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Suicide Prevention: A Public Health Approach

David A. Litts, O.D., F.A.A.O.Suicide Prevention Resource Center

December 13, 2005

“Problems are complex and go beyond the

capacity, resources, or jurisdiction for any single

person, program, organization, or sector to

change or control.”Lasker R., Weiss E., Broadening Participation in Community Problem Solving: A Multidisciplinary Model to SupportCollaborative Practice and Research. Journal of Urban Health: Bulletin of the New York Academy of Medicine. Vol 80,No 1. March 2003. p.5.

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Suicide and Mental Illness

• 90% have diagnosable mental or substance abuse disorders or both

• 60% have unipolar depression– + Aggressiveness, anxiety, agitation

• Other associated mental health problems:– Schizophrenia– Bipolar disorder– Personality disorders, e.g., borderline– Anxiety disorders

Ecological Model

IndividualIndividualPeer/FamilySocietySociety

CommunityCommunity

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Individual FactorsRisk Protective

• Age/Sex• Mental illness• Substance abuse• Loss• Previous suicide attempt• Personality traits or disorders• Incarceration• Access to means (e.g.,

firearms)• Failure/academic problems• Unemployment• Disability or illness

• Cultural and religious beliefs that discourage suicide and support self-preservation

• Support through ongoing health and mental health care relationships

• Coping/problem solving skills• Resiliency, self esteem, direction,

mission, determination, perseverance, optimism, empathy

• Intellectual competence (youth)• Reasons for living

Peer/Family FactorsRisk Protective

• History of interpersonal violence/conflict/abuse/bullying

• Exposure to suicide• No-longer married• Barriers to health

care/mental health care

• Access to means (e.g., firearms)

• Family cohesion (youth)• Sense of social support• Interconnectedness• Married/parent• Access to

comprehensive health care

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Community FactorsRisk Protective

• Isolation/social w/drawal

• Barriers to health care and mental health care

• Stigma• Exposure to suicide• Unemployment

• Access to healthcare and mental health care

• Social support, close relationships, caring adults, participation and bond with school

• Respect for help-seeking behavior

• Skills to recognize and respond to signs of risk

Societal FactorsRisk Protective

• Western• Rural/Remote • Cultural values and

attitudes• Media influence• Alcohol misuse and

abuse• Social disintegration• Economic instability

• Urban/Suburban• Access to health care

& mental health care• Cultural values

affirming life• Media influence

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Family cohesion

Resiliency

Self esteem

Problem solving skills

Social support

Academic problems

Mental health disorder

Bullying victim

Recent significant loss

Parental Psychopathology

4.1

3.1

11.7

17.5

7.5

21 39

6.4

19

12

11

22

2

10.7

293015

8

28

5

3.57

Source: World Health Organization

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Age-adjusted suicide rates among all persons by state -- United States, 1999-2002

Rates per 100,000 population

0.0 to 9.1

9.2 to 11

11.1 to 13.4

13.5 to 21.1

Source: CDC vital statistics

6.2

20

19

6.3

19

6.6

13

11

11

16

19

12

1212

Suicide Rates by Age, Race, and Gender United States -- 2002

Source: National Center for Health Statistics

Note: non-Hispanic ethnicity

0

10

20

30

40

50

60

5-9

15-19

25-29

35-39

45-49

55-59

65-69

75-79 85

+

Age Group (Years)

Rat

e/10

0,00

0

White Male Black Male White Female Black Female

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Suicide Rates by Age, Race, and Gender United States - 1999-2002

Source: National Center for Health Statistics

Note: non-Hispanic ethnicity

0

10

20

30

40

50

60

5-910

-1415

-1920

-2425

-2930

-3435

-3940

-4445

-4950

-5455

-5960

-6465

-6970

-7475

-7980

-84 85+

Age Group (Years)

Rat

e/10

0,00

0White Male AI/AN Male Black Male AI/AN Female

Suicide by MethodUnited States, 2002

Source: Natl. Center for Health Statistics

Cut/Pierce2%

Firearm55%

Suffocation20%

Poisoning17%

Fall 2%

Other4%

N= 31,655

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Suicide Rates by Method

0 2 4 6 8 10 12 14 16 18

Suicide Deaths/100,000

Denmark

Australia

New Zealand

Canada

Scotland

Norw ay

US

The Netherlands

Eng & Wales

Israel

Firearm Poisoning Suffocation All Other

Source: Lois A. Fingerhut, MA, Centers for Disease Control and Prevention, 2000, Unpublished

Suicide RatesUnited States, 1933-2002

Source: Natl. Center for Health Statistics; Rates prior to 1999 Age-adjusted to 1940 U.S. population;1999 and after adjusted to 2000.

5

7

9

11

13

15

17

19

1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

Year

Rat

e/10

0,00

0

9

Necessary Conditions for Prevention

• Knowledge base• Political will• Social strategy

Essential Ingredients for Success

• Leadership• Coalition• Vision• Organization• Planning/Process • A Plan• Resources• Implementation/Evaluation

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Coalition: Not Just Good Hearted People

Public Health Mental Health

Education Faith-based/community groups

Alcohol and Other Drug Abuse

Domestic violence/Child protective services

Child Welfare Juvenile Justice

Adult Corrections Law Enforcement/First Responders

Crisis Intervention Aging

Medical Examiner/Coroner Survivors/citizen advocates

Coalition

Effective coalitions with highly satisfied members can produce plans of poor quality if they are not trained and equipped to do otherwise.

Butterfoss F, Goodman R, Wandersman A. Community Coalitions for Prevention and Health Promotions: Factors PredictingSatisfaction, Participation, and Planning. Health Education Quarterly, Vol 23(1): 65-79, Feb 1996.

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Data-Driven Prevention Planning Model

EstablishEstablishClear Vision Clear Vision

and and Framework Framework

for Preventionfor Prevention

Assess Incidence/Assess Incidence/Prevalence, Risk/Prevalence, Risk/

Protection & Protection & DemographicsDemographics

PrioritizePrioritizePopulationsPopulations

&&Risk/Risk/

ProtectiveProtectiveFactorsFactors

Assess Assess Community and Community and Local ReadinessLocal Readiness

forforPreventionPrevention

Assess Community Assess Community and Local and Local ResourcesResources

CompareComparePopulations,Populations,

Risk/Risk/Protection, &Protection, &

ResourcesResources

PromotePromoteReadinessReadiness

forforPreventionPrevention

ImplementImplementProgramsPrograms

totoAddressAddressRisks,Risks,

EnhanceEnhanceProtection,Protection,

and Filland FillGapsGaps

Monitor Data Monitor Data toto

EvaluateEvaluatePolicy, Policy,

Funding,Funding,&&

ProgramProgramDecisionsDecisions

Adapted from Richard Catalano and David Hawkins, U of Washington.

SPRC Goals

• Increase capacity• Enhance partnerships• Train clinicians and community

members • Disseminate evidence-based

practices and other science-based information

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SPRC Services• Expert Consultation and Technical Assistance• Training support

– On-line training—youth suicide prevention • Workshop 1: Data

Workshop 2: Planning and Evaluation Workshop 3: An Introduction to Gatekeeping

– Face-to-face curricula• Community core competencies +• Clinical core competencies• First Responder Course

www.sprc.org info@sprc.org 1-877-GET-SPRC

Prevention goes beyond changing individuals--it changes cultural norms

--Murray Levine (1998)

The National Strategy for Suicide Prevention is designed to be a catalyst for social change with the power to transform attitudes, policies and services.

-- The National Strategy (2001)