Development Of Suicide Prevention Programs Research Articles

Intentional injury in Vietnam: Prevalence and contributing circumstances of suicidal ideation among ethnic boarding school graduates

The objective of this study was to investigate the prevalence of suicidal ideation and associated circumstances among students in ethnic boarding schools. The research employed a self-administered structured questionnaire adapted from the Vietnamese version of the World Health Organization (WHO) Global School-based Student Health Survey (GSHS) to assess the responses of 164 boarding school students. The results revealed that 12.2% of the students reported experiencing suicidal ideation within the last 12 months, with no discernible gender differences. Utilizing chi-square and logistic regression analyses, the study identified significant associations between suicidal ideation and factors such as a lack of parental understanding, insufficient peer support, and mental health challenges among students. The findings underscore the potential mitigating role of school social workers in addressing these risk factors and enhancing students' adjustment to the boarding school environment. The paper recommends the development of suicide prevention programs tailored to the specific needs of ethnic boarding school students. The research methodology involved the use of questionnaires in sociological surveys and employed SPSS tools for analysis. Furthermore, the study employs analytical, synthetic, historical, logical, statistical, and comparative methods to present its findings.

자살위험군 노인 대상 자살 예방 프로그램 효과성에 관한 국내 연구 동향

Objectives The purpose of this study is to examine the trends in the study of the effectiveness of suicide prevention programs for older adults in suicide risk and to present research directions for the development of suicide prevention programs in the future. Methods To this end, keywords such as ‘suicide’, ‘older adults’, ‘program’, ‘intervention’, ‘effect’, ‘effectiveness’ were searched in the National Assembly Library, KISS, Dbpia, and Riss and 10 studies of ‘suicide prevention programs for older adults in suicide risk’ published from 2000 to 2021 were analyzed based on the qualitative indicators of the research design proposed by Gersten et al. (2005) and the components of the suicide prevention program for suicide risk groups proposed by Park et al. (2022). Results First, the number of published articles increased in 2019, but none have been published since the breakout of the COVID-19 pandemic in 2020. Second, the method of screening suicide risk groups often used depression tests and suicidal ideation scales, and programs using media access accounted for half of the independent variables. Third, the majority of dependent variables were suicide ideation scales and depression tests. Fourth, as a result of analyzing whether or not Gersten et al. (2005) meets the quality indicators, most of the studies met the quality indicators, but the quality indicators were relatively low in the following areas: securing program content validity, operator information, measuring maintenance effect after program termination, and presentation of the qualitative analysis of program effectiveness. Finally, as a result of examining the components of suicide prevention programs, it was found that the following areas were insufficient: establishing safety plans, learning coping skills, forming therapeutic relationships, and forming a protection system. Conclusions Based on the results of the study, implications for the suicide prevention programs for older adults in suicide risk were discussed.

Gender-Specific Predictors of Suicidal Ideation Among Korean Older Adults: A 2-Year Prospective Study

This study aimed at assessing gender-specific predictors associated with suicidal ideation among Korean older adults using a longitudinal study. Participants of this study were 926 older adults aged 65 years and above (583 women, 343 men) who completed both 2016 and 2018 surveys on Elderly Life Conditions in Chuncheon, Korea, and reported never having thought about suicide or attempted suicide at baseline. Multivariate logistic regression was used to investigate the predictors (at baseline) of suicidal ideation (at 2-year follow-up) separately for each gender group. The results showed that among women, predictors of suicidal ideation were fearlessness about death (personal factor), filial responsibility (family factor), and social activities (social factor). However, among men, only psychological inflexibility (personal factor) predicted suicidal ideation. Results of this study provide evidence for the need to adopt separate strategies for each gender, taking the different predictors of suicidal ideation into account in the development of suicide prevention programs for older adults in Korea.

Perceived racial discrimination on the change of suicide risk among ethnic minorities in the United States

ABSTRACT Objective: Suicide ideation and attempts are serious public health concerns in the U.S. Previous studies focus mainly on individual factors that cause suicide and therefore, it is imperative to examine the impact of the environment on the onset of suicide risk. This study explored the effects of perceived race/ethnicity-based discrimination (PD; perceived institutional discrimination and perceived interpersonal discrimination) on the change in suicidal thoughts and attempts among racial/ethnic minority (REM) participants at risk for depression over time using a longitudinal nationally representative dataset. Design and methods: The sample consisted a total of 1,253 REM participants from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 1 and 2 datasets. Participants were categorized into three conditions: (1) no suicidal thoughts/attempts at Wave 1, who were at risk for onset of suicidal thoughts at Wave 2, (2) no suicidal thoughts/attempts at Wave 1, who were at risk for onset of both suicidal thoughts and attempts at Wave 2, and (3) had suicidal thoughts but no attempts at Wave 1, who were at risk for initiating suicidal attempt at Wave 2. Three logistic regressions were performed to examine the associations between PD and the three suicidal conditions, controlling for sociodemographic factors. Results: Regression results showed that perceived institutional discrimination predicted onset of suicidal thoughts for Condition 1 (OR = 1.67, 95% CI:1.05–2.66) and initiation of suicidal attempts for Condition 2 (OR = 2.67, 95% CI:1.30–5.48), whereas perceived interpersonal discrimination predicted onset of suicidal thoughts and attempts for Condition 1 (OR = 2.34, 95% CI:1.17–4.66). Conclusions: PD may have detrimental effects on suicidal behaviors among REM individuals with depressive symptoms. Development of suicide prevention programs needs to take into account PD and be specific for different at-risk groups. This also foregrounds the importance of promoting anti-discrimination policies/programs as a suicide preventive intervention for REM individuals with depressive symptoms.

What bridges the gap between emotional intelligence and suicide risk in victims of bullying? A moderated mediation study

BackgroundRecent research has demonstrated that victims of bullying report serious problems, such as depression, which heighten the risk of suicide. Emotional intelligence (EI) has been increasingly recognized as a protective factor, but little is known about the mechanisms underlying the relation between EI and suicide risk in victims. This study aimed to test a theoretical model of how EI, depressive symptoms and gender interact to influence suicidal ideation and attempts in a sample of Spanish victims of bullying. MethodsThe sample comprised 465 victims (273 girls) who completed self-report measures of perceived EI, depression and suicide risk. ResultsMediation and moderation analyses were performed using conditional process analysis. Findings showed that EI is a predictor of decreased suicide in victims. This relationship was partially mediated by depressive symptoms. Furthermore, this effect was moderated by gender, such that the mediation effect was stronger in girls compared to boys (moderated mediation). LimitationsThe cross-sectional design and the use of self-report instruments. Future research should address the longitudinal relations of these findings. ConclusionsThe promotion of emotional skills could be core to the development of suicide prevention programs in those high-risk adolescents who have suffered from bullying. Furthermore, gender should be taken into consideration, especially with regard to females reporting depressive symptoms related to having been bullied.

Behavioral and psychosocial factors associated with suicidal ideation among adolescents.

Suicidal ideation poses a serious threat to the well-being of adolescents and is the strongest risk factor for suicide. Indeed, Korea ranks first among Organisation for Economic Cooperation and Development countries regarding the age-standardized suicide rates. In the present study, we examined multiple levels of factors associated with the suicidal ideation of adolescents in Korea by applying the Ecological Models of Health Behavior. A cross-sectional study was conducted with a convenience sample of 860 adolescents. The instruments included the Beck Depression Inventory and the Adolescent Mental Health and Problem Behavior Questionnaire. The data were analyzed using hierarchical multiple regression. Sixteen percent of participants reported suicidal ideation. Intrapersonal (sleep disturbance, Internet game addiction, destructive behavior, and depressive symptoms) and interpersonal factors (family conflicts and peer victimization) were associated with suicidal ideation. Because multiple factors were associated with suicidal ideation among adolescents, both intrapersonal (sleep disturbance, Internet game addiction, and depression) and interpersonal factors (family conflicts and peer problems) should be considered in the development of suicide-prevention programs. These programs could include campaigns changing the norms (permissive attitudes toward school violence) and the development of strict and rigorous school non-violence policies.

Difficultés professionnelles et suicide : étude comparative de parcours de vie

Over 900,000 people die by suicide every year around the world. Suicide has been described as being a multidimensional act, resulting from a number of risk factors accumulating throughout the life course. Recently, in France, some authors have suggested that work environment is a major or a unique risk factor in the etiology of suicide death. This theoretical position is in contradiction with empirical and epidemiologic evidence. ObjectiveOn the base of data from life trajectories, we studied to which extent work difficulties may contribute to a burden of adversity, which contribute to suicidal vulnerability. MethodTwo groups of participants (n=84) were compared. Half (n=42) were suicide victims who were compared to (n=42) living controls. The individuals from the suicide group were employed at the moment of death and the living controls were employed at the moment of the study. Characteristics of participants were compared in regards to life trajectories (love relationships, social interactions, professional difficulties), past suicide attempts and psychiatric diagnosis. Data were collected according to a psychological autopsy and life calendar methods. ResultsSignificantly more mental health disorders on axis I (DSM-IV), especially mood and substances disorders as well as disorders on axis II (especially Cluster C) were observed among deceased participants. Moreover, comorbid mental health disorders and past suicide attempts over the life course were significantly more prevalent among participants deceased by suicide. No significant differences are observed between groups concerning adversities in love relationships and social interactions. However, participants from the control group had significantly more adversities in professional domain over the life course and during the last 5 years. ConclusionWork difficulties are not a robust or direct risk factor of suicide, but psychiatric disorders are. These results are in contradiction with opinions of a debate in France concerning a direct link between work and suicides and should foster new debate. Application should promote the development of suicide prevention programs in work environments by focusing on protection and promotion the psychological health of workers.

청소년의 자아존중감, 가족지지, 학교생활적응이 자살생각에 미치는 영향

Objectives: The objective of this paper is to study influence of self esteem, family support and adaptation to school life on adolscents’ suicidal ideation adjsuted for general characteristics effect. Methods: Using cluster sampling, 318 high school freshmen from T city were extracted as survey subjects. Independent t-test, ANOVA, Duncan test, Pearson’s correlation coefficients and multiple regression analysis were applied for statistical analysis. Results: Among general characteristics, religion, family income, single-parentedness, health status and school grades were statistically significant with suicidal ideation. Controlling the above variables, increase in self-esteem (β=?.300) and family support (β=?.267) showed statistically significant decrease in suicidal ideation but adaptation to school life did not. Conclusions: Therefore, it is proposed that measures for enhancement of self esteem and family support to be included in development of suicide prevention programs.

An Evaluation of a Unique Gatekeeper Training for Suicide Prevention of College Students: Demonstrating Effective Partnering within Student Affairs

For college students, suicide is the second leading cause of death resulting in over 1,100 student deaths per year (Center for Disease Control, 2009). Researchers from the American College Health Association (2011), assessed over 105,000 students across the United States, and found that almost 10% of students seriously contemplated suicide and 1.5% had made a suicide attempt in the past year. In addition, Hirch and Barton (2011) surveyed 439 college students and found that 46% of students reported past suicidal ideation, 10% reported making a past suicide attempt, and 2% reported that they might attempt suicide in the future (Hirsch & Barton, 2011). Thus, the development of suicide prevention programs on college campuses is an important and urgent task. Researchers have indicated that there are numerous risk factors linked to college student suicidal behavior including previous suicide attempts, history of depression or other mental illness, alcohol or drug use, stress, low self-esteem, academic problems, relationship issues, and loneliness (Center for Disease Control, 2009). Some students enter college with pre-existing mental health conditions, while others may develop risk factors during their time in college. Garlow et al. (2008) found an association between suicidal ideation, a history of suicidal acts, and depressive symptoms in college students. Specifically, individuals with more severe symptoms of depression were more likely to experience suicidal ideation. An association was also found between suicidal ideation and other internal distress such as anxiety, irritability, and rage (Garlow et al., 2008). College is a major transitional period, which may increase the likelihood for depressive symptoms and exposure to drugs and alcohol which are two major risk factors for suicide (Westefeld et al., 2006). Gatekeeper Suicide Prevention The problem of college student suicide has drawn national attention and encourages college mental health professionals to focus on suicide prevention and intervention. One type of prevention effort for at-risk students is the gatekeeper training method. Gatekeepers have primary contact with people at risk for suicide and identify them by recognizing suicidal risk factors. In essence, gatekeepers open the gate to assistance for people at risk for suicide (Gould & Kramer, 2001). Gatekeeper training programs aim to enhance recognition and referral by training staff at colleges and universities to help identify students at risk and refer these students to appropriate supportive services or counseling. Research on gatekeeper training programs for college students is limited. Findings from a recent study on gatekeeper skills of community members after a brief suicide prevention training program, indicated that 10% of participants met criteria for acceptable gatekeeper skills prior to the training compared to 54% of participants after training (Cross, Matthieu, Lezine, & Knox, 2010). According to Aseltine and Demartino (2004), youth who are suicidal may turn to their peers first for help, therefore gatekeeper prevention programs that teach peers how to recognize warning signs of suicide, deal effectively with a student in distress, and make appropriate referrals are important. The benefit of peers helping peers has been supported by research on peer health education programs on college campuses. There is significant support in the literature for the positive effects of peer health educators on college students in regards to making healthy decisions about alcohol and drug use, sex, nutrition and exercise, and mental health issues (Sloane & Zimmer, 1993; White, Park, Israel, & Cordero, 2009). Peer health educators have credibility from students and are therefore more likely to facilitate attitude and behavior changes, as well as, be able to understand the experiences of their fellow classmates (Sloane & Zimmer, 1993). In a systematic review of gatekeeper training programs, Isaac et al. …

Depression and Suicidal Ideation in Elders with Dementia

The purpose of this study was to investigate the prevalence of depression and suicidal ideation in elders with dementia and to identify factors influencing their suicidal ideation. A descriptive and cross-sectional study was conducted from February to March, 2011. The participants were 298 older adults whose MMSE-KC score was 15 to 23. Collected Data were analyzed using t-test, ANOVA, Pearson correlation coefficients, and stepwise multiple regression. According to the Geriatric Depression Scale (GDS) classification criteria, 86.2% of the elders in this study exhibited depression (GDS=5), and 31.5% manifested severe depression. The mean score of suicidal ideation was 5.70 (range 0-20). The risk factors for suicidal ideation were depression, suicidal attempt experience, present location for care, and activities of daily living. The results of this study can be utilized in the development of suicide prevention programs for older adults with dementia. In particular, depression should be screened and managed to reduce suicidal ideation of older adults with dementia.

Gender Differences in Factors Associated with Suicidal Ideation and Depressive Symptoms among Middle-aged Workers in Japan

The purpose of this study was to assess middle-aged Japanese workers for possible gender differences in the risk factors associated with depressive symptoms and suicidal ideation. 5,878 workers (40-60 yr of age) (3,631 males and 2,247 females) were recruited from randomly selected companies in northern Japan. Demographic and lifestyle factors, suicidal ideation rate, and the data for the Brief Job Stress Questionnaire (BJSQ) and the Center for Epidemiologic Studies for Depression scale (CES-D) were obtained from the self-report questionnaires. After adjusting for possible confounding variables, marital status, absent of stress reduction technique and low job compatibility were significant independent risk factors for suicidal ideation among males. In females, marital status, feeling of insufficient sleep and absence of stress reduction techniques were significant independent risk factors after adjusting for all variables. Under the same adjustments, temporary employment also showed a protective effect against female suicidal ideation. In conclusion, our results suggest that factors related to suicidal ideation differed by gender. Different approaches for each gender might be useful in the development of suicide prevention programs. However, interpretation of work-related effects, such as temporary employment, interpersonal conflict and transportation industry, was hampered by lack of data concerning personal income, working hours and organizational commitment. Additional studies are needed to examine the longitudinal relationships between the risk factors associated with suicidal ideation and depressive symptoms.

성별에 따른 청소년의 자살생각과 관련요인

This study investigates suicidal ideation and its associated factors by sex in adolescents, focusing health behaviors and health status. For this study, data of 931 adolescents(11-18years) from the Fifth Korean National Health and Nutrition Examination Survey(KNHANES V-1, 2010) were analyzed. Those who had activity limitation, depression, less exercise showed higher suicidal ideation. For male adolescents, those who were high school student compared with middle school showed lower suicidal ideation and had depression showed higher suicidal ideation. On the other hand, the risk factors of suicidal ideation for female adolescents were activity limitation, smoking experience, depression, less exercise. The development of suicide prevention program for adolescents requires different approaches for each sex.

Alcohol and Suicide in Postconflict Northern Uganda

Alcohol has been noted to be an important factor in nearly 68% of the suicides in Northern Uganda, yet exactly how alcohol contributes to suicide in this region has not been studied. To determine how alcohol contributes to suicide in this region. Qualitative psychological autopsy interviews were conducted with bereaved relatives and friends of 20 suicides mainly from Internally Displaced Peoples' camps in Northern Uganda. Data were analyzed using a modified Interpretative Phenomenological analysis (IPA). Alcohol had a direct or an indirect influence on the suicide of 16 out of the 20 decedents. Directly, alcohol facilitated the suicidal process, was a means to suicide, or had an influence on the decedents' lifestyles. Indirectly, alcohol had an influence on the suicidal process of the deceased through the drinking behavior of significant others. This study established that alcohol not only contributes to the suicidal process of the individuals through acute and chronic alcohol consumption, but also through victimization of those lowest in the power hierarchy by alcohol abusers higher up in the power hierarchy. Therefore, future development of suicide prevention programs should address the interrelated public health problem of alcohol abuse.

도시·농촌지역 고등학생들의 자살에 대한 인식 및 태도 비교

본 연구는 도시 농촌지역 고등학생들의 자살에 대한 인식 및 태도를 알아보고, 그에 관련된 요인을 파악하기 위하여 우리나라 중부권에 소재한 K시의 도시지역 학생 1,114명, 농촌지역 학생 968명을 대상으로 2009년 7월 1일부터 7월 31일까지 구조화된 자기기입식 설문지를 이용하여 설문조사하였다. 연구결과 최근 1년간 자살생각을 갖은 고등학생은 38.8%였으며 도시와 농촌 간에 유의한 차이가 없었다. 자살에 대한 인식 및 태도는 농촌지역학생이 도시지역학생보다 높았으며, 자살 인식도에 영향을 미치는 관련요인으로 도시지역학생은 부모와 동거유무, 학교계열, 최근1년 간 자살생각유무, 자살태도가 유의한 변수로 선정되었으며(설명력 22.3%), 농촌지역학생에서는 성별, 부모와 언쟁 유무, 최근1년 자살생각유무, 자살태도가 유의한 변수로 선정되었다(설명력 37.1%). 자살태도에 영향을 미치는 관련요인으로 도시지역학생은 학교계열, 자살 인식도가 유의한 변수로 선정되었으며(설명력 20.6%), 농촌지역학생은 성별, 흡연유무, 자살 인식도가 유의한 변수로 선정되었다(설명력 38.8%). 따라서 자살에 대한 인식과 태도에 영향을 주는 가정환경 및 학교생활 변인을 적극적으로 관리하는 프로그램 개발 및 자살예방을 위한 지속적인 관심과 지도가 필요하다. This study was performed to determine the levels of suicide awareness and attitudes among the high school students in urban and rural areas, and to reveal its related factors. The interviews were performed, during the period from July 1, to July 31, 2009, to the 2,082 students in urban and rural areas. As a results, the suicide awareness rate of subjects was 38.8%, and they were not significant between urban and rural areas. The levels of suicide awareness and attitudes were significantly higher in rural students than that of urban students. The factors affecting suicide awareness in urban areas were living with parents, academic speciality, suicide ideation, suicide attitudes, and sex, argument with parents, suicide ideation and suicide attitudes were affected in rural areas. The factors affecting suicide attitudes in urban areas were academic speciality, suicide awareness, and sex, smoking and suicide awareness were affected in rural areas. In conclusion, the development of suicide prevention programs would required to keep under management of the factors affecting suicide awareness and attitudes such as the factors family and school lifes.

P02-205 Maintained attitudinal changes in nursing personnel after a brief training on suicide prevention

Aim:To verify whether nursing personnel working at a general hospital change their attitudes after a brief training course on suicide prevention and if these newly acquired attitudes persist over a 6-month time.Method:317 nursing personnel attended a 6-hour training program. They answered anonymously pre- and post-training the Suicide Behavior Attitude Questionnaire (SBAQ) which comprises 21 visual analogue scale items divided in three factorial sub-scales. The scores on each SBAQ sub-scale (dependent variable) were compared along the time using ANOVA for repeated measures with rank transformation. The time of the measurement and characteristics of the nursing staff were considered as independent variables.Results:There have been positive changes in the attitudes and these gains were significantly maintained at the 6-month follow-up evaluation. Improvement was in the Feelings and Professional Capacity factorial subscales (p = 0.0001 and 0.01, respectively). There was no change on the Right to Suicide subscale.Conclusion:It was possible to demonstrate positive changes in the attitudes of nursing personnel as assessed six months after a brief training course on suicide prevention. As attitudes influence the effectiveness of the health care personnel interventions our findings may have important implications for the development of suicide prevention programs.

Maintained Attitudinal Changes in Nursing Personnel After a Brief Training on Suicide Prevention

Nursing personnel (N = 317) working at a general hospital attended a 6-hour training program on suicide prevention. They answered anonymously pre- and post-training the Suicide Behavior Attitude Questionnaire (SBAQ), which comprises 21 visual analogue scale items divided in three factorial subscales. The results indicated there were positive changes in the attitudes and these gains were significantly maintained at the 6-month follow-up evaluation. Improvement was in the Feelings and Professional Capacity subscales (ANOVA; p = 0.0001 and 0.01, respectively). There was no change on the Right to Suicide subscale. Because attitudes influence the effectiveness of health care personnel interventions, our findings may have important implications for the development of suicide prevention programs.

Does a brief training on suicide prevention among general hospital personnel impact their baseline attitudes towards suicidal behavior?

ObjectiveTo evaluate a brief training program on suicide prevention for front-line general hospital personnel in terms of its impact on their attitudes and beliefs towards suicidality. MethodForty non-clinical (e.g., security staff), and 102 clinical (e.g., nursing attendants) professionals employed in a university hospital in Brazil were evaluated with the Suicide Behavior Attitude Questionnaire [SBAQ] before the start and immediately after a 3-hour training on suicide prevention. ResultsSurprisingly, there were no significant differences for the great majority of the SBAQ items (i.e., 20 of 21) between clinical and non-clinical staff both pre- and post-training. Furthermore, their attitudes and beliefs towards suicidality were significantly improved after training in the majority of SBAQ items, with p-values ranging from 0.01 to <0.0001. LimitationsRelatively small sample size, and absence of a randomized controlled design and long-term follow-up. ConclusionsOur study suggests that attitudes and beliefs of clinical and non-clinical general hospital personnel towards suicidality were unexpectedly similar, and reinforces the need for suicide awareness training programs in the general hospital setting. Additionally, we have shown that it is feasible to provide such basic knowledge concerning suicidal behavior to this specific population. This is particularly important for the development of suicide prevention programs in under-resourced countries. However, our results are preliminary, and further studies are needed to address a number of important questions in the field.

Suicide in Asia

The available data suggest that suicide deaths in Asia may account for the majority of suicides that occur in the world every year. This significant contribution occurs primarily because of the large population sizes of some Asian countries. Together, China, India, and Japan account for more than 40% of all world suicides, and Asia in total may in fact account for up to 60% of all suicides (World Health Organization, accessed 2006). If we apply to Asia commonly used estimates (namely, that there are approximately one million suicides in the world each year, 10 to 20 times as many suicide attempts as deaths, and 5 to 6 people affected by each suicide death or serious suicide attempt), then these figures suggest that up to 60 million people, each and every year, may be affected by suicide in Asia. These estimates provide a compelling case for more research into the etiology of suicidal behavior in Asian countries and for the development of suicide prevention programs tailored to fit the specific profiles of suicidal behavior in Asian countries. Currently, much of our research about suicide is dominated by a rather Western perspective, and we know much less about suicidal behavior in Asia than we do about suicidal behavior in the West.

Preventing Suicidal Behaviour in a General Hospital Psychiatric Service: Priorities for Programming

General hospital psychiatric services are able to provide leadership and coordinate the development of suicide prevention programs for individuals serviced in general hospital settings. We completed this literature review to suggest priorities for programming. Our procedure was to update the review by Gunnell and Frankel that guided priorities for Health of the Nation, the national suicide prevention strategy in the UK. We completed a search, using the terms suicide prevention and control, of all English-language research and clinical trials conducted between January 1, 1994, and May 1, 2004. We identified 82 papers. Of these, 48 were excluded and the remaining 34 were grouped by secondary care setting categories. We found no articles on screening tools for predicting risk of suicide, 16 articles on interventions for individuals with suicidal behaviour, 14 articles on the treatment of major psychiatric disorders, 1 article and 1 published abstract on discharge from hospital, and 2 articles on reducing access to means. Based on a review of each category, we make several program and policy recommendations, including regularly updating clinical assessment skills, using guidelines for assessment of patients following a suicide attempt, assessing the risk of suicide 24 to 48 hours before discharge from hospital, and incorporating education about reducing access to means into routine psychiatric care.

Datapoints: suicide and access to care.

Back to table of contents Previous article Next article ColumnsFull AccessDatapoints: Suicide and Access to CareCarolyn Levinson Miller, M.P.H., and Benjamin Druss, M.D., M.P.H.Carolyn Levinson MillerSearch for more papers by this author, M.P.H., and Benjamin DrussSearch for more papers by this author, M.D., M.P.H.Published Online:1 Dec 2001https://doi.org/10.1176/appi.ps.52.12.1566AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In 1998 suicide claimed more than 30,000 lives in the United States and was the eighth leading cause of death for all age groups (1). Despite the significance of this problem as a public health issue, the development of suicide prevention programs lags behind that of many other initiatives (2).This analysis used data from the 1993 National Mortality Followback Survey (NMFS) (3) to investigate access to health care among people who committed suicide that year. The 1993 survey of decedents' family members was the sixth such survey conducted by the National Center for Health Statistics. It includes 22,957 records that are representative of deaths among people aged 15 and older in 1993. All analyses for the unequally weighted sample were conducted with SUDAAN software.As Figure 1 shows, less than a third of the people who committed suicide had received mental health treatment during their last year of life, and less than a fourth were being treated with an antidepressant medication. Despite the low treatment rates, 76.4 percent of those who committed suicide had a psychiatric diagnosis or exhibited signs of psychosis or depression during their last year of life, according to the respondents, and 48.2 percent had a problem with alcohol or drug abuse.Compared with people who died of other conditions—illnesses and injuries—those who committed suicide had substantially more difficulty with access to health care. On the basis of the responses, it was estimated that suicide victims were nearly three times as likely to have been unable to get needed care and twice as likely to have refused needed care. The most common barriers to care for this group were trouble paying medical bills, difficulty getting into a treatment facility, and problems finding a doctor.More than a third of the people who committed suicide had talked about suicide or expressed a wish to die to family members during their last year of life. Nearly 75 percent of those who committed suicide saw a medical professional within their last year of life. This finding is consistent with studies of suicide among elderly persons, which have found that 70 percent of elderly suicide victims had been seen by their primary care provider within a month of death (4).The NMFS offers many advantages for the study of suicide, including a large sample and clinically confirmed suicide data. However, it also has limitations. First, the data on symptoms of mental illness and diagnoses are brief, and they are obtained by proxy, which may be subject to various types of bias. Second, problems with access to care may be either underreported or overreported, depending on the decedent's course of illness before death.The results of the NMFS suggest that substantial undertreatment and barriers to care remain for people who are suicidal. Improving access to services may be an important first step in reducing the incidence of suicide in the United States.Figure 1. Health care use during the last year of life by people who died in 1993 by suicide and by other causes (illnesses and injuries)