Interviewing suicide "decedents": a fourth strategy for risk factor assessment.

Abstract

In this special issue of Suicide and Life-Threatening Behavior (SLTB), a set of research articles is presented deriving from an innovative case-control study of attempted suicide (hereafter, the CCAS study), begun over ten years ago in Houston, Texas. To appreciate the need for a groundbreaking study of this type, it is useful to consider the context in which this research was begun. Beginning in the early 1950s and continuing for the next four decades, suicide rates had gradually but steadily increased among young persons, while generally decreasing among older persons; ultimately, youth suicide rates tripled during this period (Centers for Disease Control and Prevention [CDC], 1985a, 1986). In just the 11-year period between 1970 and 1980, suicide rates increased 50% for males 15-24 years of age (CDC, 1985b). The increasing youth suicide rates during this period resulted in a striking decrease in the median age of persons who committed suicide, from 47.2 years of age in 1970 to 39.9 years in 1980. In 1970, fewer than one fourth (22.8%) of males who committed suicide were under age 30 years; by 1980, more than one third (34.3%) of males who committed suicide were under 30 (CDC, 1985b). Against the backdrop of this disturbing trend, many called for aggressive research efforts to better understand the causes of suicide among America’s youth. A staple of suicide prevention among older populations had long been (and remains to this day) the early detection, diagnosis, and treatment of clinical depression. This strategy is also important for the prevention of youth suicide, but there were then and there continue to be clear reasons to go beyond this single strategy for the prevention of youth suicide. First, many young suicide victims did not seem to fit the classic definition of clinical depression as applied to adults (Shaffer, Garland, Gould, Fisher, & Trautman, 1988). Adolescence is generally a time of great emotional volatility, and we still do not have diagnostic criteria for clinical depression among adolescents that are sufficiently sensitive to detect and refer all those at serious risk of suicide while also being sufficiently specific to screen out large numbers of “false positives.” Second, given the remarkable increases in youth suicide rates, it was imperative that every possible avenue for prevention be explored, and that every opportunity to interrupt the various complex causal chains leading to suicide in this population be tested. A variety of risk factors in addition to mental illness were suggested as possible contributors to increasing youth suicide rates: substance abuse (including alcohol abuse); impulsive, aggressive, and antisocial behavioral traits; family influences, including a history of violence, suicide, and family disruption; severe stress in school or social life; rapid sociocultural change, as reflected in factors such as geographic mobility (i.e., community-to-community migration); and increased access to firearms by the at-risk population (CDC, 1992; Goodwin & Brown, 1989).