable aspects of ownership, such as gun storage, were associated with risk. 11 To better understand the characteristics of individuals with depression who own or plan to purchase firearms, we used data from 2 waves of a large national survey conducted between April and July 2021.…”