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7/15/2019 Suicide Crisis: CQR library.cqpress.com/cqresearcher/document.php?action=print&id=cqresrre2019071200 1/30 Help | Login Advanced Search 1923 - present FULL REPORT Introduction Overview Background Current Situation Outlook Pro/Con Chronology Short Features Maps/Graphs Bibliography The Next Step Contacts Footnotes About the Author Comments Permissions July 12, 2019 – Volume 29, Issue 25 Can the rising rate be stemmed? By Christina L. Lyons Introduction More than 47,000 Americans died by suicide in 2017, twice as many as by homicide, according to the latest federal count, and another 1.4 million attempted to take their lives. The nation's suicide rate has been rising since 2000 among nearly every age group, particularly adolescents, young adults and middle-aged men. Researchers cite a variety of theories for the increase, including undiagnosed or untreated mental health problems, fallout from the opioid crisis, economic pressures, easy access to guns and increased use of social media by the young. New drug and psychological therapies offer some hope of effective treatment for those at risk of suicide, but experts say health care providers, suicide counselors, family members and others need better ways to spot signs of suicide risk. Some researchers are looking to artificial intelligence and machine learning as potential tools. Meanwhile, a new treatment based on the old party drug ketamine is being tested as a rapid- acting treatment for severe depression. Renee Conlogue Foreman, of Gray, Maine, holds a preschool graduation photo of her son, Royce, who died by suicide in April while at college. The nation's suicide rate has been rising since 2000 and is now the highest since the 1940s. (Getty Images/Portland Press Herald/Derek Davis) Go to top Mental Health Jul. 12, 2019 Suicide Crisis Mar. 13, 2015 Prisoners and Mental Illness Dec. 05, 2014 Treating Schizophrenia Sep. 12, 2014 Teen Suicide May 10, 2013 Mental Health Policy Aug. 03, 2012 Treating ADHD Jun. 01, 2012 Traumatic Brain Injury Jun. 26, 2009 Treating Depression Feb. 13, 2004 Youth Suicide Feb. 06, 2004 Mental Illness Medication Debate Mar. 29, 2002 Mental Health Insurance Feb. 08, 2002 Treating Anxiety Jul. 16, 1999 Childhood Depression Jun. 18, 1999 Boys' Emotional Needs Sep. 12, 1997 Mental Health Policy Aug. 19, 1994 Prozac Aug. 06, 1993 Mental Illness Oct. 09, 1992 Depression Jun. 14, 1991 Teenage Suicide Jul. 08, 1988 Biology Invades Psychology Feb. 13, 1987 The Mentally Ill Aug. 20, 1982 Mental Health Care Reappraisal Jun. 12, 1981 Youth Suicide Sep. 21, 1979 Mental Health Care Sep. 15, 1978 Brain Research Jul. 05, 1974 Psychomedicine Aug. 08, 1973 Emotionally Disturbed Children Dec. 27, 1972 Mental Depression Mar. 24, 1972 Schizophrenia: Medical Enigma Apr. 21, 1971 Approaches to Death Mar. 03, 1971 Encounter Groups Nov. 25, 1970 Psychological Counseling of Students Feb. 19, 1969 Future of Psychiatry Feb. 02, 1966 New Approaches to Mental Illness Jan. 22, 1964 Insanity as a Defense Sep. 25, 1963 Anatomy of Suicide Nov. 20, 1957 Drugs and Mental Health Apr. 23, 1954 Mental Health Cite Now! Print Save

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Page 1: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 130

Help | Login

Searchbykeyword

AdvancedSearch

1923-present

HOME BROWSETOPICS BROWSEREPORTS USINGCQR LIBRARIANACCOUNT ABOUT

FULLREPORT

Introduction

Overview

Background

CurrentSituation

Outlook

ProCon

Chronology

ShortFeatures

MapsGraphs

Bibliography

TheNextStep

Contacts

Footnotes

AbouttheAuthor

Comments

Permissions

SuicideCrisis July122019ndashVolume29Issue25

CantherisingratebestemmedByChristinaLLyons

Introduction

Morethan47000Americansdiedbysuicidein2017twiceasmanyasbyhomicideaccordingtothelatestfederalcountandanother14millionattemptedtotaketheirlivesThenationssuicideratehasbeenrisingsince2000amongnearlyeveryagegroupparticularlyadolescentsyoungadultsandmiddle-agedmenResearchersciteavarietyoftheoriesfortheincreaseincludingundiagnosedoruntreatedmentalhealthproblemsfalloutfromtheopioidcrisiseconomicpressureseasyaccesstogunsandincreaseduseofsocialmediabytheyoungNewdrugandpsychologicaltherapiesoffersomehopeofeffectivetreatmentforthoseatriskofsuicidebutexpertssayhealthcareproviderssuicidecounselorsfamilymembersandothersneedbetterwaystospotsignsofsuicideriskSomeresearchersarelookingtoartificialintelligenceandmachinelearningaspotentialtoolsMeanwhileanewtreatmentbasedontheoldpartydrugketamineisbeingtestedasarapid-actingtreatmentforseveredepression

ReneeConlogueForemanofGrayMaineholdsapreschoolgraduationphotoofhersonRoycewhodiedbysuicideinAprilwhileatcollegeThenationssuicideratehasbeenrisingsince2000andisnowthehighestsincethe1940s(GettyImagesPortlandPressHeraldDerekDavis)

Gototop

ISSUETRACKERforRelatedReports

MentalHealthJul122019 SuicideCrisisMar132015 PrisonersandMental

IllnessDec052014 Treating

SchizophreniaSep122014 TeenSuicideMay102013 MentalHealthPolicyAug032012 TreatingADHDJun012012 TraumaticBrain

InjuryJun262009 TreatingDepressionFeb132004 YouthSuicideFeb062004 MentalIllness

MedicationDebateMar292002 MentalHealth

InsuranceFeb082002 TreatingAnxietyJul161999 Childhood

DepressionJun181999 BoysEmotional

NeedsSep121997 MentalHealthPolicyAug191994 ProzacAug061993MentalIllnessOct091992 DepressionJun141991 TeenageSuicideJul081988 BiologyInvades

PsychologyFeb131987 TheMentallyIllAug201982MentalHealthCare

ReappraisalJun121981 YouthSuicideSep211979 MentalHealthCareSep151978 BrainResearchJul051974 PsychomedicineAug081973 Emotionally

DisturbedChildrenDec271972 MentalDepressionMar241972 Schizophrenia

MedicalEnigmaApr211971 ApproachestoDeathMar031971 EncounterGroupsNov251970 Psychological

CounselingofStudents

Feb191969 FutureofPsychiatryFeb021966 NewApproachesto

MentalIllnessJan221964 Insanityasa

DefenseSep251963 AnatomyofSuicideNov201957 DrugsandMental

HealthApr231954 MentalHealth

CiteNow Print Save

7152019 Suicide Crisis CQR

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READERCOMMENTS

Overview

Seventeen-year-oldNickBaleshadmanyfriendsplayedsportsandwasmakingstraightAsinhissenioryearatArapahoeHighSchoolinCentennialCololdquoHeseemedtohaveitallrdquosaidhismotherThenonSept29hekilledhimself

BaleshadstruggledwithdepressionandanxietysincethesixthgradeandhadtriedvarioustherapiesandmedicationsOutwardlyheshowedimprovementandhisparentsthoughthewasdoingbetterButhisdistresscontinued

ThreedaysafterBalestookhislifeoneofhisclassmatesalsodiedbysuicideSchooladministratorscanceledclassesforthedayasthetowngrievedandmentalhealthworkersrushedtohelpotherstudents

NickBalesapopularandsuccessfulhighschoolseniorfromCentennialColowhohadstruggledwithdepressionandanxietysincethesixthgradetookhislifelastSeptemberWithindaysafellowstudentkilledhimselfanexampleofwhatresearcherscallacopycatsuicideMentalhealthexpertsandresearchersareworkingtocreatereliablewaystoidentifyindividualsathighriskofsuicide(CourtesyBalesFamily)

ldquoItsjustheartbreakingrdquosaid18-year-oldJoeRobertsasenioratnearbyHeritageHighSchool

CommunitiesmentalhealthexpertsresearchersandlawmakersarescramblingtounderstandwhytheUSsuicideratehasbeensoaringIn2017itreacheditshighestlevelsincethe1940smdash14per100000populationmdashaccordingtothelatestfederaldataAfterfallingtoarecordlowin2000theratehasbeenrisingacrossnearlyeverystategenderraceandage Theincreasehasoccurred

evenastheglobalsuicideratehasfallen38percentfromitspeakin1994anddespiteincreasedresearchintocausesandtreatmentsexpandedpreventioneffortsandrepeatedcallsforaction

ResearcherscitemanytheoriesfortherisingsuicideratefrommentalhealthproblemstotheopioidcrisiseconomicpressureseasyaccesstogunsandincreaseduseofsocialmediabytheyoungExpertsagreethatearlydetectionofdangerouspsychologicaldistressiskeytoreducingsuicidesbuthowtodothatisdifficult

ldquoThisincreasing[suicide]rateisreallyexasperatingrdquosaysDavidJobesapsychologyprofessorandthedirectoroftheSuicidePreventionLaboratoryattheCatholicUniversityofAmericainWashingtonDCldquoThoseofusinthefieldwhowereencouragedinthe1990sarereallydiscouragednowbecausewethoughtweweremakingheadwayrdquo

ProgramsJul091948 MentalHealth

BROWSERELATEDTOPICS

EconomicAnalysesForecastsandStatisticsInternetandSocialMediaMedicalResearchandAdvocacyMentalHealthTeenagers

(0)

Nocommentsonthisreportyet

1

2

3

4

5

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LongDescription

The2017suicideratewas33percentgreaterthantheratein1999andrankedasthe10thleadingcauseofdeathMorethan47000Americansages10orolderdiedbysuicidein2017morethantwiceasmanyasbyhomicideAnother14millionattemptedsuicideandabout10millionAmericanseachyearreporthavingsuicidalthoughts

The10stateswiththehighestsuicideratesin2017werelargelyintheruralWestbuttherateshaveriseninnearlyeverystateoverthepast20years BabyBoomersmdashpeoplebornbetween1946

and1964mdashhavehadthehighestrateofanyagegroupsinceatleastthe1990sbutexpertsalsohavebeenalarmedbyrisingsuicideratesamongadolescentsandyoungadultsSuicidesamongthoseages15to24reachedthehighestlevelin2017mdash146per100000mdashsincethegovernmentbegancollectingdataonyouthsuicidein1960

ldquoIdontthinkitisanexaggerationhelliptosaythatwehaveamentalhealthcrisisamongadolescentsintheUSrdquosaidSanDiegoStateUniversitypsychologistJeanTwengewhostudiesgenerationaldifferencesinemotionalhealth

Middle-agedwhitemenaccountedformorethan70percentofsuicidesin2017andaccidentaldeathsmdashwhichmanyresearcherssaymayincludesuicidesmdashaswellasopioid-relatedsuicideshavedoubledinthepast17years

AndcertainoccupationsmdashsuchasconstructionlawenforcementfoodpreparationartsandmediamdashreporthighratesofsuicidecomparedwithotherjobsSuicideratesamongmilitaryveteransareabout150percenthigherthanamongcivilians

ldquoItsstartlingandoftremendousconcernthattheratesaregoingupreallytosuchahighrateacrosstheboardrdquosaidDrRobertDickerassociatedirectorofchildandadolescentpsychiatryatZuckerHillsideHospitalinNewYorkCity

SuicidescosttheUSeconomyanestimated$935billionayearprimarilyduetolostproductivityaccordingtothemostrecentdataavailable

ExpertssaymorefederalspendingisneededtobetterpinpointriskfactorsforsuicideldquoThereareveryfewfactsinsuicideresearchrdquosaysStaceyFreedenthalanassociateprofessorattheUniversityofDenverGraduateSchoolofSocialWorkwhospecializesinsuicidepreventionldquoTheresmorehypothesesandtheoriesandcorrelationsrdquo

ldquoWemustmobilizeanationwidepublichealtheffortrdquosaidColleenCreightonexecutivedirectoroftheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicidepreventionresearchandtrainingShecalledforaldquobillion-dollarwaronsuiciderdquo

FundingforsuicideresearchthroughtheNationalInstitutesofHealthrosefrom$46millioninfiscal2015to$96millioninfiscal2018Itwasbudgetedatabout$117millioninfiscal2019butsome

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CelebritychefandtraveldocumentarianAnthonyBourdaintookhislifeinJune2018Hoursafterhisdeathcallstosomenationalcrisiscentersspikedbyasmuchas500percent(GettyImagesOwenHoffmannPatrickMcMullan)

suicideexpertssaythatisnotenough

ldquoAnyotherdiseasethatcomesclosetokillingasmanyAmericansassuicidedoeslikeHIVandheartdiseasegetsmarqueerecognitionasapublichealthmenaceandmajorfederalresearchfundingrdquosaidDrRichardAFriedmanaprofessorofclinicalpsychiatryatWeillCornellMedicalCollegeinNewYorkCity

ResearcherssaymentalhealthconditionsmdashsuchasschizophreniabipolardisordermanicbehaviorsubstanceabusepoorimpulsecontrolorangermanagementproblemsmdashcanbeafactorinsuicideButmorethan54percentofthosewhodiedbysuicidein2015hadnotbeenpreviouslydiagnosedwithamentaldisorderaccordingtotheCentersforDiseaseControlandPrevention(CDC)Manyresearcherspointtostudiesfromasearlyasthe1950sthatindicatedatleast90percentofsuicidevictimshaveamentaldisorder

DepressionwasafactorinabouthalfofsuicideattemptsaccordingtotheCDCHoweveronly2percentto4percentofthosediagnosedwithdepressionwilldiebysuicideaccordingtotheNationalInstituteofMentalHealth(NIMH)inBethesdaMd

ldquoPeopletendtothinkofsuicideasthepurviewofseverelydepressedpeople[but]thatsnotthecaserdquosaysAmyBarnhorstvicechairforcommunitymentalhealthinthepsychiatrydepartmentattheUniversityofCaliforniaDavisldquoSeveredepressionisonepathwaybutitsnottheonlyonerdquoEmotionalchallengessuchaslosingajoborasignificantrelationshipalsocanbeafactorshesays

GlennRSullivananassociateprofessorofpsychologyattheVirginiaMilitaryInstituteinLexingtonVasayssocialisolationisanotherriskfactorldquoTheresalotoflonelypeopleoutthererdquohesaysldquoIfyouarehavingsuicidalthoughtsandtheresnoonetheretointerveneyoucanhellipsoonhaveasuicidalcrisisrdquo

Morethanhalfofallsuicidesinvolvetheuseofafirearmleadingsomepsychologistsguncontroladvocatesandsuicide

preventiongroupstourgelimitingaccesstofirearmsldquoIfyoutrulywanttocontinuetoreducegundeathsinthiscountryyouhavetotalkabouthellipthetoolsforpreventinggunsuiciderdquosaidJohnFeinblattpresidentofEverytownforGunSafetyaguncontroladvocacygroupinNewYorkCity

FifteenstatesandtheDistrictofColumbiahavepassedldquoredflagrdquolawswhichallowlawenforcementofficersfamiliesor(inDC)mentalhealthpractitionerstopetitionacourttoconfiscatethegunsofindividualsdeemedatriskofharmingthemselvesorothers

OtherresearchersandhealthcareproviderswarnthatanxietyanddepressionhaveincreasedasexposuretosocialmediaandsmartphoneshasgrownamongyoungchildrenandteensButtheydisagreeonwhetherincreasedscreentimeleadstosuicidalthoughts

Sincethelate1980sdrugcompanieshaveproducedantidepressantsmoodstabilizersandantipsychoticdrugsinparttotreatsuicidalthoughtsandbehaviorsThenumberofAmericanstakingsuchmedicationsforfiveyearsormoretripledbetween2000and2017mdashto155million

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LongDescription

ThedrugsreducedepressionandanxietyinsomepatientsbutmanypeoplehavedifficultystoppingthemwithoutsymptomsreturningForotherpatientsthedrugsdonotworkAnewnasal-sprayversionoftheanestheticketamineapopularpartydruginthe1990sshowspromiseforpatientswhohavenotrespondedtoantidepressantsbutseveralmentalhealthexpertssaytheydoubtitcanreversetherisingsuiciderate(SeeShortFeature)

ldquoWedliketobelievetheresamagicpillandeverythingwillbefineButitjustisnttruerdquosaysDrJulieZitoaprofessorofpharmacyandpsychiatryattheUniversityofMaryland

NewresearchsuggeststhatcertainpsychologicaltherapiesthatfocusonchangingpatientsthinkingpatternsandbehaviormdashsuchastheCollaborativeAssessmentandManagementofSuicidality(CAMS)ordialecticalbehaviortherapy(DBT)mdashcantreatpatientswithsuicidalthoughtsorbehaviorsButfewpsychologistsaretrainedinthosetherapiesandinsurancecompaniesrarelycoverthem

Othersespeciallythosewhodistrustorcannotafforddrugsorpsychotherapyareseekinghelpandadvicefromgroupsandwebsitesorganizedbypeoplewhohavesurvivedsuicideattempts(SeeShortFeature)

HealthcareprovidersandresearcherssayearlyidentificationofthoseatriskandearlytreatmentarethekeystoloweringsuicideratesTothatendexpertsinartificialintelligenceandmachineanalyticsareraisinghopesthatcomputerizedtoolsthatsiftthroughmassiveamountsofhealthdatacouldhelpidentifypotentiallysuicidalpatientsTheDepartmentofVeteransAffairs(VA)isusingsuchatooltoaddressrisingsuicideratesamongveterans

AsthefederalgovernmentcommunitiesresearchersandhealthcareprovidersseekwaystoreversetherisingUSsuicideratethesearesomequestionsbeingdebated

Couldtougherguncontrollawsreducethesuiciderate

Abouttwo-thirdsofthenearly40000gun-relateddeathsin2017weresuicideswithwhitemenaccountingforthehighestpercentageofsuchsuicides Andfirearmsaccountformorethanhalf

ofallsuicidedeathseventhoughtheyareusedinlessthan6percentofsuicideattemptsThatisbecausefirearmsarethedeadliestmethodofsuicide825percentofattemptsusingafirearmarefatal

HoweverexpertsdisagreeonwhethereasyaccesstogunsistoblameforAmericasrisingsuiciderateldquoGunsrepresentanopportunityweasanationcanleverageinaconcertedefforttosubstantiallylowerthenationalsuicideraterdquoMichaelDAnestisaUniversityofSouthernMississippiassociateprofessorofpsychologywroteinGunsandSuicideAnAmericanEpidemic

ButSullivanattheVirginiaMilitaryInstitutesaysgunsarenottheonlyproblemldquoTherecantpossiblybeasingleexplanationforaphenomenonsowidespreadandcomplexassuiciderdquohesays

ResearchersattheRANDCorpaSantaMonicaCalif-basedthinktanksaiditseemslogicalthatbecausegunsarethemostlethalformofsuicideldquowhengunsarelessavailablefewersuicideattemptswillresultinfatalityrdquoButstudieshavenotclearlyprovedthataccordingtotheRANDresearchers

SomeresearcherspointoutthatsuiciderateshavefallenincountriesthathaverestrictedaccesstocertainpoisonsordrugstypicallyusedinsuicidesForexampledeathsinEnglandandWales

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attributedtooverdosesofparacetamol(theBritishequivalentofTylenol)fell43percentin11yearsaftera1998lawrestrictedpackagingsize AndsuicideratesinSriLankadecreasedsignificantly

afterthegovernmentrestrictedtheimportationandsalesoftoxicpesticidescommonlyusedinself-poisonings

LongDescription

ldquoItappearsifyoutakeawaythe[methodsthatsuicidalindividuals]werefocusedontheycangetoffthattrajectoryandyoucansavealiferdquosaysJaneLPearsonspecialadvisertothedirectorofsuicideresearchatNIMHPearsonsaysresearchershavefoundthatmanysuicideattemptsareimpulsiveactsandpeoplewhoseattemptsfaildonotusuallytryagainForeverysuicidedeathabout25attemptsfailaccordingtotheCDC

ldquoIfthemethodyouusedoesntkillyouitdoesntmeanyouwilljustgooutrdquoandfindanothermethodsaysPaulSNestadtanassistantprofessorofpsychiatryandbehavioralsciencesatJohnsHopkinsUniversityinBaltimoreHecitedaUniversityofCaliforniaBerkeleystudyshowingthatonlyabout6percentofpeoplestoppedfromjumpingofftheGoldenGateBridgeinSanFranciscobetween1937and1971evertriedtoattemptsuicideagain

ResearchersalsodisagreeonwhichtypeofguncontrollawswouldhelpreducesuicidesSomeexpertsbelievebackgroundchecksforgunpurchaserswouldworkiftheylookforpreviousmentalhealthissuesButa2018HarvardUniversitystudyfoundthat87percentofsuicidevictimscouldhavepassedabackgroundcheckonthedayoftheirdeath

NestadtsayscertainguncontrolactionshavecoincidedwithfallingsuicideratesForinstancehesaysinthedecadeaftertheDistrictofColumbiabarredthepurchaseorsaleofhandgunsbyciviliansin1976suicidesbyfirearmsdropped23percent

AstudyledbyAnestisonthecorrelationbetweenpassageofstateguncontrollawsandchangesinsuicideratesfoundthatlegislationfocusedonldquopreventinggunownershipratherthanregulatinguseandstoragerdquoofexistinggunsdidthemosttolowersuiciderates

AmongproposedguncontrolmeasuresredflaglawsappeartohavethegreatestpublicsupportbutstudiesoftheireffectivenessinreducingsuicideshaveproducedmixedresultsAUniversityofIndianapolisstudysaidfirearms-relatedsuicidesfell75percentinIndianainthedecadeaftertheLegislaturepassedaredflaglawin2005

AndastudyledbyDukeUniversitypsychiatryprofessorDrJeffreySwansononwhetherConnecticuts1999redflaglawhelpedpoliceavertsuicidesfoundthatsuchgunremovallawscouldbeldquoatleastmodestlyeffectiveinpreventingsuiciderdquoBetween1999and2013theresearcherssaid61percentofthe762peoplewhosegunswereconfiscatedforayearwereconsideredasuicideriskOfthose21laterdidkillthemselvessixwithagun

ButDavidBKopelresearchdirectoroftheIndependentInstituteinDenverColoagun-rightsadvocacycenterpointedouttotheUSSenateJudiciaryCommitteeinMarchthattheConnecticutlawdidnotpreventallsuicidesOfthosewhodiedbysuicideaftertheirgunswereconfiscatedhesaid10werecompletedbyhangingorstrangulationThetheorythatdeprivingsuicidalpeopleoffirearmswillmakeitlesslikelythattheywilldiebysuicideisincorrecthesaidldquoSeveralothermethodsofsuicidemdashnamelyhangingcarbonmonoxideexhaustordrowningmdasharenearlyaslikelyasfirearmstoresultindeathrdquo

JohnRLottJragun-rightsadvocateandthefounderoftheCrimePreventionResearchCenterinSwarthmorePaandCarlisleEMoodyaprofessorofcriminologyandeconomicsattheCollegeof

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WilliamampMaryinWilliamsburgVaconductedtheirownresearchandconcludedthatredflaglawsinCaliforniaConnecticutIndianaandWashingtonstatehadldquonosignificanteffectrdquoonsuicide

DrPaulSAppelbaumaprofessorofpsychiatryandlawatColumbiaUniversitysaysthelawsrepresentldquoaninnovativeapproachrdquotoidentifyingpeopleatriskofviolence

HoweverhesaysldquoOverallIthinkthecontributiontheywillmaketoreducingthesuiciderateasawholewillberelativelysmallbecausemostpeoplewhoaresuicidalwillprobablynotdoanythingthatcallsattentiontothemselvesinsuchawaythatpolicearesummonedtointervenerdquo

Doessocialmediaincreasetheriskforsuicide

SanDiegoStateUniversitysTwengeauthorofiGenabookaboutthefirstgenerationofAmericanstospendtheirteenyearsusingsocialmediabelievestheincreasinguseofsocialmediaiscreatingmentalhealthproblemsforadolescents

TwengeledastudyanalyzingdatafromtwosurveysonUSadolescentsandyouthbehavioralongwithCDCdataonsuicidedeathssince1999Thedatashowedthatbetween2010and2015thenumberofadolescentsreportingseveredepressionrose33percentandthenumberofsuicidesincreased31percentGirlsmdashparticularlythosewhospentmoretimeonlinethantheirpeersmdashweremostlikelytoreportdepressiveorsuicidalsymptomsTheresearchersconcludedthattheincreasedtimethatadolescentsspentonscreenactivitiesmayaccountforincreasesindepressionandsuicide

InanotherstudyTwengeandseveralcolleaguesreportedthat132percentof18-to25-year-oldsreportedseriouspsychologicaldistressin2017up71percentfrom2008Meanwhilemajordepressiveepisodesamong12-to17-year-oldsin2017wereup52percentfrom2005Andoneofeveryfiveteenagegirlshadexperiencedmajordepressioninthepreviousyear

Twengesteamattributedsuchdistresstolessin-personsocialinteractionamongadolescentsthanamongyouthsinpriorgenerationslargelyduetothegrowingprevalenceoftimespentonsmartphonesandsocialmedia

ButotherresearchersquestionTwengesconclusionthatscreentimedirectlyleadstomdashoristheprimarycauseofmdashdepressionorsuicide

OxfordUniversitypsychologyresearchersAmyOrbenandAndrewKPrzybylskibelievethecorrelationbetweendigitaltechnologyuseandadolescentsmentalhealthisoverstatedStudieslikeTwengesarebasedonanalysesoflargedatasetsthatcanbesubjecttoresearchersbiastheysaidAnalyzingthesamedatasetsTwengeusedforiGentheresearchersconcludedthatscreenusehadaldquotinyrdquoeffectonteensmentalhealthwhencomparedwitharangeofotherpotentialcorrelatingfactors

ldquoUsingtechnologyisaboutasassociatedwithwell-beingaseatingpotatoesrdquoPrzybylskisaidBullyinghadafourtimesgreatereffectonmentalhealthsaidOrbenandPrzybylski

InMaythetworesearchersevaluatedwhethertheamountoftimeadolescentsspendonsocialmediaaffectstheirmoodAgaintheyfoundthatscreentimehadaldquotinymdasharguablytrivialrdquomdasheffectonmood

ldquoItsnottimespentthatisassociatedwithpositiveornegativeoutcomesbuthowpeopleusesocialmediardquosaysChristopherFergusonapsychologyprofessoratStetsonUniversityinFloridaIna2017studyFergusonfoundthatmoderateuseofscreensdidnotincreasebehavioralormentalhealthproblemsamongchildrenandexcessivescreentimeonlymarginallycorrelatedwithsuchproblemsInanotherstudyheandtwootherresearchersconcludedthattimespentonlinedidnotresultindepressionorsuicidalthoughtsamongyoungadults

MikeBrooksdirectoroftheAustinPsychologyandAssessmentCenterinAustinTexasandauthorofTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldsaysldquoMypettheoryisthatwhenweseeassociationbetweenscreenuseandnegativehealthoutcomesitmaybethatitsbecausetheyareupuntil1amandtheirsleepistakingahitandthentheirmoodrdquo

AstudyledbyaUniversityofColoradoBoulderintegrativephysiologyprofessorfoundalinkbetweendigitalmediauseandreducedsleepandastudyledbyaStanfordpsychiatryprofessorfoundthatsleepproblemscouldprovideearlycluestosuicidalthoughtsincertainyoungadults

BrooksandFergusonagreehoweverwithTwengestheorythatdigitalmediausecanleadtosocialisolationifitreplacesin-personinteractionldquoTheresagoodreasontobeconcernedbutalarmismisproblematicrdquoBrookssays

SaraKonrathanassociateprofessorofphilanthropicstudiesatIndianaUniversitysayssmartphonesandsocialmediacanreducelonelinessamongyoungpeoplebecausetheyfeelsurroundedbyothersA2015studybytwoGermanresearchersfoundthatbrowsingFacebooktriggerspositiveemotionsmoreoftenthannegativeones

HoweverastudyledbyUniversityofMichiganpsychologyprofessorEthanKrossfoundthatthemoretimepeoplespentonFacebooktheworsetheyfeltpsychologicallyAndaBritishstudyfoundthatamongsocialmediasitesInstagramand

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7152019 Suicide Crisis CQR

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IanRussellsdaughterMollytookherlifeatage14afterviewingdisturbingmaterialonInstagramInJuneRussellspokeataconferenceinLondontourgesocialmediacompaniestobettercontrolonlinematerialthatpromotessuicideandotherformsofselfharm(GettyImagesHelenWIlliams)

Snapchatwerethemostdetrimentaltothementalhealthofyoungpeople(ages14to24)basedontheirresponsestoquestionsaboutanxietydepressionlonelinesssleepbodyimageandcyberbullying

ManyobserversraisealarmsabouttheavailabilityonlineofinformationabouthowtotakeoneslifeIanRussellwhose14-year-olddaughterMollykilledherselfin2017holdsInstagrampartlyresponsibleAfterhersuicidethefamilyfoundmaterialinherInstagramaccountaboutdepressionandsuicidalmethodsInstagramsaiditldquodoesnotallowcontentthatpromotesorglorifiesself-harmorsuiciderdquoandhassaiditwouldremovesuchcontent

ManyworrythatcyberbullyingcanleadtosuicidalthoughtsparticularlyamonggirlsThesuiciderateamonggirlsages10to14grew127percentbetween2007and2016comparedwith71percentamongboysinthesameagegroupaccordingtoonestudy

ldquoGirlsaremoreoftenhellipcyberbullied[thanboys]onsocialmediardquosaidJoanLubyapsychiatristatWashingtonUniversitySchoolofMedicineinStLouisandldquotheytendtohavemuchmorenegativepsychologicaleffectstothatcyberbullyingrdquo

ButDanielJReidenbergexecutivedirectorofSuicideAwarenessVoicesofEducationanonprofitsuicidepreventionandpubliceducationgroupinBloomingtonMinnsayspeoplesharetheirsuicidalthoughtsonlinefarmorefrequentlynowthaninthepastandinsuchcasesfriendsoftencanprovidehelp

InJanuaryafterChicagorapperCupcakKetweetedthatshewassuicidalherfollowersimmediatelymessagedherandalertedauthoritieswhotookhertothehospitalwhereshebegantreatmentfordepression

Canldquobigdatardquohelpreducesuiciderates

TheDepartmentofVeteransAffairsisusingacomputeralgorithmthatsiftsthroughvoluminoushealthdatatodetectcommonwarningsignsandflagveteranswhoareatriskofsuicideVAhealthcareprovidersthenreachoutdirectlytothoseindividualsandtheveteransdecidewhethertoseekhelp

ldquo[V]eteransathighestriskofsuicidearealsoatveryhighriskofsomeotherthingsrdquosuchasaccidentsoverdosesandopioidaddictionsaidAaronEaganthedepartmentsdeputydirectorforinnovation

Withinayearofimplementingtheso-calledREACHVetprograminApril2017theVAhadcontactedmorethan30000veteransThoseparticipatingintheprogramwereadmittedtomentalhealthinpatientunitslessoftenshowedupmoreoftenfordoctorappointmentsandvisitedtheVAmorefrequentlythanothervetsthedepartmentreported

Manyresearchershealthcareprovidersandothersbelievesimilardataanalyticscanhelpalertnonmilitarydoctorsaboutat-riskpatientsHealthcareproviderstypicallyassesssuicideriskbyaskingpatientssuchquestionsaswhethertheyaredepressedhaveconsideredharmingthemselvesorhaveasuicideplanHoweverone-thirdofsuicideattemptsanddeathsoccuramongpatientswhohavenotreportedsuicidalthoughts

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7152019 Suicide Crisis CQR

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AtaMay2016eventinWashingtonDCaimedatpreventingveteransuicideveteranstheirfamiliesandsurvivorsofveteranswhohavediedbysuicidereachouttooneanotherandtotouchtheSpartanswordmadefrommelted-downsteelfromtheWorldTradeCenter(GettyImagesTheWashingtonPostMichaelSWIlliamson)

ResearchersbelievethathealthprofessionalscouldpreventasuicideiftheyknewmoreaboutapatientsriskA2014studyfoundthat83percentofthosewhokilledthemselveshadvisitedadoctorsofficewithinthepreviousyearbutabouthalfofthemdidnothaveamentalhealthdiagnosis

DataanalyticscouldhelptrackstreamsofinformationandalertdoctorswhenapatientmayneedathoroughassessmentsaysGregoryESimonaseniorinvestigatorforKaiserPermanenteWashingtonHealthResearchInstituteinSeattleandapsychiatristatKaiserHeequatesittoawarninglightonacarssideviewmirrorthatilluminateswhenanothercarpullsintothedriversblindspotldquoThepurposeistodeliverinformationtoourhealthcareprovidersthatpeopleareatriskthenlet[theproviders]dowhattheydobetterrdquo

FacebookalsousesartificialintelligencetoscanpostingsforlivevideosofsuicideorphrasesorwordsthatsuggestsuicidalthoughtsWithinayearofstartingtheprogramin2017Facebookhadfound3500postsorvideoscontainingcontentthatledthecompanytocontactemergencyresponders

NeverthelessmanymedicalcareprovidersresearchersandothersareuncertainwhethersuchtoolscanhelpPeopleatriskofsuicideoftenaresociallyisolatedandunlikelytovisitadoctorsotheymightnotgenerateenoughhealthrecordsforalgorithmstoevaluatesaysBarnhorstattheUniversityofCaliforniaDavisldquoIdontknowwherethepredictiveanalytics[data]wouldcomefromrdquoshesaysldquoTheresnotalotofoutputfromthesepeoplerdquo

TheNIMHsPearsonissimilarlycautiousldquoWehavewaysofhelpingpeoplebyusingexistingdatatofindsomeoneatriskrdquoshesaysButmoreresearchisneededtoensurethatartificialintelligencetoolsdonotmisswholegroupsofpeopleldquoTheremayberacialethnicminoritiesorsexualminoritieswhoarenothittingthehealthcaresystemveryoftenforanumberofreasonsrdquoshesaysldquoHowdotheyfareinpredictiveanalyticsThatsareallyimportantquestionrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteaNewYorkCitymentalhealthtreatmentcentercallspredictiveanalyticsldquoextremelyusefulrdquoinhelpingidentifypotentialsuicidevictimsHoweveritcannotensurethatpeoplewillgetthetreatmenttheyneedldquoIfpredictiveanalyticsledtoaprogramwherepeoplewhoareathigherriskhadtheirguns[confiscated]thatwouldreducethesuicideraterdquohesays

ColumbiaUniversitysAppelbaumsayspeoplehavetriedtopredictsuicidesbasedonvariousriskfactorsldquoforalongtimeandithasbeenextremelydifficultrdquoldquoThevariablesassociatedwithsuicidearecommoninthepopulationanduncommonlyleadtosuicidaloutcomesrdquohesaysForexampledepressionisastrongpredictorofsuicidebutmostpeoplewithdepressiondonotattemptsuicide

Heandotherresearcherssayyearsofresearchshowthatscientistsstilldonotknowexactlyhowtopredictsuicide Ameta-analysisof50yearsofresearchpublishedin2016concludedthat

scientistshavenotgottenanybetteratpredictingsuicideattemptssayingldquopredictionwasonlyslightlybetterthanchancerdquo

OtherresearchersacknowledgethatthescienceofpredictionisnotperfectbutsayitcouldhelphealthcareprovidersdotheirjobbetterldquoItwillmissahugepercentageofpeopleItsnotgoingtosolveallofourproblemsrdquoUrsulaWhitesideaclinicalpsychologistattheUniversityofWashingtoninSeattlesaysldquoButitishelpfultocliniciansrdquo

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7152019 Suicide Crisis CQR

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LongDescription

OtherresearchersareraisingprivacyconcernsabouttheuseofpredictiveanalyticsinsuicidepreventiontoolsMasonMarksavisitingfellowatYaleLawSchoolsInformationSocietyProjectsaidthatwhilehealthcareprivacylawsgovernhowmedicalproviderscanusepatientmedicalrecordsartificial-intelligence-basedsuicidepredictionusingsocialmediainformationanddataisunregulatedandcouldposesafetyandethicalconcerns

ldquoTherisksincludestigmatizationofpeoplewithmentalillnessthetransferofsensitivehealthdatatothird-partieshellipunnecessaryinvoluntaryconfinementviolentconfrontationswithpoliceexacerbationofmentalhealthconditionsandhellipincreasesinsuicideriskrdquohesaid

Companiesandlawmakerswillhavetoexaminepolicyandlegalframeworksheadded

Gototop

Background

ResearchEmerges

InancientsocietiesphilosophersreligiousleadersandgovernmentsreactedtosuicideinavarietyofwaysrangingfromglorificationtoreligiouscondemnationColonistsinearlyAmericaviewedsuicideasasinandacrimeuntiljuriesbegantoseeitasasymptomofdiseaseCourtsstoppedrulingitacrimebytheendofthe1800s

Alsointhe19thcenturyresearchersbeganstudyingwhethereconomicandsociologicalchangesmdashincreasedindustrializationandloosenedfamilyandcommunitytiesmdashledtomentalillnessandsuicidePhysiciansbegansendingsuicidalpatientstoasylumsfortreatmentwithsedativesorstimulants

ScientistsgavesuicideonlysporadicattentionhoweveruntilFrenchsociologistEacutemileDurkheimconcludedinhis1897bookLeSuicidethatpeoplewhoweremoresociallyintegratedwerelesslikelytokillthemselvesHealsofoundsuicidemorecommonamongmenthanwomenandsoldiersthancivilians

DurkheimsbookpromptedotherscientiststoanalyzementalillnessmorecloselyIn1925psychiatristsKarlandWilliamMenningeropenedaclinicoutsideTopekaKantotreatthementallyillInhis1930bookTheHumanMindKarlcontendedthatpsychiatrycouldhelpsuchpatientsEightyearslaterhisManAgainstHimselfsuggestedthatthesuicidalimpulsewasamisdirectionofthesurvivalinstinct

DuringtheGreatDepressionthesuiciderateintheUnitedStatesreacheda20th-centurypeakmdash219suicidesper100000mdashin1932 Itwouldfallto114per100000by1957climberratically

duringthe1960sthroughthe1970sreaching137in1977andfalltoanall-timelowof104in2000(SeeGraphic)

AfterWorldWarIIclinicalpsychologistEdwinShneidmanpropelledsuicideresearchwhenhebeganinvestigatingacacheofLosAngelesdeathrecordsfilledwithhundredsofsuicidenotes

In1958ShneidmanandpsychologistNormanLFarberowalongwithDrRobertELitmanusedafederalgranttoopenthefirstsuicidepreventionfacilityinacondemnedbuildingoftheLosAngelesCountyGeneralHospitalStaffofferedin-personandphonecounselingtoindividualsexperiencing

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depressionandsuicidalthoughtsMostfamouslythecenterconductedthefirstpsychologicalautopsiesmdashinterviewswithfamilyfriendsdoctorsandotherassociatesofsuicidevictimstoconfirmthecauseofdeath

TheNationalCenterforHealthStatisticsreportedthatin1964anaverageof56Americanskilledthemselveseverydayaccountingfor1percentofdeathsthatyearButthecenteralsosaidsuicidestatisticslikelywereldquogrosslyunderstatedrdquobecausefamilyandfriendsoftenpreventedcoronersfromreportingsuicidesondeathcertificates

TheNationalInstituteofMentalHealthbeganacampaigninthe1960storeducementalillnessandsuicideTheinstitutein1966hiredShneidmantocreateasuicidepreventionprogramwhichledtoajumpinthenumberofUSsuicidepreventioncentersmdashfrom15tomorethan100withinafewyears

SuicideandHealth

Inthe1980sand90ssuicidebecamealeadinghealthconcernintheUnitedStatesandtheworldBy1990USrateshadreached124per100000forallagegroupsbutforages15to24theraterosefrom88to132per100000

ExpertsspeculatedthatfamilydisintegrationduetorisingdivorceratesdrugabusedwindlingjobandeducationalopportunitiesandtheavailabilityofgunscouldbepartlytoblameFirearmscontinuedtobethemostcommonmethodofsuicide

Studiesinthe1980sbyDavidPPhillipsasociologistattheUniversityofCaliforniaSanDiegofoundthatsuicidesrosesignificantlyafterwell-publicizedcaseswiththerisegreatestamongteenagers Andresearchersfoundcorrelationsbetweenfictionalizedsuicideattemptsin

televisionmoviesandincreasedsuicideattemptsamongteens

AsthesuiciderateamongadolescentsandyoungadultsrosetheDepartmentofHealthandHumanServicescreatedataskforceonyouthsuicidein1985 In1987agroupoffamiliesaffectedby

suicidejoinedwithscientiststoestablishtheAmericanFoundationforSuicidePreventiontofundresearchandeducationaboutsuicideMoregrassrootsorganizationsfollowed

ResearchersandcommunitiesgrewincreasinglyconcernedaboutsuicideclustersmdashmultiplesuicidesoccurringinthesamegeographicalareainashortspanoftimeInMarch1987forexamplefourteenagersinBergenfieldNJkilledthemselvesbylockingthemselvesinagarageandrunningacarengineWithinaweekatleasttwootheryoungpeopleattemptedsuicideinthesamemanner

ldquoThenewscoverageofteenagesuicidescanportraythevictimsasmartyrsofsortsrdquosaidDrDavidShafferachildpsychiatryprofessoratColumbiaUniversityandthedirectorofthesuicideresearchunitattheNewYorkStatePsychiatricInstituteldquoThemoresentimentalizeditisthemorelegitimatemdashevenheroicmdashitmayseemtosometeenagersrdquo

Drugtreatmentsfordepressionwereintroducedinthelate1980sbeginningwiththe1987approvalofProzacbytheUSFoodandDrugAdministration(FDA)Thedrugaimedtoeasedepressionbyraisingthelevelsofachemicalcalledserotonininthebrain

In1989suicideexpertsotherresearcherspublichealthofficialsandnewsoutletsmettodiscusswaystopreventsuicidecontagionTheydevelopedrecommendationsfordiscussionswiththemediaandsuggestedthatnewsoutletsavoidprovidingdetailsofsuicidemethods

Intheearly1990sUniversityofWashingtonpsychologistMarshaLinehandevelopedoneofthethreeevidence-basedinterventionsandtreatmentsthathavebeenshowntobeeffectiveinreducingsuicidalityHerprogramcalleddialecticalbehaviortherapyteachespatientshowtomanagepainfulemotionsanddecreaseconflictinrelationships Theothertwotreatmentsarecognitivebehavior

therapywhichencouragespatientstochallengedistortedviewpointsandchangedestructivepatternsofbehaviorandCAMSdevelopedbyCatholicUniversitysJobesTherapistsusingCAMStalkindetailwithpatientsabouttheirthoughtsofhopelessnessandsuicideandhelpthembuildatreatmentplan

Althoughsuicideratesfellinthe1990sresearchersandhealthofficialsremainedconcernedaboutfindinganeffectivetreatmentforsuicidalbehaviormdashparticularlyafterthehighlypublicizedsuicideofKurtCobainleadsingerfortherockbandNirvanaonApril51994ACatholicUniversitystudydeterminedthatCobainssuicidewasnotfollowedbycopycatsuicidesbutdidsparkmorecallstosuicidecrisishotlinesmdashlikelyduetohowthemediacoveredthestoryandcommunityoutreacheffortsencouragingpeopleatrisktoseekhelp

ldquoCalltoActionrdquo

In1996theWorldHealthOrganizationurgedmembernationstoaddressrisingsuicideratesintheircountriesMostalarminglythenumberofsuicidesintheUnitedStateshadnearlytripledamongadolescentsandyoungadultssince1952Suicidewasthethirdleadingcauseofdeathamongthoseages15to24andthefourthleadingcauseamongthoseages10to14

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7152019 Suicide Crisis CQR

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Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

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couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

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volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

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WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

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Page 2: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

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READERCOMMENTS

Overview

Seventeen-year-oldNickBaleshadmanyfriendsplayedsportsandwasmakingstraightAsinhissenioryearatArapahoeHighSchoolinCentennialCololdquoHeseemedtohaveitallrdquosaidhismotherThenonSept29hekilledhimself

BaleshadstruggledwithdepressionandanxietysincethesixthgradeandhadtriedvarioustherapiesandmedicationsOutwardlyheshowedimprovementandhisparentsthoughthewasdoingbetterButhisdistresscontinued

ThreedaysafterBalestookhislifeoneofhisclassmatesalsodiedbysuicideSchooladministratorscanceledclassesforthedayasthetowngrievedandmentalhealthworkersrushedtohelpotherstudents

NickBalesapopularandsuccessfulhighschoolseniorfromCentennialColowhohadstruggledwithdepressionandanxietysincethesixthgradetookhislifelastSeptemberWithindaysafellowstudentkilledhimselfanexampleofwhatresearcherscallacopycatsuicideMentalhealthexpertsandresearchersareworkingtocreatereliablewaystoidentifyindividualsathighriskofsuicide(CourtesyBalesFamily)

ldquoItsjustheartbreakingrdquosaid18-year-oldJoeRobertsasenioratnearbyHeritageHighSchool

CommunitiesmentalhealthexpertsresearchersandlawmakersarescramblingtounderstandwhytheUSsuicideratehasbeensoaringIn2017itreacheditshighestlevelsincethe1940smdash14per100000populationmdashaccordingtothelatestfederaldataAfterfallingtoarecordlowin2000theratehasbeenrisingacrossnearlyeverystategenderraceandage Theincreasehasoccurred

evenastheglobalsuicideratehasfallen38percentfromitspeakin1994anddespiteincreasedresearchintocausesandtreatmentsexpandedpreventioneffortsandrepeatedcallsforaction

ResearcherscitemanytheoriesfortherisingsuicideratefrommentalhealthproblemstotheopioidcrisiseconomicpressureseasyaccesstogunsandincreaseduseofsocialmediabytheyoungExpertsagreethatearlydetectionofdangerouspsychologicaldistressiskeytoreducingsuicidesbuthowtodothatisdifficult

ldquoThisincreasing[suicide]rateisreallyexasperatingrdquosaysDavidJobesapsychologyprofessorandthedirectoroftheSuicidePreventionLaboratoryattheCatholicUniversityofAmericainWashingtonDCldquoThoseofusinthefieldwhowereencouragedinthe1990sarereallydiscouragednowbecausewethoughtweweremakingheadwayrdquo

ProgramsJul091948 MentalHealth

BROWSERELATEDTOPICS

EconomicAnalysesForecastsandStatisticsInternetandSocialMediaMedicalResearchandAdvocacyMentalHealthTeenagers

(0)

Nocommentsonthisreportyet

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7152019 Suicide Crisis CQR

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LongDescription

The2017suicideratewas33percentgreaterthantheratein1999andrankedasthe10thleadingcauseofdeathMorethan47000Americansages10orolderdiedbysuicidein2017morethantwiceasmanyasbyhomicideAnother14millionattemptedsuicideandabout10millionAmericanseachyearreporthavingsuicidalthoughts

The10stateswiththehighestsuicideratesin2017werelargelyintheruralWestbuttherateshaveriseninnearlyeverystateoverthepast20years BabyBoomersmdashpeoplebornbetween1946

and1964mdashhavehadthehighestrateofanyagegroupsinceatleastthe1990sbutexpertsalsohavebeenalarmedbyrisingsuicideratesamongadolescentsandyoungadultsSuicidesamongthoseages15to24reachedthehighestlevelin2017mdash146per100000mdashsincethegovernmentbegancollectingdataonyouthsuicidein1960

ldquoIdontthinkitisanexaggerationhelliptosaythatwehaveamentalhealthcrisisamongadolescentsintheUSrdquosaidSanDiegoStateUniversitypsychologistJeanTwengewhostudiesgenerationaldifferencesinemotionalhealth

Middle-agedwhitemenaccountedformorethan70percentofsuicidesin2017andaccidentaldeathsmdashwhichmanyresearcherssaymayincludesuicidesmdashaswellasopioid-relatedsuicideshavedoubledinthepast17years

AndcertainoccupationsmdashsuchasconstructionlawenforcementfoodpreparationartsandmediamdashreporthighratesofsuicidecomparedwithotherjobsSuicideratesamongmilitaryveteransareabout150percenthigherthanamongcivilians

ldquoItsstartlingandoftremendousconcernthattheratesaregoingupreallytosuchahighrateacrosstheboardrdquosaidDrRobertDickerassociatedirectorofchildandadolescentpsychiatryatZuckerHillsideHospitalinNewYorkCity

SuicidescosttheUSeconomyanestimated$935billionayearprimarilyduetolostproductivityaccordingtothemostrecentdataavailable

ExpertssaymorefederalspendingisneededtobetterpinpointriskfactorsforsuicideldquoThereareveryfewfactsinsuicideresearchrdquosaysStaceyFreedenthalanassociateprofessorattheUniversityofDenverGraduateSchoolofSocialWorkwhospecializesinsuicidepreventionldquoTheresmorehypothesesandtheoriesandcorrelationsrdquo

ldquoWemustmobilizeanationwidepublichealtheffortrdquosaidColleenCreightonexecutivedirectoroftheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicidepreventionresearchandtrainingShecalledforaldquobillion-dollarwaronsuiciderdquo

FundingforsuicideresearchthroughtheNationalInstitutesofHealthrosefrom$46millioninfiscal2015to$96millioninfiscal2018Itwasbudgetedatabout$117millioninfiscal2019butsome

6

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7152019 Suicide Crisis CQR

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CelebritychefandtraveldocumentarianAnthonyBourdaintookhislifeinJune2018Hoursafterhisdeathcallstosomenationalcrisiscentersspikedbyasmuchas500percent(GettyImagesOwenHoffmannPatrickMcMullan)

suicideexpertssaythatisnotenough

ldquoAnyotherdiseasethatcomesclosetokillingasmanyAmericansassuicidedoeslikeHIVandheartdiseasegetsmarqueerecognitionasapublichealthmenaceandmajorfederalresearchfundingrdquosaidDrRichardAFriedmanaprofessorofclinicalpsychiatryatWeillCornellMedicalCollegeinNewYorkCity

ResearcherssaymentalhealthconditionsmdashsuchasschizophreniabipolardisordermanicbehaviorsubstanceabusepoorimpulsecontrolorangermanagementproblemsmdashcanbeafactorinsuicideButmorethan54percentofthosewhodiedbysuicidein2015hadnotbeenpreviouslydiagnosedwithamentaldisorderaccordingtotheCentersforDiseaseControlandPrevention(CDC)Manyresearcherspointtostudiesfromasearlyasthe1950sthatindicatedatleast90percentofsuicidevictimshaveamentaldisorder

DepressionwasafactorinabouthalfofsuicideattemptsaccordingtotheCDCHoweveronly2percentto4percentofthosediagnosedwithdepressionwilldiebysuicideaccordingtotheNationalInstituteofMentalHealth(NIMH)inBethesdaMd

ldquoPeopletendtothinkofsuicideasthepurviewofseverelydepressedpeople[but]thatsnotthecaserdquosaysAmyBarnhorstvicechairforcommunitymentalhealthinthepsychiatrydepartmentattheUniversityofCaliforniaDavisldquoSeveredepressionisonepathwaybutitsnottheonlyonerdquoEmotionalchallengessuchaslosingajoborasignificantrelationshipalsocanbeafactorshesays

GlennRSullivananassociateprofessorofpsychologyattheVirginiaMilitaryInstituteinLexingtonVasayssocialisolationisanotherriskfactorldquoTheresalotoflonelypeopleoutthererdquohesaysldquoIfyouarehavingsuicidalthoughtsandtheresnoonetheretointerveneyoucanhellipsoonhaveasuicidalcrisisrdquo

Morethanhalfofallsuicidesinvolvetheuseofafirearmleadingsomepsychologistsguncontroladvocatesandsuicide

preventiongroupstourgelimitingaccesstofirearmsldquoIfyoutrulywanttocontinuetoreducegundeathsinthiscountryyouhavetotalkabouthellipthetoolsforpreventinggunsuiciderdquosaidJohnFeinblattpresidentofEverytownforGunSafetyaguncontroladvocacygroupinNewYorkCity

FifteenstatesandtheDistrictofColumbiahavepassedldquoredflagrdquolawswhichallowlawenforcementofficersfamiliesor(inDC)mentalhealthpractitionerstopetitionacourttoconfiscatethegunsofindividualsdeemedatriskofharmingthemselvesorothers

OtherresearchersandhealthcareproviderswarnthatanxietyanddepressionhaveincreasedasexposuretosocialmediaandsmartphoneshasgrownamongyoungchildrenandteensButtheydisagreeonwhetherincreasedscreentimeleadstosuicidalthoughts

Sincethelate1980sdrugcompanieshaveproducedantidepressantsmoodstabilizersandantipsychoticdrugsinparttotreatsuicidalthoughtsandbehaviorsThenumberofAmericanstakingsuchmedicationsforfiveyearsormoretripledbetween2000and2017mdashto155million

15

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7152019 Suicide Crisis CQR

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LongDescription

ThedrugsreducedepressionandanxietyinsomepatientsbutmanypeoplehavedifficultystoppingthemwithoutsymptomsreturningForotherpatientsthedrugsdonotworkAnewnasal-sprayversionoftheanestheticketamineapopularpartydruginthe1990sshowspromiseforpatientswhohavenotrespondedtoantidepressantsbutseveralmentalhealthexpertssaytheydoubtitcanreversetherisingsuiciderate(SeeShortFeature)

ldquoWedliketobelievetheresamagicpillandeverythingwillbefineButitjustisnttruerdquosaysDrJulieZitoaprofessorofpharmacyandpsychiatryattheUniversityofMaryland

NewresearchsuggeststhatcertainpsychologicaltherapiesthatfocusonchangingpatientsthinkingpatternsandbehaviormdashsuchastheCollaborativeAssessmentandManagementofSuicidality(CAMS)ordialecticalbehaviortherapy(DBT)mdashcantreatpatientswithsuicidalthoughtsorbehaviorsButfewpsychologistsaretrainedinthosetherapiesandinsurancecompaniesrarelycoverthem

Othersespeciallythosewhodistrustorcannotafforddrugsorpsychotherapyareseekinghelpandadvicefromgroupsandwebsitesorganizedbypeoplewhohavesurvivedsuicideattempts(SeeShortFeature)

HealthcareprovidersandresearcherssayearlyidentificationofthoseatriskandearlytreatmentarethekeystoloweringsuicideratesTothatendexpertsinartificialintelligenceandmachineanalyticsareraisinghopesthatcomputerizedtoolsthatsiftthroughmassiveamountsofhealthdatacouldhelpidentifypotentiallysuicidalpatientsTheDepartmentofVeteransAffairs(VA)isusingsuchatooltoaddressrisingsuicideratesamongveterans

AsthefederalgovernmentcommunitiesresearchersandhealthcareprovidersseekwaystoreversetherisingUSsuicideratethesearesomequestionsbeingdebated

Couldtougherguncontrollawsreducethesuiciderate

Abouttwo-thirdsofthenearly40000gun-relateddeathsin2017weresuicideswithwhitemenaccountingforthehighestpercentageofsuchsuicides Andfirearmsaccountformorethanhalf

ofallsuicidedeathseventhoughtheyareusedinlessthan6percentofsuicideattemptsThatisbecausefirearmsarethedeadliestmethodofsuicide825percentofattemptsusingafirearmarefatal

HoweverexpertsdisagreeonwhethereasyaccesstogunsistoblameforAmericasrisingsuiciderateldquoGunsrepresentanopportunityweasanationcanleverageinaconcertedefforttosubstantiallylowerthenationalsuicideraterdquoMichaelDAnestisaUniversityofSouthernMississippiassociateprofessorofpsychologywroteinGunsandSuicideAnAmericanEpidemic

ButSullivanattheVirginiaMilitaryInstitutesaysgunsarenottheonlyproblemldquoTherecantpossiblybeasingleexplanationforaphenomenonsowidespreadandcomplexassuiciderdquohesays

ResearchersattheRANDCorpaSantaMonicaCalif-basedthinktanksaiditseemslogicalthatbecausegunsarethemostlethalformofsuicideldquowhengunsarelessavailablefewersuicideattemptswillresultinfatalityrdquoButstudieshavenotclearlyprovedthataccordingtotheRANDresearchers

SomeresearcherspointoutthatsuiciderateshavefallenincountriesthathaverestrictedaccesstocertainpoisonsordrugstypicallyusedinsuicidesForexampledeathsinEnglandandWales

22

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7152019 Suicide Crisis CQR

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attributedtooverdosesofparacetamol(theBritishequivalentofTylenol)fell43percentin11yearsaftera1998lawrestrictedpackagingsize AndsuicideratesinSriLankadecreasedsignificantly

afterthegovernmentrestrictedtheimportationandsalesoftoxicpesticidescommonlyusedinself-poisonings

LongDescription

ldquoItappearsifyoutakeawaythe[methodsthatsuicidalindividuals]werefocusedontheycangetoffthattrajectoryandyoucansavealiferdquosaysJaneLPearsonspecialadvisertothedirectorofsuicideresearchatNIMHPearsonsaysresearchershavefoundthatmanysuicideattemptsareimpulsiveactsandpeoplewhoseattemptsfaildonotusuallytryagainForeverysuicidedeathabout25attemptsfailaccordingtotheCDC

ldquoIfthemethodyouusedoesntkillyouitdoesntmeanyouwilljustgooutrdquoandfindanothermethodsaysPaulSNestadtanassistantprofessorofpsychiatryandbehavioralsciencesatJohnsHopkinsUniversityinBaltimoreHecitedaUniversityofCaliforniaBerkeleystudyshowingthatonlyabout6percentofpeoplestoppedfromjumpingofftheGoldenGateBridgeinSanFranciscobetween1937and1971evertriedtoattemptsuicideagain

ResearchersalsodisagreeonwhichtypeofguncontrollawswouldhelpreducesuicidesSomeexpertsbelievebackgroundchecksforgunpurchaserswouldworkiftheylookforpreviousmentalhealthissuesButa2018HarvardUniversitystudyfoundthat87percentofsuicidevictimscouldhavepassedabackgroundcheckonthedayoftheirdeath

NestadtsayscertainguncontrolactionshavecoincidedwithfallingsuicideratesForinstancehesaysinthedecadeaftertheDistrictofColumbiabarredthepurchaseorsaleofhandgunsbyciviliansin1976suicidesbyfirearmsdropped23percent

AstudyledbyAnestisonthecorrelationbetweenpassageofstateguncontrollawsandchangesinsuicideratesfoundthatlegislationfocusedonldquopreventinggunownershipratherthanregulatinguseandstoragerdquoofexistinggunsdidthemosttolowersuiciderates

AmongproposedguncontrolmeasuresredflaglawsappeartohavethegreatestpublicsupportbutstudiesoftheireffectivenessinreducingsuicideshaveproducedmixedresultsAUniversityofIndianapolisstudysaidfirearms-relatedsuicidesfell75percentinIndianainthedecadeaftertheLegislaturepassedaredflaglawin2005

AndastudyledbyDukeUniversitypsychiatryprofessorDrJeffreySwansononwhetherConnecticuts1999redflaglawhelpedpoliceavertsuicidesfoundthatsuchgunremovallawscouldbeldquoatleastmodestlyeffectiveinpreventingsuiciderdquoBetween1999and2013theresearcherssaid61percentofthe762peoplewhosegunswereconfiscatedforayearwereconsideredasuicideriskOfthose21laterdidkillthemselvessixwithagun

ButDavidBKopelresearchdirectoroftheIndependentInstituteinDenverColoagun-rightsadvocacycenterpointedouttotheUSSenateJudiciaryCommitteeinMarchthattheConnecticutlawdidnotpreventallsuicidesOfthosewhodiedbysuicideaftertheirgunswereconfiscatedhesaid10werecompletedbyhangingorstrangulationThetheorythatdeprivingsuicidalpeopleoffirearmswillmakeitlesslikelythattheywilldiebysuicideisincorrecthesaidldquoSeveralothermethodsofsuicidemdashnamelyhangingcarbonmonoxideexhaustordrowningmdasharenearlyaslikelyasfirearmstoresultindeathrdquo

JohnRLottJragun-rightsadvocateandthefounderoftheCrimePreventionResearchCenterinSwarthmorePaandCarlisleEMoodyaprofessorofcriminologyandeconomicsattheCollegeof

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7152019 Suicide Crisis CQR

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WilliamampMaryinWilliamsburgVaconductedtheirownresearchandconcludedthatredflaglawsinCaliforniaConnecticutIndianaandWashingtonstatehadldquonosignificanteffectrdquoonsuicide

DrPaulSAppelbaumaprofessorofpsychiatryandlawatColumbiaUniversitysaysthelawsrepresentldquoaninnovativeapproachrdquotoidentifyingpeopleatriskofviolence

HoweverhesaysldquoOverallIthinkthecontributiontheywillmaketoreducingthesuiciderateasawholewillberelativelysmallbecausemostpeoplewhoaresuicidalwillprobablynotdoanythingthatcallsattentiontothemselvesinsuchawaythatpolicearesummonedtointervenerdquo

Doessocialmediaincreasetheriskforsuicide

SanDiegoStateUniversitysTwengeauthorofiGenabookaboutthefirstgenerationofAmericanstospendtheirteenyearsusingsocialmediabelievestheincreasinguseofsocialmediaiscreatingmentalhealthproblemsforadolescents

TwengeledastudyanalyzingdatafromtwosurveysonUSadolescentsandyouthbehavioralongwithCDCdataonsuicidedeathssince1999Thedatashowedthatbetween2010and2015thenumberofadolescentsreportingseveredepressionrose33percentandthenumberofsuicidesincreased31percentGirlsmdashparticularlythosewhospentmoretimeonlinethantheirpeersmdashweremostlikelytoreportdepressiveorsuicidalsymptomsTheresearchersconcludedthattheincreasedtimethatadolescentsspentonscreenactivitiesmayaccountforincreasesindepressionandsuicide

InanotherstudyTwengeandseveralcolleaguesreportedthat132percentof18-to25-year-oldsreportedseriouspsychologicaldistressin2017up71percentfrom2008Meanwhilemajordepressiveepisodesamong12-to17-year-oldsin2017wereup52percentfrom2005Andoneofeveryfiveteenagegirlshadexperiencedmajordepressioninthepreviousyear

Twengesteamattributedsuchdistresstolessin-personsocialinteractionamongadolescentsthanamongyouthsinpriorgenerationslargelyduetothegrowingprevalenceoftimespentonsmartphonesandsocialmedia

ButotherresearchersquestionTwengesconclusionthatscreentimedirectlyleadstomdashoristheprimarycauseofmdashdepressionorsuicide

OxfordUniversitypsychologyresearchersAmyOrbenandAndrewKPrzybylskibelievethecorrelationbetweendigitaltechnologyuseandadolescentsmentalhealthisoverstatedStudieslikeTwengesarebasedonanalysesoflargedatasetsthatcanbesubjecttoresearchersbiastheysaidAnalyzingthesamedatasetsTwengeusedforiGentheresearchersconcludedthatscreenusehadaldquotinyrdquoeffectonteensmentalhealthwhencomparedwitharangeofotherpotentialcorrelatingfactors

ldquoUsingtechnologyisaboutasassociatedwithwell-beingaseatingpotatoesrdquoPrzybylskisaidBullyinghadafourtimesgreatereffectonmentalhealthsaidOrbenandPrzybylski

InMaythetworesearchersevaluatedwhethertheamountoftimeadolescentsspendonsocialmediaaffectstheirmoodAgaintheyfoundthatscreentimehadaldquotinymdasharguablytrivialrdquomdasheffectonmood

ldquoItsnottimespentthatisassociatedwithpositiveornegativeoutcomesbuthowpeopleusesocialmediardquosaysChristopherFergusonapsychologyprofessoratStetsonUniversityinFloridaIna2017studyFergusonfoundthatmoderateuseofscreensdidnotincreasebehavioralormentalhealthproblemsamongchildrenandexcessivescreentimeonlymarginallycorrelatedwithsuchproblemsInanotherstudyheandtwootherresearchersconcludedthattimespentonlinedidnotresultindepressionorsuicidalthoughtsamongyoungadults

MikeBrooksdirectoroftheAustinPsychologyandAssessmentCenterinAustinTexasandauthorofTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldsaysldquoMypettheoryisthatwhenweseeassociationbetweenscreenuseandnegativehealthoutcomesitmaybethatitsbecausetheyareupuntil1amandtheirsleepistakingahitandthentheirmoodrdquo

AstudyledbyaUniversityofColoradoBoulderintegrativephysiologyprofessorfoundalinkbetweendigitalmediauseandreducedsleepandastudyledbyaStanfordpsychiatryprofessorfoundthatsleepproblemscouldprovideearlycluestosuicidalthoughtsincertainyoungadults

BrooksandFergusonagreehoweverwithTwengestheorythatdigitalmediausecanleadtosocialisolationifitreplacesin-personinteractionldquoTheresagoodreasontobeconcernedbutalarmismisproblematicrdquoBrookssays

SaraKonrathanassociateprofessorofphilanthropicstudiesatIndianaUniversitysayssmartphonesandsocialmediacanreducelonelinessamongyoungpeoplebecausetheyfeelsurroundedbyothersA2015studybytwoGermanresearchersfoundthatbrowsingFacebooktriggerspositiveemotionsmoreoftenthannegativeones

HoweverastudyledbyUniversityofMichiganpsychologyprofessorEthanKrossfoundthatthemoretimepeoplespentonFacebooktheworsetheyfeltpsychologicallyAndaBritishstudyfoundthatamongsocialmediasitesInstagramand

36

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7152019 Suicide Crisis CQR

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IanRussellsdaughterMollytookherlifeatage14afterviewingdisturbingmaterialonInstagramInJuneRussellspokeataconferenceinLondontourgesocialmediacompaniestobettercontrolonlinematerialthatpromotessuicideandotherformsofselfharm(GettyImagesHelenWIlliams)

Snapchatwerethemostdetrimentaltothementalhealthofyoungpeople(ages14to24)basedontheirresponsestoquestionsaboutanxietydepressionlonelinesssleepbodyimageandcyberbullying

ManyobserversraisealarmsabouttheavailabilityonlineofinformationabouthowtotakeoneslifeIanRussellwhose14-year-olddaughterMollykilledherselfin2017holdsInstagrampartlyresponsibleAfterhersuicidethefamilyfoundmaterialinherInstagramaccountaboutdepressionandsuicidalmethodsInstagramsaiditldquodoesnotallowcontentthatpromotesorglorifiesself-harmorsuiciderdquoandhassaiditwouldremovesuchcontent

ManyworrythatcyberbullyingcanleadtosuicidalthoughtsparticularlyamonggirlsThesuiciderateamonggirlsages10to14grew127percentbetween2007and2016comparedwith71percentamongboysinthesameagegroupaccordingtoonestudy

ldquoGirlsaremoreoftenhellipcyberbullied[thanboys]onsocialmediardquosaidJoanLubyapsychiatristatWashingtonUniversitySchoolofMedicineinStLouisandldquotheytendtohavemuchmorenegativepsychologicaleffectstothatcyberbullyingrdquo

ButDanielJReidenbergexecutivedirectorofSuicideAwarenessVoicesofEducationanonprofitsuicidepreventionandpubliceducationgroupinBloomingtonMinnsayspeoplesharetheirsuicidalthoughtsonlinefarmorefrequentlynowthaninthepastandinsuchcasesfriendsoftencanprovidehelp

InJanuaryafterChicagorapperCupcakKetweetedthatshewassuicidalherfollowersimmediatelymessagedherandalertedauthoritieswhotookhertothehospitalwhereshebegantreatmentfordepression

Canldquobigdatardquohelpreducesuiciderates

TheDepartmentofVeteransAffairsisusingacomputeralgorithmthatsiftsthroughvoluminoushealthdatatodetectcommonwarningsignsandflagveteranswhoareatriskofsuicideVAhealthcareprovidersthenreachoutdirectlytothoseindividualsandtheveteransdecidewhethertoseekhelp

ldquo[V]eteransathighestriskofsuicidearealsoatveryhighriskofsomeotherthingsrdquosuchasaccidentsoverdosesandopioidaddictionsaidAaronEaganthedepartmentsdeputydirectorforinnovation

Withinayearofimplementingtheso-calledREACHVetprograminApril2017theVAhadcontactedmorethan30000veteransThoseparticipatingintheprogramwereadmittedtomentalhealthinpatientunitslessoftenshowedupmoreoftenfordoctorappointmentsandvisitedtheVAmorefrequentlythanothervetsthedepartmentreported

Manyresearchershealthcareprovidersandothersbelievesimilardataanalyticscanhelpalertnonmilitarydoctorsaboutat-riskpatientsHealthcareproviderstypicallyassesssuicideriskbyaskingpatientssuchquestionsaswhethertheyaredepressedhaveconsideredharmingthemselvesorhaveasuicideplanHoweverone-thirdofsuicideattemptsanddeathsoccuramongpatientswhohavenotreportedsuicidalthoughts

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7152019 Suicide Crisis CQR

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AtaMay2016eventinWashingtonDCaimedatpreventingveteransuicideveteranstheirfamiliesandsurvivorsofveteranswhohavediedbysuicidereachouttooneanotherandtotouchtheSpartanswordmadefrommelted-downsteelfromtheWorldTradeCenter(GettyImagesTheWashingtonPostMichaelSWIlliamson)

ResearchersbelievethathealthprofessionalscouldpreventasuicideiftheyknewmoreaboutapatientsriskA2014studyfoundthat83percentofthosewhokilledthemselveshadvisitedadoctorsofficewithinthepreviousyearbutabouthalfofthemdidnothaveamentalhealthdiagnosis

DataanalyticscouldhelptrackstreamsofinformationandalertdoctorswhenapatientmayneedathoroughassessmentsaysGregoryESimonaseniorinvestigatorforKaiserPermanenteWashingtonHealthResearchInstituteinSeattleandapsychiatristatKaiserHeequatesittoawarninglightonacarssideviewmirrorthatilluminateswhenanothercarpullsintothedriversblindspotldquoThepurposeistodeliverinformationtoourhealthcareprovidersthatpeopleareatriskthenlet[theproviders]dowhattheydobetterrdquo

FacebookalsousesartificialintelligencetoscanpostingsforlivevideosofsuicideorphrasesorwordsthatsuggestsuicidalthoughtsWithinayearofstartingtheprogramin2017Facebookhadfound3500postsorvideoscontainingcontentthatledthecompanytocontactemergencyresponders

NeverthelessmanymedicalcareprovidersresearchersandothersareuncertainwhethersuchtoolscanhelpPeopleatriskofsuicideoftenaresociallyisolatedandunlikelytovisitadoctorsotheymightnotgenerateenoughhealthrecordsforalgorithmstoevaluatesaysBarnhorstattheUniversityofCaliforniaDavisldquoIdontknowwherethepredictiveanalytics[data]wouldcomefromrdquoshesaysldquoTheresnotalotofoutputfromthesepeoplerdquo

TheNIMHsPearsonissimilarlycautiousldquoWehavewaysofhelpingpeoplebyusingexistingdatatofindsomeoneatriskrdquoshesaysButmoreresearchisneededtoensurethatartificialintelligencetoolsdonotmisswholegroupsofpeopleldquoTheremayberacialethnicminoritiesorsexualminoritieswhoarenothittingthehealthcaresystemveryoftenforanumberofreasonsrdquoshesaysldquoHowdotheyfareinpredictiveanalyticsThatsareallyimportantquestionrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteaNewYorkCitymentalhealthtreatmentcentercallspredictiveanalyticsldquoextremelyusefulrdquoinhelpingidentifypotentialsuicidevictimsHoweveritcannotensurethatpeoplewillgetthetreatmenttheyneedldquoIfpredictiveanalyticsledtoaprogramwherepeoplewhoareathigherriskhadtheirguns[confiscated]thatwouldreducethesuicideraterdquohesays

ColumbiaUniversitysAppelbaumsayspeoplehavetriedtopredictsuicidesbasedonvariousriskfactorsldquoforalongtimeandithasbeenextremelydifficultrdquoldquoThevariablesassociatedwithsuicidearecommoninthepopulationanduncommonlyleadtosuicidaloutcomesrdquohesaysForexampledepressionisastrongpredictorofsuicidebutmostpeoplewithdepressiondonotattemptsuicide

Heandotherresearcherssayyearsofresearchshowthatscientistsstilldonotknowexactlyhowtopredictsuicide Ameta-analysisof50yearsofresearchpublishedin2016concludedthat

scientistshavenotgottenanybetteratpredictingsuicideattemptssayingldquopredictionwasonlyslightlybetterthanchancerdquo

OtherresearchersacknowledgethatthescienceofpredictionisnotperfectbutsayitcouldhelphealthcareprovidersdotheirjobbetterldquoItwillmissahugepercentageofpeopleItsnotgoingtosolveallofourproblemsrdquoUrsulaWhitesideaclinicalpsychologistattheUniversityofWashingtoninSeattlesaysldquoButitishelpfultocliniciansrdquo

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7152019 Suicide Crisis CQR

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LongDescription

OtherresearchersareraisingprivacyconcernsabouttheuseofpredictiveanalyticsinsuicidepreventiontoolsMasonMarksavisitingfellowatYaleLawSchoolsInformationSocietyProjectsaidthatwhilehealthcareprivacylawsgovernhowmedicalproviderscanusepatientmedicalrecordsartificial-intelligence-basedsuicidepredictionusingsocialmediainformationanddataisunregulatedandcouldposesafetyandethicalconcerns

ldquoTherisksincludestigmatizationofpeoplewithmentalillnessthetransferofsensitivehealthdatatothird-partieshellipunnecessaryinvoluntaryconfinementviolentconfrontationswithpoliceexacerbationofmentalhealthconditionsandhellipincreasesinsuicideriskrdquohesaid

Companiesandlawmakerswillhavetoexaminepolicyandlegalframeworksheadded

Gototop

Background

ResearchEmerges

InancientsocietiesphilosophersreligiousleadersandgovernmentsreactedtosuicideinavarietyofwaysrangingfromglorificationtoreligiouscondemnationColonistsinearlyAmericaviewedsuicideasasinandacrimeuntiljuriesbegantoseeitasasymptomofdiseaseCourtsstoppedrulingitacrimebytheendofthe1800s

Alsointhe19thcenturyresearchersbeganstudyingwhethereconomicandsociologicalchangesmdashincreasedindustrializationandloosenedfamilyandcommunitytiesmdashledtomentalillnessandsuicidePhysiciansbegansendingsuicidalpatientstoasylumsfortreatmentwithsedativesorstimulants

ScientistsgavesuicideonlysporadicattentionhoweveruntilFrenchsociologistEacutemileDurkheimconcludedinhis1897bookLeSuicidethatpeoplewhoweremoresociallyintegratedwerelesslikelytokillthemselvesHealsofoundsuicidemorecommonamongmenthanwomenandsoldiersthancivilians

DurkheimsbookpromptedotherscientiststoanalyzementalillnessmorecloselyIn1925psychiatristsKarlandWilliamMenningeropenedaclinicoutsideTopekaKantotreatthementallyillInhis1930bookTheHumanMindKarlcontendedthatpsychiatrycouldhelpsuchpatientsEightyearslaterhisManAgainstHimselfsuggestedthatthesuicidalimpulsewasamisdirectionofthesurvivalinstinct

DuringtheGreatDepressionthesuiciderateintheUnitedStatesreacheda20th-centurypeakmdash219suicidesper100000mdashin1932 Itwouldfallto114per100000by1957climberratically

duringthe1960sthroughthe1970sreaching137in1977andfalltoanall-timelowof104in2000(SeeGraphic)

AfterWorldWarIIclinicalpsychologistEdwinShneidmanpropelledsuicideresearchwhenhebeganinvestigatingacacheofLosAngelesdeathrecordsfilledwithhundredsofsuicidenotes

In1958ShneidmanandpsychologistNormanLFarberowalongwithDrRobertELitmanusedafederalgranttoopenthefirstsuicidepreventionfacilityinacondemnedbuildingoftheLosAngelesCountyGeneralHospitalStaffofferedin-personandphonecounselingtoindividualsexperiencing

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depressionandsuicidalthoughtsMostfamouslythecenterconductedthefirstpsychologicalautopsiesmdashinterviewswithfamilyfriendsdoctorsandotherassociatesofsuicidevictimstoconfirmthecauseofdeath

TheNationalCenterforHealthStatisticsreportedthatin1964anaverageof56Americanskilledthemselveseverydayaccountingfor1percentofdeathsthatyearButthecenteralsosaidsuicidestatisticslikelywereldquogrosslyunderstatedrdquobecausefamilyandfriendsoftenpreventedcoronersfromreportingsuicidesondeathcertificates

TheNationalInstituteofMentalHealthbeganacampaigninthe1960storeducementalillnessandsuicideTheinstitutein1966hiredShneidmantocreateasuicidepreventionprogramwhichledtoajumpinthenumberofUSsuicidepreventioncentersmdashfrom15tomorethan100withinafewyears

SuicideandHealth

Inthe1980sand90ssuicidebecamealeadinghealthconcernintheUnitedStatesandtheworldBy1990USrateshadreached124per100000forallagegroupsbutforages15to24theraterosefrom88to132per100000

ExpertsspeculatedthatfamilydisintegrationduetorisingdivorceratesdrugabusedwindlingjobandeducationalopportunitiesandtheavailabilityofgunscouldbepartlytoblameFirearmscontinuedtobethemostcommonmethodofsuicide

Studiesinthe1980sbyDavidPPhillipsasociologistattheUniversityofCaliforniaSanDiegofoundthatsuicidesrosesignificantlyafterwell-publicizedcaseswiththerisegreatestamongteenagers Andresearchersfoundcorrelationsbetweenfictionalizedsuicideattemptsin

televisionmoviesandincreasedsuicideattemptsamongteens

AsthesuiciderateamongadolescentsandyoungadultsrosetheDepartmentofHealthandHumanServicescreatedataskforceonyouthsuicidein1985 In1987agroupoffamiliesaffectedby

suicidejoinedwithscientiststoestablishtheAmericanFoundationforSuicidePreventiontofundresearchandeducationaboutsuicideMoregrassrootsorganizationsfollowed

ResearchersandcommunitiesgrewincreasinglyconcernedaboutsuicideclustersmdashmultiplesuicidesoccurringinthesamegeographicalareainashortspanoftimeInMarch1987forexamplefourteenagersinBergenfieldNJkilledthemselvesbylockingthemselvesinagarageandrunningacarengineWithinaweekatleasttwootheryoungpeopleattemptedsuicideinthesamemanner

ldquoThenewscoverageofteenagesuicidescanportraythevictimsasmartyrsofsortsrdquosaidDrDavidShafferachildpsychiatryprofessoratColumbiaUniversityandthedirectorofthesuicideresearchunitattheNewYorkStatePsychiatricInstituteldquoThemoresentimentalizeditisthemorelegitimatemdashevenheroicmdashitmayseemtosometeenagersrdquo

Drugtreatmentsfordepressionwereintroducedinthelate1980sbeginningwiththe1987approvalofProzacbytheUSFoodandDrugAdministration(FDA)Thedrugaimedtoeasedepressionbyraisingthelevelsofachemicalcalledserotonininthebrain

In1989suicideexpertsotherresearcherspublichealthofficialsandnewsoutletsmettodiscusswaystopreventsuicidecontagionTheydevelopedrecommendationsfordiscussionswiththemediaandsuggestedthatnewsoutletsavoidprovidingdetailsofsuicidemethods

Intheearly1990sUniversityofWashingtonpsychologistMarshaLinehandevelopedoneofthethreeevidence-basedinterventionsandtreatmentsthathavebeenshowntobeeffectiveinreducingsuicidalityHerprogramcalleddialecticalbehaviortherapyteachespatientshowtomanagepainfulemotionsanddecreaseconflictinrelationships Theothertwotreatmentsarecognitivebehavior

therapywhichencouragespatientstochallengedistortedviewpointsandchangedestructivepatternsofbehaviorandCAMSdevelopedbyCatholicUniversitysJobesTherapistsusingCAMStalkindetailwithpatientsabouttheirthoughtsofhopelessnessandsuicideandhelpthembuildatreatmentplan

Althoughsuicideratesfellinthe1990sresearchersandhealthofficialsremainedconcernedaboutfindinganeffectivetreatmentforsuicidalbehaviormdashparticularlyafterthehighlypublicizedsuicideofKurtCobainleadsingerfortherockbandNirvanaonApril51994ACatholicUniversitystudydeterminedthatCobainssuicidewasnotfollowedbycopycatsuicidesbutdidsparkmorecallstosuicidecrisishotlinesmdashlikelyduetohowthemediacoveredthestoryandcommunityoutreacheffortsencouragingpeopleatrisktoseekhelp

ldquoCalltoActionrdquo

In1996theWorldHealthOrganizationurgedmembernationstoaddressrisingsuicideratesintheircountriesMostalarminglythenumberofsuicidesintheUnitedStateshadnearlytripledamongadolescentsandyoungadultssince1952Suicidewasthethirdleadingcauseofdeathamongthoseages15to24andthefourthleadingcauseamongthoseages10to14

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Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

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couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

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volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

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WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 3: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

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LongDescription

The2017suicideratewas33percentgreaterthantheratein1999andrankedasthe10thleadingcauseofdeathMorethan47000Americansages10orolderdiedbysuicidein2017morethantwiceasmanyasbyhomicideAnother14millionattemptedsuicideandabout10millionAmericanseachyearreporthavingsuicidalthoughts

The10stateswiththehighestsuicideratesin2017werelargelyintheruralWestbuttherateshaveriseninnearlyeverystateoverthepast20years BabyBoomersmdashpeoplebornbetween1946

and1964mdashhavehadthehighestrateofanyagegroupsinceatleastthe1990sbutexpertsalsohavebeenalarmedbyrisingsuicideratesamongadolescentsandyoungadultsSuicidesamongthoseages15to24reachedthehighestlevelin2017mdash146per100000mdashsincethegovernmentbegancollectingdataonyouthsuicidein1960

ldquoIdontthinkitisanexaggerationhelliptosaythatwehaveamentalhealthcrisisamongadolescentsintheUSrdquosaidSanDiegoStateUniversitypsychologistJeanTwengewhostudiesgenerationaldifferencesinemotionalhealth

Middle-agedwhitemenaccountedformorethan70percentofsuicidesin2017andaccidentaldeathsmdashwhichmanyresearcherssaymayincludesuicidesmdashaswellasopioid-relatedsuicideshavedoubledinthepast17years

AndcertainoccupationsmdashsuchasconstructionlawenforcementfoodpreparationartsandmediamdashreporthighratesofsuicidecomparedwithotherjobsSuicideratesamongmilitaryveteransareabout150percenthigherthanamongcivilians

ldquoItsstartlingandoftremendousconcernthattheratesaregoingupreallytosuchahighrateacrosstheboardrdquosaidDrRobertDickerassociatedirectorofchildandadolescentpsychiatryatZuckerHillsideHospitalinNewYorkCity

SuicidescosttheUSeconomyanestimated$935billionayearprimarilyduetolostproductivityaccordingtothemostrecentdataavailable

ExpertssaymorefederalspendingisneededtobetterpinpointriskfactorsforsuicideldquoThereareveryfewfactsinsuicideresearchrdquosaysStaceyFreedenthalanassociateprofessorattheUniversityofDenverGraduateSchoolofSocialWorkwhospecializesinsuicidepreventionldquoTheresmorehypothesesandtheoriesandcorrelationsrdquo

ldquoWemustmobilizeanationwidepublichealtheffortrdquosaidColleenCreightonexecutivedirectoroftheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicidepreventionresearchandtrainingShecalledforaldquobillion-dollarwaronsuiciderdquo

FundingforsuicideresearchthroughtheNationalInstitutesofHealthrosefrom$46millioninfiscal2015to$96millioninfiscal2018Itwasbudgetedatabout$117millioninfiscal2019butsome

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7152019 Suicide Crisis CQR

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CelebritychefandtraveldocumentarianAnthonyBourdaintookhislifeinJune2018Hoursafterhisdeathcallstosomenationalcrisiscentersspikedbyasmuchas500percent(GettyImagesOwenHoffmannPatrickMcMullan)

suicideexpertssaythatisnotenough

ldquoAnyotherdiseasethatcomesclosetokillingasmanyAmericansassuicidedoeslikeHIVandheartdiseasegetsmarqueerecognitionasapublichealthmenaceandmajorfederalresearchfundingrdquosaidDrRichardAFriedmanaprofessorofclinicalpsychiatryatWeillCornellMedicalCollegeinNewYorkCity

ResearcherssaymentalhealthconditionsmdashsuchasschizophreniabipolardisordermanicbehaviorsubstanceabusepoorimpulsecontrolorangermanagementproblemsmdashcanbeafactorinsuicideButmorethan54percentofthosewhodiedbysuicidein2015hadnotbeenpreviouslydiagnosedwithamentaldisorderaccordingtotheCentersforDiseaseControlandPrevention(CDC)Manyresearcherspointtostudiesfromasearlyasthe1950sthatindicatedatleast90percentofsuicidevictimshaveamentaldisorder

DepressionwasafactorinabouthalfofsuicideattemptsaccordingtotheCDCHoweveronly2percentto4percentofthosediagnosedwithdepressionwilldiebysuicideaccordingtotheNationalInstituteofMentalHealth(NIMH)inBethesdaMd

ldquoPeopletendtothinkofsuicideasthepurviewofseverelydepressedpeople[but]thatsnotthecaserdquosaysAmyBarnhorstvicechairforcommunitymentalhealthinthepsychiatrydepartmentattheUniversityofCaliforniaDavisldquoSeveredepressionisonepathwaybutitsnottheonlyonerdquoEmotionalchallengessuchaslosingajoborasignificantrelationshipalsocanbeafactorshesays

GlennRSullivananassociateprofessorofpsychologyattheVirginiaMilitaryInstituteinLexingtonVasayssocialisolationisanotherriskfactorldquoTheresalotoflonelypeopleoutthererdquohesaysldquoIfyouarehavingsuicidalthoughtsandtheresnoonetheretointerveneyoucanhellipsoonhaveasuicidalcrisisrdquo

Morethanhalfofallsuicidesinvolvetheuseofafirearmleadingsomepsychologistsguncontroladvocatesandsuicide

preventiongroupstourgelimitingaccesstofirearmsldquoIfyoutrulywanttocontinuetoreducegundeathsinthiscountryyouhavetotalkabouthellipthetoolsforpreventinggunsuiciderdquosaidJohnFeinblattpresidentofEverytownforGunSafetyaguncontroladvocacygroupinNewYorkCity

FifteenstatesandtheDistrictofColumbiahavepassedldquoredflagrdquolawswhichallowlawenforcementofficersfamiliesor(inDC)mentalhealthpractitionerstopetitionacourttoconfiscatethegunsofindividualsdeemedatriskofharmingthemselvesorothers

OtherresearchersandhealthcareproviderswarnthatanxietyanddepressionhaveincreasedasexposuretosocialmediaandsmartphoneshasgrownamongyoungchildrenandteensButtheydisagreeonwhetherincreasedscreentimeleadstosuicidalthoughts

Sincethelate1980sdrugcompanieshaveproducedantidepressantsmoodstabilizersandantipsychoticdrugsinparttotreatsuicidalthoughtsandbehaviorsThenumberofAmericanstakingsuchmedicationsforfiveyearsormoretripledbetween2000and2017mdashto155million

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7152019 Suicide Crisis CQR

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LongDescription

ThedrugsreducedepressionandanxietyinsomepatientsbutmanypeoplehavedifficultystoppingthemwithoutsymptomsreturningForotherpatientsthedrugsdonotworkAnewnasal-sprayversionoftheanestheticketamineapopularpartydruginthe1990sshowspromiseforpatientswhohavenotrespondedtoantidepressantsbutseveralmentalhealthexpertssaytheydoubtitcanreversetherisingsuiciderate(SeeShortFeature)

ldquoWedliketobelievetheresamagicpillandeverythingwillbefineButitjustisnttruerdquosaysDrJulieZitoaprofessorofpharmacyandpsychiatryattheUniversityofMaryland

NewresearchsuggeststhatcertainpsychologicaltherapiesthatfocusonchangingpatientsthinkingpatternsandbehaviormdashsuchastheCollaborativeAssessmentandManagementofSuicidality(CAMS)ordialecticalbehaviortherapy(DBT)mdashcantreatpatientswithsuicidalthoughtsorbehaviorsButfewpsychologistsaretrainedinthosetherapiesandinsurancecompaniesrarelycoverthem

Othersespeciallythosewhodistrustorcannotafforddrugsorpsychotherapyareseekinghelpandadvicefromgroupsandwebsitesorganizedbypeoplewhohavesurvivedsuicideattempts(SeeShortFeature)

HealthcareprovidersandresearcherssayearlyidentificationofthoseatriskandearlytreatmentarethekeystoloweringsuicideratesTothatendexpertsinartificialintelligenceandmachineanalyticsareraisinghopesthatcomputerizedtoolsthatsiftthroughmassiveamountsofhealthdatacouldhelpidentifypotentiallysuicidalpatientsTheDepartmentofVeteransAffairs(VA)isusingsuchatooltoaddressrisingsuicideratesamongveterans

AsthefederalgovernmentcommunitiesresearchersandhealthcareprovidersseekwaystoreversetherisingUSsuicideratethesearesomequestionsbeingdebated

Couldtougherguncontrollawsreducethesuiciderate

Abouttwo-thirdsofthenearly40000gun-relateddeathsin2017weresuicideswithwhitemenaccountingforthehighestpercentageofsuchsuicides Andfirearmsaccountformorethanhalf

ofallsuicidedeathseventhoughtheyareusedinlessthan6percentofsuicideattemptsThatisbecausefirearmsarethedeadliestmethodofsuicide825percentofattemptsusingafirearmarefatal

HoweverexpertsdisagreeonwhethereasyaccesstogunsistoblameforAmericasrisingsuiciderateldquoGunsrepresentanopportunityweasanationcanleverageinaconcertedefforttosubstantiallylowerthenationalsuicideraterdquoMichaelDAnestisaUniversityofSouthernMississippiassociateprofessorofpsychologywroteinGunsandSuicideAnAmericanEpidemic

ButSullivanattheVirginiaMilitaryInstitutesaysgunsarenottheonlyproblemldquoTherecantpossiblybeasingleexplanationforaphenomenonsowidespreadandcomplexassuiciderdquohesays

ResearchersattheRANDCorpaSantaMonicaCalif-basedthinktanksaiditseemslogicalthatbecausegunsarethemostlethalformofsuicideldquowhengunsarelessavailablefewersuicideattemptswillresultinfatalityrdquoButstudieshavenotclearlyprovedthataccordingtotheRANDresearchers

SomeresearcherspointoutthatsuiciderateshavefallenincountriesthathaverestrictedaccesstocertainpoisonsordrugstypicallyusedinsuicidesForexampledeathsinEnglandandWales

22

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7152019 Suicide Crisis CQR

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attributedtooverdosesofparacetamol(theBritishequivalentofTylenol)fell43percentin11yearsaftera1998lawrestrictedpackagingsize AndsuicideratesinSriLankadecreasedsignificantly

afterthegovernmentrestrictedtheimportationandsalesoftoxicpesticidescommonlyusedinself-poisonings

LongDescription

ldquoItappearsifyoutakeawaythe[methodsthatsuicidalindividuals]werefocusedontheycangetoffthattrajectoryandyoucansavealiferdquosaysJaneLPearsonspecialadvisertothedirectorofsuicideresearchatNIMHPearsonsaysresearchershavefoundthatmanysuicideattemptsareimpulsiveactsandpeoplewhoseattemptsfaildonotusuallytryagainForeverysuicidedeathabout25attemptsfailaccordingtotheCDC

ldquoIfthemethodyouusedoesntkillyouitdoesntmeanyouwilljustgooutrdquoandfindanothermethodsaysPaulSNestadtanassistantprofessorofpsychiatryandbehavioralsciencesatJohnsHopkinsUniversityinBaltimoreHecitedaUniversityofCaliforniaBerkeleystudyshowingthatonlyabout6percentofpeoplestoppedfromjumpingofftheGoldenGateBridgeinSanFranciscobetween1937and1971evertriedtoattemptsuicideagain

ResearchersalsodisagreeonwhichtypeofguncontrollawswouldhelpreducesuicidesSomeexpertsbelievebackgroundchecksforgunpurchaserswouldworkiftheylookforpreviousmentalhealthissuesButa2018HarvardUniversitystudyfoundthat87percentofsuicidevictimscouldhavepassedabackgroundcheckonthedayoftheirdeath

NestadtsayscertainguncontrolactionshavecoincidedwithfallingsuicideratesForinstancehesaysinthedecadeaftertheDistrictofColumbiabarredthepurchaseorsaleofhandgunsbyciviliansin1976suicidesbyfirearmsdropped23percent

AstudyledbyAnestisonthecorrelationbetweenpassageofstateguncontrollawsandchangesinsuicideratesfoundthatlegislationfocusedonldquopreventinggunownershipratherthanregulatinguseandstoragerdquoofexistinggunsdidthemosttolowersuiciderates

AmongproposedguncontrolmeasuresredflaglawsappeartohavethegreatestpublicsupportbutstudiesoftheireffectivenessinreducingsuicideshaveproducedmixedresultsAUniversityofIndianapolisstudysaidfirearms-relatedsuicidesfell75percentinIndianainthedecadeaftertheLegislaturepassedaredflaglawin2005

AndastudyledbyDukeUniversitypsychiatryprofessorDrJeffreySwansononwhetherConnecticuts1999redflaglawhelpedpoliceavertsuicidesfoundthatsuchgunremovallawscouldbeldquoatleastmodestlyeffectiveinpreventingsuiciderdquoBetween1999and2013theresearcherssaid61percentofthe762peoplewhosegunswereconfiscatedforayearwereconsideredasuicideriskOfthose21laterdidkillthemselvessixwithagun

ButDavidBKopelresearchdirectoroftheIndependentInstituteinDenverColoagun-rightsadvocacycenterpointedouttotheUSSenateJudiciaryCommitteeinMarchthattheConnecticutlawdidnotpreventallsuicidesOfthosewhodiedbysuicideaftertheirgunswereconfiscatedhesaid10werecompletedbyhangingorstrangulationThetheorythatdeprivingsuicidalpeopleoffirearmswillmakeitlesslikelythattheywilldiebysuicideisincorrecthesaidldquoSeveralothermethodsofsuicidemdashnamelyhangingcarbonmonoxideexhaustordrowningmdasharenearlyaslikelyasfirearmstoresultindeathrdquo

JohnRLottJragun-rightsadvocateandthefounderoftheCrimePreventionResearchCenterinSwarthmorePaandCarlisleEMoodyaprofessorofcriminologyandeconomicsattheCollegeof

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7152019 Suicide Crisis CQR

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WilliamampMaryinWilliamsburgVaconductedtheirownresearchandconcludedthatredflaglawsinCaliforniaConnecticutIndianaandWashingtonstatehadldquonosignificanteffectrdquoonsuicide

DrPaulSAppelbaumaprofessorofpsychiatryandlawatColumbiaUniversitysaysthelawsrepresentldquoaninnovativeapproachrdquotoidentifyingpeopleatriskofviolence

HoweverhesaysldquoOverallIthinkthecontributiontheywillmaketoreducingthesuiciderateasawholewillberelativelysmallbecausemostpeoplewhoaresuicidalwillprobablynotdoanythingthatcallsattentiontothemselvesinsuchawaythatpolicearesummonedtointervenerdquo

Doessocialmediaincreasetheriskforsuicide

SanDiegoStateUniversitysTwengeauthorofiGenabookaboutthefirstgenerationofAmericanstospendtheirteenyearsusingsocialmediabelievestheincreasinguseofsocialmediaiscreatingmentalhealthproblemsforadolescents

TwengeledastudyanalyzingdatafromtwosurveysonUSadolescentsandyouthbehavioralongwithCDCdataonsuicidedeathssince1999Thedatashowedthatbetween2010and2015thenumberofadolescentsreportingseveredepressionrose33percentandthenumberofsuicidesincreased31percentGirlsmdashparticularlythosewhospentmoretimeonlinethantheirpeersmdashweremostlikelytoreportdepressiveorsuicidalsymptomsTheresearchersconcludedthattheincreasedtimethatadolescentsspentonscreenactivitiesmayaccountforincreasesindepressionandsuicide

InanotherstudyTwengeandseveralcolleaguesreportedthat132percentof18-to25-year-oldsreportedseriouspsychologicaldistressin2017up71percentfrom2008Meanwhilemajordepressiveepisodesamong12-to17-year-oldsin2017wereup52percentfrom2005Andoneofeveryfiveteenagegirlshadexperiencedmajordepressioninthepreviousyear

Twengesteamattributedsuchdistresstolessin-personsocialinteractionamongadolescentsthanamongyouthsinpriorgenerationslargelyduetothegrowingprevalenceoftimespentonsmartphonesandsocialmedia

ButotherresearchersquestionTwengesconclusionthatscreentimedirectlyleadstomdashoristheprimarycauseofmdashdepressionorsuicide

OxfordUniversitypsychologyresearchersAmyOrbenandAndrewKPrzybylskibelievethecorrelationbetweendigitaltechnologyuseandadolescentsmentalhealthisoverstatedStudieslikeTwengesarebasedonanalysesoflargedatasetsthatcanbesubjecttoresearchersbiastheysaidAnalyzingthesamedatasetsTwengeusedforiGentheresearchersconcludedthatscreenusehadaldquotinyrdquoeffectonteensmentalhealthwhencomparedwitharangeofotherpotentialcorrelatingfactors

ldquoUsingtechnologyisaboutasassociatedwithwell-beingaseatingpotatoesrdquoPrzybylskisaidBullyinghadafourtimesgreatereffectonmentalhealthsaidOrbenandPrzybylski

InMaythetworesearchersevaluatedwhethertheamountoftimeadolescentsspendonsocialmediaaffectstheirmoodAgaintheyfoundthatscreentimehadaldquotinymdasharguablytrivialrdquomdasheffectonmood

ldquoItsnottimespentthatisassociatedwithpositiveornegativeoutcomesbuthowpeopleusesocialmediardquosaysChristopherFergusonapsychologyprofessoratStetsonUniversityinFloridaIna2017studyFergusonfoundthatmoderateuseofscreensdidnotincreasebehavioralormentalhealthproblemsamongchildrenandexcessivescreentimeonlymarginallycorrelatedwithsuchproblemsInanotherstudyheandtwootherresearchersconcludedthattimespentonlinedidnotresultindepressionorsuicidalthoughtsamongyoungadults

MikeBrooksdirectoroftheAustinPsychologyandAssessmentCenterinAustinTexasandauthorofTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldsaysldquoMypettheoryisthatwhenweseeassociationbetweenscreenuseandnegativehealthoutcomesitmaybethatitsbecausetheyareupuntil1amandtheirsleepistakingahitandthentheirmoodrdquo

AstudyledbyaUniversityofColoradoBoulderintegrativephysiologyprofessorfoundalinkbetweendigitalmediauseandreducedsleepandastudyledbyaStanfordpsychiatryprofessorfoundthatsleepproblemscouldprovideearlycluestosuicidalthoughtsincertainyoungadults

BrooksandFergusonagreehoweverwithTwengestheorythatdigitalmediausecanleadtosocialisolationifitreplacesin-personinteractionldquoTheresagoodreasontobeconcernedbutalarmismisproblematicrdquoBrookssays

SaraKonrathanassociateprofessorofphilanthropicstudiesatIndianaUniversitysayssmartphonesandsocialmediacanreducelonelinessamongyoungpeoplebecausetheyfeelsurroundedbyothersA2015studybytwoGermanresearchersfoundthatbrowsingFacebooktriggerspositiveemotionsmoreoftenthannegativeones

HoweverastudyledbyUniversityofMichiganpsychologyprofessorEthanKrossfoundthatthemoretimepeoplespentonFacebooktheworsetheyfeltpsychologicallyAndaBritishstudyfoundthatamongsocialmediasitesInstagramand

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7152019 Suicide Crisis CQR

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IanRussellsdaughterMollytookherlifeatage14afterviewingdisturbingmaterialonInstagramInJuneRussellspokeataconferenceinLondontourgesocialmediacompaniestobettercontrolonlinematerialthatpromotessuicideandotherformsofselfharm(GettyImagesHelenWIlliams)

Snapchatwerethemostdetrimentaltothementalhealthofyoungpeople(ages14to24)basedontheirresponsestoquestionsaboutanxietydepressionlonelinesssleepbodyimageandcyberbullying

ManyobserversraisealarmsabouttheavailabilityonlineofinformationabouthowtotakeoneslifeIanRussellwhose14-year-olddaughterMollykilledherselfin2017holdsInstagrampartlyresponsibleAfterhersuicidethefamilyfoundmaterialinherInstagramaccountaboutdepressionandsuicidalmethodsInstagramsaiditldquodoesnotallowcontentthatpromotesorglorifiesself-harmorsuiciderdquoandhassaiditwouldremovesuchcontent

ManyworrythatcyberbullyingcanleadtosuicidalthoughtsparticularlyamonggirlsThesuiciderateamonggirlsages10to14grew127percentbetween2007and2016comparedwith71percentamongboysinthesameagegroupaccordingtoonestudy

ldquoGirlsaremoreoftenhellipcyberbullied[thanboys]onsocialmediardquosaidJoanLubyapsychiatristatWashingtonUniversitySchoolofMedicineinStLouisandldquotheytendtohavemuchmorenegativepsychologicaleffectstothatcyberbullyingrdquo

ButDanielJReidenbergexecutivedirectorofSuicideAwarenessVoicesofEducationanonprofitsuicidepreventionandpubliceducationgroupinBloomingtonMinnsayspeoplesharetheirsuicidalthoughtsonlinefarmorefrequentlynowthaninthepastandinsuchcasesfriendsoftencanprovidehelp

InJanuaryafterChicagorapperCupcakKetweetedthatshewassuicidalherfollowersimmediatelymessagedherandalertedauthoritieswhotookhertothehospitalwhereshebegantreatmentfordepression

Canldquobigdatardquohelpreducesuiciderates

TheDepartmentofVeteransAffairsisusingacomputeralgorithmthatsiftsthroughvoluminoushealthdatatodetectcommonwarningsignsandflagveteranswhoareatriskofsuicideVAhealthcareprovidersthenreachoutdirectlytothoseindividualsandtheveteransdecidewhethertoseekhelp

ldquo[V]eteransathighestriskofsuicidearealsoatveryhighriskofsomeotherthingsrdquosuchasaccidentsoverdosesandopioidaddictionsaidAaronEaganthedepartmentsdeputydirectorforinnovation

Withinayearofimplementingtheso-calledREACHVetprograminApril2017theVAhadcontactedmorethan30000veteransThoseparticipatingintheprogramwereadmittedtomentalhealthinpatientunitslessoftenshowedupmoreoftenfordoctorappointmentsandvisitedtheVAmorefrequentlythanothervetsthedepartmentreported

Manyresearchershealthcareprovidersandothersbelievesimilardataanalyticscanhelpalertnonmilitarydoctorsaboutat-riskpatientsHealthcareproviderstypicallyassesssuicideriskbyaskingpatientssuchquestionsaswhethertheyaredepressedhaveconsideredharmingthemselvesorhaveasuicideplanHoweverone-thirdofsuicideattemptsanddeathsoccuramongpatientswhohavenotreportedsuicidalthoughts

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7152019 Suicide Crisis CQR

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AtaMay2016eventinWashingtonDCaimedatpreventingveteransuicideveteranstheirfamiliesandsurvivorsofveteranswhohavediedbysuicidereachouttooneanotherandtotouchtheSpartanswordmadefrommelted-downsteelfromtheWorldTradeCenter(GettyImagesTheWashingtonPostMichaelSWIlliamson)

ResearchersbelievethathealthprofessionalscouldpreventasuicideiftheyknewmoreaboutapatientsriskA2014studyfoundthat83percentofthosewhokilledthemselveshadvisitedadoctorsofficewithinthepreviousyearbutabouthalfofthemdidnothaveamentalhealthdiagnosis

DataanalyticscouldhelptrackstreamsofinformationandalertdoctorswhenapatientmayneedathoroughassessmentsaysGregoryESimonaseniorinvestigatorforKaiserPermanenteWashingtonHealthResearchInstituteinSeattleandapsychiatristatKaiserHeequatesittoawarninglightonacarssideviewmirrorthatilluminateswhenanothercarpullsintothedriversblindspotldquoThepurposeistodeliverinformationtoourhealthcareprovidersthatpeopleareatriskthenlet[theproviders]dowhattheydobetterrdquo

FacebookalsousesartificialintelligencetoscanpostingsforlivevideosofsuicideorphrasesorwordsthatsuggestsuicidalthoughtsWithinayearofstartingtheprogramin2017Facebookhadfound3500postsorvideoscontainingcontentthatledthecompanytocontactemergencyresponders

NeverthelessmanymedicalcareprovidersresearchersandothersareuncertainwhethersuchtoolscanhelpPeopleatriskofsuicideoftenaresociallyisolatedandunlikelytovisitadoctorsotheymightnotgenerateenoughhealthrecordsforalgorithmstoevaluatesaysBarnhorstattheUniversityofCaliforniaDavisldquoIdontknowwherethepredictiveanalytics[data]wouldcomefromrdquoshesaysldquoTheresnotalotofoutputfromthesepeoplerdquo

TheNIMHsPearsonissimilarlycautiousldquoWehavewaysofhelpingpeoplebyusingexistingdatatofindsomeoneatriskrdquoshesaysButmoreresearchisneededtoensurethatartificialintelligencetoolsdonotmisswholegroupsofpeopleldquoTheremayberacialethnicminoritiesorsexualminoritieswhoarenothittingthehealthcaresystemveryoftenforanumberofreasonsrdquoshesaysldquoHowdotheyfareinpredictiveanalyticsThatsareallyimportantquestionrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteaNewYorkCitymentalhealthtreatmentcentercallspredictiveanalyticsldquoextremelyusefulrdquoinhelpingidentifypotentialsuicidevictimsHoweveritcannotensurethatpeoplewillgetthetreatmenttheyneedldquoIfpredictiveanalyticsledtoaprogramwherepeoplewhoareathigherriskhadtheirguns[confiscated]thatwouldreducethesuicideraterdquohesays

ColumbiaUniversitysAppelbaumsayspeoplehavetriedtopredictsuicidesbasedonvariousriskfactorsldquoforalongtimeandithasbeenextremelydifficultrdquoldquoThevariablesassociatedwithsuicidearecommoninthepopulationanduncommonlyleadtosuicidaloutcomesrdquohesaysForexampledepressionisastrongpredictorofsuicidebutmostpeoplewithdepressiondonotattemptsuicide

Heandotherresearcherssayyearsofresearchshowthatscientistsstilldonotknowexactlyhowtopredictsuicide Ameta-analysisof50yearsofresearchpublishedin2016concludedthat

scientistshavenotgottenanybetteratpredictingsuicideattemptssayingldquopredictionwasonlyslightlybetterthanchancerdquo

OtherresearchersacknowledgethatthescienceofpredictionisnotperfectbutsayitcouldhelphealthcareprovidersdotheirjobbetterldquoItwillmissahugepercentageofpeopleItsnotgoingtosolveallofourproblemsrdquoUrsulaWhitesideaclinicalpsychologistattheUniversityofWashingtoninSeattlesaysldquoButitishelpfultocliniciansrdquo

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7152019 Suicide Crisis CQR

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LongDescription

OtherresearchersareraisingprivacyconcernsabouttheuseofpredictiveanalyticsinsuicidepreventiontoolsMasonMarksavisitingfellowatYaleLawSchoolsInformationSocietyProjectsaidthatwhilehealthcareprivacylawsgovernhowmedicalproviderscanusepatientmedicalrecordsartificial-intelligence-basedsuicidepredictionusingsocialmediainformationanddataisunregulatedandcouldposesafetyandethicalconcerns

ldquoTherisksincludestigmatizationofpeoplewithmentalillnessthetransferofsensitivehealthdatatothird-partieshellipunnecessaryinvoluntaryconfinementviolentconfrontationswithpoliceexacerbationofmentalhealthconditionsandhellipincreasesinsuicideriskrdquohesaid

Companiesandlawmakerswillhavetoexaminepolicyandlegalframeworksheadded

Gototop

Background

ResearchEmerges

InancientsocietiesphilosophersreligiousleadersandgovernmentsreactedtosuicideinavarietyofwaysrangingfromglorificationtoreligiouscondemnationColonistsinearlyAmericaviewedsuicideasasinandacrimeuntiljuriesbegantoseeitasasymptomofdiseaseCourtsstoppedrulingitacrimebytheendofthe1800s

Alsointhe19thcenturyresearchersbeganstudyingwhethereconomicandsociologicalchangesmdashincreasedindustrializationandloosenedfamilyandcommunitytiesmdashledtomentalillnessandsuicidePhysiciansbegansendingsuicidalpatientstoasylumsfortreatmentwithsedativesorstimulants

ScientistsgavesuicideonlysporadicattentionhoweveruntilFrenchsociologistEacutemileDurkheimconcludedinhis1897bookLeSuicidethatpeoplewhoweremoresociallyintegratedwerelesslikelytokillthemselvesHealsofoundsuicidemorecommonamongmenthanwomenandsoldiersthancivilians

DurkheimsbookpromptedotherscientiststoanalyzementalillnessmorecloselyIn1925psychiatristsKarlandWilliamMenningeropenedaclinicoutsideTopekaKantotreatthementallyillInhis1930bookTheHumanMindKarlcontendedthatpsychiatrycouldhelpsuchpatientsEightyearslaterhisManAgainstHimselfsuggestedthatthesuicidalimpulsewasamisdirectionofthesurvivalinstinct

DuringtheGreatDepressionthesuiciderateintheUnitedStatesreacheda20th-centurypeakmdash219suicidesper100000mdashin1932 Itwouldfallto114per100000by1957climberratically

duringthe1960sthroughthe1970sreaching137in1977andfalltoanall-timelowof104in2000(SeeGraphic)

AfterWorldWarIIclinicalpsychologistEdwinShneidmanpropelledsuicideresearchwhenhebeganinvestigatingacacheofLosAngelesdeathrecordsfilledwithhundredsofsuicidenotes

In1958ShneidmanandpsychologistNormanLFarberowalongwithDrRobertELitmanusedafederalgranttoopenthefirstsuicidepreventionfacilityinacondemnedbuildingoftheLosAngelesCountyGeneralHospitalStaffofferedin-personandphonecounselingtoindividualsexperiencing

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depressionandsuicidalthoughtsMostfamouslythecenterconductedthefirstpsychologicalautopsiesmdashinterviewswithfamilyfriendsdoctorsandotherassociatesofsuicidevictimstoconfirmthecauseofdeath

TheNationalCenterforHealthStatisticsreportedthatin1964anaverageof56Americanskilledthemselveseverydayaccountingfor1percentofdeathsthatyearButthecenteralsosaidsuicidestatisticslikelywereldquogrosslyunderstatedrdquobecausefamilyandfriendsoftenpreventedcoronersfromreportingsuicidesondeathcertificates

TheNationalInstituteofMentalHealthbeganacampaigninthe1960storeducementalillnessandsuicideTheinstitutein1966hiredShneidmantocreateasuicidepreventionprogramwhichledtoajumpinthenumberofUSsuicidepreventioncentersmdashfrom15tomorethan100withinafewyears

SuicideandHealth

Inthe1980sand90ssuicidebecamealeadinghealthconcernintheUnitedStatesandtheworldBy1990USrateshadreached124per100000forallagegroupsbutforages15to24theraterosefrom88to132per100000

ExpertsspeculatedthatfamilydisintegrationduetorisingdivorceratesdrugabusedwindlingjobandeducationalopportunitiesandtheavailabilityofgunscouldbepartlytoblameFirearmscontinuedtobethemostcommonmethodofsuicide

Studiesinthe1980sbyDavidPPhillipsasociologistattheUniversityofCaliforniaSanDiegofoundthatsuicidesrosesignificantlyafterwell-publicizedcaseswiththerisegreatestamongteenagers Andresearchersfoundcorrelationsbetweenfictionalizedsuicideattemptsin

televisionmoviesandincreasedsuicideattemptsamongteens

AsthesuiciderateamongadolescentsandyoungadultsrosetheDepartmentofHealthandHumanServicescreatedataskforceonyouthsuicidein1985 In1987agroupoffamiliesaffectedby

suicidejoinedwithscientiststoestablishtheAmericanFoundationforSuicidePreventiontofundresearchandeducationaboutsuicideMoregrassrootsorganizationsfollowed

ResearchersandcommunitiesgrewincreasinglyconcernedaboutsuicideclustersmdashmultiplesuicidesoccurringinthesamegeographicalareainashortspanoftimeInMarch1987forexamplefourteenagersinBergenfieldNJkilledthemselvesbylockingthemselvesinagarageandrunningacarengineWithinaweekatleasttwootheryoungpeopleattemptedsuicideinthesamemanner

ldquoThenewscoverageofteenagesuicidescanportraythevictimsasmartyrsofsortsrdquosaidDrDavidShafferachildpsychiatryprofessoratColumbiaUniversityandthedirectorofthesuicideresearchunitattheNewYorkStatePsychiatricInstituteldquoThemoresentimentalizeditisthemorelegitimatemdashevenheroicmdashitmayseemtosometeenagersrdquo

Drugtreatmentsfordepressionwereintroducedinthelate1980sbeginningwiththe1987approvalofProzacbytheUSFoodandDrugAdministration(FDA)Thedrugaimedtoeasedepressionbyraisingthelevelsofachemicalcalledserotonininthebrain

In1989suicideexpertsotherresearcherspublichealthofficialsandnewsoutletsmettodiscusswaystopreventsuicidecontagionTheydevelopedrecommendationsfordiscussionswiththemediaandsuggestedthatnewsoutletsavoidprovidingdetailsofsuicidemethods

Intheearly1990sUniversityofWashingtonpsychologistMarshaLinehandevelopedoneofthethreeevidence-basedinterventionsandtreatmentsthathavebeenshowntobeeffectiveinreducingsuicidalityHerprogramcalleddialecticalbehaviortherapyteachespatientshowtomanagepainfulemotionsanddecreaseconflictinrelationships Theothertwotreatmentsarecognitivebehavior

therapywhichencouragespatientstochallengedistortedviewpointsandchangedestructivepatternsofbehaviorandCAMSdevelopedbyCatholicUniversitysJobesTherapistsusingCAMStalkindetailwithpatientsabouttheirthoughtsofhopelessnessandsuicideandhelpthembuildatreatmentplan

Althoughsuicideratesfellinthe1990sresearchersandhealthofficialsremainedconcernedaboutfindinganeffectivetreatmentforsuicidalbehaviormdashparticularlyafterthehighlypublicizedsuicideofKurtCobainleadsingerfortherockbandNirvanaonApril51994ACatholicUniversitystudydeterminedthatCobainssuicidewasnotfollowedbycopycatsuicidesbutdidsparkmorecallstosuicidecrisishotlinesmdashlikelyduetohowthemediacoveredthestoryandcommunityoutreacheffortsencouragingpeopleatrisktoseekhelp

ldquoCalltoActionrdquo

In1996theWorldHealthOrganizationurgedmembernationstoaddressrisingsuicideratesintheircountriesMostalarminglythenumberofsuicidesintheUnitedStateshadnearlytripledamongadolescentsandyoungadultssince1952Suicidewasthethirdleadingcauseofdeathamongthoseages15to24andthefourthleadingcauseamongthoseages10to14

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Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

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couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

7152019 Suicide Crisis CQR

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

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volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

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copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 4: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 430

CelebritychefandtraveldocumentarianAnthonyBourdaintookhislifeinJune2018Hoursafterhisdeathcallstosomenationalcrisiscentersspikedbyasmuchas500percent(GettyImagesOwenHoffmannPatrickMcMullan)

suicideexpertssaythatisnotenough

ldquoAnyotherdiseasethatcomesclosetokillingasmanyAmericansassuicidedoeslikeHIVandheartdiseasegetsmarqueerecognitionasapublichealthmenaceandmajorfederalresearchfundingrdquosaidDrRichardAFriedmanaprofessorofclinicalpsychiatryatWeillCornellMedicalCollegeinNewYorkCity

ResearcherssaymentalhealthconditionsmdashsuchasschizophreniabipolardisordermanicbehaviorsubstanceabusepoorimpulsecontrolorangermanagementproblemsmdashcanbeafactorinsuicideButmorethan54percentofthosewhodiedbysuicidein2015hadnotbeenpreviouslydiagnosedwithamentaldisorderaccordingtotheCentersforDiseaseControlandPrevention(CDC)Manyresearcherspointtostudiesfromasearlyasthe1950sthatindicatedatleast90percentofsuicidevictimshaveamentaldisorder

DepressionwasafactorinabouthalfofsuicideattemptsaccordingtotheCDCHoweveronly2percentto4percentofthosediagnosedwithdepressionwilldiebysuicideaccordingtotheNationalInstituteofMentalHealth(NIMH)inBethesdaMd

ldquoPeopletendtothinkofsuicideasthepurviewofseverelydepressedpeople[but]thatsnotthecaserdquosaysAmyBarnhorstvicechairforcommunitymentalhealthinthepsychiatrydepartmentattheUniversityofCaliforniaDavisldquoSeveredepressionisonepathwaybutitsnottheonlyonerdquoEmotionalchallengessuchaslosingajoborasignificantrelationshipalsocanbeafactorshesays

GlennRSullivananassociateprofessorofpsychologyattheVirginiaMilitaryInstituteinLexingtonVasayssocialisolationisanotherriskfactorldquoTheresalotoflonelypeopleoutthererdquohesaysldquoIfyouarehavingsuicidalthoughtsandtheresnoonetheretointerveneyoucanhellipsoonhaveasuicidalcrisisrdquo

Morethanhalfofallsuicidesinvolvetheuseofafirearmleadingsomepsychologistsguncontroladvocatesandsuicide

preventiongroupstourgelimitingaccesstofirearmsldquoIfyoutrulywanttocontinuetoreducegundeathsinthiscountryyouhavetotalkabouthellipthetoolsforpreventinggunsuiciderdquosaidJohnFeinblattpresidentofEverytownforGunSafetyaguncontroladvocacygroupinNewYorkCity

FifteenstatesandtheDistrictofColumbiahavepassedldquoredflagrdquolawswhichallowlawenforcementofficersfamiliesor(inDC)mentalhealthpractitionerstopetitionacourttoconfiscatethegunsofindividualsdeemedatriskofharmingthemselvesorothers

OtherresearchersandhealthcareproviderswarnthatanxietyanddepressionhaveincreasedasexposuretosocialmediaandsmartphoneshasgrownamongyoungchildrenandteensButtheydisagreeonwhetherincreasedscreentimeleadstosuicidalthoughts

Sincethelate1980sdrugcompanieshaveproducedantidepressantsmoodstabilizersandantipsychoticdrugsinparttotreatsuicidalthoughtsandbehaviorsThenumberofAmericanstakingsuchmedicationsforfiveyearsormoretripledbetween2000and2017mdashto155million

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LongDescription

ThedrugsreducedepressionandanxietyinsomepatientsbutmanypeoplehavedifficultystoppingthemwithoutsymptomsreturningForotherpatientsthedrugsdonotworkAnewnasal-sprayversionoftheanestheticketamineapopularpartydruginthe1990sshowspromiseforpatientswhohavenotrespondedtoantidepressantsbutseveralmentalhealthexpertssaytheydoubtitcanreversetherisingsuiciderate(SeeShortFeature)

ldquoWedliketobelievetheresamagicpillandeverythingwillbefineButitjustisnttruerdquosaysDrJulieZitoaprofessorofpharmacyandpsychiatryattheUniversityofMaryland

NewresearchsuggeststhatcertainpsychologicaltherapiesthatfocusonchangingpatientsthinkingpatternsandbehaviormdashsuchastheCollaborativeAssessmentandManagementofSuicidality(CAMS)ordialecticalbehaviortherapy(DBT)mdashcantreatpatientswithsuicidalthoughtsorbehaviorsButfewpsychologistsaretrainedinthosetherapiesandinsurancecompaniesrarelycoverthem

Othersespeciallythosewhodistrustorcannotafforddrugsorpsychotherapyareseekinghelpandadvicefromgroupsandwebsitesorganizedbypeoplewhohavesurvivedsuicideattempts(SeeShortFeature)

HealthcareprovidersandresearcherssayearlyidentificationofthoseatriskandearlytreatmentarethekeystoloweringsuicideratesTothatendexpertsinartificialintelligenceandmachineanalyticsareraisinghopesthatcomputerizedtoolsthatsiftthroughmassiveamountsofhealthdatacouldhelpidentifypotentiallysuicidalpatientsTheDepartmentofVeteransAffairs(VA)isusingsuchatooltoaddressrisingsuicideratesamongveterans

AsthefederalgovernmentcommunitiesresearchersandhealthcareprovidersseekwaystoreversetherisingUSsuicideratethesearesomequestionsbeingdebated

Couldtougherguncontrollawsreducethesuiciderate

Abouttwo-thirdsofthenearly40000gun-relateddeathsin2017weresuicideswithwhitemenaccountingforthehighestpercentageofsuchsuicides Andfirearmsaccountformorethanhalf

ofallsuicidedeathseventhoughtheyareusedinlessthan6percentofsuicideattemptsThatisbecausefirearmsarethedeadliestmethodofsuicide825percentofattemptsusingafirearmarefatal

HoweverexpertsdisagreeonwhethereasyaccesstogunsistoblameforAmericasrisingsuiciderateldquoGunsrepresentanopportunityweasanationcanleverageinaconcertedefforttosubstantiallylowerthenationalsuicideraterdquoMichaelDAnestisaUniversityofSouthernMississippiassociateprofessorofpsychologywroteinGunsandSuicideAnAmericanEpidemic

ButSullivanattheVirginiaMilitaryInstitutesaysgunsarenottheonlyproblemldquoTherecantpossiblybeasingleexplanationforaphenomenonsowidespreadandcomplexassuiciderdquohesays

ResearchersattheRANDCorpaSantaMonicaCalif-basedthinktanksaiditseemslogicalthatbecausegunsarethemostlethalformofsuicideldquowhengunsarelessavailablefewersuicideattemptswillresultinfatalityrdquoButstudieshavenotclearlyprovedthataccordingtotheRANDresearchers

SomeresearcherspointoutthatsuiciderateshavefallenincountriesthathaverestrictedaccesstocertainpoisonsordrugstypicallyusedinsuicidesForexampledeathsinEnglandandWales

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attributedtooverdosesofparacetamol(theBritishequivalentofTylenol)fell43percentin11yearsaftera1998lawrestrictedpackagingsize AndsuicideratesinSriLankadecreasedsignificantly

afterthegovernmentrestrictedtheimportationandsalesoftoxicpesticidescommonlyusedinself-poisonings

LongDescription

ldquoItappearsifyoutakeawaythe[methodsthatsuicidalindividuals]werefocusedontheycangetoffthattrajectoryandyoucansavealiferdquosaysJaneLPearsonspecialadvisertothedirectorofsuicideresearchatNIMHPearsonsaysresearchershavefoundthatmanysuicideattemptsareimpulsiveactsandpeoplewhoseattemptsfaildonotusuallytryagainForeverysuicidedeathabout25attemptsfailaccordingtotheCDC

ldquoIfthemethodyouusedoesntkillyouitdoesntmeanyouwilljustgooutrdquoandfindanothermethodsaysPaulSNestadtanassistantprofessorofpsychiatryandbehavioralsciencesatJohnsHopkinsUniversityinBaltimoreHecitedaUniversityofCaliforniaBerkeleystudyshowingthatonlyabout6percentofpeoplestoppedfromjumpingofftheGoldenGateBridgeinSanFranciscobetween1937and1971evertriedtoattemptsuicideagain

ResearchersalsodisagreeonwhichtypeofguncontrollawswouldhelpreducesuicidesSomeexpertsbelievebackgroundchecksforgunpurchaserswouldworkiftheylookforpreviousmentalhealthissuesButa2018HarvardUniversitystudyfoundthat87percentofsuicidevictimscouldhavepassedabackgroundcheckonthedayoftheirdeath

NestadtsayscertainguncontrolactionshavecoincidedwithfallingsuicideratesForinstancehesaysinthedecadeaftertheDistrictofColumbiabarredthepurchaseorsaleofhandgunsbyciviliansin1976suicidesbyfirearmsdropped23percent

AstudyledbyAnestisonthecorrelationbetweenpassageofstateguncontrollawsandchangesinsuicideratesfoundthatlegislationfocusedonldquopreventinggunownershipratherthanregulatinguseandstoragerdquoofexistinggunsdidthemosttolowersuiciderates

AmongproposedguncontrolmeasuresredflaglawsappeartohavethegreatestpublicsupportbutstudiesoftheireffectivenessinreducingsuicideshaveproducedmixedresultsAUniversityofIndianapolisstudysaidfirearms-relatedsuicidesfell75percentinIndianainthedecadeaftertheLegislaturepassedaredflaglawin2005

AndastudyledbyDukeUniversitypsychiatryprofessorDrJeffreySwansononwhetherConnecticuts1999redflaglawhelpedpoliceavertsuicidesfoundthatsuchgunremovallawscouldbeldquoatleastmodestlyeffectiveinpreventingsuiciderdquoBetween1999and2013theresearcherssaid61percentofthe762peoplewhosegunswereconfiscatedforayearwereconsideredasuicideriskOfthose21laterdidkillthemselvessixwithagun

ButDavidBKopelresearchdirectoroftheIndependentInstituteinDenverColoagun-rightsadvocacycenterpointedouttotheUSSenateJudiciaryCommitteeinMarchthattheConnecticutlawdidnotpreventallsuicidesOfthosewhodiedbysuicideaftertheirgunswereconfiscatedhesaid10werecompletedbyhangingorstrangulationThetheorythatdeprivingsuicidalpeopleoffirearmswillmakeitlesslikelythattheywilldiebysuicideisincorrecthesaidldquoSeveralothermethodsofsuicidemdashnamelyhangingcarbonmonoxideexhaustordrowningmdasharenearlyaslikelyasfirearmstoresultindeathrdquo

JohnRLottJragun-rightsadvocateandthefounderoftheCrimePreventionResearchCenterinSwarthmorePaandCarlisleEMoodyaprofessorofcriminologyandeconomicsattheCollegeof

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WilliamampMaryinWilliamsburgVaconductedtheirownresearchandconcludedthatredflaglawsinCaliforniaConnecticutIndianaandWashingtonstatehadldquonosignificanteffectrdquoonsuicide

DrPaulSAppelbaumaprofessorofpsychiatryandlawatColumbiaUniversitysaysthelawsrepresentldquoaninnovativeapproachrdquotoidentifyingpeopleatriskofviolence

HoweverhesaysldquoOverallIthinkthecontributiontheywillmaketoreducingthesuiciderateasawholewillberelativelysmallbecausemostpeoplewhoaresuicidalwillprobablynotdoanythingthatcallsattentiontothemselvesinsuchawaythatpolicearesummonedtointervenerdquo

Doessocialmediaincreasetheriskforsuicide

SanDiegoStateUniversitysTwengeauthorofiGenabookaboutthefirstgenerationofAmericanstospendtheirteenyearsusingsocialmediabelievestheincreasinguseofsocialmediaiscreatingmentalhealthproblemsforadolescents

TwengeledastudyanalyzingdatafromtwosurveysonUSadolescentsandyouthbehavioralongwithCDCdataonsuicidedeathssince1999Thedatashowedthatbetween2010and2015thenumberofadolescentsreportingseveredepressionrose33percentandthenumberofsuicidesincreased31percentGirlsmdashparticularlythosewhospentmoretimeonlinethantheirpeersmdashweremostlikelytoreportdepressiveorsuicidalsymptomsTheresearchersconcludedthattheincreasedtimethatadolescentsspentonscreenactivitiesmayaccountforincreasesindepressionandsuicide

InanotherstudyTwengeandseveralcolleaguesreportedthat132percentof18-to25-year-oldsreportedseriouspsychologicaldistressin2017up71percentfrom2008Meanwhilemajordepressiveepisodesamong12-to17-year-oldsin2017wereup52percentfrom2005Andoneofeveryfiveteenagegirlshadexperiencedmajordepressioninthepreviousyear

Twengesteamattributedsuchdistresstolessin-personsocialinteractionamongadolescentsthanamongyouthsinpriorgenerationslargelyduetothegrowingprevalenceoftimespentonsmartphonesandsocialmedia

ButotherresearchersquestionTwengesconclusionthatscreentimedirectlyleadstomdashoristheprimarycauseofmdashdepressionorsuicide

OxfordUniversitypsychologyresearchersAmyOrbenandAndrewKPrzybylskibelievethecorrelationbetweendigitaltechnologyuseandadolescentsmentalhealthisoverstatedStudieslikeTwengesarebasedonanalysesoflargedatasetsthatcanbesubjecttoresearchersbiastheysaidAnalyzingthesamedatasetsTwengeusedforiGentheresearchersconcludedthatscreenusehadaldquotinyrdquoeffectonteensmentalhealthwhencomparedwitharangeofotherpotentialcorrelatingfactors

ldquoUsingtechnologyisaboutasassociatedwithwell-beingaseatingpotatoesrdquoPrzybylskisaidBullyinghadafourtimesgreatereffectonmentalhealthsaidOrbenandPrzybylski

InMaythetworesearchersevaluatedwhethertheamountoftimeadolescentsspendonsocialmediaaffectstheirmoodAgaintheyfoundthatscreentimehadaldquotinymdasharguablytrivialrdquomdasheffectonmood

ldquoItsnottimespentthatisassociatedwithpositiveornegativeoutcomesbuthowpeopleusesocialmediardquosaysChristopherFergusonapsychologyprofessoratStetsonUniversityinFloridaIna2017studyFergusonfoundthatmoderateuseofscreensdidnotincreasebehavioralormentalhealthproblemsamongchildrenandexcessivescreentimeonlymarginallycorrelatedwithsuchproblemsInanotherstudyheandtwootherresearchersconcludedthattimespentonlinedidnotresultindepressionorsuicidalthoughtsamongyoungadults

MikeBrooksdirectoroftheAustinPsychologyandAssessmentCenterinAustinTexasandauthorofTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldsaysldquoMypettheoryisthatwhenweseeassociationbetweenscreenuseandnegativehealthoutcomesitmaybethatitsbecausetheyareupuntil1amandtheirsleepistakingahitandthentheirmoodrdquo

AstudyledbyaUniversityofColoradoBoulderintegrativephysiologyprofessorfoundalinkbetweendigitalmediauseandreducedsleepandastudyledbyaStanfordpsychiatryprofessorfoundthatsleepproblemscouldprovideearlycluestosuicidalthoughtsincertainyoungadults

BrooksandFergusonagreehoweverwithTwengestheorythatdigitalmediausecanleadtosocialisolationifitreplacesin-personinteractionldquoTheresagoodreasontobeconcernedbutalarmismisproblematicrdquoBrookssays

SaraKonrathanassociateprofessorofphilanthropicstudiesatIndianaUniversitysayssmartphonesandsocialmediacanreducelonelinessamongyoungpeoplebecausetheyfeelsurroundedbyothersA2015studybytwoGermanresearchersfoundthatbrowsingFacebooktriggerspositiveemotionsmoreoftenthannegativeones

HoweverastudyledbyUniversityofMichiganpsychologyprofessorEthanKrossfoundthatthemoretimepeoplespentonFacebooktheworsetheyfeltpsychologicallyAndaBritishstudyfoundthatamongsocialmediasitesInstagramand

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IanRussellsdaughterMollytookherlifeatage14afterviewingdisturbingmaterialonInstagramInJuneRussellspokeataconferenceinLondontourgesocialmediacompaniestobettercontrolonlinematerialthatpromotessuicideandotherformsofselfharm(GettyImagesHelenWIlliams)

Snapchatwerethemostdetrimentaltothementalhealthofyoungpeople(ages14to24)basedontheirresponsestoquestionsaboutanxietydepressionlonelinesssleepbodyimageandcyberbullying

ManyobserversraisealarmsabouttheavailabilityonlineofinformationabouthowtotakeoneslifeIanRussellwhose14-year-olddaughterMollykilledherselfin2017holdsInstagrampartlyresponsibleAfterhersuicidethefamilyfoundmaterialinherInstagramaccountaboutdepressionandsuicidalmethodsInstagramsaiditldquodoesnotallowcontentthatpromotesorglorifiesself-harmorsuiciderdquoandhassaiditwouldremovesuchcontent

ManyworrythatcyberbullyingcanleadtosuicidalthoughtsparticularlyamonggirlsThesuiciderateamonggirlsages10to14grew127percentbetween2007and2016comparedwith71percentamongboysinthesameagegroupaccordingtoonestudy

ldquoGirlsaremoreoftenhellipcyberbullied[thanboys]onsocialmediardquosaidJoanLubyapsychiatristatWashingtonUniversitySchoolofMedicineinStLouisandldquotheytendtohavemuchmorenegativepsychologicaleffectstothatcyberbullyingrdquo

ButDanielJReidenbergexecutivedirectorofSuicideAwarenessVoicesofEducationanonprofitsuicidepreventionandpubliceducationgroupinBloomingtonMinnsayspeoplesharetheirsuicidalthoughtsonlinefarmorefrequentlynowthaninthepastandinsuchcasesfriendsoftencanprovidehelp

InJanuaryafterChicagorapperCupcakKetweetedthatshewassuicidalherfollowersimmediatelymessagedherandalertedauthoritieswhotookhertothehospitalwhereshebegantreatmentfordepression

Canldquobigdatardquohelpreducesuiciderates

TheDepartmentofVeteransAffairsisusingacomputeralgorithmthatsiftsthroughvoluminoushealthdatatodetectcommonwarningsignsandflagveteranswhoareatriskofsuicideVAhealthcareprovidersthenreachoutdirectlytothoseindividualsandtheveteransdecidewhethertoseekhelp

ldquo[V]eteransathighestriskofsuicidearealsoatveryhighriskofsomeotherthingsrdquosuchasaccidentsoverdosesandopioidaddictionsaidAaronEaganthedepartmentsdeputydirectorforinnovation

Withinayearofimplementingtheso-calledREACHVetprograminApril2017theVAhadcontactedmorethan30000veteransThoseparticipatingintheprogramwereadmittedtomentalhealthinpatientunitslessoftenshowedupmoreoftenfordoctorappointmentsandvisitedtheVAmorefrequentlythanothervetsthedepartmentreported

Manyresearchershealthcareprovidersandothersbelievesimilardataanalyticscanhelpalertnonmilitarydoctorsaboutat-riskpatientsHealthcareproviderstypicallyassesssuicideriskbyaskingpatientssuchquestionsaswhethertheyaredepressedhaveconsideredharmingthemselvesorhaveasuicideplanHoweverone-thirdofsuicideattemptsanddeathsoccuramongpatientswhohavenotreportedsuicidalthoughts

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AtaMay2016eventinWashingtonDCaimedatpreventingveteransuicideveteranstheirfamiliesandsurvivorsofveteranswhohavediedbysuicidereachouttooneanotherandtotouchtheSpartanswordmadefrommelted-downsteelfromtheWorldTradeCenter(GettyImagesTheWashingtonPostMichaelSWIlliamson)

ResearchersbelievethathealthprofessionalscouldpreventasuicideiftheyknewmoreaboutapatientsriskA2014studyfoundthat83percentofthosewhokilledthemselveshadvisitedadoctorsofficewithinthepreviousyearbutabouthalfofthemdidnothaveamentalhealthdiagnosis

DataanalyticscouldhelptrackstreamsofinformationandalertdoctorswhenapatientmayneedathoroughassessmentsaysGregoryESimonaseniorinvestigatorforKaiserPermanenteWashingtonHealthResearchInstituteinSeattleandapsychiatristatKaiserHeequatesittoawarninglightonacarssideviewmirrorthatilluminateswhenanothercarpullsintothedriversblindspotldquoThepurposeistodeliverinformationtoourhealthcareprovidersthatpeopleareatriskthenlet[theproviders]dowhattheydobetterrdquo

FacebookalsousesartificialintelligencetoscanpostingsforlivevideosofsuicideorphrasesorwordsthatsuggestsuicidalthoughtsWithinayearofstartingtheprogramin2017Facebookhadfound3500postsorvideoscontainingcontentthatledthecompanytocontactemergencyresponders

NeverthelessmanymedicalcareprovidersresearchersandothersareuncertainwhethersuchtoolscanhelpPeopleatriskofsuicideoftenaresociallyisolatedandunlikelytovisitadoctorsotheymightnotgenerateenoughhealthrecordsforalgorithmstoevaluatesaysBarnhorstattheUniversityofCaliforniaDavisldquoIdontknowwherethepredictiveanalytics[data]wouldcomefromrdquoshesaysldquoTheresnotalotofoutputfromthesepeoplerdquo

TheNIMHsPearsonissimilarlycautiousldquoWehavewaysofhelpingpeoplebyusingexistingdatatofindsomeoneatriskrdquoshesaysButmoreresearchisneededtoensurethatartificialintelligencetoolsdonotmisswholegroupsofpeopleldquoTheremayberacialethnicminoritiesorsexualminoritieswhoarenothittingthehealthcaresystemveryoftenforanumberofreasonsrdquoshesaysldquoHowdotheyfareinpredictiveanalyticsThatsareallyimportantquestionrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteaNewYorkCitymentalhealthtreatmentcentercallspredictiveanalyticsldquoextremelyusefulrdquoinhelpingidentifypotentialsuicidevictimsHoweveritcannotensurethatpeoplewillgetthetreatmenttheyneedldquoIfpredictiveanalyticsledtoaprogramwherepeoplewhoareathigherriskhadtheirguns[confiscated]thatwouldreducethesuicideraterdquohesays

ColumbiaUniversitysAppelbaumsayspeoplehavetriedtopredictsuicidesbasedonvariousriskfactorsldquoforalongtimeandithasbeenextremelydifficultrdquoldquoThevariablesassociatedwithsuicidearecommoninthepopulationanduncommonlyleadtosuicidaloutcomesrdquohesaysForexampledepressionisastrongpredictorofsuicidebutmostpeoplewithdepressiondonotattemptsuicide

Heandotherresearcherssayyearsofresearchshowthatscientistsstilldonotknowexactlyhowtopredictsuicide Ameta-analysisof50yearsofresearchpublishedin2016concludedthat

scientistshavenotgottenanybetteratpredictingsuicideattemptssayingldquopredictionwasonlyslightlybetterthanchancerdquo

OtherresearchersacknowledgethatthescienceofpredictionisnotperfectbutsayitcouldhelphealthcareprovidersdotheirjobbetterldquoItwillmissahugepercentageofpeopleItsnotgoingtosolveallofourproblemsrdquoUrsulaWhitesideaclinicalpsychologistattheUniversityofWashingtoninSeattlesaysldquoButitishelpfultocliniciansrdquo

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LongDescription

OtherresearchersareraisingprivacyconcernsabouttheuseofpredictiveanalyticsinsuicidepreventiontoolsMasonMarksavisitingfellowatYaleLawSchoolsInformationSocietyProjectsaidthatwhilehealthcareprivacylawsgovernhowmedicalproviderscanusepatientmedicalrecordsartificial-intelligence-basedsuicidepredictionusingsocialmediainformationanddataisunregulatedandcouldposesafetyandethicalconcerns

ldquoTherisksincludestigmatizationofpeoplewithmentalillnessthetransferofsensitivehealthdatatothird-partieshellipunnecessaryinvoluntaryconfinementviolentconfrontationswithpoliceexacerbationofmentalhealthconditionsandhellipincreasesinsuicideriskrdquohesaid

Companiesandlawmakerswillhavetoexaminepolicyandlegalframeworksheadded

Gototop

Background

ResearchEmerges

InancientsocietiesphilosophersreligiousleadersandgovernmentsreactedtosuicideinavarietyofwaysrangingfromglorificationtoreligiouscondemnationColonistsinearlyAmericaviewedsuicideasasinandacrimeuntiljuriesbegantoseeitasasymptomofdiseaseCourtsstoppedrulingitacrimebytheendofthe1800s

Alsointhe19thcenturyresearchersbeganstudyingwhethereconomicandsociologicalchangesmdashincreasedindustrializationandloosenedfamilyandcommunitytiesmdashledtomentalillnessandsuicidePhysiciansbegansendingsuicidalpatientstoasylumsfortreatmentwithsedativesorstimulants

ScientistsgavesuicideonlysporadicattentionhoweveruntilFrenchsociologistEacutemileDurkheimconcludedinhis1897bookLeSuicidethatpeoplewhoweremoresociallyintegratedwerelesslikelytokillthemselvesHealsofoundsuicidemorecommonamongmenthanwomenandsoldiersthancivilians

DurkheimsbookpromptedotherscientiststoanalyzementalillnessmorecloselyIn1925psychiatristsKarlandWilliamMenningeropenedaclinicoutsideTopekaKantotreatthementallyillInhis1930bookTheHumanMindKarlcontendedthatpsychiatrycouldhelpsuchpatientsEightyearslaterhisManAgainstHimselfsuggestedthatthesuicidalimpulsewasamisdirectionofthesurvivalinstinct

DuringtheGreatDepressionthesuiciderateintheUnitedStatesreacheda20th-centurypeakmdash219suicidesper100000mdashin1932 Itwouldfallto114per100000by1957climberratically

duringthe1960sthroughthe1970sreaching137in1977andfalltoanall-timelowof104in2000(SeeGraphic)

AfterWorldWarIIclinicalpsychologistEdwinShneidmanpropelledsuicideresearchwhenhebeganinvestigatingacacheofLosAngelesdeathrecordsfilledwithhundredsofsuicidenotes

In1958ShneidmanandpsychologistNormanLFarberowalongwithDrRobertELitmanusedafederalgranttoopenthefirstsuicidepreventionfacilityinacondemnedbuildingoftheLosAngelesCountyGeneralHospitalStaffofferedin-personandphonecounselingtoindividualsexperiencing

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7152019 Suicide Crisis CQR

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depressionandsuicidalthoughtsMostfamouslythecenterconductedthefirstpsychologicalautopsiesmdashinterviewswithfamilyfriendsdoctorsandotherassociatesofsuicidevictimstoconfirmthecauseofdeath

TheNationalCenterforHealthStatisticsreportedthatin1964anaverageof56Americanskilledthemselveseverydayaccountingfor1percentofdeathsthatyearButthecenteralsosaidsuicidestatisticslikelywereldquogrosslyunderstatedrdquobecausefamilyandfriendsoftenpreventedcoronersfromreportingsuicidesondeathcertificates

TheNationalInstituteofMentalHealthbeganacampaigninthe1960storeducementalillnessandsuicideTheinstitutein1966hiredShneidmantocreateasuicidepreventionprogramwhichledtoajumpinthenumberofUSsuicidepreventioncentersmdashfrom15tomorethan100withinafewyears

SuicideandHealth

Inthe1980sand90ssuicidebecamealeadinghealthconcernintheUnitedStatesandtheworldBy1990USrateshadreached124per100000forallagegroupsbutforages15to24theraterosefrom88to132per100000

ExpertsspeculatedthatfamilydisintegrationduetorisingdivorceratesdrugabusedwindlingjobandeducationalopportunitiesandtheavailabilityofgunscouldbepartlytoblameFirearmscontinuedtobethemostcommonmethodofsuicide

Studiesinthe1980sbyDavidPPhillipsasociologistattheUniversityofCaliforniaSanDiegofoundthatsuicidesrosesignificantlyafterwell-publicizedcaseswiththerisegreatestamongteenagers Andresearchersfoundcorrelationsbetweenfictionalizedsuicideattemptsin

televisionmoviesandincreasedsuicideattemptsamongteens

AsthesuiciderateamongadolescentsandyoungadultsrosetheDepartmentofHealthandHumanServicescreatedataskforceonyouthsuicidein1985 In1987agroupoffamiliesaffectedby

suicidejoinedwithscientiststoestablishtheAmericanFoundationforSuicidePreventiontofundresearchandeducationaboutsuicideMoregrassrootsorganizationsfollowed

ResearchersandcommunitiesgrewincreasinglyconcernedaboutsuicideclustersmdashmultiplesuicidesoccurringinthesamegeographicalareainashortspanoftimeInMarch1987forexamplefourteenagersinBergenfieldNJkilledthemselvesbylockingthemselvesinagarageandrunningacarengineWithinaweekatleasttwootheryoungpeopleattemptedsuicideinthesamemanner

ldquoThenewscoverageofteenagesuicidescanportraythevictimsasmartyrsofsortsrdquosaidDrDavidShafferachildpsychiatryprofessoratColumbiaUniversityandthedirectorofthesuicideresearchunitattheNewYorkStatePsychiatricInstituteldquoThemoresentimentalizeditisthemorelegitimatemdashevenheroicmdashitmayseemtosometeenagersrdquo

Drugtreatmentsfordepressionwereintroducedinthelate1980sbeginningwiththe1987approvalofProzacbytheUSFoodandDrugAdministration(FDA)Thedrugaimedtoeasedepressionbyraisingthelevelsofachemicalcalledserotonininthebrain

In1989suicideexpertsotherresearcherspublichealthofficialsandnewsoutletsmettodiscusswaystopreventsuicidecontagionTheydevelopedrecommendationsfordiscussionswiththemediaandsuggestedthatnewsoutletsavoidprovidingdetailsofsuicidemethods

Intheearly1990sUniversityofWashingtonpsychologistMarshaLinehandevelopedoneofthethreeevidence-basedinterventionsandtreatmentsthathavebeenshowntobeeffectiveinreducingsuicidalityHerprogramcalleddialecticalbehaviortherapyteachespatientshowtomanagepainfulemotionsanddecreaseconflictinrelationships Theothertwotreatmentsarecognitivebehavior

therapywhichencouragespatientstochallengedistortedviewpointsandchangedestructivepatternsofbehaviorandCAMSdevelopedbyCatholicUniversitysJobesTherapistsusingCAMStalkindetailwithpatientsabouttheirthoughtsofhopelessnessandsuicideandhelpthembuildatreatmentplan

Althoughsuicideratesfellinthe1990sresearchersandhealthofficialsremainedconcernedaboutfindinganeffectivetreatmentforsuicidalbehaviormdashparticularlyafterthehighlypublicizedsuicideofKurtCobainleadsingerfortherockbandNirvanaonApril51994ACatholicUniversitystudydeterminedthatCobainssuicidewasnotfollowedbycopycatsuicidesbutdidsparkmorecallstosuicidecrisishotlinesmdashlikelyduetohowthemediacoveredthestoryandcommunityoutreacheffortsencouragingpeopleatrisktoseekhelp

ldquoCalltoActionrdquo

In1996theWorldHealthOrganizationurgedmembernationstoaddressrisingsuicideratesintheircountriesMostalarminglythenumberofsuicidesintheUnitedStateshadnearlytripledamongadolescentsandyoungadultssince1952Suicidewasthethirdleadingcauseofdeathamongthoseages15to24andthefourthleadingcauseamongthoseages10to14

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Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

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couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

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7152019 Suicide Crisis CQR

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 5: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 530

LongDescription

ThedrugsreducedepressionandanxietyinsomepatientsbutmanypeoplehavedifficultystoppingthemwithoutsymptomsreturningForotherpatientsthedrugsdonotworkAnewnasal-sprayversionoftheanestheticketamineapopularpartydruginthe1990sshowspromiseforpatientswhohavenotrespondedtoantidepressantsbutseveralmentalhealthexpertssaytheydoubtitcanreversetherisingsuiciderate(SeeShortFeature)

ldquoWedliketobelievetheresamagicpillandeverythingwillbefineButitjustisnttruerdquosaysDrJulieZitoaprofessorofpharmacyandpsychiatryattheUniversityofMaryland

NewresearchsuggeststhatcertainpsychologicaltherapiesthatfocusonchangingpatientsthinkingpatternsandbehaviormdashsuchastheCollaborativeAssessmentandManagementofSuicidality(CAMS)ordialecticalbehaviortherapy(DBT)mdashcantreatpatientswithsuicidalthoughtsorbehaviorsButfewpsychologistsaretrainedinthosetherapiesandinsurancecompaniesrarelycoverthem

Othersespeciallythosewhodistrustorcannotafforddrugsorpsychotherapyareseekinghelpandadvicefromgroupsandwebsitesorganizedbypeoplewhohavesurvivedsuicideattempts(SeeShortFeature)

HealthcareprovidersandresearcherssayearlyidentificationofthoseatriskandearlytreatmentarethekeystoloweringsuicideratesTothatendexpertsinartificialintelligenceandmachineanalyticsareraisinghopesthatcomputerizedtoolsthatsiftthroughmassiveamountsofhealthdatacouldhelpidentifypotentiallysuicidalpatientsTheDepartmentofVeteransAffairs(VA)isusingsuchatooltoaddressrisingsuicideratesamongveterans

AsthefederalgovernmentcommunitiesresearchersandhealthcareprovidersseekwaystoreversetherisingUSsuicideratethesearesomequestionsbeingdebated

Couldtougherguncontrollawsreducethesuiciderate

Abouttwo-thirdsofthenearly40000gun-relateddeathsin2017weresuicideswithwhitemenaccountingforthehighestpercentageofsuchsuicides Andfirearmsaccountformorethanhalf

ofallsuicidedeathseventhoughtheyareusedinlessthan6percentofsuicideattemptsThatisbecausefirearmsarethedeadliestmethodofsuicide825percentofattemptsusingafirearmarefatal

HoweverexpertsdisagreeonwhethereasyaccesstogunsistoblameforAmericasrisingsuiciderateldquoGunsrepresentanopportunityweasanationcanleverageinaconcertedefforttosubstantiallylowerthenationalsuicideraterdquoMichaelDAnestisaUniversityofSouthernMississippiassociateprofessorofpsychologywroteinGunsandSuicideAnAmericanEpidemic

ButSullivanattheVirginiaMilitaryInstitutesaysgunsarenottheonlyproblemldquoTherecantpossiblybeasingleexplanationforaphenomenonsowidespreadandcomplexassuiciderdquohesays

ResearchersattheRANDCorpaSantaMonicaCalif-basedthinktanksaiditseemslogicalthatbecausegunsarethemostlethalformofsuicideldquowhengunsarelessavailablefewersuicideattemptswillresultinfatalityrdquoButstudieshavenotclearlyprovedthataccordingtotheRANDresearchers

SomeresearcherspointoutthatsuiciderateshavefallenincountriesthathaverestrictedaccesstocertainpoisonsordrugstypicallyusedinsuicidesForexampledeathsinEnglandandWales

22

23

24

25

26

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 630

attributedtooverdosesofparacetamol(theBritishequivalentofTylenol)fell43percentin11yearsaftera1998lawrestrictedpackagingsize AndsuicideratesinSriLankadecreasedsignificantly

afterthegovernmentrestrictedtheimportationandsalesoftoxicpesticidescommonlyusedinself-poisonings

LongDescription

ldquoItappearsifyoutakeawaythe[methodsthatsuicidalindividuals]werefocusedontheycangetoffthattrajectoryandyoucansavealiferdquosaysJaneLPearsonspecialadvisertothedirectorofsuicideresearchatNIMHPearsonsaysresearchershavefoundthatmanysuicideattemptsareimpulsiveactsandpeoplewhoseattemptsfaildonotusuallytryagainForeverysuicidedeathabout25attemptsfailaccordingtotheCDC

ldquoIfthemethodyouusedoesntkillyouitdoesntmeanyouwilljustgooutrdquoandfindanothermethodsaysPaulSNestadtanassistantprofessorofpsychiatryandbehavioralsciencesatJohnsHopkinsUniversityinBaltimoreHecitedaUniversityofCaliforniaBerkeleystudyshowingthatonlyabout6percentofpeoplestoppedfromjumpingofftheGoldenGateBridgeinSanFranciscobetween1937and1971evertriedtoattemptsuicideagain

ResearchersalsodisagreeonwhichtypeofguncontrollawswouldhelpreducesuicidesSomeexpertsbelievebackgroundchecksforgunpurchaserswouldworkiftheylookforpreviousmentalhealthissuesButa2018HarvardUniversitystudyfoundthat87percentofsuicidevictimscouldhavepassedabackgroundcheckonthedayoftheirdeath

NestadtsayscertainguncontrolactionshavecoincidedwithfallingsuicideratesForinstancehesaysinthedecadeaftertheDistrictofColumbiabarredthepurchaseorsaleofhandgunsbyciviliansin1976suicidesbyfirearmsdropped23percent

AstudyledbyAnestisonthecorrelationbetweenpassageofstateguncontrollawsandchangesinsuicideratesfoundthatlegislationfocusedonldquopreventinggunownershipratherthanregulatinguseandstoragerdquoofexistinggunsdidthemosttolowersuiciderates

AmongproposedguncontrolmeasuresredflaglawsappeartohavethegreatestpublicsupportbutstudiesoftheireffectivenessinreducingsuicideshaveproducedmixedresultsAUniversityofIndianapolisstudysaidfirearms-relatedsuicidesfell75percentinIndianainthedecadeaftertheLegislaturepassedaredflaglawin2005

AndastudyledbyDukeUniversitypsychiatryprofessorDrJeffreySwansononwhetherConnecticuts1999redflaglawhelpedpoliceavertsuicidesfoundthatsuchgunremovallawscouldbeldquoatleastmodestlyeffectiveinpreventingsuiciderdquoBetween1999and2013theresearcherssaid61percentofthe762peoplewhosegunswereconfiscatedforayearwereconsideredasuicideriskOfthose21laterdidkillthemselvessixwithagun

ButDavidBKopelresearchdirectoroftheIndependentInstituteinDenverColoagun-rightsadvocacycenterpointedouttotheUSSenateJudiciaryCommitteeinMarchthattheConnecticutlawdidnotpreventallsuicidesOfthosewhodiedbysuicideaftertheirgunswereconfiscatedhesaid10werecompletedbyhangingorstrangulationThetheorythatdeprivingsuicidalpeopleoffirearmswillmakeitlesslikelythattheywilldiebysuicideisincorrecthesaidldquoSeveralothermethodsofsuicidemdashnamelyhangingcarbonmonoxideexhaustordrowningmdasharenearlyaslikelyasfirearmstoresultindeathrdquo

JohnRLottJragun-rightsadvocateandthefounderoftheCrimePreventionResearchCenterinSwarthmorePaandCarlisleEMoodyaprofessorofcriminologyandeconomicsattheCollegeof

27

28

29

30

31

32

33

34

35

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 730

WilliamampMaryinWilliamsburgVaconductedtheirownresearchandconcludedthatredflaglawsinCaliforniaConnecticutIndianaandWashingtonstatehadldquonosignificanteffectrdquoonsuicide

DrPaulSAppelbaumaprofessorofpsychiatryandlawatColumbiaUniversitysaysthelawsrepresentldquoaninnovativeapproachrdquotoidentifyingpeopleatriskofviolence

HoweverhesaysldquoOverallIthinkthecontributiontheywillmaketoreducingthesuiciderateasawholewillberelativelysmallbecausemostpeoplewhoaresuicidalwillprobablynotdoanythingthatcallsattentiontothemselvesinsuchawaythatpolicearesummonedtointervenerdquo

Doessocialmediaincreasetheriskforsuicide

SanDiegoStateUniversitysTwengeauthorofiGenabookaboutthefirstgenerationofAmericanstospendtheirteenyearsusingsocialmediabelievestheincreasinguseofsocialmediaiscreatingmentalhealthproblemsforadolescents

TwengeledastudyanalyzingdatafromtwosurveysonUSadolescentsandyouthbehavioralongwithCDCdataonsuicidedeathssince1999Thedatashowedthatbetween2010and2015thenumberofadolescentsreportingseveredepressionrose33percentandthenumberofsuicidesincreased31percentGirlsmdashparticularlythosewhospentmoretimeonlinethantheirpeersmdashweremostlikelytoreportdepressiveorsuicidalsymptomsTheresearchersconcludedthattheincreasedtimethatadolescentsspentonscreenactivitiesmayaccountforincreasesindepressionandsuicide

InanotherstudyTwengeandseveralcolleaguesreportedthat132percentof18-to25-year-oldsreportedseriouspsychologicaldistressin2017up71percentfrom2008Meanwhilemajordepressiveepisodesamong12-to17-year-oldsin2017wereup52percentfrom2005Andoneofeveryfiveteenagegirlshadexperiencedmajordepressioninthepreviousyear

Twengesteamattributedsuchdistresstolessin-personsocialinteractionamongadolescentsthanamongyouthsinpriorgenerationslargelyduetothegrowingprevalenceoftimespentonsmartphonesandsocialmedia

ButotherresearchersquestionTwengesconclusionthatscreentimedirectlyleadstomdashoristheprimarycauseofmdashdepressionorsuicide

OxfordUniversitypsychologyresearchersAmyOrbenandAndrewKPrzybylskibelievethecorrelationbetweendigitaltechnologyuseandadolescentsmentalhealthisoverstatedStudieslikeTwengesarebasedonanalysesoflargedatasetsthatcanbesubjecttoresearchersbiastheysaidAnalyzingthesamedatasetsTwengeusedforiGentheresearchersconcludedthatscreenusehadaldquotinyrdquoeffectonteensmentalhealthwhencomparedwitharangeofotherpotentialcorrelatingfactors

ldquoUsingtechnologyisaboutasassociatedwithwell-beingaseatingpotatoesrdquoPrzybylskisaidBullyinghadafourtimesgreatereffectonmentalhealthsaidOrbenandPrzybylski

InMaythetworesearchersevaluatedwhethertheamountoftimeadolescentsspendonsocialmediaaffectstheirmoodAgaintheyfoundthatscreentimehadaldquotinymdasharguablytrivialrdquomdasheffectonmood

ldquoItsnottimespentthatisassociatedwithpositiveornegativeoutcomesbuthowpeopleusesocialmediardquosaysChristopherFergusonapsychologyprofessoratStetsonUniversityinFloridaIna2017studyFergusonfoundthatmoderateuseofscreensdidnotincreasebehavioralormentalhealthproblemsamongchildrenandexcessivescreentimeonlymarginallycorrelatedwithsuchproblemsInanotherstudyheandtwootherresearchersconcludedthattimespentonlinedidnotresultindepressionorsuicidalthoughtsamongyoungadults

MikeBrooksdirectoroftheAustinPsychologyandAssessmentCenterinAustinTexasandauthorofTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldsaysldquoMypettheoryisthatwhenweseeassociationbetweenscreenuseandnegativehealthoutcomesitmaybethatitsbecausetheyareupuntil1amandtheirsleepistakingahitandthentheirmoodrdquo

AstudyledbyaUniversityofColoradoBoulderintegrativephysiologyprofessorfoundalinkbetweendigitalmediauseandreducedsleepandastudyledbyaStanfordpsychiatryprofessorfoundthatsleepproblemscouldprovideearlycluestosuicidalthoughtsincertainyoungadults

BrooksandFergusonagreehoweverwithTwengestheorythatdigitalmediausecanleadtosocialisolationifitreplacesin-personinteractionldquoTheresagoodreasontobeconcernedbutalarmismisproblematicrdquoBrookssays

SaraKonrathanassociateprofessorofphilanthropicstudiesatIndianaUniversitysayssmartphonesandsocialmediacanreducelonelinessamongyoungpeoplebecausetheyfeelsurroundedbyothersA2015studybytwoGermanresearchersfoundthatbrowsingFacebooktriggerspositiveemotionsmoreoftenthannegativeones

HoweverastudyledbyUniversityofMichiganpsychologyprofessorEthanKrossfoundthatthemoretimepeoplespentonFacebooktheworsetheyfeltpsychologicallyAndaBritishstudyfoundthatamongsocialmediasitesInstagramand

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IanRussellsdaughterMollytookherlifeatage14afterviewingdisturbingmaterialonInstagramInJuneRussellspokeataconferenceinLondontourgesocialmediacompaniestobettercontrolonlinematerialthatpromotessuicideandotherformsofselfharm(GettyImagesHelenWIlliams)

Snapchatwerethemostdetrimentaltothementalhealthofyoungpeople(ages14to24)basedontheirresponsestoquestionsaboutanxietydepressionlonelinesssleepbodyimageandcyberbullying

ManyobserversraisealarmsabouttheavailabilityonlineofinformationabouthowtotakeoneslifeIanRussellwhose14-year-olddaughterMollykilledherselfin2017holdsInstagrampartlyresponsibleAfterhersuicidethefamilyfoundmaterialinherInstagramaccountaboutdepressionandsuicidalmethodsInstagramsaiditldquodoesnotallowcontentthatpromotesorglorifiesself-harmorsuiciderdquoandhassaiditwouldremovesuchcontent

ManyworrythatcyberbullyingcanleadtosuicidalthoughtsparticularlyamonggirlsThesuiciderateamonggirlsages10to14grew127percentbetween2007and2016comparedwith71percentamongboysinthesameagegroupaccordingtoonestudy

ldquoGirlsaremoreoftenhellipcyberbullied[thanboys]onsocialmediardquosaidJoanLubyapsychiatristatWashingtonUniversitySchoolofMedicineinStLouisandldquotheytendtohavemuchmorenegativepsychologicaleffectstothatcyberbullyingrdquo

ButDanielJReidenbergexecutivedirectorofSuicideAwarenessVoicesofEducationanonprofitsuicidepreventionandpubliceducationgroupinBloomingtonMinnsayspeoplesharetheirsuicidalthoughtsonlinefarmorefrequentlynowthaninthepastandinsuchcasesfriendsoftencanprovidehelp

InJanuaryafterChicagorapperCupcakKetweetedthatshewassuicidalherfollowersimmediatelymessagedherandalertedauthoritieswhotookhertothehospitalwhereshebegantreatmentfordepression

Canldquobigdatardquohelpreducesuiciderates

TheDepartmentofVeteransAffairsisusingacomputeralgorithmthatsiftsthroughvoluminoushealthdatatodetectcommonwarningsignsandflagveteranswhoareatriskofsuicideVAhealthcareprovidersthenreachoutdirectlytothoseindividualsandtheveteransdecidewhethertoseekhelp

ldquo[V]eteransathighestriskofsuicidearealsoatveryhighriskofsomeotherthingsrdquosuchasaccidentsoverdosesandopioidaddictionsaidAaronEaganthedepartmentsdeputydirectorforinnovation

Withinayearofimplementingtheso-calledREACHVetprograminApril2017theVAhadcontactedmorethan30000veteransThoseparticipatingintheprogramwereadmittedtomentalhealthinpatientunitslessoftenshowedupmoreoftenfordoctorappointmentsandvisitedtheVAmorefrequentlythanothervetsthedepartmentreported

Manyresearchershealthcareprovidersandothersbelievesimilardataanalyticscanhelpalertnonmilitarydoctorsaboutat-riskpatientsHealthcareproviderstypicallyassesssuicideriskbyaskingpatientssuchquestionsaswhethertheyaredepressedhaveconsideredharmingthemselvesorhaveasuicideplanHoweverone-thirdofsuicideattemptsanddeathsoccuramongpatientswhohavenotreportedsuicidalthoughts

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AtaMay2016eventinWashingtonDCaimedatpreventingveteransuicideveteranstheirfamiliesandsurvivorsofveteranswhohavediedbysuicidereachouttooneanotherandtotouchtheSpartanswordmadefrommelted-downsteelfromtheWorldTradeCenter(GettyImagesTheWashingtonPostMichaelSWIlliamson)

ResearchersbelievethathealthprofessionalscouldpreventasuicideiftheyknewmoreaboutapatientsriskA2014studyfoundthat83percentofthosewhokilledthemselveshadvisitedadoctorsofficewithinthepreviousyearbutabouthalfofthemdidnothaveamentalhealthdiagnosis

DataanalyticscouldhelptrackstreamsofinformationandalertdoctorswhenapatientmayneedathoroughassessmentsaysGregoryESimonaseniorinvestigatorforKaiserPermanenteWashingtonHealthResearchInstituteinSeattleandapsychiatristatKaiserHeequatesittoawarninglightonacarssideviewmirrorthatilluminateswhenanothercarpullsintothedriversblindspotldquoThepurposeistodeliverinformationtoourhealthcareprovidersthatpeopleareatriskthenlet[theproviders]dowhattheydobetterrdquo

FacebookalsousesartificialintelligencetoscanpostingsforlivevideosofsuicideorphrasesorwordsthatsuggestsuicidalthoughtsWithinayearofstartingtheprogramin2017Facebookhadfound3500postsorvideoscontainingcontentthatledthecompanytocontactemergencyresponders

NeverthelessmanymedicalcareprovidersresearchersandothersareuncertainwhethersuchtoolscanhelpPeopleatriskofsuicideoftenaresociallyisolatedandunlikelytovisitadoctorsotheymightnotgenerateenoughhealthrecordsforalgorithmstoevaluatesaysBarnhorstattheUniversityofCaliforniaDavisldquoIdontknowwherethepredictiveanalytics[data]wouldcomefromrdquoshesaysldquoTheresnotalotofoutputfromthesepeoplerdquo

TheNIMHsPearsonissimilarlycautiousldquoWehavewaysofhelpingpeoplebyusingexistingdatatofindsomeoneatriskrdquoshesaysButmoreresearchisneededtoensurethatartificialintelligencetoolsdonotmisswholegroupsofpeopleldquoTheremayberacialethnicminoritiesorsexualminoritieswhoarenothittingthehealthcaresystemveryoftenforanumberofreasonsrdquoshesaysldquoHowdotheyfareinpredictiveanalyticsThatsareallyimportantquestionrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteaNewYorkCitymentalhealthtreatmentcentercallspredictiveanalyticsldquoextremelyusefulrdquoinhelpingidentifypotentialsuicidevictimsHoweveritcannotensurethatpeoplewillgetthetreatmenttheyneedldquoIfpredictiveanalyticsledtoaprogramwherepeoplewhoareathigherriskhadtheirguns[confiscated]thatwouldreducethesuicideraterdquohesays

ColumbiaUniversitysAppelbaumsayspeoplehavetriedtopredictsuicidesbasedonvariousriskfactorsldquoforalongtimeandithasbeenextremelydifficultrdquoldquoThevariablesassociatedwithsuicidearecommoninthepopulationanduncommonlyleadtosuicidaloutcomesrdquohesaysForexampledepressionisastrongpredictorofsuicidebutmostpeoplewithdepressiondonotattemptsuicide

Heandotherresearcherssayyearsofresearchshowthatscientistsstilldonotknowexactlyhowtopredictsuicide Ameta-analysisof50yearsofresearchpublishedin2016concludedthat

scientistshavenotgottenanybetteratpredictingsuicideattemptssayingldquopredictionwasonlyslightlybetterthanchancerdquo

OtherresearchersacknowledgethatthescienceofpredictionisnotperfectbutsayitcouldhelphealthcareprovidersdotheirjobbetterldquoItwillmissahugepercentageofpeopleItsnotgoingtosolveallofourproblemsrdquoUrsulaWhitesideaclinicalpsychologistattheUniversityofWashingtoninSeattlesaysldquoButitishelpfultocliniciansrdquo

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LongDescription

OtherresearchersareraisingprivacyconcernsabouttheuseofpredictiveanalyticsinsuicidepreventiontoolsMasonMarksavisitingfellowatYaleLawSchoolsInformationSocietyProjectsaidthatwhilehealthcareprivacylawsgovernhowmedicalproviderscanusepatientmedicalrecordsartificial-intelligence-basedsuicidepredictionusingsocialmediainformationanddataisunregulatedandcouldposesafetyandethicalconcerns

ldquoTherisksincludestigmatizationofpeoplewithmentalillnessthetransferofsensitivehealthdatatothird-partieshellipunnecessaryinvoluntaryconfinementviolentconfrontationswithpoliceexacerbationofmentalhealthconditionsandhellipincreasesinsuicideriskrdquohesaid

Companiesandlawmakerswillhavetoexaminepolicyandlegalframeworksheadded

Gototop

Background

ResearchEmerges

InancientsocietiesphilosophersreligiousleadersandgovernmentsreactedtosuicideinavarietyofwaysrangingfromglorificationtoreligiouscondemnationColonistsinearlyAmericaviewedsuicideasasinandacrimeuntiljuriesbegantoseeitasasymptomofdiseaseCourtsstoppedrulingitacrimebytheendofthe1800s

Alsointhe19thcenturyresearchersbeganstudyingwhethereconomicandsociologicalchangesmdashincreasedindustrializationandloosenedfamilyandcommunitytiesmdashledtomentalillnessandsuicidePhysiciansbegansendingsuicidalpatientstoasylumsfortreatmentwithsedativesorstimulants

ScientistsgavesuicideonlysporadicattentionhoweveruntilFrenchsociologistEacutemileDurkheimconcludedinhis1897bookLeSuicidethatpeoplewhoweremoresociallyintegratedwerelesslikelytokillthemselvesHealsofoundsuicidemorecommonamongmenthanwomenandsoldiersthancivilians

DurkheimsbookpromptedotherscientiststoanalyzementalillnessmorecloselyIn1925psychiatristsKarlandWilliamMenningeropenedaclinicoutsideTopekaKantotreatthementallyillInhis1930bookTheHumanMindKarlcontendedthatpsychiatrycouldhelpsuchpatientsEightyearslaterhisManAgainstHimselfsuggestedthatthesuicidalimpulsewasamisdirectionofthesurvivalinstinct

DuringtheGreatDepressionthesuiciderateintheUnitedStatesreacheda20th-centurypeakmdash219suicidesper100000mdashin1932 Itwouldfallto114per100000by1957climberratically

duringthe1960sthroughthe1970sreaching137in1977andfalltoanall-timelowof104in2000(SeeGraphic)

AfterWorldWarIIclinicalpsychologistEdwinShneidmanpropelledsuicideresearchwhenhebeganinvestigatingacacheofLosAngelesdeathrecordsfilledwithhundredsofsuicidenotes

In1958ShneidmanandpsychologistNormanLFarberowalongwithDrRobertELitmanusedafederalgranttoopenthefirstsuicidepreventionfacilityinacondemnedbuildingoftheLosAngelesCountyGeneralHospitalStaffofferedin-personandphonecounselingtoindividualsexperiencing

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depressionandsuicidalthoughtsMostfamouslythecenterconductedthefirstpsychologicalautopsiesmdashinterviewswithfamilyfriendsdoctorsandotherassociatesofsuicidevictimstoconfirmthecauseofdeath

TheNationalCenterforHealthStatisticsreportedthatin1964anaverageof56Americanskilledthemselveseverydayaccountingfor1percentofdeathsthatyearButthecenteralsosaidsuicidestatisticslikelywereldquogrosslyunderstatedrdquobecausefamilyandfriendsoftenpreventedcoronersfromreportingsuicidesondeathcertificates

TheNationalInstituteofMentalHealthbeganacampaigninthe1960storeducementalillnessandsuicideTheinstitutein1966hiredShneidmantocreateasuicidepreventionprogramwhichledtoajumpinthenumberofUSsuicidepreventioncentersmdashfrom15tomorethan100withinafewyears

SuicideandHealth

Inthe1980sand90ssuicidebecamealeadinghealthconcernintheUnitedStatesandtheworldBy1990USrateshadreached124per100000forallagegroupsbutforages15to24theraterosefrom88to132per100000

ExpertsspeculatedthatfamilydisintegrationduetorisingdivorceratesdrugabusedwindlingjobandeducationalopportunitiesandtheavailabilityofgunscouldbepartlytoblameFirearmscontinuedtobethemostcommonmethodofsuicide

Studiesinthe1980sbyDavidPPhillipsasociologistattheUniversityofCaliforniaSanDiegofoundthatsuicidesrosesignificantlyafterwell-publicizedcaseswiththerisegreatestamongteenagers Andresearchersfoundcorrelationsbetweenfictionalizedsuicideattemptsin

televisionmoviesandincreasedsuicideattemptsamongteens

AsthesuiciderateamongadolescentsandyoungadultsrosetheDepartmentofHealthandHumanServicescreatedataskforceonyouthsuicidein1985 In1987agroupoffamiliesaffectedby

suicidejoinedwithscientiststoestablishtheAmericanFoundationforSuicidePreventiontofundresearchandeducationaboutsuicideMoregrassrootsorganizationsfollowed

ResearchersandcommunitiesgrewincreasinglyconcernedaboutsuicideclustersmdashmultiplesuicidesoccurringinthesamegeographicalareainashortspanoftimeInMarch1987forexamplefourteenagersinBergenfieldNJkilledthemselvesbylockingthemselvesinagarageandrunningacarengineWithinaweekatleasttwootheryoungpeopleattemptedsuicideinthesamemanner

ldquoThenewscoverageofteenagesuicidescanportraythevictimsasmartyrsofsortsrdquosaidDrDavidShafferachildpsychiatryprofessoratColumbiaUniversityandthedirectorofthesuicideresearchunitattheNewYorkStatePsychiatricInstituteldquoThemoresentimentalizeditisthemorelegitimatemdashevenheroicmdashitmayseemtosometeenagersrdquo

Drugtreatmentsfordepressionwereintroducedinthelate1980sbeginningwiththe1987approvalofProzacbytheUSFoodandDrugAdministration(FDA)Thedrugaimedtoeasedepressionbyraisingthelevelsofachemicalcalledserotonininthebrain

In1989suicideexpertsotherresearcherspublichealthofficialsandnewsoutletsmettodiscusswaystopreventsuicidecontagionTheydevelopedrecommendationsfordiscussionswiththemediaandsuggestedthatnewsoutletsavoidprovidingdetailsofsuicidemethods

Intheearly1990sUniversityofWashingtonpsychologistMarshaLinehandevelopedoneofthethreeevidence-basedinterventionsandtreatmentsthathavebeenshowntobeeffectiveinreducingsuicidalityHerprogramcalleddialecticalbehaviortherapyteachespatientshowtomanagepainfulemotionsanddecreaseconflictinrelationships Theothertwotreatmentsarecognitivebehavior

therapywhichencouragespatientstochallengedistortedviewpointsandchangedestructivepatternsofbehaviorandCAMSdevelopedbyCatholicUniversitysJobesTherapistsusingCAMStalkindetailwithpatientsabouttheirthoughtsofhopelessnessandsuicideandhelpthembuildatreatmentplan

Althoughsuicideratesfellinthe1990sresearchersandhealthofficialsremainedconcernedaboutfindinganeffectivetreatmentforsuicidalbehaviormdashparticularlyafterthehighlypublicizedsuicideofKurtCobainleadsingerfortherockbandNirvanaonApril51994ACatholicUniversitystudydeterminedthatCobainssuicidewasnotfollowedbycopycatsuicidesbutdidsparkmorecallstosuicidecrisishotlinesmdashlikelyduetohowthemediacoveredthestoryandcommunityoutreacheffortsencouragingpeopleatrisktoseekhelp

ldquoCalltoActionrdquo

In1996theWorldHealthOrganizationurgedmembernationstoaddressrisingsuicideratesintheircountriesMostalarminglythenumberofsuicidesintheUnitedStateshadnearlytripledamongadolescentsandyoungadultssince1952Suicidewasthethirdleadingcauseofdeathamongthoseages15to24andthefourthleadingcauseamongthoseages10to14

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Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

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couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

106

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

112

113

114

115

116

117

118

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

7152019 Suicide Crisis CQR

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

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7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

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volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 6: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 630

attributedtooverdosesofparacetamol(theBritishequivalentofTylenol)fell43percentin11yearsaftera1998lawrestrictedpackagingsize AndsuicideratesinSriLankadecreasedsignificantly

afterthegovernmentrestrictedtheimportationandsalesoftoxicpesticidescommonlyusedinself-poisonings

LongDescription

ldquoItappearsifyoutakeawaythe[methodsthatsuicidalindividuals]werefocusedontheycangetoffthattrajectoryandyoucansavealiferdquosaysJaneLPearsonspecialadvisertothedirectorofsuicideresearchatNIMHPearsonsaysresearchershavefoundthatmanysuicideattemptsareimpulsiveactsandpeoplewhoseattemptsfaildonotusuallytryagainForeverysuicidedeathabout25attemptsfailaccordingtotheCDC

ldquoIfthemethodyouusedoesntkillyouitdoesntmeanyouwilljustgooutrdquoandfindanothermethodsaysPaulSNestadtanassistantprofessorofpsychiatryandbehavioralsciencesatJohnsHopkinsUniversityinBaltimoreHecitedaUniversityofCaliforniaBerkeleystudyshowingthatonlyabout6percentofpeoplestoppedfromjumpingofftheGoldenGateBridgeinSanFranciscobetween1937and1971evertriedtoattemptsuicideagain

ResearchersalsodisagreeonwhichtypeofguncontrollawswouldhelpreducesuicidesSomeexpertsbelievebackgroundchecksforgunpurchaserswouldworkiftheylookforpreviousmentalhealthissuesButa2018HarvardUniversitystudyfoundthat87percentofsuicidevictimscouldhavepassedabackgroundcheckonthedayoftheirdeath

NestadtsayscertainguncontrolactionshavecoincidedwithfallingsuicideratesForinstancehesaysinthedecadeaftertheDistrictofColumbiabarredthepurchaseorsaleofhandgunsbyciviliansin1976suicidesbyfirearmsdropped23percent

AstudyledbyAnestisonthecorrelationbetweenpassageofstateguncontrollawsandchangesinsuicideratesfoundthatlegislationfocusedonldquopreventinggunownershipratherthanregulatinguseandstoragerdquoofexistinggunsdidthemosttolowersuiciderates

AmongproposedguncontrolmeasuresredflaglawsappeartohavethegreatestpublicsupportbutstudiesoftheireffectivenessinreducingsuicideshaveproducedmixedresultsAUniversityofIndianapolisstudysaidfirearms-relatedsuicidesfell75percentinIndianainthedecadeaftertheLegislaturepassedaredflaglawin2005

AndastudyledbyDukeUniversitypsychiatryprofessorDrJeffreySwansononwhetherConnecticuts1999redflaglawhelpedpoliceavertsuicidesfoundthatsuchgunremovallawscouldbeldquoatleastmodestlyeffectiveinpreventingsuiciderdquoBetween1999and2013theresearcherssaid61percentofthe762peoplewhosegunswereconfiscatedforayearwereconsideredasuicideriskOfthose21laterdidkillthemselvessixwithagun

ButDavidBKopelresearchdirectoroftheIndependentInstituteinDenverColoagun-rightsadvocacycenterpointedouttotheUSSenateJudiciaryCommitteeinMarchthattheConnecticutlawdidnotpreventallsuicidesOfthosewhodiedbysuicideaftertheirgunswereconfiscatedhesaid10werecompletedbyhangingorstrangulationThetheorythatdeprivingsuicidalpeopleoffirearmswillmakeitlesslikelythattheywilldiebysuicideisincorrecthesaidldquoSeveralothermethodsofsuicidemdashnamelyhangingcarbonmonoxideexhaustordrowningmdasharenearlyaslikelyasfirearmstoresultindeathrdquo

JohnRLottJragun-rightsadvocateandthefounderoftheCrimePreventionResearchCenterinSwarthmorePaandCarlisleEMoodyaprofessorofcriminologyandeconomicsattheCollegeof

27

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7152019 Suicide Crisis CQR

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WilliamampMaryinWilliamsburgVaconductedtheirownresearchandconcludedthatredflaglawsinCaliforniaConnecticutIndianaandWashingtonstatehadldquonosignificanteffectrdquoonsuicide

DrPaulSAppelbaumaprofessorofpsychiatryandlawatColumbiaUniversitysaysthelawsrepresentldquoaninnovativeapproachrdquotoidentifyingpeopleatriskofviolence

HoweverhesaysldquoOverallIthinkthecontributiontheywillmaketoreducingthesuiciderateasawholewillberelativelysmallbecausemostpeoplewhoaresuicidalwillprobablynotdoanythingthatcallsattentiontothemselvesinsuchawaythatpolicearesummonedtointervenerdquo

Doessocialmediaincreasetheriskforsuicide

SanDiegoStateUniversitysTwengeauthorofiGenabookaboutthefirstgenerationofAmericanstospendtheirteenyearsusingsocialmediabelievestheincreasinguseofsocialmediaiscreatingmentalhealthproblemsforadolescents

TwengeledastudyanalyzingdatafromtwosurveysonUSadolescentsandyouthbehavioralongwithCDCdataonsuicidedeathssince1999Thedatashowedthatbetween2010and2015thenumberofadolescentsreportingseveredepressionrose33percentandthenumberofsuicidesincreased31percentGirlsmdashparticularlythosewhospentmoretimeonlinethantheirpeersmdashweremostlikelytoreportdepressiveorsuicidalsymptomsTheresearchersconcludedthattheincreasedtimethatadolescentsspentonscreenactivitiesmayaccountforincreasesindepressionandsuicide

InanotherstudyTwengeandseveralcolleaguesreportedthat132percentof18-to25-year-oldsreportedseriouspsychologicaldistressin2017up71percentfrom2008Meanwhilemajordepressiveepisodesamong12-to17-year-oldsin2017wereup52percentfrom2005Andoneofeveryfiveteenagegirlshadexperiencedmajordepressioninthepreviousyear

Twengesteamattributedsuchdistresstolessin-personsocialinteractionamongadolescentsthanamongyouthsinpriorgenerationslargelyduetothegrowingprevalenceoftimespentonsmartphonesandsocialmedia

ButotherresearchersquestionTwengesconclusionthatscreentimedirectlyleadstomdashoristheprimarycauseofmdashdepressionorsuicide

OxfordUniversitypsychologyresearchersAmyOrbenandAndrewKPrzybylskibelievethecorrelationbetweendigitaltechnologyuseandadolescentsmentalhealthisoverstatedStudieslikeTwengesarebasedonanalysesoflargedatasetsthatcanbesubjecttoresearchersbiastheysaidAnalyzingthesamedatasetsTwengeusedforiGentheresearchersconcludedthatscreenusehadaldquotinyrdquoeffectonteensmentalhealthwhencomparedwitharangeofotherpotentialcorrelatingfactors

ldquoUsingtechnologyisaboutasassociatedwithwell-beingaseatingpotatoesrdquoPrzybylskisaidBullyinghadafourtimesgreatereffectonmentalhealthsaidOrbenandPrzybylski

InMaythetworesearchersevaluatedwhethertheamountoftimeadolescentsspendonsocialmediaaffectstheirmoodAgaintheyfoundthatscreentimehadaldquotinymdasharguablytrivialrdquomdasheffectonmood

ldquoItsnottimespentthatisassociatedwithpositiveornegativeoutcomesbuthowpeopleusesocialmediardquosaysChristopherFergusonapsychologyprofessoratStetsonUniversityinFloridaIna2017studyFergusonfoundthatmoderateuseofscreensdidnotincreasebehavioralormentalhealthproblemsamongchildrenandexcessivescreentimeonlymarginallycorrelatedwithsuchproblemsInanotherstudyheandtwootherresearchersconcludedthattimespentonlinedidnotresultindepressionorsuicidalthoughtsamongyoungadults

MikeBrooksdirectoroftheAustinPsychologyandAssessmentCenterinAustinTexasandauthorofTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldsaysldquoMypettheoryisthatwhenweseeassociationbetweenscreenuseandnegativehealthoutcomesitmaybethatitsbecausetheyareupuntil1amandtheirsleepistakingahitandthentheirmoodrdquo

AstudyledbyaUniversityofColoradoBoulderintegrativephysiologyprofessorfoundalinkbetweendigitalmediauseandreducedsleepandastudyledbyaStanfordpsychiatryprofessorfoundthatsleepproblemscouldprovideearlycluestosuicidalthoughtsincertainyoungadults

BrooksandFergusonagreehoweverwithTwengestheorythatdigitalmediausecanleadtosocialisolationifitreplacesin-personinteractionldquoTheresagoodreasontobeconcernedbutalarmismisproblematicrdquoBrookssays

SaraKonrathanassociateprofessorofphilanthropicstudiesatIndianaUniversitysayssmartphonesandsocialmediacanreducelonelinessamongyoungpeoplebecausetheyfeelsurroundedbyothersA2015studybytwoGermanresearchersfoundthatbrowsingFacebooktriggerspositiveemotionsmoreoftenthannegativeones

HoweverastudyledbyUniversityofMichiganpsychologyprofessorEthanKrossfoundthatthemoretimepeoplespentonFacebooktheworsetheyfeltpsychologicallyAndaBritishstudyfoundthatamongsocialmediasitesInstagramand

36

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7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 830

IanRussellsdaughterMollytookherlifeatage14afterviewingdisturbingmaterialonInstagramInJuneRussellspokeataconferenceinLondontourgesocialmediacompaniestobettercontrolonlinematerialthatpromotessuicideandotherformsofselfharm(GettyImagesHelenWIlliams)

Snapchatwerethemostdetrimentaltothementalhealthofyoungpeople(ages14to24)basedontheirresponsestoquestionsaboutanxietydepressionlonelinesssleepbodyimageandcyberbullying

ManyobserversraisealarmsabouttheavailabilityonlineofinformationabouthowtotakeoneslifeIanRussellwhose14-year-olddaughterMollykilledherselfin2017holdsInstagrampartlyresponsibleAfterhersuicidethefamilyfoundmaterialinherInstagramaccountaboutdepressionandsuicidalmethodsInstagramsaiditldquodoesnotallowcontentthatpromotesorglorifiesself-harmorsuiciderdquoandhassaiditwouldremovesuchcontent

ManyworrythatcyberbullyingcanleadtosuicidalthoughtsparticularlyamonggirlsThesuiciderateamonggirlsages10to14grew127percentbetween2007and2016comparedwith71percentamongboysinthesameagegroupaccordingtoonestudy

ldquoGirlsaremoreoftenhellipcyberbullied[thanboys]onsocialmediardquosaidJoanLubyapsychiatristatWashingtonUniversitySchoolofMedicineinStLouisandldquotheytendtohavemuchmorenegativepsychologicaleffectstothatcyberbullyingrdquo

ButDanielJReidenbergexecutivedirectorofSuicideAwarenessVoicesofEducationanonprofitsuicidepreventionandpubliceducationgroupinBloomingtonMinnsayspeoplesharetheirsuicidalthoughtsonlinefarmorefrequentlynowthaninthepastandinsuchcasesfriendsoftencanprovidehelp

InJanuaryafterChicagorapperCupcakKetweetedthatshewassuicidalherfollowersimmediatelymessagedherandalertedauthoritieswhotookhertothehospitalwhereshebegantreatmentfordepression

Canldquobigdatardquohelpreducesuiciderates

TheDepartmentofVeteransAffairsisusingacomputeralgorithmthatsiftsthroughvoluminoushealthdatatodetectcommonwarningsignsandflagveteranswhoareatriskofsuicideVAhealthcareprovidersthenreachoutdirectlytothoseindividualsandtheveteransdecidewhethertoseekhelp

ldquo[V]eteransathighestriskofsuicidearealsoatveryhighriskofsomeotherthingsrdquosuchasaccidentsoverdosesandopioidaddictionsaidAaronEaganthedepartmentsdeputydirectorforinnovation

Withinayearofimplementingtheso-calledREACHVetprograminApril2017theVAhadcontactedmorethan30000veteransThoseparticipatingintheprogramwereadmittedtomentalhealthinpatientunitslessoftenshowedupmoreoftenfordoctorappointmentsandvisitedtheVAmorefrequentlythanothervetsthedepartmentreported

Manyresearchershealthcareprovidersandothersbelievesimilardataanalyticscanhelpalertnonmilitarydoctorsaboutat-riskpatientsHealthcareproviderstypicallyassesssuicideriskbyaskingpatientssuchquestionsaswhethertheyaredepressedhaveconsideredharmingthemselvesorhaveasuicideplanHoweverone-thirdofsuicideattemptsanddeathsoccuramongpatientswhohavenotreportedsuicidalthoughts

45

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7152019 Suicide Crisis CQR

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AtaMay2016eventinWashingtonDCaimedatpreventingveteransuicideveteranstheirfamiliesandsurvivorsofveteranswhohavediedbysuicidereachouttooneanotherandtotouchtheSpartanswordmadefrommelted-downsteelfromtheWorldTradeCenter(GettyImagesTheWashingtonPostMichaelSWIlliamson)

ResearchersbelievethathealthprofessionalscouldpreventasuicideiftheyknewmoreaboutapatientsriskA2014studyfoundthat83percentofthosewhokilledthemselveshadvisitedadoctorsofficewithinthepreviousyearbutabouthalfofthemdidnothaveamentalhealthdiagnosis

DataanalyticscouldhelptrackstreamsofinformationandalertdoctorswhenapatientmayneedathoroughassessmentsaysGregoryESimonaseniorinvestigatorforKaiserPermanenteWashingtonHealthResearchInstituteinSeattleandapsychiatristatKaiserHeequatesittoawarninglightonacarssideviewmirrorthatilluminateswhenanothercarpullsintothedriversblindspotldquoThepurposeistodeliverinformationtoourhealthcareprovidersthatpeopleareatriskthenlet[theproviders]dowhattheydobetterrdquo

FacebookalsousesartificialintelligencetoscanpostingsforlivevideosofsuicideorphrasesorwordsthatsuggestsuicidalthoughtsWithinayearofstartingtheprogramin2017Facebookhadfound3500postsorvideoscontainingcontentthatledthecompanytocontactemergencyresponders

NeverthelessmanymedicalcareprovidersresearchersandothersareuncertainwhethersuchtoolscanhelpPeopleatriskofsuicideoftenaresociallyisolatedandunlikelytovisitadoctorsotheymightnotgenerateenoughhealthrecordsforalgorithmstoevaluatesaysBarnhorstattheUniversityofCaliforniaDavisldquoIdontknowwherethepredictiveanalytics[data]wouldcomefromrdquoshesaysldquoTheresnotalotofoutputfromthesepeoplerdquo

TheNIMHsPearsonissimilarlycautiousldquoWehavewaysofhelpingpeoplebyusingexistingdatatofindsomeoneatriskrdquoshesaysButmoreresearchisneededtoensurethatartificialintelligencetoolsdonotmisswholegroupsofpeopleldquoTheremayberacialethnicminoritiesorsexualminoritieswhoarenothittingthehealthcaresystemveryoftenforanumberofreasonsrdquoshesaysldquoHowdotheyfareinpredictiveanalyticsThatsareallyimportantquestionrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteaNewYorkCitymentalhealthtreatmentcentercallspredictiveanalyticsldquoextremelyusefulrdquoinhelpingidentifypotentialsuicidevictimsHoweveritcannotensurethatpeoplewillgetthetreatmenttheyneedldquoIfpredictiveanalyticsledtoaprogramwherepeoplewhoareathigherriskhadtheirguns[confiscated]thatwouldreducethesuicideraterdquohesays

ColumbiaUniversitysAppelbaumsayspeoplehavetriedtopredictsuicidesbasedonvariousriskfactorsldquoforalongtimeandithasbeenextremelydifficultrdquoldquoThevariablesassociatedwithsuicidearecommoninthepopulationanduncommonlyleadtosuicidaloutcomesrdquohesaysForexampledepressionisastrongpredictorofsuicidebutmostpeoplewithdepressiondonotattemptsuicide

Heandotherresearcherssayyearsofresearchshowthatscientistsstilldonotknowexactlyhowtopredictsuicide Ameta-analysisof50yearsofresearchpublishedin2016concludedthat

scientistshavenotgottenanybetteratpredictingsuicideattemptssayingldquopredictionwasonlyslightlybetterthanchancerdquo

OtherresearchersacknowledgethatthescienceofpredictionisnotperfectbutsayitcouldhelphealthcareprovidersdotheirjobbetterldquoItwillmissahugepercentageofpeopleItsnotgoingtosolveallofourproblemsrdquoUrsulaWhitesideaclinicalpsychologistattheUniversityofWashingtoninSeattlesaysldquoButitishelpfultocliniciansrdquo

54

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7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1030

LongDescription

OtherresearchersareraisingprivacyconcernsabouttheuseofpredictiveanalyticsinsuicidepreventiontoolsMasonMarksavisitingfellowatYaleLawSchoolsInformationSocietyProjectsaidthatwhilehealthcareprivacylawsgovernhowmedicalproviderscanusepatientmedicalrecordsartificial-intelligence-basedsuicidepredictionusingsocialmediainformationanddataisunregulatedandcouldposesafetyandethicalconcerns

ldquoTherisksincludestigmatizationofpeoplewithmentalillnessthetransferofsensitivehealthdatatothird-partieshellipunnecessaryinvoluntaryconfinementviolentconfrontationswithpoliceexacerbationofmentalhealthconditionsandhellipincreasesinsuicideriskrdquohesaid

Companiesandlawmakerswillhavetoexaminepolicyandlegalframeworksheadded

Gototop

Background

ResearchEmerges

InancientsocietiesphilosophersreligiousleadersandgovernmentsreactedtosuicideinavarietyofwaysrangingfromglorificationtoreligiouscondemnationColonistsinearlyAmericaviewedsuicideasasinandacrimeuntiljuriesbegantoseeitasasymptomofdiseaseCourtsstoppedrulingitacrimebytheendofthe1800s

Alsointhe19thcenturyresearchersbeganstudyingwhethereconomicandsociologicalchangesmdashincreasedindustrializationandloosenedfamilyandcommunitytiesmdashledtomentalillnessandsuicidePhysiciansbegansendingsuicidalpatientstoasylumsfortreatmentwithsedativesorstimulants

ScientistsgavesuicideonlysporadicattentionhoweveruntilFrenchsociologistEacutemileDurkheimconcludedinhis1897bookLeSuicidethatpeoplewhoweremoresociallyintegratedwerelesslikelytokillthemselvesHealsofoundsuicidemorecommonamongmenthanwomenandsoldiersthancivilians

DurkheimsbookpromptedotherscientiststoanalyzementalillnessmorecloselyIn1925psychiatristsKarlandWilliamMenningeropenedaclinicoutsideTopekaKantotreatthementallyillInhis1930bookTheHumanMindKarlcontendedthatpsychiatrycouldhelpsuchpatientsEightyearslaterhisManAgainstHimselfsuggestedthatthesuicidalimpulsewasamisdirectionofthesurvivalinstinct

DuringtheGreatDepressionthesuiciderateintheUnitedStatesreacheda20th-centurypeakmdash219suicidesper100000mdashin1932 Itwouldfallto114per100000by1957climberratically

duringthe1960sthroughthe1970sreaching137in1977andfalltoanall-timelowof104in2000(SeeGraphic)

AfterWorldWarIIclinicalpsychologistEdwinShneidmanpropelledsuicideresearchwhenhebeganinvestigatingacacheofLosAngelesdeathrecordsfilledwithhundredsofsuicidenotes

In1958ShneidmanandpsychologistNormanLFarberowalongwithDrRobertELitmanusedafederalgranttoopenthefirstsuicidepreventionfacilityinacondemnedbuildingoftheLosAngelesCountyGeneralHospitalStaffofferedin-personandphonecounselingtoindividualsexperiencing

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depressionandsuicidalthoughtsMostfamouslythecenterconductedthefirstpsychologicalautopsiesmdashinterviewswithfamilyfriendsdoctorsandotherassociatesofsuicidevictimstoconfirmthecauseofdeath

TheNationalCenterforHealthStatisticsreportedthatin1964anaverageof56Americanskilledthemselveseverydayaccountingfor1percentofdeathsthatyearButthecenteralsosaidsuicidestatisticslikelywereldquogrosslyunderstatedrdquobecausefamilyandfriendsoftenpreventedcoronersfromreportingsuicidesondeathcertificates

TheNationalInstituteofMentalHealthbeganacampaigninthe1960storeducementalillnessandsuicideTheinstitutein1966hiredShneidmantocreateasuicidepreventionprogramwhichledtoajumpinthenumberofUSsuicidepreventioncentersmdashfrom15tomorethan100withinafewyears

SuicideandHealth

Inthe1980sand90ssuicidebecamealeadinghealthconcernintheUnitedStatesandtheworldBy1990USrateshadreached124per100000forallagegroupsbutforages15to24theraterosefrom88to132per100000

ExpertsspeculatedthatfamilydisintegrationduetorisingdivorceratesdrugabusedwindlingjobandeducationalopportunitiesandtheavailabilityofgunscouldbepartlytoblameFirearmscontinuedtobethemostcommonmethodofsuicide

Studiesinthe1980sbyDavidPPhillipsasociologistattheUniversityofCaliforniaSanDiegofoundthatsuicidesrosesignificantlyafterwell-publicizedcaseswiththerisegreatestamongteenagers Andresearchersfoundcorrelationsbetweenfictionalizedsuicideattemptsin

televisionmoviesandincreasedsuicideattemptsamongteens

AsthesuiciderateamongadolescentsandyoungadultsrosetheDepartmentofHealthandHumanServicescreatedataskforceonyouthsuicidein1985 In1987agroupoffamiliesaffectedby

suicidejoinedwithscientiststoestablishtheAmericanFoundationforSuicidePreventiontofundresearchandeducationaboutsuicideMoregrassrootsorganizationsfollowed

ResearchersandcommunitiesgrewincreasinglyconcernedaboutsuicideclustersmdashmultiplesuicidesoccurringinthesamegeographicalareainashortspanoftimeInMarch1987forexamplefourteenagersinBergenfieldNJkilledthemselvesbylockingthemselvesinagarageandrunningacarengineWithinaweekatleasttwootheryoungpeopleattemptedsuicideinthesamemanner

ldquoThenewscoverageofteenagesuicidescanportraythevictimsasmartyrsofsortsrdquosaidDrDavidShafferachildpsychiatryprofessoratColumbiaUniversityandthedirectorofthesuicideresearchunitattheNewYorkStatePsychiatricInstituteldquoThemoresentimentalizeditisthemorelegitimatemdashevenheroicmdashitmayseemtosometeenagersrdquo

Drugtreatmentsfordepressionwereintroducedinthelate1980sbeginningwiththe1987approvalofProzacbytheUSFoodandDrugAdministration(FDA)Thedrugaimedtoeasedepressionbyraisingthelevelsofachemicalcalledserotonininthebrain

In1989suicideexpertsotherresearcherspublichealthofficialsandnewsoutletsmettodiscusswaystopreventsuicidecontagionTheydevelopedrecommendationsfordiscussionswiththemediaandsuggestedthatnewsoutletsavoidprovidingdetailsofsuicidemethods

Intheearly1990sUniversityofWashingtonpsychologistMarshaLinehandevelopedoneofthethreeevidence-basedinterventionsandtreatmentsthathavebeenshowntobeeffectiveinreducingsuicidalityHerprogramcalleddialecticalbehaviortherapyteachespatientshowtomanagepainfulemotionsanddecreaseconflictinrelationships Theothertwotreatmentsarecognitivebehavior

therapywhichencouragespatientstochallengedistortedviewpointsandchangedestructivepatternsofbehaviorandCAMSdevelopedbyCatholicUniversitysJobesTherapistsusingCAMStalkindetailwithpatientsabouttheirthoughtsofhopelessnessandsuicideandhelpthembuildatreatmentplan

Althoughsuicideratesfellinthe1990sresearchersandhealthofficialsremainedconcernedaboutfindinganeffectivetreatmentforsuicidalbehaviormdashparticularlyafterthehighlypublicizedsuicideofKurtCobainleadsingerfortherockbandNirvanaonApril51994ACatholicUniversitystudydeterminedthatCobainssuicidewasnotfollowedbycopycatsuicidesbutdidsparkmorecallstosuicidecrisishotlinesmdashlikelyduetohowthemediacoveredthestoryandcommunityoutreacheffortsencouragingpeopleatrisktoseekhelp

ldquoCalltoActionrdquo

In1996theWorldHealthOrganizationurgedmembernationstoaddressrisingsuicideratesintheircountriesMostalarminglythenumberofsuicidesintheUnitedStateshadnearlytripledamongadolescentsandyoungadultssince1952Suicidewasthethirdleadingcauseofdeathamongthoseages15to24andthefourthleadingcauseamongthoseages10to14

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Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

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couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

7152019 Suicide Crisis CQR

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

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copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 7: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 730

WilliamampMaryinWilliamsburgVaconductedtheirownresearchandconcludedthatredflaglawsinCaliforniaConnecticutIndianaandWashingtonstatehadldquonosignificanteffectrdquoonsuicide

DrPaulSAppelbaumaprofessorofpsychiatryandlawatColumbiaUniversitysaysthelawsrepresentldquoaninnovativeapproachrdquotoidentifyingpeopleatriskofviolence

HoweverhesaysldquoOverallIthinkthecontributiontheywillmaketoreducingthesuiciderateasawholewillberelativelysmallbecausemostpeoplewhoaresuicidalwillprobablynotdoanythingthatcallsattentiontothemselvesinsuchawaythatpolicearesummonedtointervenerdquo

Doessocialmediaincreasetheriskforsuicide

SanDiegoStateUniversitysTwengeauthorofiGenabookaboutthefirstgenerationofAmericanstospendtheirteenyearsusingsocialmediabelievestheincreasinguseofsocialmediaiscreatingmentalhealthproblemsforadolescents

TwengeledastudyanalyzingdatafromtwosurveysonUSadolescentsandyouthbehavioralongwithCDCdataonsuicidedeathssince1999Thedatashowedthatbetween2010and2015thenumberofadolescentsreportingseveredepressionrose33percentandthenumberofsuicidesincreased31percentGirlsmdashparticularlythosewhospentmoretimeonlinethantheirpeersmdashweremostlikelytoreportdepressiveorsuicidalsymptomsTheresearchersconcludedthattheincreasedtimethatadolescentsspentonscreenactivitiesmayaccountforincreasesindepressionandsuicide

InanotherstudyTwengeandseveralcolleaguesreportedthat132percentof18-to25-year-oldsreportedseriouspsychologicaldistressin2017up71percentfrom2008Meanwhilemajordepressiveepisodesamong12-to17-year-oldsin2017wereup52percentfrom2005Andoneofeveryfiveteenagegirlshadexperiencedmajordepressioninthepreviousyear

Twengesteamattributedsuchdistresstolessin-personsocialinteractionamongadolescentsthanamongyouthsinpriorgenerationslargelyduetothegrowingprevalenceoftimespentonsmartphonesandsocialmedia

ButotherresearchersquestionTwengesconclusionthatscreentimedirectlyleadstomdashoristheprimarycauseofmdashdepressionorsuicide

OxfordUniversitypsychologyresearchersAmyOrbenandAndrewKPrzybylskibelievethecorrelationbetweendigitaltechnologyuseandadolescentsmentalhealthisoverstatedStudieslikeTwengesarebasedonanalysesoflargedatasetsthatcanbesubjecttoresearchersbiastheysaidAnalyzingthesamedatasetsTwengeusedforiGentheresearchersconcludedthatscreenusehadaldquotinyrdquoeffectonteensmentalhealthwhencomparedwitharangeofotherpotentialcorrelatingfactors

ldquoUsingtechnologyisaboutasassociatedwithwell-beingaseatingpotatoesrdquoPrzybylskisaidBullyinghadafourtimesgreatereffectonmentalhealthsaidOrbenandPrzybylski

InMaythetworesearchersevaluatedwhethertheamountoftimeadolescentsspendonsocialmediaaffectstheirmoodAgaintheyfoundthatscreentimehadaldquotinymdasharguablytrivialrdquomdasheffectonmood

ldquoItsnottimespentthatisassociatedwithpositiveornegativeoutcomesbuthowpeopleusesocialmediardquosaysChristopherFergusonapsychologyprofessoratStetsonUniversityinFloridaIna2017studyFergusonfoundthatmoderateuseofscreensdidnotincreasebehavioralormentalhealthproblemsamongchildrenandexcessivescreentimeonlymarginallycorrelatedwithsuchproblemsInanotherstudyheandtwootherresearchersconcludedthattimespentonlinedidnotresultindepressionorsuicidalthoughtsamongyoungadults

MikeBrooksdirectoroftheAustinPsychologyandAssessmentCenterinAustinTexasandauthorofTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldsaysldquoMypettheoryisthatwhenweseeassociationbetweenscreenuseandnegativehealthoutcomesitmaybethatitsbecausetheyareupuntil1amandtheirsleepistakingahitandthentheirmoodrdquo

AstudyledbyaUniversityofColoradoBoulderintegrativephysiologyprofessorfoundalinkbetweendigitalmediauseandreducedsleepandastudyledbyaStanfordpsychiatryprofessorfoundthatsleepproblemscouldprovideearlycluestosuicidalthoughtsincertainyoungadults

BrooksandFergusonagreehoweverwithTwengestheorythatdigitalmediausecanleadtosocialisolationifitreplacesin-personinteractionldquoTheresagoodreasontobeconcernedbutalarmismisproblematicrdquoBrookssays

SaraKonrathanassociateprofessorofphilanthropicstudiesatIndianaUniversitysayssmartphonesandsocialmediacanreducelonelinessamongyoungpeoplebecausetheyfeelsurroundedbyothersA2015studybytwoGermanresearchersfoundthatbrowsingFacebooktriggerspositiveemotionsmoreoftenthannegativeones

HoweverastudyledbyUniversityofMichiganpsychologyprofessorEthanKrossfoundthatthemoretimepeoplespentonFacebooktheworsetheyfeltpsychologicallyAndaBritishstudyfoundthatamongsocialmediasitesInstagramand

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IanRussellsdaughterMollytookherlifeatage14afterviewingdisturbingmaterialonInstagramInJuneRussellspokeataconferenceinLondontourgesocialmediacompaniestobettercontrolonlinematerialthatpromotessuicideandotherformsofselfharm(GettyImagesHelenWIlliams)

Snapchatwerethemostdetrimentaltothementalhealthofyoungpeople(ages14to24)basedontheirresponsestoquestionsaboutanxietydepressionlonelinesssleepbodyimageandcyberbullying

ManyobserversraisealarmsabouttheavailabilityonlineofinformationabouthowtotakeoneslifeIanRussellwhose14-year-olddaughterMollykilledherselfin2017holdsInstagrampartlyresponsibleAfterhersuicidethefamilyfoundmaterialinherInstagramaccountaboutdepressionandsuicidalmethodsInstagramsaiditldquodoesnotallowcontentthatpromotesorglorifiesself-harmorsuiciderdquoandhassaiditwouldremovesuchcontent

ManyworrythatcyberbullyingcanleadtosuicidalthoughtsparticularlyamonggirlsThesuiciderateamonggirlsages10to14grew127percentbetween2007and2016comparedwith71percentamongboysinthesameagegroupaccordingtoonestudy

ldquoGirlsaremoreoftenhellipcyberbullied[thanboys]onsocialmediardquosaidJoanLubyapsychiatristatWashingtonUniversitySchoolofMedicineinStLouisandldquotheytendtohavemuchmorenegativepsychologicaleffectstothatcyberbullyingrdquo

ButDanielJReidenbergexecutivedirectorofSuicideAwarenessVoicesofEducationanonprofitsuicidepreventionandpubliceducationgroupinBloomingtonMinnsayspeoplesharetheirsuicidalthoughtsonlinefarmorefrequentlynowthaninthepastandinsuchcasesfriendsoftencanprovidehelp

InJanuaryafterChicagorapperCupcakKetweetedthatshewassuicidalherfollowersimmediatelymessagedherandalertedauthoritieswhotookhertothehospitalwhereshebegantreatmentfordepression

Canldquobigdatardquohelpreducesuiciderates

TheDepartmentofVeteransAffairsisusingacomputeralgorithmthatsiftsthroughvoluminoushealthdatatodetectcommonwarningsignsandflagveteranswhoareatriskofsuicideVAhealthcareprovidersthenreachoutdirectlytothoseindividualsandtheveteransdecidewhethertoseekhelp

ldquo[V]eteransathighestriskofsuicidearealsoatveryhighriskofsomeotherthingsrdquosuchasaccidentsoverdosesandopioidaddictionsaidAaronEaganthedepartmentsdeputydirectorforinnovation

Withinayearofimplementingtheso-calledREACHVetprograminApril2017theVAhadcontactedmorethan30000veteransThoseparticipatingintheprogramwereadmittedtomentalhealthinpatientunitslessoftenshowedupmoreoftenfordoctorappointmentsandvisitedtheVAmorefrequentlythanothervetsthedepartmentreported

Manyresearchershealthcareprovidersandothersbelievesimilardataanalyticscanhelpalertnonmilitarydoctorsaboutat-riskpatientsHealthcareproviderstypicallyassesssuicideriskbyaskingpatientssuchquestionsaswhethertheyaredepressedhaveconsideredharmingthemselvesorhaveasuicideplanHoweverone-thirdofsuicideattemptsanddeathsoccuramongpatientswhohavenotreportedsuicidalthoughts

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AtaMay2016eventinWashingtonDCaimedatpreventingveteransuicideveteranstheirfamiliesandsurvivorsofveteranswhohavediedbysuicidereachouttooneanotherandtotouchtheSpartanswordmadefrommelted-downsteelfromtheWorldTradeCenter(GettyImagesTheWashingtonPostMichaelSWIlliamson)

ResearchersbelievethathealthprofessionalscouldpreventasuicideiftheyknewmoreaboutapatientsriskA2014studyfoundthat83percentofthosewhokilledthemselveshadvisitedadoctorsofficewithinthepreviousyearbutabouthalfofthemdidnothaveamentalhealthdiagnosis

DataanalyticscouldhelptrackstreamsofinformationandalertdoctorswhenapatientmayneedathoroughassessmentsaysGregoryESimonaseniorinvestigatorforKaiserPermanenteWashingtonHealthResearchInstituteinSeattleandapsychiatristatKaiserHeequatesittoawarninglightonacarssideviewmirrorthatilluminateswhenanothercarpullsintothedriversblindspotldquoThepurposeistodeliverinformationtoourhealthcareprovidersthatpeopleareatriskthenlet[theproviders]dowhattheydobetterrdquo

FacebookalsousesartificialintelligencetoscanpostingsforlivevideosofsuicideorphrasesorwordsthatsuggestsuicidalthoughtsWithinayearofstartingtheprogramin2017Facebookhadfound3500postsorvideoscontainingcontentthatledthecompanytocontactemergencyresponders

NeverthelessmanymedicalcareprovidersresearchersandothersareuncertainwhethersuchtoolscanhelpPeopleatriskofsuicideoftenaresociallyisolatedandunlikelytovisitadoctorsotheymightnotgenerateenoughhealthrecordsforalgorithmstoevaluatesaysBarnhorstattheUniversityofCaliforniaDavisldquoIdontknowwherethepredictiveanalytics[data]wouldcomefromrdquoshesaysldquoTheresnotalotofoutputfromthesepeoplerdquo

TheNIMHsPearsonissimilarlycautiousldquoWehavewaysofhelpingpeoplebyusingexistingdatatofindsomeoneatriskrdquoshesaysButmoreresearchisneededtoensurethatartificialintelligencetoolsdonotmisswholegroupsofpeopleldquoTheremayberacialethnicminoritiesorsexualminoritieswhoarenothittingthehealthcaresystemveryoftenforanumberofreasonsrdquoshesaysldquoHowdotheyfareinpredictiveanalyticsThatsareallyimportantquestionrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteaNewYorkCitymentalhealthtreatmentcentercallspredictiveanalyticsldquoextremelyusefulrdquoinhelpingidentifypotentialsuicidevictimsHoweveritcannotensurethatpeoplewillgetthetreatmenttheyneedldquoIfpredictiveanalyticsledtoaprogramwherepeoplewhoareathigherriskhadtheirguns[confiscated]thatwouldreducethesuicideraterdquohesays

ColumbiaUniversitysAppelbaumsayspeoplehavetriedtopredictsuicidesbasedonvariousriskfactorsldquoforalongtimeandithasbeenextremelydifficultrdquoldquoThevariablesassociatedwithsuicidearecommoninthepopulationanduncommonlyleadtosuicidaloutcomesrdquohesaysForexampledepressionisastrongpredictorofsuicidebutmostpeoplewithdepressiondonotattemptsuicide

Heandotherresearcherssayyearsofresearchshowthatscientistsstilldonotknowexactlyhowtopredictsuicide Ameta-analysisof50yearsofresearchpublishedin2016concludedthat

scientistshavenotgottenanybetteratpredictingsuicideattemptssayingldquopredictionwasonlyslightlybetterthanchancerdquo

OtherresearchersacknowledgethatthescienceofpredictionisnotperfectbutsayitcouldhelphealthcareprovidersdotheirjobbetterldquoItwillmissahugepercentageofpeopleItsnotgoingtosolveallofourproblemsrdquoUrsulaWhitesideaclinicalpsychologistattheUniversityofWashingtoninSeattlesaysldquoButitishelpfultocliniciansrdquo

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LongDescription

OtherresearchersareraisingprivacyconcernsabouttheuseofpredictiveanalyticsinsuicidepreventiontoolsMasonMarksavisitingfellowatYaleLawSchoolsInformationSocietyProjectsaidthatwhilehealthcareprivacylawsgovernhowmedicalproviderscanusepatientmedicalrecordsartificial-intelligence-basedsuicidepredictionusingsocialmediainformationanddataisunregulatedandcouldposesafetyandethicalconcerns

ldquoTherisksincludestigmatizationofpeoplewithmentalillnessthetransferofsensitivehealthdatatothird-partieshellipunnecessaryinvoluntaryconfinementviolentconfrontationswithpoliceexacerbationofmentalhealthconditionsandhellipincreasesinsuicideriskrdquohesaid

Companiesandlawmakerswillhavetoexaminepolicyandlegalframeworksheadded

Gototop

Background

ResearchEmerges

InancientsocietiesphilosophersreligiousleadersandgovernmentsreactedtosuicideinavarietyofwaysrangingfromglorificationtoreligiouscondemnationColonistsinearlyAmericaviewedsuicideasasinandacrimeuntiljuriesbegantoseeitasasymptomofdiseaseCourtsstoppedrulingitacrimebytheendofthe1800s

Alsointhe19thcenturyresearchersbeganstudyingwhethereconomicandsociologicalchangesmdashincreasedindustrializationandloosenedfamilyandcommunitytiesmdashledtomentalillnessandsuicidePhysiciansbegansendingsuicidalpatientstoasylumsfortreatmentwithsedativesorstimulants

ScientistsgavesuicideonlysporadicattentionhoweveruntilFrenchsociologistEacutemileDurkheimconcludedinhis1897bookLeSuicidethatpeoplewhoweremoresociallyintegratedwerelesslikelytokillthemselvesHealsofoundsuicidemorecommonamongmenthanwomenandsoldiersthancivilians

DurkheimsbookpromptedotherscientiststoanalyzementalillnessmorecloselyIn1925psychiatristsKarlandWilliamMenningeropenedaclinicoutsideTopekaKantotreatthementallyillInhis1930bookTheHumanMindKarlcontendedthatpsychiatrycouldhelpsuchpatientsEightyearslaterhisManAgainstHimselfsuggestedthatthesuicidalimpulsewasamisdirectionofthesurvivalinstinct

DuringtheGreatDepressionthesuiciderateintheUnitedStatesreacheda20th-centurypeakmdash219suicidesper100000mdashin1932 Itwouldfallto114per100000by1957climberratically

duringthe1960sthroughthe1970sreaching137in1977andfalltoanall-timelowof104in2000(SeeGraphic)

AfterWorldWarIIclinicalpsychologistEdwinShneidmanpropelledsuicideresearchwhenhebeganinvestigatingacacheofLosAngelesdeathrecordsfilledwithhundredsofsuicidenotes

In1958ShneidmanandpsychologistNormanLFarberowalongwithDrRobertELitmanusedafederalgranttoopenthefirstsuicidepreventionfacilityinacondemnedbuildingoftheLosAngelesCountyGeneralHospitalStaffofferedin-personandphonecounselingtoindividualsexperiencing

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depressionandsuicidalthoughtsMostfamouslythecenterconductedthefirstpsychologicalautopsiesmdashinterviewswithfamilyfriendsdoctorsandotherassociatesofsuicidevictimstoconfirmthecauseofdeath

TheNationalCenterforHealthStatisticsreportedthatin1964anaverageof56Americanskilledthemselveseverydayaccountingfor1percentofdeathsthatyearButthecenteralsosaidsuicidestatisticslikelywereldquogrosslyunderstatedrdquobecausefamilyandfriendsoftenpreventedcoronersfromreportingsuicidesondeathcertificates

TheNationalInstituteofMentalHealthbeganacampaigninthe1960storeducementalillnessandsuicideTheinstitutein1966hiredShneidmantocreateasuicidepreventionprogramwhichledtoajumpinthenumberofUSsuicidepreventioncentersmdashfrom15tomorethan100withinafewyears

SuicideandHealth

Inthe1980sand90ssuicidebecamealeadinghealthconcernintheUnitedStatesandtheworldBy1990USrateshadreached124per100000forallagegroupsbutforages15to24theraterosefrom88to132per100000

ExpertsspeculatedthatfamilydisintegrationduetorisingdivorceratesdrugabusedwindlingjobandeducationalopportunitiesandtheavailabilityofgunscouldbepartlytoblameFirearmscontinuedtobethemostcommonmethodofsuicide

Studiesinthe1980sbyDavidPPhillipsasociologistattheUniversityofCaliforniaSanDiegofoundthatsuicidesrosesignificantlyafterwell-publicizedcaseswiththerisegreatestamongteenagers Andresearchersfoundcorrelationsbetweenfictionalizedsuicideattemptsin

televisionmoviesandincreasedsuicideattemptsamongteens

AsthesuiciderateamongadolescentsandyoungadultsrosetheDepartmentofHealthandHumanServicescreatedataskforceonyouthsuicidein1985 In1987agroupoffamiliesaffectedby

suicidejoinedwithscientiststoestablishtheAmericanFoundationforSuicidePreventiontofundresearchandeducationaboutsuicideMoregrassrootsorganizationsfollowed

ResearchersandcommunitiesgrewincreasinglyconcernedaboutsuicideclustersmdashmultiplesuicidesoccurringinthesamegeographicalareainashortspanoftimeInMarch1987forexamplefourteenagersinBergenfieldNJkilledthemselvesbylockingthemselvesinagarageandrunningacarengineWithinaweekatleasttwootheryoungpeopleattemptedsuicideinthesamemanner

ldquoThenewscoverageofteenagesuicidescanportraythevictimsasmartyrsofsortsrdquosaidDrDavidShafferachildpsychiatryprofessoratColumbiaUniversityandthedirectorofthesuicideresearchunitattheNewYorkStatePsychiatricInstituteldquoThemoresentimentalizeditisthemorelegitimatemdashevenheroicmdashitmayseemtosometeenagersrdquo

Drugtreatmentsfordepressionwereintroducedinthelate1980sbeginningwiththe1987approvalofProzacbytheUSFoodandDrugAdministration(FDA)Thedrugaimedtoeasedepressionbyraisingthelevelsofachemicalcalledserotonininthebrain

In1989suicideexpertsotherresearcherspublichealthofficialsandnewsoutletsmettodiscusswaystopreventsuicidecontagionTheydevelopedrecommendationsfordiscussionswiththemediaandsuggestedthatnewsoutletsavoidprovidingdetailsofsuicidemethods

Intheearly1990sUniversityofWashingtonpsychologistMarshaLinehandevelopedoneofthethreeevidence-basedinterventionsandtreatmentsthathavebeenshowntobeeffectiveinreducingsuicidalityHerprogramcalleddialecticalbehaviortherapyteachespatientshowtomanagepainfulemotionsanddecreaseconflictinrelationships Theothertwotreatmentsarecognitivebehavior

therapywhichencouragespatientstochallengedistortedviewpointsandchangedestructivepatternsofbehaviorandCAMSdevelopedbyCatholicUniversitysJobesTherapistsusingCAMStalkindetailwithpatientsabouttheirthoughtsofhopelessnessandsuicideandhelpthembuildatreatmentplan

Althoughsuicideratesfellinthe1990sresearchersandhealthofficialsremainedconcernedaboutfindinganeffectivetreatmentforsuicidalbehaviormdashparticularlyafterthehighlypublicizedsuicideofKurtCobainleadsingerfortherockbandNirvanaonApril51994ACatholicUniversitystudydeterminedthatCobainssuicidewasnotfollowedbycopycatsuicidesbutdidsparkmorecallstosuicidecrisishotlinesmdashlikelyduetohowthemediacoveredthestoryandcommunityoutreacheffortsencouragingpeopleatrisktoseekhelp

ldquoCalltoActionrdquo

In1996theWorldHealthOrganizationurgedmembernationstoaddressrisingsuicideratesintheircountriesMostalarminglythenumberofsuicidesintheUnitedStateshadnearlytripledamongadolescentsandyoungadultssince1952Suicidewasthethirdleadingcauseofdeathamongthoseages15to24andthefourthleadingcauseamongthoseages10to14

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Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

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couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

106

107

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

112

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

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7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

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volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 8: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 830

IanRussellsdaughterMollytookherlifeatage14afterviewingdisturbingmaterialonInstagramInJuneRussellspokeataconferenceinLondontourgesocialmediacompaniestobettercontrolonlinematerialthatpromotessuicideandotherformsofselfharm(GettyImagesHelenWIlliams)

Snapchatwerethemostdetrimentaltothementalhealthofyoungpeople(ages14to24)basedontheirresponsestoquestionsaboutanxietydepressionlonelinesssleepbodyimageandcyberbullying

ManyobserversraisealarmsabouttheavailabilityonlineofinformationabouthowtotakeoneslifeIanRussellwhose14-year-olddaughterMollykilledherselfin2017holdsInstagrampartlyresponsibleAfterhersuicidethefamilyfoundmaterialinherInstagramaccountaboutdepressionandsuicidalmethodsInstagramsaiditldquodoesnotallowcontentthatpromotesorglorifiesself-harmorsuiciderdquoandhassaiditwouldremovesuchcontent

ManyworrythatcyberbullyingcanleadtosuicidalthoughtsparticularlyamonggirlsThesuiciderateamonggirlsages10to14grew127percentbetween2007and2016comparedwith71percentamongboysinthesameagegroupaccordingtoonestudy

ldquoGirlsaremoreoftenhellipcyberbullied[thanboys]onsocialmediardquosaidJoanLubyapsychiatristatWashingtonUniversitySchoolofMedicineinStLouisandldquotheytendtohavemuchmorenegativepsychologicaleffectstothatcyberbullyingrdquo

ButDanielJReidenbergexecutivedirectorofSuicideAwarenessVoicesofEducationanonprofitsuicidepreventionandpubliceducationgroupinBloomingtonMinnsayspeoplesharetheirsuicidalthoughtsonlinefarmorefrequentlynowthaninthepastandinsuchcasesfriendsoftencanprovidehelp

InJanuaryafterChicagorapperCupcakKetweetedthatshewassuicidalherfollowersimmediatelymessagedherandalertedauthoritieswhotookhertothehospitalwhereshebegantreatmentfordepression

Canldquobigdatardquohelpreducesuiciderates

TheDepartmentofVeteransAffairsisusingacomputeralgorithmthatsiftsthroughvoluminoushealthdatatodetectcommonwarningsignsandflagveteranswhoareatriskofsuicideVAhealthcareprovidersthenreachoutdirectlytothoseindividualsandtheveteransdecidewhethertoseekhelp

ldquo[V]eteransathighestriskofsuicidearealsoatveryhighriskofsomeotherthingsrdquosuchasaccidentsoverdosesandopioidaddictionsaidAaronEaganthedepartmentsdeputydirectorforinnovation

Withinayearofimplementingtheso-calledREACHVetprograminApril2017theVAhadcontactedmorethan30000veteransThoseparticipatingintheprogramwereadmittedtomentalhealthinpatientunitslessoftenshowedupmoreoftenfordoctorappointmentsandvisitedtheVAmorefrequentlythanothervetsthedepartmentreported

Manyresearchershealthcareprovidersandothersbelievesimilardataanalyticscanhelpalertnonmilitarydoctorsaboutat-riskpatientsHealthcareproviderstypicallyassesssuicideriskbyaskingpatientssuchquestionsaswhethertheyaredepressedhaveconsideredharmingthemselvesorhaveasuicideplanHoweverone-thirdofsuicideattemptsanddeathsoccuramongpatientswhohavenotreportedsuicidalthoughts

45

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7152019 Suicide Crisis CQR

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AtaMay2016eventinWashingtonDCaimedatpreventingveteransuicideveteranstheirfamiliesandsurvivorsofveteranswhohavediedbysuicidereachouttooneanotherandtotouchtheSpartanswordmadefrommelted-downsteelfromtheWorldTradeCenter(GettyImagesTheWashingtonPostMichaelSWIlliamson)

ResearchersbelievethathealthprofessionalscouldpreventasuicideiftheyknewmoreaboutapatientsriskA2014studyfoundthat83percentofthosewhokilledthemselveshadvisitedadoctorsofficewithinthepreviousyearbutabouthalfofthemdidnothaveamentalhealthdiagnosis

DataanalyticscouldhelptrackstreamsofinformationandalertdoctorswhenapatientmayneedathoroughassessmentsaysGregoryESimonaseniorinvestigatorforKaiserPermanenteWashingtonHealthResearchInstituteinSeattleandapsychiatristatKaiserHeequatesittoawarninglightonacarssideviewmirrorthatilluminateswhenanothercarpullsintothedriversblindspotldquoThepurposeistodeliverinformationtoourhealthcareprovidersthatpeopleareatriskthenlet[theproviders]dowhattheydobetterrdquo

FacebookalsousesartificialintelligencetoscanpostingsforlivevideosofsuicideorphrasesorwordsthatsuggestsuicidalthoughtsWithinayearofstartingtheprogramin2017Facebookhadfound3500postsorvideoscontainingcontentthatledthecompanytocontactemergencyresponders

NeverthelessmanymedicalcareprovidersresearchersandothersareuncertainwhethersuchtoolscanhelpPeopleatriskofsuicideoftenaresociallyisolatedandunlikelytovisitadoctorsotheymightnotgenerateenoughhealthrecordsforalgorithmstoevaluatesaysBarnhorstattheUniversityofCaliforniaDavisldquoIdontknowwherethepredictiveanalytics[data]wouldcomefromrdquoshesaysldquoTheresnotalotofoutputfromthesepeoplerdquo

TheNIMHsPearsonissimilarlycautiousldquoWehavewaysofhelpingpeoplebyusingexistingdatatofindsomeoneatriskrdquoshesaysButmoreresearchisneededtoensurethatartificialintelligencetoolsdonotmisswholegroupsofpeopleldquoTheremayberacialethnicminoritiesorsexualminoritieswhoarenothittingthehealthcaresystemveryoftenforanumberofreasonsrdquoshesaysldquoHowdotheyfareinpredictiveanalyticsThatsareallyimportantquestionrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteaNewYorkCitymentalhealthtreatmentcentercallspredictiveanalyticsldquoextremelyusefulrdquoinhelpingidentifypotentialsuicidevictimsHoweveritcannotensurethatpeoplewillgetthetreatmenttheyneedldquoIfpredictiveanalyticsledtoaprogramwherepeoplewhoareathigherriskhadtheirguns[confiscated]thatwouldreducethesuicideraterdquohesays

ColumbiaUniversitysAppelbaumsayspeoplehavetriedtopredictsuicidesbasedonvariousriskfactorsldquoforalongtimeandithasbeenextremelydifficultrdquoldquoThevariablesassociatedwithsuicidearecommoninthepopulationanduncommonlyleadtosuicidaloutcomesrdquohesaysForexampledepressionisastrongpredictorofsuicidebutmostpeoplewithdepressiondonotattemptsuicide

Heandotherresearcherssayyearsofresearchshowthatscientistsstilldonotknowexactlyhowtopredictsuicide Ameta-analysisof50yearsofresearchpublishedin2016concludedthat

scientistshavenotgottenanybetteratpredictingsuicideattemptssayingldquopredictionwasonlyslightlybetterthanchancerdquo

OtherresearchersacknowledgethatthescienceofpredictionisnotperfectbutsayitcouldhelphealthcareprovidersdotheirjobbetterldquoItwillmissahugepercentageofpeopleItsnotgoingtosolveallofourproblemsrdquoUrsulaWhitesideaclinicalpsychologistattheUniversityofWashingtoninSeattlesaysldquoButitishelpfultocliniciansrdquo

54

55

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7152019 Suicide Crisis CQR

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LongDescription

OtherresearchersareraisingprivacyconcernsabouttheuseofpredictiveanalyticsinsuicidepreventiontoolsMasonMarksavisitingfellowatYaleLawSchoolsInformationSocietyProjectsaidthatwhilehealthcareprivacylawsgovernhowmedicalproviderscanusepatientmedicalrecordsartificial-intelligence-basedsuicidepredictionusingsocialmediainformationanddataisunregulatedandcouldposesafetyandethicalconcerns

ldquoTherisksincludestigmatizationofpeoplewithmentalillnessthetransferofsensitivehealthdatatothird-partieshellipunnecessaryinvoluntaryconfinementviolentconfrontationswithpoliceexacerbationofmentalhealthconditionsandhellipincreasesinsuicideriskrdquohesaid

Companiesandlawmakerswillhavetoexaminepolicyandlegalframeworksheadded

Gototop

Background

ResearchEmerges

InancientsocietiesphilosophersreligiousleadersandgovernmentsreactedtosuicideinavarietyofwaysrangingfromglorificationtoreligiouscondemnationColonistsinearlyAmericaviewedsuicideasasinandacrimeuntiljuriesbegantoseeitasasymptomofdiseaseCourtsstoppedrulingitacrimebytheendofthe1800s

Alsointhe19thcenturyresearchersbeganstudyingwhethereconomicandsociologicalchangesmdashincreasedindustrializationandloosenedfamilyandcommunitytiesmdashledtomentalillnessandsuicidePhysiciansbegansendingsuicidalpatientstoasylumsfortreatmentwithsedativesorstimulants

ScientistsgavesuicideonlysporadicattentionhoweveruntilFrenchsociologistEacutemileDurkheimconcludedinhis1897bookLeSuicidethatpeoplewhoweremoresociallyintegratedwerelesslikelytokillthemselvesHealsofoundsuicidemorecommonamongmenthanwomenandsoldiersthancivilians

DurkheimsbookpromptedotherscientiststoanalyzementalillnessmorecloselyIn1925psychiatristsKarlandWilliamMenningeropenedaclinicoutsideTopekaKantotreatthementallyillInhis1930bookTheHumanMindKarlcontendedthatpsychiatrycouldhelpsuchpatientsEightyearslaterhisManAgainstHimselfsuggestedthatthesuicidalimpulsewasamisdirectionofthesurvivalinstinct

DuringtheGreatDepressionthesuiciderateintheUnitedStatesreacheda20th-centurypeakmdash219suicidesper100000mdashin1932 Itwouldfallto114per100000by1957climberratically

duringthe1960sthroughthe1970sreaching137in1977andfalltoanall-timelowof104in2000(SeeGraphic)

AfterWorldWarIIclinicalpsychologistEdwinShneidmanpropelledsuicideresearchwhenhebeganinvestigatingacacheofLosAngelesdeathrecordsfilledwithhundredsofsuicidenotes

In1958ShneidmanandpsychologistNormanLFarberowalongwithDrRobertELitmanusedafederalgranttoopenthefirstsuicidepreventionfacilityinacondemnedbuildingoftheLosAngelesCountyGeneralHospitalStaffofferedin-personandphonecounselingtoindividualsexperiencing

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7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1130

depressionandsuicidalthoughtsMostfamouslythecenterconductedthefirstpsychologicalautopsiesmdashinterviewswithfamilyfriendsdoctorsandotherassociatesofsuicidevictimstoconfirmthecauseofdeath

TheNationalCenterforHealthStatisticsreportedthatin1964anaverageof56Americanskilledthemselveseverydayaccountingfor1percentofdeathsthatyearButthecenteralsosaidsuicidestatisticslikelywereldquogrosslyunderstatedrdquobecausefamilyandfriendsoftenpreventedcoronersfromreportingsuicidesondeathcertificates

TheNationalInstituteofMentalHealthbeganacampaigninthe1960storeducementalillnessandsuicideTheinstitutein1966hiredShneidmantocreateasuicidepreventionprogramwhichledtoajumpinthenumberofUSsuicidepreventioncentersmdashfrom15tomorethan100withinafewyears

SuicideandHealth

Inthe1980sand90ssuicidebecamealeadinghealthconcernintheUnitedStatesandtheworldBy1990USrateshadreached124per100000forallagegroupsbutforages15to24theraterosefrom88to132per100000

ExpertsspeculatedthatfamilydisintegrationduetorisingdivorceratesdrugabusedwindlingjobandeducationalopportunitiesandtheavailabilityofgunscouldbepartlytoblameFirearmscontinuedtobethemostcommonmethodofsuicide

Studiesinthe1980sbyDavidPPhillipsasociologistattheUniversityofCaliforniaSanDiegofoundthatsuicidesrosesignificantlyafterwell-publicizedcaseswiththerisegreatestamongteenagers Andresearchersfoundcorrelationsbetweenfictionalizedsuicideattemptsin

televisionmoviesandincreasedsuicideattemptsamongteens

AsthesuiciderateamongadolescentsandyoungadultsrosetheDepartmentofHealthandHumanServicescreatedataskforceonyouthsuicidein1985 In1987agroupoffamiliesaffectedby

suicidejoinedwithscientiststoestablishtheAmericanFoundationforSuicidePreventiontofundresearchandeducationaboutsuicideMoregrassrootsorganizationsfollowed

ResearchersandcommunitiesgrewincreasinglyconcernedaboutsuicideclustersmdashmultiplesuicidesoccurringinthesamegeographicalareainashortspanoftimeInMarch1987forexamplefourteenagersinBergenfieldNJkilledthemselvesbylockingthemselvesinagarageandrunningacarengineWithinaweekatleasttwootheryoungpeopleattemptedsuicideinthesamemanner

ldquoThenewscoverageofteenagesuicidescanportraythevictimsasmartyrsofsortsrdquosaidDrDavidShafferachildpsychiatryprofessoratColumbiaUniversityandthedirectorofthesuicideresearchunitattheNewYorkStatePsychiatricInstituteldquoThemoresentimentalizeditisthemorelegitimatemdashevenheroicmdashitmayseemtosometeenagersrdquo

Drugtreatmentsfordepressionwereintroducedinthelate1980sbeginningwiththe1987approvalofProzacbytheUSFoodandDrugAdministration(FDA)Thedrugaimedtoeasedepressionbyraisingthelevelsofachemicalcalledserotonininthebrain

In1989suicideexpertsotherresearcherspublichealthofficialsandnewsoutletsmettodiscusswaystopreventsuicidecontagionTheydevelopedrecommendationsfordiscussionswiththemediaandsuggestedthatnewsoutletsavoidprovidingdetailsofsuicidemethods

Intheearly1990sUniversityofWashingtonpsychologistMarshaLinehandevelopedoneofthethreeevidence-basedinterventionsandtreatmentsthathavebeenshowntobeeffectiveinreducingsuicidalityHerprogramcalleddialecticalbehaviortherapyteachespatientshowtomanagepainfulemotionsanddecreaseconflictinrelationships Theothertwotreatmentsarecognitivebehavior

therapywhichencouragespatientstochallengedistortedviewpointsandchangedestructivepatternsofbehaviorandCAMSdevelopedbyCatholicUniversitysJobesTherapistsusingCAMStalkindetailwithpatientsabouttheirthoughtsofhopelessnessandsuicideandhelpthembuildatreatmentplan

Althoughsuicideratesfellinthe1990sresearchersandhealthofficialsremainedconcernedaboutfindinganeffectivetreatmentforsuicidalbehaviormdashparticularlyafterthehighlypublicizedsuicideofKurtCobainleadsingerfortherockbandNirvanaonApril51994ACatholicUniversitystudydeterminedthatCobainssuicidewasnotfollowedbycopycatsuicidesbutdidsparkmorecallstosuicidecrisishotlinesmdashlikelyduetohowthemediacoveredthestoryandcommunityoutreacheffortsencouragingpeopleatrisktoseekhelp

ldquoCalltoActionrdquo

In1996theWorldHealthOrganizationurgedmembernationstoaddressrisingsuicideratesintheircountriesMostalarminglythenumberofsuicidesintheUnitedStateshadnearlytripledamongadolescentsandyoungadultssince1952Suicidewasthethirdleadingcauseofdeathamongthoseages15to24andthefourthleadingcauseamongthoseages10to14

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7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1230

Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

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7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1330

couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 9: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 930

AtaMay2016eventinWashingtonDCaimedatpreventingveteransuicideveteranstheirfamiliesandsurvivorsofveteranswhohavediedbysuicidereachouttooneanotherandtotouchtheSpartanswordmadefrommelted-downsteelfromtheWorldTradeCenter(GettyImagesTheWashingtonPostMichaelSWIlliamson)

ResearchersbelievethathealthprofessionalscouldpreventasuicideiftheyknewmoreaboutapatientsriskA2014studyfoundthat83percentofthosewhokilledthemselveshadvisitedadoctorsofficewithinthepreviousyearbutabouthalfofthemdidnothaveamentalhealthdiagnosis

DataanalyticscouldhelptrackstreamsofinformationandalertdoctorswhenapatientmayneedathoroughassessmentsaysGregoryESimonaseniorinvestigatorforKaiserPermanenteWashingtonHealthResearchInstituteinSeattleandapsychiatristatKaiserHeequatesittoawarninglightonacarssideviewmirrorthatilluminateswhenanothercarpullsintothedriversblindspotldquoThepurposeistodeliverinformationtoourhealthcareprovidersthatpeopleareatriskthenlet[theproviders]dowhattheydobetterrdquo

FacebookalsousesartificialintelligencetoscanpostingsforlivevideosofsuicideorphrasesorwordsthatsuggestsuicidalthoughtsWithinayearofstartingtheprogramin2017Facebookhadfound3500postsorvideoscontainingcontentthatledthecompanytocontactemergencyresponders

NeverthelessmanymedicalcareprovidersresearchersandothersareuncertainwhethersuchtoolscanhelpPeopleatriskofsuicideoftenaresociallyisolatedandunlikelytovisitadoctorsotheymightnotgenerateenoughhealthrecordsforalgorithmstoevaluatesaysBarnhorstattheUniversityofCaliforniaDavisldquoIdontknowwherethepredictiveanalytics[data]wouldcomefromrdquoshesaysldquoTheresnotalotofoutputfromthesepeoplerdquo

TheNIMHsPearsonissimilarlycautiousldquoWehavewaysofhelpingpeoplebyusingexistingdatatofindsomeoneatriskrdquoshesaysButmoreresearchisneededtoensurethatartificialintelligencetoolsdonotmisswholegroupsofpeopleldquoTheremayberacialethnicminoritiesorsexualminoritieswhoarenothittingthehealthcaresystemveryoftenforanumberofreasonsrdquoshesaysldquoHowdotheyfareinpredictiveanalyticsThatsareallyimportantquestionrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteaNewYorkCitymentalhealthtreatmentcentercallspredictiveanalyticsldquoextremelyusefulrdquoinhelpingidentifypotentialsuicidevictimsHoweveritcannotensurethatpeoplewillgetthetreatmenttheyneedldquoIfpredictiveanalyticsledtoaprogramwherepeoplewhoareathigherriskhadtheirguns[confiscated]thatwouldreducethesuicideraterdquohesays

ColumbiaUniversitysAppelbaumsayspeoplehavetriedtopredictsuicidesbasedonvariousriskfactorsldquoforalongtimeandithasbeenextremelydifficultrdquoldquoThevariablesassociatedwithsuicidearecommoninthepopulationanduncommonlyleadtosuicidaloutcomesrdquohesaysForexampledepressionisastrongpredictorofsuicidebutmostpeoplewithdepressiondonotattemptsuicide

Heandotherresearcherssayyearsofresearchshowthatscientistsstilldonotknowexactlyhowtopredictsuicide Ameta-analysisof50yearsofresearchpublishedin2016concludedthat

scientistshavenotgottenanybetteratpredictingsuicideattemptssayingldquopredictionwasonlyslightlybetterthanchancerdquo

OtherresearchersacknowledgethatthescienceofpredictionisnotperfectbutsayitcouldhelphealthcareprovidersdotheirjobbetterldquoItwillmissahugepercentageofpeopleItsnotgoingtosolveallofourproblemsrdquoUrsulaWhitesideaclinicalpsychologistattheUniversityofWashingtoninSeattlesaysldquoButitishelpfultocliniciansrdquo

54

55

56

57

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1030

LongDescription

OtherresearchersareraisingprivacyconcernsabouttheuseofpredictiveanalyticsinsuicidepreventiontoolsMasonMarksavisitingfellowatYaleLawSchoolsInformationSocietyProjectsaidthatwhilehealthcareprivacylawsgovernhowmedicalproviderscanusepatientmedicalrecordsartificial-intelligence-basedsuicidepredictionusingsocialmediainformationanddataisunregulatedandcouldposesafetyandethicalconcerns

ldquoTherisksincludestigmatizationofpeoplewithmentalillnessthetransferofsensitivehealthdatatothird-partieshellipunnecessaryinvoluntaryconfinementviolentconfrontationswithpoliceexacerbationofmentalhealthconditionsandhellipincreasesinsuicideriskrdquohesaid

Companiesandlawmakerswillhavetoexaminepolicyandlegalframeworksheadded

Gototop

Background

ResearchEmerges

InancientsocietiesphilosophersreligiousleadersandgovernmentsreactedtosuicideinavarietyofwaysrangingfromglorificationtoreligiouscondemnationColonistsinearlyAmericaviewedsuicideasasinandacrimeuntiljuriesbegantoseeitasasymptomofdiseaseCourtsstoppedrulingitacrimebytheendofthe1800s

Alsointhe19thcenturyresearchersbeganstudyingwhethereconomicandsociologicalchangesmdashincreasedindustrializationandloosenedfamilyandcommunitytiesmdashledtomentalillnessandsuicidePhysiciansbegansendingsuicidalpatientstoasylumsfortreatmentwithsedativesorstimulants

ScientistsgavesuicideonlysporadicattentionhoweveruntilFrenchsociologistEacutemileDurkheimconcludedinhis1897bookLeSuicidethatpeoplewhoweremoresociallyintegratedwerelesslikelytokillthemselvesHealsofoundsuicidemorecommonamongmenthanwomenandsoldiersthancivilians

DurkheimsbookpromptedotherscientiststoanalyzementalillnessmorecloselyIn1925psychiatristsKarlandWilliamMenningeropenedaclinicoutsideTopekaKantotreatthementallyillInhis1930bookTheHumanMindKarlcontendedthatpsychiatrycouldhelpsuchpatientsEightyearslaterhisManAgainstHimselfsuggestedthatthesuicidalimpulsewasamisdirectionofthesurvivalinstinct

DuringtheGreatDepressionthesuiciderateintheUnitedStatesreacheda20th-centurypeakmdash219suicidesper100000mdashin1932 Itwouldfallto114per100000by1957climberratically

duringthe1960sthroughthe1970sreaching137in1977andfalltoanall-timelowof104in2000(SeeGraphic)

AfterWorldWarIIclinicalpsychologistEdwinShneidmanpropelledsuicideresearchwhenhebeganinvestigatingacacheofLosAngelesdeathrecordsfilledwithhundredsofsuicidenotes

In1958ShneidmanandpsychologistNormanLFarberowalongwithDrRobertELitmanusedafederalgranttoopenthefirstsuicidepreventionfacilityinacondemnedbuildingoftheLosAngelesCountyGeneralHospitalStaffofferedin-personandphonecounselingtoindividualsexperiencing

58

59

60

61

62

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1130

depressionandsuicidalthoughtsMostfamouslythecenterconductedthefirstpsychologicalautopsiesmdashinterviewswithfamilyfriendsdoctorsandotherassociatesofsuicidevictimstoconfirmthecauseofdeath

TheNationalCenterforHealthStatisticsreportedthatin1964anaverageof56Americanskilledthemselveseverydayaccountingfor1percentofdeathsthatyearButthecenteralsosaidsuicidestatisticslikelywereldquogrosslyunderstatedrdquobecausefamilyandfriendsoftenpreventedcoronersfromreportingsuicidesondeathcertificates

TheNationalInstituteofMentalHealthbeganacampaigninthe1960storeducementalillnessandsuicideTheinstitutein1966hiredShneidmantocreateasuicidepreventionprogramwhichledtoajumpinthenumberofUSsuicidepreventioncentersmdashfrom15tomorethan100withinafewyears

SuicideandHealth

Inthe1980sand90ssuicidebecamealeadinghealthconcernintheUnitedStatesandtheworldBy1990USrateshadreached124per100000forallagegroupsbutforages15to24theraterosefrom88to132per100000

ExpertsspeculatedthatfamilydisintegrationduetorisingdivorceratesdrugabusedwindlingjobandeducationalopportunitiesandtheavailabilityofgunscouldbepartlytoblameFirearmscontinuedtobethemostcommonmethodofsuicide

Studiesinthe1980sbyDavidPPhillipsasociologistattheUniversityofCaliforniaSanDiegofoundthatsuicidesrosesignificantlyafterwell-publicizedcaseswiththerisegreatestamongteenagers Andresearchersfoundcorrelationsbetweenfictionalizedsuicideattemptsin

televisionmoviesandincreasedsuicideattemptsamongteens

AsthesuiciderateamongadolescentsandyoungadultsrosetheDepartmentofHealthandHumanServicescreatedataskforceonyouthsuicidein1985 In1987agroupoffamiliesaffectedby

suicidejoinedwithscientiststoestablishtheAmericanFoundationforSuicidePreventiontofundresearchandeducationaboutsuicideMoregrassrootsorganizationsfollowed

ResearchersandcommunitiesgrewincreasinglyconcernedaboutsuicideclustersmdashmultiplesuicidesoccurringinthesamegeographicalareainashortspanoftimeInMarch1987forexamplefourteenagersinBergenfieldNJkilledthemselvesbylockingthemselvesinagarageandrunningacarengineWithinaweekatleasttwootheryoungpeopleattemptedsuicideinthesamemanner

ldquoThenewscoverageofteenagesuicidescanportraythevictimsasmartyrsofsortsrdquosaidDrDavidShafferachildpsychiatryprofessoratColumbiaUniversityandthedirectorofthesuicideresearchunitattheNewYorkStatePsychiatricInstituteldquoThemoresentimentalizeditisthemorelegitimatemdashevenheroicmdashitmayseemtosometeenagersrdquo

Drugtreatmentsfordepressionwereintroducedinthelate1980sbeginningwiththe1987approvalofProzacbytheUSFoodandDrugAdministration(FDA)Thedrugaimedtoeasedepressionbyraisingthelevelsofachemicalcalledserotonininthebrain

In1989suicideexpertsotherresearcherspublichealthofficialsandnewsoutletsmettodiscusswaystopreventsuicidecontagionTheydevelopedrecommendationsfordiscussionswiththemediaandsuggestedthatnewsoutletsavoidprovidingdetailsofsuicidemethods

Intheearly1990sUniversityofWashingtonpsychologistMarshaLinehandevelopedoneofthethreeevidence-basedinterventionsandtreatmentsthathavebeenshowntobeeffectiveinreducingsuicidalityHerprogramcalleddialecticalbehaviortherapyteachespatientshowtomanagepainfulemotionsanddecreaseconflictinrelationships Theothertwotreatmentsarecognitivebehavior

therapywhichencouragespatientstochallengedistortedviewpointsandchangedestructivepatternsofbehaviorandCAMSdevelopedbyCatholicUniversitysJobesTherapistsusingCAMStalkindetailwithpatientsabouttheirthoughtsofhopelessnessandsuicideandhelpthembuildatreatmentplan

Althoughsuicideratesfellinthe1990sresearchersandhealthofficialsremainedconcernedaboutfindinganeffectivetreatmentforsuicidalbehaviormdashparticularlyafterthehighlypublicizedsuicideofKurtCobainleadsingerfortherockbandNirvanaonApril51994ACatholicUniversitystudydeterminedthatCobainssuicidewasnotfollowedbycopycatsuicidesbutdidsparkmorecallstosuicidecrisishotlinesmdashlikelyduetohowthemediacoveredthestoryandcommunityoutreacheffortsencouragingpeopleatrisktoseekhelp

ldquoCalltoActionrdquo

In1996theWorldHealthOrganizationurgedmembernationstoaddressrisingsuicideratesintheircountriesMostalarminglythenumberofsuicidesintheUnitedStateshadnearlytripledamongadolescentsandyoungadultssince1952Suicidewasthethirdleadingcauseofdeathamongthoseages15to24andthefourthleadingcauseamongthoseages10to14

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Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

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couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

7152019 Suicide Crisis CQR

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 10: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1030

LongDescription

OtherresearchersareraisingprivacyconcernsabouttheuseofpredictiveanalyticsinsuicidepreventiontoolsMasonMarksavisitingfellowatYaleLawSchoolsInformationSocietyProjectsaidthatwhilehealthcareprivacylawsgovernhowmedicalproviderscanusepatientmedicalrecordsartificial-intelligence-basedsuicidepredictionusingsocialmediainformationanddataisunregulatedandcouldposesafetyandethicalconcerns

ldquoTherisksincludestigmatizationofpeoplewithmentalillnessthetransferofsensitivehealthdatatothird-partieshellipunnecessaryinvoluntaryconfinementviolentconfrontationswithpoliceexacerbationofmentalhealthconditionsandhellipincreasesinsuicideriskrdquohesaid

Companiesandlawmakerswillhavetoexaminepolicyandlegalframeworksheadded

Gototop

Background

ResearchEmerges

InancientsocietiesphilosophersreligiousleadersandgovernmentsreactedtosuicideinavarietyofwaysrangingfromglorificationtoreligiouscondemnationColonistsinearlyAmericaviewedsuicideasasinandacrimeuntiljuriesbegantoseeitasasymptomofdiseaseCourtsstoppedrulingitacrimebytheendofthe1800s

Alsointhe19thcenturyresearchersbeganstudyingwhethereconomicandsociologicalchangesmdashincreasedindustrializationandloosenedfamilyandcommunitytiesmdashledtomentalillnessandsuicidePhysiciansbegansendingsuicidalpatientstoasylumsfortreatmentwithsedativesorstimulants

ScientistsgavesuicideonlysporadicattentionhoweveruntilFrenchsociologistEacutemileDurkheimconcludedinhis1897bookLeSuicidethatpeoplewhoweremoresociallyintegratedwerelesslikelytokillthemselvesHealsofoundsuicidemorecommonamongmenthanwomenandsoldiersthancivilians

DurkheimsbookpromptedotherscientiststoanalyzementalillnessmorecloselyIn1925psychiatristsKarlandWilliamMenningeropenedaclinicoutsideTopekaKantotreatthementallyillInhis1930bookTheHumanMindKarlcontendedthatpsychiatrycouldhelpsuchpatientsEightyearslaterhisManAgainstHimselfsuggestedthatthesuicidalimpulsewasamisdirectionofthesurvivalinstinct

DuringtheGreatDepressionthesuiciderateintheUnitedStatesreacheda20th-centurypeakmdash219suicidesper100000mdashin1932 Itwouldfallto114per100000by1957climberratically

duringthe1960sthroughthe1970sreaching137in1977andfalltoanall-timelowof104in2000(SeeGraphic)

AfterWorldWarIIclinicalpsychologistEdwinShneidmanpropelledsuicideresearchwhenhebeganinvestigatingacacheofLosAngelesdeathrecordsfilledwithhundredsofsuicidenotes

In1958ShneidmanandpsychologistNormanLFarberowalongwithDrRobertELitmanusedafederalgranttoopenthefirstsuicidepreventionfacilityinacondemnedbuildingoftheLosAngelesCountyGeneralHospitalStaffofferedin-personandphonecounselingtoindividualsexperiencing

58

59

60

61

62

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1130

depressionandsuicidalthoughtsMostfamouslythecenterconductedthefirstpsychologicalautopsiesmdashinterviewswithfamilyfriendsdoctorsandotherassociatesofsuicidevictimstoconfirmthecauseofdeath

TheNationalCenterforHealthStatisticsreportedthatin1964anaverageof56Americanskilledthemselveseverydayaccountingfor1percentofdeathsthatyearButthecenteralsosaidsuicidestatisticslikelywereldquogrosslyunderstatedrdquobecausefamilyandfriendsoftenpreventedcoronersfromreportingsuicidesondeathcertificates

TheNationalInstituteofMentalHealthbeganacampaigninthe1960storeducementalillnessandsuicideTheinstitutein1966hiredShneidmantocreateasuicidepreventionprogramwhichledtoajumpinthenumberofUSsuicidepreventioncentersmdashfrom15tomorethan100withinafewyears

SuicideandHealth

Inthe1980sand90ssuicidebecamealeadinghealthconcernintheUnitedStatesandtheworldBy1990USrateshadreached124per100000forallagegroupsbutforages15to24theraterosefrom88to132per100000

ExpertsspeculatedthatfamilydisintegrationduetorisingdivorceratesdrugabusedwindlingjobandeducationalopportunitiesandtheavailabilityofgunscouldbepartlytoblameFirearmscontinuedtobethemostcommonmethodofsuicide

Studiesinthe1980sbyDavidPPhillipsasociologistattheUniversityofCaliforniaSanDiegofoundthatsuicidesrosesignificantlyafterwell-publicizedcaseswiththerisegreatestamongteenagers Andresearchersfoundcorrelationsbetweenfictionalizedsuicideattemptsin

televisionmoviesandincreasedsuicideattemptsamongteens

AsthesuiciderateamongadolescentsandyoungadultsrosetheDepartmentofHealthandHumanServicescreatedataskforceonyouthsuicidein1985 In1987agroupoffamiliesaffectedby

suicidejoinedwithscientiststoestablishtheAmericanFoundationforSuicidePreventiontofundresearchandeducationaboutsuicideMoregrassrootsorganizationsfollowed

ResearchersandcommunitiesgrewincreasinglyconcernedaboutsuicideclustersmdashmultiplesuicidesoccurringinthesamegeographicalareainashortspanoftimeInMarch1987forexamplefourteenagersinBergenfieldNJkilledthemselvesbylockingthemselvesinagarageandrunningacarengineWithinaweekatleasttwootheryoungpeopleattemptedsuicideinthesamemanner

ldquoThenewscoverageofteenagesuicidescanportraythevictimsasmartyrsofsortsrdquosaidDrDavidShafferachildpsychiatryprofessoratColumbiaUniversityandthedirectorofthesuicideresearchunitattheNewYorkStatePsychiatricInstituteldquoThemoresentimentalizeditisthemorelegitimatemdashevenheroicmdashitmayseemtosometeenagersrdquo

Drugtreatmentsfordepressionwereintroducedinthelate1980sbeginningwiththe1987approvalofProzacbytheUSFoodandDrugAdministration(FDA)Thedrugaimedtoeasedepressionbyraisingthelevelsofachemicalcalledserotonininthebrain

In1989suicideexpertsotherresearcherspublichealthofficialsandnewsoutletsmettodiscusswaystopreventsuicidecontagionTheydevelopedrecommendationsfordiscussionswiththemediaandsuggestedthatnewsoutletsavoidprovidingdetailsofsuicidemethods

Intheearly1990sUniversityofWashingtonpsychologistMarshaLinehandevelopedoneofthethreeevidence-basedinterventionsandtreatmentsthathavebeenshowntobeeffectiveinreducingsuicidalityHerprogramcalleddialecticalbehaviortherapyteachespatientshowtomanagepainfulemotionsanddecreaseconflictinrelationships Theothertwotreatmentsarecognitivebehavior

therapywhichencouragespatientstochallengedistortedviewpointsandchangedestructivepatternsofbehaviorandCAMSdevelopedbyCatholicUniversitysJobesTherapistsusingCAMStalkindetailwithpatientsabouttheirthoughtsofhopelessnessandsuicideandhelpthembuildatreatmentplan

Althoughsuicideratesfellinthe1990sresearchersandhealthofficialsremainedconcernedaboutfindinganeffectivetreatmentforsuicidalbehaviormdashparticularlyafterthehighlypublicizedsuicideofKurtCobainleadsingerfortherockbandNirvanaonApril51994ACatholicUniversitystudydeterminedthatCobainssuicidewasnotfollowedbycopycatsuicidesbutdidsparkmorecallstosuicidecrisishotlinesmdashlikelyduetohowthemediacoveredthestoryandcommunityoutreacheffortsencouragingpeopleatrisktoseekhelp

ldquoCalltoActionrdquo

In1996theWorldHealthOrganizationurgedmembernationstoaddressrisingsuicideratesintheircountriesMostalarminglythenumberofsuicidesintheUnitedStateshadnearlytripledamongadolescentsandyoungadultssince1952Suicidewasthethirdleadingcauseofdeathamongthoseages15to24andthefourthleadingcauseamongthoseages10to14

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Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

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couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

7152019 Suicide Crisis CQR

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

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copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 11: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1130

depressionandsuicidalthoughtsMostfamouslythecenterconductedthefirstpsychologicalautopsiesmdashinterviewswithfamilyfriendsdoctorsandotherassociatesofsuicidevictimstoconfirmthecauseofdeath

TheNationalCenterforHealthStatisticsreportedthatin1964anaverageof56Americanskilledthemselveseverydayaccountingfor1percentofdeathsthatyearButthecenteralsosaidsuicidestatisticslikelywereldquogrosslyunderstatedrdquobecausefamilyandfriendsoftenpreventedcoronersfromreportingsuicidesondeathcertificates

TheNationalInstituteofMentalHealthbeganacampaigninthe1960storeducementalillnessandsuicideTheinstitutein1966hiredShneidmantocreateasuicidepreventionprogramwhichledtoajumpinthenumberofUSsuicidepreventioncentersmdashfrom15tomorethan100withinafewyears

SuicideandHealth

Inthe1980sand90ssuicidebecamealeadinghealthconcernintheUnitedStatesandtheworldBy1990USrateshadreached124per100000forallagegroupsbutforages15to24theraterosefrom88to132per100000

ExpertsspeculatedthatfamilydisintegrationduetorisingdivorceratesdrugabusedwindlingjobandeducationalopportunitiesandtheavailabilityofgunscouldbepartlytoblameFirearmscontinuedtobethemostcommonmethodofsuicide

Studiesinthe1980sbyDavidPPhillipsasociologistattheUniversityofCaliforniaSanDiegofoundthatsuicidesrosesignificantlyafterwell-publicizedcaseswiththerisegreatestamongteenagers Andresearchersfoundcorrelationsbetweenfictionalizedsuicideattemptsin

televisionmoviesandincreasedsuicideattemptsamongteens

AsthesuiciderateamongadolescentsandyoungadultsrosetheDepartmentofHealthandHumanServicescreatedataskforceonyouthsuicidein1985 In1987agroupoffamiliesaffectedby

suicidejoinedwithscientiststoestablishtheAmericanFoundationforSuicidePreventiontofundresearchandeducationaboutsuicideMoregrassrootsorganizationsfollowed

ResearchersandcommunitiesgrewincreasinglyconcernedaboutsuicideclustersmdashmultiplesuicidesoccurringinthesamegeographicalareainashortspanoftimeInMarch1987forexamplefourteenagersinBergenfieldNJkilledthemselvesbylockingthemselvesinagarageandrunningacarengineWithinaweekatleasttwootheryoungpeopleattemptedsuicideinthesamemanner

ldquoThenewscoverageofteenagesuicidescanportraythevictimsasmartyrsofsortsrdquosaidDrDavidShafferachildpsychiatryprofessoratColumbiaUniversityandthedirectorofthesuicideresearchunitattheNewYorkStatePsychiatricInstituteldquoThemoresentimentalizeditisthemorelegitimatemdashevenheroicmdashitmayseemtosometeenagersrdquo

Drugtreatmentsfordepressionwereintroducedinthelate1980sbeginningwiththe1987approvalofProzacbytheUSFoodandDrugAdministration(FDA)Thedrugaimedtoeasedepressionbyraisingthelevelsofachemicalcalledserotonininthebrain

In1989suicideexpertsotherresearcherspublichealthofficialsandnewsoutletsmettodiscusswaystopreventsuicidecontagionTheydevelopedrecommendationsfordiscussionswiththemediaandsuggestedthatnewsoutletsavoidprovidingdetailsofsuicidemethods

Intheearly1990sUniversityofWashingtonpsychologistMarshaLinehandevelopedoneofthethreeevidence-basedinterventionsandtreatmentsthathavebeenshowntobeeffectiveinreducingsuicidalityHerprogramcalleddialecticalbehaviortherapyteachespatientshowtomanagepainfulemotionsanddecreaseconflictinrelationships Theothertwotreatmentsarecognitivebehavior

therapywhichencouragespatientstochallengedistortedviewpointsandchangedestructivepatternsofbehaviorandCAMSdevelopedbyCatholicUniversitysJobesTherapistsusingCAMStalkindetailwithpatientsabouttheirthoughtsofhopelessnessandsuicideandhelpthembuildatreatmentplan

Althoughsuicideratesfellinthe1990sresearchersandhealthofficialsremainedconcernedaboutfindinganeffectivetreatmentforsuicidalbehaviormdashparticularlyafterthehighlypublicizedsuicideofKurtCobainleadsingerfortherockbandNirvanaonApril51994ACatholicUniversitystudydeterminedthatCobainssuicidewasnotfollowedbycopycatsuicidesbutdidsparkmorecallstosuicidecrisishotlinesmdashlikelyduetohowthemediacoveredthestoryandcommunityoutreacheffortsencouragingpeopleatrisktoseekhelp

ldquoCalltoActionrdquo

In1996theWorldHealthOrganizationurgedmembernationstoaddressrisingsuicideratesintheircountriesMostalarminglythenumberofsuicidesintheUnitedStateshadnearlytripledamongadolescentsandyoungadultssince1952Suicidewasthethirdleadingcauseofdeathamongthoseages15to24andthefourthleadingcauseamongthoseages10to14

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Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

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couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

7152019 Suicide Crisis CQR

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 12: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1230

Suicideremainedapublichealthproblemamongmanyothergroupsaswellincludingwhitemenoverage65NativeAmericansandAlaskanNatives

In1998ShneidmansTheSuicidalMindoutlinedcommonfeaturesofindividualswhokilledthemselvesincludingfeelingsofhopelessnessanddeependuringpsychologicalpainHesaidvictimsoftenexperiencedlifelongemotionalstrugglesandleftsignstheyplannedtokillthemselves

ldquoWemustlooktopreviousepisodesofdisturbancedarktimesinthatlifehellipapenchantforconstrictionanddichotomousthinkingatendencytothrowinthetowelrdquohewrote

Evenastheoverallsuicideratedeclinedtherateamongyoungpeopleages15-19hadincreased14percentbetween1980and1996andamongthoseages10-14yearsitincreased100percent

In1999USSurgeonGeneralDavidSatcherissuedaldquoCalltoActiontoPreventSuiciderdquoaskingthenationtoaddresssuicideldquoasasignificantpublichealthproblemandputintoplacenationalstrategiestopreventthelossoflifeandthesufferingsuicidecausesrdquoIn2001heurgedpublicinformationcampaignsandcommunity-basedsuicidepreventionprogramsineverystate

Therisingnumberofchildrenandadolescentsexperiencingdepressionandothermentalhealthissuespromptedsomepediatriciansin2002tobeginprescribingantidepressantstosuchpatientseventhoughtheFDAhadnotapprovedthemastreatmentsforyoungpeopleProvidingprescriptionsoutsideofFDAguidelinescalledoff-labelisalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateNewsoutletssoonbeganreportingcasesofadolescentskillingthemselvesmdashorattemptingtodosomdashwhiletakingsuchmedications

JaneClementissonTylerkilledhimselfinSeptember2010afterhisroommateatRutgersUniversityinNewJerseysurreptitiouslyfilmedhimwithanothermanandstreamedthevideoParentsandhealthcareresearchersworrythatcyberbullyingmaybecontributingtohighyouthsuiciderates(AFPGettyImagesJewelSamad)

Inthefallof2004theFDAwarnedthattakingantidepressantscouldproducesuicidalthoughtsandbehaviorsinchildrenandadolescentsTheagencybeganrequiringdrugmanufacturerstoaddawarningonantidepressantlabelsabouttheincreasedrisktochildren

ThewarningstirredcontroversyhoweverandmanymedicalproviderspushedbackIn2005theAmericanMedicalAssociationadoptedaresolutionsayingthedrugshadnotbeenshowntoraisetheriskofldquocompletedsuiciderdquosochildrendealingwithseriousdepressionshouldnotbedeniedsuchmedicationsifthedrugscouldsavetheirlives

ThatsameyearFloridaStateUniversitypsychologyprofessorThomasEJoinertheorizedinWhyPeopleDiebySuicidethatindividualswouldnotkillthemselveswithoutboththedesireandabilitytodosoandthatthosewhowanttodiefeelsociallyalienatedandbelievetheyareaburdentootherpeople

In2007theFDAexpandedthewarningonantidepressantstoincludeadultsages18to24

Manyhealthcareproviderscontinuedtoobjecttothewarningandtotheclaimsthatantidepressants

78

79

80

81

82

83

84

85

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1330

couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 13: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1330

couldleadtosuicidalbehaviorarguingthatnoonecouldknowwhethersuicidalsymptomsthatdevelopduringtreatmentareduetothemedicationortotheunderlyingillness

Meanwhileafterbottomingoutat104suicidesper100000peoplein2000USsuicideratesbegantoclimbto124per100000by2010withthegreatestincreaseamongadultsages35to64

Inthe2010sastheuseofdigitaldevicesandsocialmediaamongyoungpeoplegrewparentsandhealthcareofficialsbegantoworrythatcyberbullyingmightbecontributingtoyouthsuicideratesInonenationallypublicizedcaseRutgersUniversityfreshmanTylerClementi18killedhimselfbyjumpingfromtheGeorgeWashingtonBridgelinkingNewYorkCityandNewJerseyinSeptember2010afterhisroommateusedawebcamtorecordClementikissinganothermanandtheninvitedpeopletowatchthestreamingvideo

ThatsameyeartheUSDepartmentofHealthandHumanServicesandthePentagonannouncedtheywereformingtheNationalActionAllianceforSuicidePreventionapublic-privatepartnershiptotrytostemtheriseinsuicides

Thesurgeongeneralsofficein2012againcalledforaheightenednationalfocusonsuicidesettingagoalofreducingtheoverallrateby20percentby2025Theofficesaidthelargestnumberofsuicideswereoccurringamongmiddle-agedAmericansldquosappingtheworkforceweneedtogrowoureconomyrdquo

Theofficealsoencouragedhealthcareandcommunitygroupstoaimforanidealofldquozerosuicidesrdquotherebyurgingallhealthcareproviderstohelpidentifyandtreatpatientspotentiallyatrisk

FocusingonthezerosuicideidealtheNationalActionAllianceforSuicidePreventionandtheSuicidePreventionResourceCenterbegananationwideefforttoprovidesuicidepreventiontrainingfornursesanddoctorsinallhealthcaresystems

InMay2013theCDCreportedthatBabyBoomershadhighersuicideratesthanearliergenerationsevenasyouthsAndinthewakeofthewarsinAfghanistanandIraqsuicidesamongveteranswereclimbingBy2016veteransaccountedfor14percentofadultsuicideseventhoughtheycomprisedonly8percentoftheUSpopulation

ResearchersinDenmarkfoundin2016thatantidepressantscoulddoubletheriskofsuicidalbehaviororviolenceinadultswhoexhibitnosignsofamentaldisorderOtherstudiesshowedthatyouthswhosesexualidentityororientationdiffersfromthemajorityintheircommunitiesaretwotoseventimesmorelikelythanheterosexualyouthstodiebysuicide

InMarch2017Netflixbeganairingldquo13ReasonsWhyrdquoashowaboutahighschoolstudentwhokillsherselfandleavesbehind13audiorecordingsexplainingwhyExecutiveproducerSelenaGomezsaidshewantedtohelpstrugglingteensbutresearchersattheNationwideChildrensHospitalinColumbusOhiofoundthatintheninemonthsimmediatelyfollowingtheshowsreleaseabout195moresuicidedeathsamong10-to17-year-oldsoccurredacrossthecountrythanwereexpected

AttemptedsuicidesamongadolescentssurgedafterNetflixairedtheshowldquo13ReasonsWhyrdquoinMarch2017aboutateensuicideSomeresearcherssaidtheshowwhichaimedtohelpteensstrugglingwithsuicidalthoughtsglorifiedsuicide(SAGEPublishingIncScreenshot)

ANorthwesternUniversitysurveycommissionedbyNetflixfoundalmostthree-quartersofadolescentviewerssaidtheshowmadethemfeelldquomorecomfortableprocessingtoughtopicsrdquosaid

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7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1430

Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

93

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101

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104

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7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1530

ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

106

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7152019 Suicide Crisis CQR

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

112

113

114

115

116

117

118

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7152019 Suicide Crisis CQR

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

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volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

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WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 14: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1430

Netflix

InJanuary2018followingreportsthatanaverageof20veteransadaydiedbysuicidePresidentTrumpissuedanexecutiveorderstatingthatveteransmustbeautomaticallyenrolledinVAmentalhealthcareforayearafterleavingtheserviceMeanwhilesuicidesamongactive-dutymilitarymembersalsowererisingwith321membersdyingbysuicidein2018

HoweveraGovernmentAccountabilityOffice(GAO)studylaterfoundthatanti-suicidemessagespostedonsocialmediabytheVAdroppedbymorethantwo-thirdsfromfiscal2017tofiscal2018andnopublicoutreachmessageswereairedonnationaltelevisionorradioformorethanayearOfthe$62millionsetasideforsuicidepreventionmediaadvertisementsinfiscal2018theVAonlyused$57000accordingtotheGAOlargelyduetoldquoleadershipturnoverandreorganizationrdquo

ldquoAtatimewhen20veteransadaystilldiebysuicideVAshouldbedoingeverythinginitspowertoinformthepublicabouttheresourcesavailabletoveteransincrisisrdquosaidRepTimWalzD-MinnrankingmemberoftheHouseVeteransAffairsCommitteeldquoUnfortunatelyVAhasfailedtodothatdespiteclaimingtheeliminationofveteransuicideasitshighestclinicalpriorityrdquo

InJuneofthatyearfashiondesignerKateSpadeandcelebritychefAnthonyBourdaintooktheirliveshighlightingtheworseningcrisisInthehoursafterBourdainsdeaththeNationalSuicidePreventionLifelinereportedspikesofupto500percentincallstoitscrisiscentersInAugustTrumpsignedintolawabillmandatingastudyontheeffectivenessofthelifeline(1-800-273-TALK)andthefeasibilityofcreatinganeasier-to-rememberthree-digitdialingcodelike911

Trumpsignedafiscal2019spendingbillinSeptemberthatincludedatotalincreaseof$48millioninthebudgetsforthelifelinegrantsfortheNationalStrategyforSuicidePreventionandforNIMHresearchonsuicidepreventionAdvocatesforsuicidepreventionhadpushedfora$150millionincrease

Gototop

CurrentSituation

GovernmentEfforts

TheTrumpadministrationisboostingeffortstoaddressthesustainedhighrateofsuicidesamongveteransRecentstatisticsindicatethatbetween2005and2016thesuiciderateamongveteransincreased259percent

AnewfederaltaskforcebegunbytheadministrationearlierthisyearisworkingtobettercoordinatesuicideresearchamongthedepartmentsofDefenseVeteransAffairsandHomelandSecuritySuchresearchisexaminingpotentialriskfactorssuchashomelessnesstraumaticbraininjurypost-traumaticstresssyndromeandmentalhealthdisorders

AmongotherthingsthetaskforcewillseekwaystobetterreachveteranswhoarenotaccessingtheVAhealthcaresystemsinceabout70percentofveteransuicidevictimshadlittleornocontactwiththesystem

Theadministrationisproposingraisingtheamountearmarkedforsuicidepreventionoutreachin2020to$222millionmdasha$156millionincreasefrom2019

MeanwhileguncontrolgroupssuicidepreventionadvocatesandothersacrossthecountrycontinueadvocatingpassageofmorestateredflaglawsTheNationalRifleAssociationwhichhadopposedsuchlegislationrecentlyreverseditsstanceandsaidCongressshouldgivestatesfundingtoadoptsuchlaws

TheSenateheldahearinginMarchonredflaglawsjustdaysafterthesuicidesofthreesurvivorsofrecentmassschoolshootingsmdashtwoteenagersfromParklandFlathesceneofa2018ValentinesDayschoolmassacreandthefatherofoneof20childrenkilledintheDecember2012shootingatSandyHookElementarySchoolinNewtownConn

SeparatebillsintroducedbySenDianneFeinsteinandRepSaludCarbajalbothCaliforniaDemocratswouldallowstatestousefederalfundstoadministerredflaglawsBothmeasuresareawaitingaction

TheDemocratic-controlledHouseinFebruary2019passedauniversalbackgroundchecklawforfirearmspurchasesameasureapplaudedbysomesuicidepreventiongroupsButexpertssaythemeasurehaslittlechanceofmakingitthroughtheRepublican-controlledSenate

Bothchambershavebipartisanmeasurespendingthatwouldfundresearchontheimpactoftechnologyandmediaonchildrenandteensincludingwhethertheyleadtobullyinganddepression

ManystatelegislaturesareconsideringbillstorequirethathealthcareprovidersbetrainedinsuicidepreventionWashingtonandKentuckyadoptedsuchlegislationin2012and2013andotherstatesareexpectedtofollow

93

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7152019 Suicide Crisis CQR

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ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

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7152019 Suicide Crisis CQR

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OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

112

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119

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1730

Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1830

Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1930

afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

7152019 Suicide Crisis CQR

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 15: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1530

ElinaAsensio13holdsaphotoofherbestfriendEmmaBenavideswhodiedinanapparentmurder-suicideatthehandsofEmmasmotherCristiinaDenversuburbin2017Guncontroladvocatessupportldquoredflagrdquolawsthatallowauthoritiestoconfiscategunsofpeoplewhomaybeatriskofself-harmorviolence(GettyImagesTheDenverPostJoeAmon)

OnMay8ArizonasRepublicangovernorsignedlegislationrequiringallschoolfacultytobetrainedinsuicidepreventionInGrandJunctionColoallschoolemployeesmustreceivetraininginsuicidepreventionandtheschooldistrictalsohasbeguntrainingsomestudentsinsixthgradeorhigheronhowtodetectsignsthatanotherstudentmaybeconsideringsuicide

IntheCourts

Manycollegesanduniversitiesaredebatingwhethertheycouldbeheldaccountableforstudentsuicidesaftera2018rulingbytheSupremeJudicialCourtofMassachusettsThecourtsaidthateventhoughtheMassachusettsInstituteofTechnologycouldnotbesuedforthe2009suicideofa25-year-oldgraduatestudentcollegeofficialscouldbeheldresponsiblefornotpreventingstudentsuicidesmdashevenamongstudentslivingoffcampusmdashldquo[if]itwaswithintheuniversitysknowledgeandpowertodosordquo

SuchliabilitylawsuitsarependingagainstseveralotherinstitutionsincludingtheUniversityofPennsylvaniaWashingtonandLeeUniversityinLexingtonVaandtheUniversityofSouthCarolina

ThreestudentsandamentalhealthgrouparesuingStanfordUniversityinfederalcourtforrequiringthatstudentstakealeaveofabsenceiftheyhavealdquopsychiatricpsychologicalormedicalconditionrdquothatldquojeopardizesthelifeorsafetyrdquoofthemselvesorothersorthatsignificantlydisruptscampusactivitiesSomeStanfordstudentssaythepolicyisdiscriminatorydeprivesstudentsofpeer-supportnetworksandforcesthemtopayhousingterminationfeesandotherunexpectedcostsOtherstudentshoweverhavesaidtheybenefitedfromtakingaleaveofabsencetogetneededmentalhealthcare

ParentsalsoaretryingtoholdschooladministratorsaccountableforconditionsthatcouldleadtosuicidalbehaviorintheirchildrenForexamplethemotherofafourthgradespecialeducationstudentataChicagoelementaryschoolissuingschoolofficialsforallegedlybullyinghersonbeforehetriedtokillhimselfonFeb18

MeanwhileafederaljudgeinNorthernCaliforniaruledonMarch5thatUnitedBehavioralHealthadivisionofUnitedHealthGroupimproperlydeniedclaimsformentalhealthandsubstanceaddictiontreatmentformorethan50000patientsinviolationofthefederalMentalHealthParityandAddictionEquityActof2008ThelawrequiresthatinsurersprovidethesamecoverageformentalhealthandaddictiontreatmentthattheyprovideforotherhealthconditionsUnitedHealthsaiditwillappealtheruling

ldquoWelookforwardtodemonstratinginthenextphaseofthiscasehowourmembersreceivedappropriatecarerdquothecompanysaid

ResearchandPredictions

Researchersarecontinuingtostudythecausestreatmentandeffectsofsuicidalbehavior

KaiserPermanentesSimonisworkingwithabout20000patientsmdashthelargestrandomizedsampleeverusedinsuchastudymdashtocomparethreesuicideinterventionprogramsmentalhealthcarealonemedicalcareplusaWeb-andphone-basedprogramtocoachpatientsonhowtomanagedifficultemotionsandmedicalcaresupplementedbyphoneoremailsupportResultsofthestudyareexpectedinearly2020accordingtoSimon

106

107

108

109

110

111

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1630

OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

112

113

114

115

116

117

118

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7152019 Suicide Crisis CQR

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

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Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

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afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

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volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

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WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 16: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1630

OneUniversityofWashingtonresearcherstudiedsuicidalpatientsinanemergencyroomvirtuallyusinganavatarandotheronlinetoolstoassesstheeffectivenessofJobesCollaborativeAssessmentandManagementofSuicidalitytherapyTheresearcherfoundthattheCAMSprotocolhelpedsomepatientsThreeclinicaltrialsarestudyingwhethertheapproachreducessuicideattempts

Otherstudiesareexamining

WorkersatriskResearchersaroundthecountryalongwithsuicidologistJulieCerelattheUniversityofKentuckyareexamininghowsuicideaffectsworkersinvariousoccupationssuchaslawenforcementconstructionandthefoodindustry

CopycatsuicidesJohnsHopkinsUniversitysNestadtisstudyingsuicideandthecopycateffectamongMarylandhighschoolstudentsHesayshispreliminaryresearchhaspinpointedabout28suicideclustersmdasheachincludingatleasttwosuicidesmdashamongschool-agechildrenbetween2007and2018

PredictiveanalyticsTheVAandtheEnergyDepartmentareanalyzingmedicaldatacollectedfrommorethan22millionveteranstoidentifypatientsatriskofsuicide

ResearchersatMassachusettsGeneralHospitalandBostonChildrensHospitalalsoareresearchingtheeffectivenessofusingdataanalyticstopredictsuicideattempts

SocialmediaPeoplewhohavelostlovedonestosuicidecandonatetheirsocialmediadatatoOurDataHelpsaprojectofQntfyadataanalyticscompanyinArlingtonVatohelpresearchersdeterminewaystopredictsuicide

BrainimagingResearchersatCarnegieMellonUniversityandtheUniversityofPittsburghareusingbrainimaginginhopesofidentifyingindividualswithsuicidalthoughtsbasedontheirbrainactivitypatterns

EffectsofsuicideCerelalsoisstudyinghowasuicideaffectsfamilyfriendsco-workersandothersSherecentlyfoundthateachsuicideaffectsabout135otherpeoplemdashfarmorethanthesixpsychologistShneidmanonceestimated

ldquoBygettingabetterestimateofthoseaffectedtherewillbeadaywhenhealthcareandmentalhealthcarearebetter-fundedsystemsthatcantrulyhelppeoplerdquoCerelsays

MeanwhilescientistsareanalyzingwhymdashdespitetherisingsuiciderateintheUnitedStatesmdashthe2018globalsuicideratefelltoitslowestlevelintwodecades

AliMokdadaprofessorofhealthmetricssciencesattheUniversityofWashingtoninSeattlesaidrateshavedroppedmdashespeciallyamongyoungpeopleandwomenmdashinChinaandIndiabecauseincreasedurbanizationhasgivenwomenmorelibertytoworkWilliamPridemoredeanandaprofessorattheSchoolofCriminalJusticeattheUniversityatAlbanyinNewYorksaiddecliningsuicideratesinRussiamdashparticularlyamongmiddle-agedmenmdashcouldbetheresultofanimprovedqualityoflife

Gototop

Outlook

MoreResearch

ResearcherslawmakerssuicidepreventiongroupsandcompaniesarelookingfornewwaystocontributetothesuicidepreventioneffortAndadvertisersmayincreasinglypressuresocialmediaplatformstotakeresponsibilityforcontentpostedbyusers

InMarchafterreportsofInstagrampostscontainingdepictionsofself-harmandsuicidetheWorldFederationofAdvertiserstoldmemberstoldquothinkcarefullyaboutwheretheyplaceadvertisingrdquoandacknowledgetheirmoralresponsibilityindecidingwheretorunads

ManymentalhealthproviderssayfurtherresearchwillhelprefinetheuseofpredictiveanalyticstopreventsuicidesButEssigattheWilliamAlansonWhiteInstitutesaysldquothistechnologicalfetish[of]lookingtomachinestosolveproblemsrdquocoulddetractfromthetreatmentofsuicidalpatientsandwillultimatelyfailunlesshealthcareprovidersusetechnologytohelpfocusonhumanrelationshipsThenhesaysldquothingswillgetbetterrdquo

BarnhorstattheUniversityofCaliforniaDavissaysthateveniftechnologyhelpsidentifysuiciderisksthehealthcarecommunitywillremainlimitedinitsabilitytoaidthoseexperiencingasuicidalcrisisldquoWerenotmagiciansAndantidepressantsarenotacure-allrdquoshesaysldquoTheresalotofotherstuffgoingonforpeoplethatwecannotfixrdquosuchasrelationshipproblemsunemploymentfamilydisintegrationrisingcollegecostsandmore

JobesofCatholicUniversitysaysthenationssuicideratewilldroponlywithbetterpubliceducationabouteffectivetherapiesThe30percentto40percentofindividualsatriskofsuicidewhoseektreatmentldquoshouldgettreatmentthatworksrdquohesaysldquobuttheydontnecessarilygetthatrdquoHeurgestrainingmoremedicalprovidersinsuicidepreventionandstartingapubliceducationcampaigntoinformpatientsaboutavailabletreatments

ldquoWehavedifferenttoolsfordifferentneedsrdquoandprovingthatdifferenttherapiesworkfordifferentpeopleldquocouldsavethousandsofdollarsrdquohesays

112

113

114

115

116

117

118

119

7152019 Suicide Crisis CQR

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Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1830

Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1930

afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2030

LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2130

PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 17: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1730

Howeverhecontinuesldquoweneedsomuchmorerdquosuchasanationalmentalhealthservicecorpsmdashagovernment-ledinitiativeinwhichmedicalschoolgraduatescangetloanforgivenessiftheyparticipateinsuicidepreventionandinterventionprogramsOtherwisehesaysldquowellneverhaveenoughclinicianstotreat106millionAmericansrdquowithsuicidalthoughts

PearsonattheNIMHsaysitwouldhelptoldquogetabetterpictureonhowtoreduceaccesstolethalmeansandmakecommunitiesawarerdquoofpeopleatrisk

NestadtatJohnsHopkinswhowillsoonbeginstudyingsuicidesamongNativeAmericansandpossiblelinksbetweenopioidsandsuicidesinMarylandsaysthatwithsomanystudiesunderwayacrossthecountryheisupbeataboutthecountrysabilitytoaddresstherisingsuiciderate

ldquoWearerecognizingtheproblemmoreandmoresoweknowhowtoaddressitrdquohesaysldquoWearerecognizingtheroleofgunshelliptheroleofopioidsandweareseeingthattherearethingsthathaveworkedrdquo

AndasaclinicianhesaysldquoeverydayIseepeoplewhogotbetterrdquo

Gototop

ProCon

Cancomputerizedrisk-assessmenttoolsreducethesuiciderate

ProPhilipResnikProfessorDepartmentofLinguisticsandInstituteforAdvancedComputerStudies

UniversityofMaryland

WrittenforCQResearcherJuly2019

PreventingsuicideisdifficultandconventionalresearchonsuicidepreventionhasfailedtomakeprogressOnerecentanalysisofthemedicalliteratureshowsnoimprovementinidentifyingpredictivesuicideriskfactorsoverthepast50yearsanotherfoundthatunlikeothermajormortalitiessuchastuberculosistherateofdeathbysuicidehasessentiallynotchangedinacentury

SuicidalthoughtsandbehaviorsdonotgenerallytakeplaceinthelabwhereresearcherscanstudythemInadditionamajorityofpeoplewhodiebysuicidewillnotsharetheirsuicidalthoughtswithadoctorevenwhentheyseeoneandareaskeddirectly

IncreasinglythoughanothersourceofinformationcanprovidethepredictivesignalweneedtoidentifysuicideriskpeopleseverydaylanguageDuringthelonggapsbetweenclinicalencountersmanypeoplecreatearichwindowintotheirdailythoughtsfeelingsandlivesthroughtheiruseofsocialmedia

InrecentyearsagrowingcommunityoftechnologistshasbeendevelopingmethodstoanalyzewhatpeoplesayonlineandtopredictwhethertheymaybeatriskofsuicideandtheseverityofthatriskTechniquesofthiskindhavebeendevelopedtotargetsettingswherepeoplehavealreadychosentoreachoutforsupport(suchasReachOutcomorRedditsrSuicideWatchforum)andtoaddressthechallengingproblemofscreeningwhennoexplicitindicatorofriskhasbeenidentified

ThispredictivetechnologyisnotperfectbutalreadyitcanbeasgoodorbetterthanwhatdoctorscandoUsingawiderangeofsubtlelanguage-basedcuespredictivemodelshavebeenshowntodistinguishuserswhowouldgoontoattemptsuicidewithasuccessratemanytimesbetterthancliniciansabilitytoidentifytherisk

ConDrPaulSAppelbaumDollardProfessorofPsychiatryMedicineandLawColumbiaUniversityCollegeofPhysiciansampSurgeonsWrittenforCQResearcherJuly2019

Itstimetogetrealisticabouthowbesttopreventsuicideandcomputerizedrisk-assessmenttoolsarelikelynottheanswer

Despitedecadesofstudiesaimedatassessingsuicideriskpredictiveaccuracyhasnotincreasedoverthelasthalf-centuryNoneoftheexistingtoolssomeofwhicharewidelyusedhasdemonstratedastrongabilitytoidentifypeoplewhoarelikelytoattemptsuicideIndeedmostpeopleidentifiedashighrisknevertrytoendtheirlivesandmostwhodoareclassifiedaslowrisk

WhyissuicidepredictionsodifficultAlthoughsuicideisatragedyespeciallywhenayoungpersonisinvolveditisuncommonOnlyabout14inevery100000peopletaketheirlivesAttemptstopredictrareeventsespeciallywhenthevariablesbeingusedarecommoninthepopulationinevitablyresultinlowspecificitywithmanypeoplewronglyidentifiedashighriskMoreoverthevariableshavelowsensitivityresultinginmanypeoplewhoshouldbeidentifiedashighriskbeingmissedentirely

ThatsexactlythesituationwithsuicidepredictionManypredictorshavebeenidentifiedbuttheyaremuchmorecommonthansuicideitselfAtanypointintimeabout7percentofAmericansexperiencemajordepressiononeofthestrongestcorrelatesofsuicideRoughly6percenthavealcohol-usedisordersanotheroft-citedpredictorMalesexadvancedagesocialisolationmdashthelistofsuicidecorrelatesisalmostendlessButmanymorepeoplefallintotheseriskgroupsthanwilleverendtheirownlives

HencealthoughmanypeopleintuitivelybelievethatsomeonemdashespeciallymentalhealthprofessionalsmdashshouldbeabletotellwhenapersonisplanningsuicidethetaskisimpossibletoperformwithacceptableaccuracyEvenstudiesthathavestartedwithsamplesofpeopleknowntohavecommittedsuicidehavefailedtoidentifyalgorithmsthatwouldhavepredictedtheirbehavior

WhatstheanswerReducingthesuiciderateismuchmorelikelytobeaccomplishedbyusingpopulation-basedapproachestoidentifyandtreatseriousmentaldisordersmdashsuchasdepressionandsubstanceabusemdashthanby

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1830

Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1930

afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

7152019 Suicide Crisis CQR

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 18: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1830

Soreducingthesuiciderateisnowaquestionofhowtousethisemergingtechnologyappropriatelyandeffectivelyandhowtocreateapracticalethicalframeworkforlarge-scaleopt-inparticipationbyindividualswhoareormightbeatriskInadditiontheinterventionecosystemneedstoberedesignedsothatonceamuchlargernumberofpeopleareidentifiedasbeingatrisktheycangetthehelptheyneed

focusingresourcesonthosepeoplewebelieveusuallymistakenlytobeathighriskInadditionreducingtheeasyavailabilityofthemeansofsuicidemdashintheUnitedStatesusuallyagunmdashwouldsavelivesResourceswouldbebetterspentonsuchapproachesthanonthelatesthigh-techtoolthatpurportstopredictwhatlikelywillremainunpredictable

Gototop

Chronology

1890sndash1960s Researchonsuicidebeginsandfirstsuicidepreventioncentersopen

1897 FrenchsociologistEacutemileDurkheimsbookLeSuicidesuggestssocialissuessuchassocialisolationcanleadtosuicide

1925 TheMenningerClinicfoundedinTopekaKangainsinternationalattentionforitstreatmentofthementallyill

1958 PsychologistsEdwinShneidmanandNormanFarberowandpsychiatristRobertELitmanopennationsfirstsuicidepreventioncenterinLosAngeles

1964 Anaverageof56peoplekillthemselvesdailyintheUnitedStatesaccordingtotheNationalInstituteofMentalHealth(NIMH)

1966 NIMHhiresShneidmantocreatecomprehensivenationalsuicidepreventionprogram

1970sndash1990s Grassrootsorganizationsformtoadvocateforsuicidepreventionresearchersdeveloptherapiestotreatpatientsatriskofsuicide

1974 AsociologistattheUniversityofCaliforniaSanDiegoDavidPPhillipsbeginstostudywhethernewsreportsofsuicidescanincreaseriskofmoresuicides

1980 CentersforDiseaseControlandPrevention(CDC)reportsthatthesuiciderateforolderteensandyoungadultshasrisen40percentsince1970andthatfirearmsarethemostcommonmeansofsuicide

1987 FamiliesaffectedbysuicidejoinwithscientiststocreatetheAmericanFoundationforSuicidePreventiontofundresearchandeducationhellipFoodandDrugAdministration(FDA)approvesProzactotreatdepression

1989 Researcherspublichealthofficialsandnewsmediarepresentativesmeettodiscusshowthemediacanreportonsuicideswithoutfosteringldquosuicidecontagionrdquoorcopycatsuicides

1993 UniversityofWashingtonpsychologistMarshaLinehandevelopsdialecticalbehaviortherapytohelpsuicidalpatientsmanagetheiremotions

1996 WorldHealthOrganizationurgesmembernationstoaddresssuicidehellipCDCreportsthatsuicideistheninthleadingcauseofdeathinUnitedStates

1999 USSurgeonGeneralDavidSatcherdeclaressuicideaseriouspublichealththreat

2000stoPresent Electedofficialsrespondtosurgingsuiciderates

2002 Physiciansbeginprescribingantidepressantsforchildrenandadolescentsoff-labelorwithoutFDAapproval

2004 FDArequireswarninglabelsonantidepressantsalertingconsumersthatchildrenandteenstakingthedrugsmightexperiencesuicidalthoughts

2005 FloridaStateUniversitypsychologistThomasEJoinersWhyPeopleDiebySuicidesaysmanypeopletaketheirlivesbecausetheyfeelsociallyisolatedandviewthemselvesasaburden

2010 FederalhealthofficialsannouncegoaltoreducesuicideratehellipInacasethathighlightedtheroleofsocialmediaandbullyinginrisingsuicideratesRutgersUniversitystudentTylerClementikillshimself

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1930

afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

7152019 Suicide Crisis CQR

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LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

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PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 19: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 1930

afterhisroommatesecretlyrecordshimkissinganothermanandinvitespeopleonTwittertowatchthevideo

2012 SurgeonGeneralReginaMBenjaminannouncesthatsuicideisamongthetopfivecausesofdeathforadultsunderage46announcesgoaltoreducesuiciderate20percentby2025andencouragescommunitiesandhealthcareproviderstoaimforldquozerosuicidesrdquo

2013 CDCreportsBabyBoomershavehighestsuiciderateofanyagegroup

2017 USsuicideisathighestlevelinnearly30yearshellipAftertheDepartmentofVeteransAffairsreportsthatmilitaryveteransaccountedfor14percentofallsuicidedeathsamongUSadultsin2016thedepartmentbeginsusinglargehealthdatasetstohelpidentifyveteransatriskofsuicide

2018 PresidentTrumpordersdepartmentsofDefenseHomelandSecurityandVeteransAffairstoimproveveteransaccesstosuicidepreventionresourceshellipFashiondesignerKateSpadeandCNNcelebritychefandtraveldocumentarianAnthonyBourdaindiebysuicidehellipMassachusettsSupremeCourtrulescollegesmaybeheldliableforstudentsuicides

2019 FDAapprovesnasal-spraycontaininganactiveingredientofketamineananesthetictotreatcertainpatientswithdepressionhellipUSSenateweighswhethertohelpfundstateldquoredflagrdquolawsthatallowtemporaryconfiscationofgunsfrompeopledeemedatriskofdyingbysuicideorviolencehellipResearcherssaythe2017Netflixshowldquo13ReasonsWhyrdquocausedasharpriseinsuicidesamong10-to17-year-oldsinthemonthafteritsrelease

Gototop

ShortFeatures

VersionofPartyDrugKetamineApprovedWithCautionforDepression

Thepowerfulanestheticcouldreducesuicidalideation

Acomponentofthe1980sldquoclubdrugrdquoketaminedubbedSpecialKisinspiringhopeamongsomedoctorsandresearchersthatitcouldtreatseveredepressionmdashandmightevenhelppreventsomesuicidesHoweverseveralexpertsarecautiouswarningthatthedrugspotentialforpreventingsuicideisnotyetproven

ldquoThisisthefirsttrulynovelmechanism[fortreatingdepression]thathasbeenpresentedinover50yearsrdquosaidDrGerardSanacoraaYaleUniversitypsychiatryprofessoranddirectoroftheYaleDepressionResearchProgramHewasreferringtotheUSFoodandDrugAdministration(FDA)approvalinMarchofSpravatoanasalspraycontainingesketamineanactiveingredientofketamineldquoButthisisnotamedicineforeverybodyrdquo

ManyexpertshopethemedicinewilltreatcertainpatientswithseveredepressionanillnessthatcouldleadsomepeopletosuicideButresearcherssaythereisnoconclusiveevidencethatSpravatowillreducesuicidalbehaviorGregoryESimonapsychiatristatKaiserPermanenteWashingtonandaseniorinvestigatoratKaiserPermanenteWashingtonHealthResearchInstituteinSeattleWashsaysthatwhilestudieshaveshowntheproductcaneffectivelyreduceldquosymptomsofdepressionandsuicidalideationhelliponeshouldnotassumeifamedicinereducessuicidalthoughtsitwillreducesuicideattemptsrdquo

TheFDAapprovedSpravatodevelopedbyJohnsonampJohnsonsubsidiaryJanssenPharmaceuticalsonlyforpatientssufferingfromldquotreatment-resistantdepressionrdquomeaningtheyhavenotrespondedtoatleasttwootherantidepressantmedicationsUpto20percentofthe16millionAmericanswhosufferfromdepressiondonotgetrelieffromtraditionalantidepressants

ThecompanycontinuestostudywhetherSpravatocanhelppatientsspecificallyatriskofsuicide

BecauseSpravatoisintendedtotreataseriousorpotentiallylife-threateningconditiontheFDAconsidereditasabreakthroughdrugallowingittobeconsideredforfinalapprovalviaanexpeditedprocessThelastphaseoftestingincludedfourrandomizedcontrolledtrialsinwhichpatientsreceivingesketamineexperiencedldquostatisticallysignificantlygreaterimprovementindepressivesymptomsrdquothanthosewhoreceivedaplaceboThesideeffectswhichcouldlastuptotwohoursaftertreatmentincludedsedationelevatedbloodpressureanddisassociation(patientsnotknowingwhoorwheretheywere)Asaresultthespraymustbeadministeredinadoctorsofficeandapatientmustremaintherefortwohoursunderobservation

1

2

3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2030

LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2130

PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 20: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2030

LaurenPestikaswhohasstruggledwithdepressionandhasrepeatedlytriedtoendherlifefoundthattreatmentwiththedrugketaminemadeherfeelbetterIn2019theFederalDrugAdministrationapprovedanasalspraycontaininganactiveingredientofketamineoriginallydevelopedasananestheticasatreatmentfordepression(APPhotoTeresaCrawford)

TwoFDAadvisorypanelsdecidedthebenefitsoutweighedtherisksandthesideeffects

HoweverDrJulieZitoaprofessoremeritaofpharmacyandpsychiatryattheUniversityofMarylandinBaltimoreisoneoftwoFDAadvisorypanelmemberswhoopposedrecommendingthattheFDAapprovethedrug(Fourteenmembersvotedforapproval)Zitosayssheremainsconcernedthatthetrialsdidnotshowenoughbenefitforpatientsandthatpatientscouldexperiencesideeffectsafterleavingadoctorsoffice

ldquoThisisaminddrugrdquoshesaysldquoHowcanyoutellmeImgoingtowalkoutandhaveaveryseveredisassociateepisodeandthatitsnotthedrugrdquo

DuringtheadvisorypanelsFeb12meetingJaskaranSinghtheseniordirectorofclinicalresearchforJanssenPharmaceuticalssaidsuchsideeffectsareshort-livedbecausethedrugisrapidlyabsorbedandmetabolized

ZitoisalsoconcernedaboutthesafetyofthedrugKetamineisapowerfulanestheticthatbecameapopularpartydrugduringthe1980sand90sforitshallucinatoryeffectsAbuseofthedrugledtoseveresideeffectssuchasdisruptedlearningandmemoryprocessingIn1999theUSDrugEnforcementAdministrationbannednonmedicalusesofketamineandclassifieditinthesamecategoryasaddictivesubstancessuchasmorphineandoxycodone

Zitopointsoutthatsixdeathsmdashthreebysuicidemdashoccurredamongthosereceivingesketamineduringthetrialswhichinvolvedmorethan1000patientsoverallThedeathswereallamongpatientsreceivingtheesketamineratherthanaplaceboandthesuicidesoccurredwithinfour12and20daysofthelastdoseOnepatientdrovehismotorcycleintoatree26hoursafterhislastdose ldquoYouhavetoexplaintomehowthoseareunrelatedrdquoshesays

PsychiatristDrDavidHoughwholedtheesketaminetrialsforJanssensaidsuicideisforcomplexreasonsldquofartoocommonrdquoamongpatientswithtreatment-resistantdepressionInvestigatorscloselyexaminedeachofthesuicidedeathsthatoccurredduringthetrialshesaidanddeterminedthattheywereldquonotrelatedtotheunderlyingmedicationrdquo

DrToddEssigapsychologistandpsychoanalystattheWilliamAlansonWhiteInstituteatraininginstitutionformentalhealthprofessionalsinNewYorksaidSpravatoisnotldquomagicrdquobuthesaidhehopesitcanhelpmanypatientssufferingfromlong-termdepressionbasedonthesuccesshehasseenwithinfusionsofpureketaminewhichhavebeenavailablefordecadesApatientwhohasbattleddepressionfor25yearshasnowldquostartedtogetherlifebacktogetherrdquoafterbeginningaketamine-infusiontriallastyearEssigsaidandmanyotherketamineusershavesharedsimilarsuccessstories

UntiltheapprovalofSpravatoneitherketaminenoritsderivativeshadbeenapprovedasatreatmentfordepressionHoweversincethelate1990sresearchershavefoundthatketamineinfusionsworkquicklytotreatdepressionTraditionalantidepressantswhichaltertheactivityoftheneurotransmitterserotonintakefourtosixweekstoworkButketaminetriggersrapidproductionoftheneurotransmitterglutamatemdashandtheeffectscanbefeltwithinhoursaccordingtoresearchersAlthoughthedrugstaysinthebodyonlyforashorttimeitsinitialeffectscanlastforthreeto14days

4

5

6

7

8

9

10

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2130

PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 21: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2130

PatientsobtainingketamineinfusionsalsoreportedstrangesensationsinitiallysuchasseeingcolorsandpatternsbutsoonfeltastrongsenseofoptimismInrecentyearshundredsofclinicsnationwidehaveofferedintravenousdosesofketaminetotreatdepressionanddozensofstudieshaveshownpositiveresults

Howeversomeresearchershaveraisedalarmsaboutsuchoff-labeluseofthedrugmeaningdoctorshaveprescribeditoutsideofFDAguidelinesmdashalegalandcommonpracticeamongdoctorswhentheyconsideradrugmedicallyappropriateAtaskforceoftheAmericanPsychiatricAssociationin2017calledforfurtherresearchintohowketamineworksandwhatguidelinesshouldapplytoitsuse

JohnMannaColumbiaUniversityprofessoroftranslationalneurosciencewhichfocusesontranslatingscienceintonewtherapieshasledresearchontheuseofpureketamineHesaidtherecentapprovalofSpravatoldquoisverygoodnewsfordepressedpatientsbutwehavemoretolearnaboutitrdquosuchasthebestdosagelevelsbestfollow-uptreatmentsandwhetherbetterdrugscanbedevelopedthatdonotcreatethenegativesideeffects

mdashChristinaLLyons

[1]AllisonEckldquoFDAApprovesFirstMajorNewDepressionTreatmentinDecadesrdquoNovaNextPBSMarch52019httpstinyurlcomy3u4y4sbLauraSandersldquoNewantidepressantraisesquestionsrdquoScienceNewsApril132019httpstinyurlcomyxjds4gp

[2]DavidAMrazeketalldquoAReviewoftheClinicalEconomicandSocietalBurdenofTreatment-ResistantDepression1996-2013rdquoPsychiatricServicesAug12014httpstinyurlcomy6omp48x

[3]CarolineWinterldquoIsketaminethebesthopeforcuringmajordepressionrdquoBloombergBusinessweekAug192015httpstinyurlcomy3hu8k8jldquoJanssenAnnouncesUSFDAApprovalofSPRAVATO(esketamine)CIIINasalSprayforAdultswithTreatment-ResistantDepressionWhoHaveCycledThroughMultipleTreatmentsWithoutReliefrdquoJohnsonampJohnsonMarch52019httpstinyurlcomyxpdp523

[4]ldquoFDABriefingDocumentPsychopharmacologicDrugsAdvisoryCommittee(PDAC)andDrugSafetyandRiskManagement(DSaRM)AdvisoryCommitteeMeetingrdquoUSFoodandDrugAdministrationFeb122019httpstinyurlcomy2n2p5jdShamardCharlesMDldquoNasalspraydrugrelatedtoketamineapprovedbyFDAtotreatdepressionrdquoNBCNewsMarch52019httpstinyurlcomyxs6z7nn

[5]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommittee(PDAC)andtheDrugSafetyandRiskManagementAdvisoryCommittee(SDaRM)rdquoCenterforDrugEvaluationandResearchUSFoodandDrugAdministrationFeb122019pp40-41httpstinyurlcomy2rfpcsc

[6]Winteropcit

[7]TranscriptldquoJointMeetingofthePsychopharmacologicAdvisoryCommitteerdquoopcitpp159-160

[8]Ibidpp123-127

[9]DoreenGentzlerandPatriciaFantisldquoHowthePartyDrugKetamineIsHelpingBattleSevereDepressionrdquoNews4May202019httpstinyurlcomy2c5v8uh

[10]JenniferChenldquoHowNewKetamineDrugHelpswithDepressionrdquoYaleMedicineMarch212019httpstinyurlcomy5hjzwp5ldquoKetamineExploringcontinuation-phasetreatmentfordepressionrdquoPsychiatryandPsychologyMayoClinicundatedhttpstinyurlcomy5op9bno

[11]Winteropcit

[12]LiuetalopcitGerardSanacoraetalldquoAConsensusStatementontheUseofKetamineintheTreatmentofMoodDisordersrdquoJAMAPsychiatryApril2017httpstinyurlcomyyjjar2r

[13]ldquoFDAcommitteessupportesketaminenasalsprayfortreatment-resistantdepressionrdquoHealioPsychiatryFeb202019httpstinyurlcomy3bl4kmo

Gototop

SuicideSurvivorsHelpPeersResearchers

ldquoWeneedtobeinvolvedineveryconversationaboutusrdquo

DeseRaeStagebegansufferingfromdepressionandself-injuryasahighschoolfreshmanAntidepressantsmadeherfeelworseThenshelostafriendtosuicide

YearslaterconflictwithhergirlfriendpromptedStagetobeginconsideringendingherownlifeInthesummerof2005aftercontinuedclasheswithhergirlfriendStageattemptedsuicideButthegirlfriendcalledthepoliceandemergencyhelparrivedintime

In2010StagelaunchedawebsiteLiveThroughThisorgwhereshesharedherstoryandaskedothersurvivorsofattemptedsuicidetosharetheirsShehassincecollectedmorethan100storiesandwebtraffichassteadilygrownreachingabout100000visitorslastyearshesays

ldquoLiveThroughThisisliftingupamarginalizedcommunitymdashonethatsneverbeengivenavoicehellipand[hashad]stereotypesheapedonitrdquoStagesays

Theso-calledlivedexperiencecommunityalsocouldhelpresearcherssaysJulieCerelasuicidologistatUniversityofKentuckysCollegeofSocialWorkwhohasworkedwithStageand

11

12

13

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 22: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2230

volunteersthroughthewebsiteldquoItisincrediblyimportanttohearthevoicesofpeoplewhohaveattemptedsuicideandsurvivedinordertobetterunderstandhowtopreventfuturesuicidesrdquoshesays

Typicallyabout118millionAmericanssurvivesuicideattemptseachyearanumberthatincreasedto14millionin2017accordingtotheAmericanAssociationofSuicidologyanadvocacygroupinWashingtonfocusedonsuicideprevention Healthcareexpertssaymanysurvivorscouldhelp

othersstrugglingwithsuicidalthoughtsbutwhowonttellamedicalprofessionalduetothestigmacostoftreatmentorfearofbeinginvoluntarilyhospitalized

SuicidesurvivorsareinvaryingdegreesldquodisconnectedfromhealthcarerdquobecausesomanyhavehadanegativeexperiencewithdoctorssaysDavidAJobesdirectoroftheSuicidePreventionLaboratoryatTheCatholicUniversityofAmericainWashingtonDCHesayshehopesldquothepeersupportmovementmaycapturesomeonewhowouldneverseeapersonlikemerdquo

MoreoverldquoPeoplewithlivedexperiencehaveintimateknowledgeofsuicidalitythatthosewithoutitjustdontrdquosaysStageldquoAlotoffolkswhoveneverhadtheseexperiencescomeatthemfromafear-drivenplaceandimmediatelywanttoescalatesometimeswithoutunderstandingthatathoughtorafeelingjustneedsvalidationandanearrdquo

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtoninSeattleoperatesnowmattersnoworgawebsitethatprovidesfreesuicidepreventionresourcesalongwithstoriesfromindividualswhohaverecoveredfromsuicidalthoughtsafterreceivingtreatmentcalleddialecticalbehaviortherapyorDBTDevelopedbyUniversityofWashingtonpsychologistMarshaLinehanDBTfocusesonchangingapatientsbehaviorsandpatternsofthinkingthroughindividualandgrouptherapysessions

UrsulaWhitesideaclinicalpsychologistwiththeUniversityofWashingtonandwhohashadsuicidalthoughtsrunsthewebsitenowmattersnoworgwhichprovidesfreeresourcestothosestrugglingwithsuicidalthoughts(Courtesynowmattersnow)

AlthoughstudieshavefoundthatDBTworksfewtherapistsaretrainedinhowtouseitWhitesidesays Plusshesaysthetherapycosts$200foranindividualsession($100foragroupsession)

andtypicallyinvolvesweeklyortwice-weeklysessionsforsixto12monthsThetotalcostcanbetoohighformanypeopleandtypicallyisnotcoveredbyinsurancesaysWhitesidewhohasexperiencedsuicidalthoughtsherself

Recentlyshesaysshesurveyedthemorethan138000individualswhovisitednowmattersnoworgbetweenMarch2015andDecember2017Amongthe3670visitorswhoansweredthesurveythosewhosaidtheyhadhadintensesuicidalthoughtsreportedtheyexperiencedldquosignificantreductionsrdquointheintensityofsuchthoughtsandemotionsafterreviewingthesitemdashsometimeswithinminutes

14

15

16

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 23: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2330

WhiletheresultsshowonlyacorrelationbetweenusingthesiteandfeelingbetterWhitesideisstudyingwhyusersfeelbetterldquoItcouldjustbeadistractionrdquothatallowsthesuicidalimpulsetopassshesaysOrwebsitevisitorsmayfindhelpjustwhentheyneeditshesaysduringtheacuteperiodswhenpeoplemakedecisionstheywouldnototherwisemake

AmyBarnhorstvicechairofcommunityhealthattheUniversityofCaliforniaDavisdepartmentofpsychiatrysayspeopledonotmakelong-rangeplansaboutsuicideTheideasurfacesduringldquoadarktimetheydipintosometimesacoupletimesinalifetimesometimesacoupletimesinamonthrdquoItisunlikelythatsomeoneldquowillbetheretointervenerdquoatsuchtimesshesaysHoweveronlinenetworksandcrisishotlinesoftenstaffedbysuicidesurvivorsareavailablearoundtheclock

SurvivorsalsoareparticipatinginstudiestohelppinpointcommonriskfactorsandsuccessfultreatmentsForinstancesurvivorswillworkwithpatientsinhospitalemergencydepartmentsaspartofastudyJobesisoverseeinginwhichmentalhealthcareproviderswilltalkwithpatientsabouttheirthoughtsofhopelessnessandhelpdevelopatreatmentplanforthem

StagehasbeenworkingwithotherresearchersanalyzingriskfactorsandtreatmentsforsuicidalthoughtsorbehaviorsincludingarecentstudyanalyzingtheexperienceofsuicidesurvivorswhosegenderorsexualidentitydifferedfrommostofthoseinthesurroundingcommunityThestudyfoundcommontraitssuchasinternalizedself-hatehiddenidentitiesandlackofpeersupport

StagesayssheisencouragedthatscientistsandothersareseekinginputfromsuicidesurvivorsldquoHoweverresearcherscliniciansandthemedicalcommunityhavealongwaytogordquosheaddsandldquoweneedtobeinvolvedineveryconversationaboutusrdquo

mdashChristinaLLyons

[14]ChristopherWDrapeauandJohnLMcIntoshldquoUSASuicide2017OfficialFinalDatardquoAmericanAssociationofSuicidologyDec102018httpstinyurlcomy564wvsv

[15]ChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuo

[16]UrsulaWhitesideetalldquoDevelopmentandEvaluationofaWeb-BasedResourceforSuicidalThoughtsnowmattersnoworgrdquoJournalofMedicalInternetResearchFeb52019httpstinyurlcomy3fancdd

[17]SaraMWilliamsetalldquoExploringLivedExperienceinGenderandSexualMinoritySuicideAttemptSurvivorsrdquoAmericanJournalofOrthopsychiatryAugust2018httpstinyurlcomy39oet4m

Gototop

Bibliography

Books

AnestisMichaelDGunsandSuicideAnAmericanEpidemicOxfordUniversityPress2018ApsychologyprofessorattheUniversityofMississippiarguesthatlawmakersandthepublicshouldfocusonreducingfirearmsaccesstoreducethesuiciderateandsaysmorefirearmownersshouldbeeducatedaboutsuiciderisk

BrooksMikeandJonLasserTechGenerationRaisingBalancedKidsinaHyper-ConnectedWorldOxfordUniversityPress2018ThedirectoroftheAustinPsychologyampAssessmentCenterinTexas(Brooks)andaschoolpsychologyprofessoratTexasStateUniversity(Lasser)explainthatparentsshouldmoderatetheirchildrensuseofdigitaltechnologyandsocialmediatoencouragehealthyin-personrelationshipsandsufficientsleep

KieranDavidSignatureWoundsTheUntoldStoryoftheMilitarysMentalHealthCrisisNYUPress2019AnassistantprofessorofhistoryatWashingtonampJeffersonCollegeinWashingtonPadescribesthemilitaryseffortstodealwithsuicidepost-traumaticstressdisorderandtraumaticbraininjuriesexperiencedbyveteransoftheIraqandAfghanistanwars

LinehanMarshaMBuildingaLieWorthLivingAMemoirRandomHouseforthcoming(2020)AformerUniversityofWashingtonpsychologyprofessorrecountsherstrugglewithmentalillnessandsuicidalbehavioranddescribesherdevelopmentofdialecticalbehaviortherapyatreatmentforsuicidalpatients

Articles

CharlesShamardldquoSocialmedialinkedtoriseinmentalhealthdisordersinteenssurveyfindsrdquoNBCNewsMarch142019httpstinyurlcomyyytqgtbJeanTwengeapsychologyprofessoratSanDiegoStateUniversitydiscussesacorrelationbetweenrisinguseofdigitalmediaandincreasedpsychologicalproblemsandsuicideattemptsamongadolescentsandyoungadultssincethemid-2000s

KoonsCynthiaandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessWeekFeb52019httpstinyurlcomy7hupqccAnewnasalsprayfromJohnsonampJohnsonisthefirstdrugbasedontheanestheticketaminethathaswonFoodandDrugAdministrationapprovalforpatientswhodonotrespondtotraditionalantidepressants

RapaportLisaldquoMoreUSYouthSeekingHelpDuringPsychiatricEmergenciesrdquoPsychiatryampBehavioralHealthLearningNetworkMarch182019httpstinyurlcomy5awvdydAstudybyresearchersatJohnsHopkinsUniversityshowsa28percentincreaseinpsychiatricemergencydepartmentvisitsamongpeopleages6to24between2011and2015

17

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 24: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2430

SteinhauerJenniferldquoVAOfficialsandtheNationBattleanUnrelentingTideofVeteranSuicidesrdquoTheNewYorkTimesApril142019httpstinyurlcomy4ka7mqoMilitarymentalhealthcareandsuicide-preventiontrainingprogramshavefailedtoreducesuicideratesamongveteransmanyofwhomarehomelessorsufferfromtraumaticbraininjuryorpost-traumaticstress

ReportsandStudies

BohnertAmySBandMarkAIlgenldquoUnderstandingLinksamongOpioidUseOverdoseandSuiciderdquoTheNewEnglandJournalofMedicineJan22019httpstinyurlcomyxr8nyewTwoUniversityofMichiganresearchersreportthatdeathsfromsuicideandunintentionaldrugoverdosemorethandoubledintheUnitedStatesbetween2000and2017andthatbothproblemsareconnectedwithpainandopioiduse

ChoiBongKyooldquoJobstrainlongworkhoursandsuicidalideationinUSworkersalongitudinalstudyrdquoInternationalArchivesofOccupationalandEnvironmentalHealthJune292018httpstinyurlcomy3d8b6t3AnassistantprofessorofpublichealthattheUniversityofCaliforniaIrvinesaysjobstrainandlongworkhoursareassociatedwithmoderateorseveresuicidalideationandthatreducingworkplacedemandscouldhelppreventmanysuicides

StoneDeborahMetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportCentersforDiseaseControlandPreventionJune82018httpstinyurlcomy3ubtfzvFederalhealthstatisticsshowthatsuicideratesincreasedsignificantlyin44statesbetween1999and2016with25statesexperiencingincreasesofmorethan30percentand54percentofindividualswhodiedbysuicidedidnothaveaknownmentalhealthcondition

Gototop

TheNextStep

At-riskCommunities

BaileyMelissaldquoAsseniorsgointotwilightyearssomeofthemprivatelymulllsquorationalsuicidersquordquoTheWashingtonPostJune232019httpstinyurlcomy64xgw7oSomeagingBabyBoomersareconsideringtakingtheirlivestoavoidtheeffectsofdeclininghealth

DastagirAliaEldquoSuiciderateforNativeAmericanwomenisup139rdquoUSATodayupdatedJune222019httpstinyurlcomy4mykoyhNativeAmericanandAlaskaNativewomenaremorelikelytoexperienceviolencethanotherUSwomenleadingtohigherratesofsuicide

MullaneShannonldquoAsilentsorrowRuralColoradoshighsuiciderateandwhatsdrivingitrdquoTheColoradoIndependentDec202018httpstinyurlcomy3zp3em4RuralcommunitiesinColoradoexperiencesomeofthecountryshighestsuicideratesduetofactorsthatincludealackofaccesstomentalhealthservicessaysajournalist

BigData

JeffersonRobinSeatonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxm5uqu8Governmentanduniversityresearchershavebandedtogethertodevelopanartificialintelligencetooltopredictsuicideattempts

RobbinsRebeccaldquoAspatientstellappstheyrefeelingsuicidaldigitalhealthstartupsscrambletorespondrdquoStatMarch252019httpstinyurlcomyxzvgw2eManypeopletreatdigitalhealthchatbotsandappsascrisishotlinesraisingquestionsabouthowsuchservicesshoulddealwithpeoplewhosaytheyfeelsuicidal

SabrowskyHelenandJDDugganldquoStudentsuicidetrackingshowspromiseinpreventionrdquoMinnesotaDailyDec122018httpstinyurlcomy4rmzoh9FewerthanhalfofthelargestuniversitiesintheUnitedStatestrackstudentsuicideratesdespitegrowingevidencethatsuchdatacanhelpidentifyriskfactorsforsuicidesaytworeporters

RedFlagLaws

BirkelandBenteldquoBattleOverlsquoRedFlagrsquoGunLawFlaresUpAsPolisCallsForDismissalOfLawsuitrdquoColoradoPublicRadioJune282019httptinyurlcomyydkgkc7ColoradoRepublicanlawmakerssayarecentlypassedstatebillallowingcourtstoconfiscategunsfrompeopledeemedadangertothemselvesorothersviolatedthestateconstitutionbecauseitwasnotreadaloudafterbeingintroduced

ElinsonZushaldquoTheOneTypeofGunControlGainingBipartisanSupportrdquoTheWallStreetJournalJune22019httptinyurlcomyxtkp636Pennsylvaniaispoisedtojoin15otherstatesmdashincludingsomeconsideredbastionsofpro-gunsentimentmdashinpassingaredflaglawdesignedtokeepgunsoutofthehandsofpeoplewhocouldposeathreatofsuicideorviolence

LawlorMikeldquoConnecticutslsquoredflaglawrsquowasthefirstinthenationTwentyyearslateritssavedmanylivesrdquoHartfordCourantJune282019httptinyurlcomy5q3waqjConnecticutsredflaglawhaspreventeddozensofsuicidesandlikelymanymurderssinceitwasimplementedin1999saysthestatesformerundersecretaryforcriminaljusticepolicyandplanning

SocialMedia

HealyMelissaldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLosAngelesTimesJune182019httptinyurlcomy3gdz3t7Youngpeoplearespendingmoretimeonsocialmediaandlesstimeonactivitiesthataregoodformentalhealthsuchasface-

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

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Page 25: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2530

to-faceencounterswithfriendsashiftthatresearcherssayhascontributedtodepressionandrisingsuicideratesamongteensandyoungadults

KlassPerrildquoWhenSocialMediaIsReallyProblematicforAdolescentsrdquoTheNewYorkTimesJune32019httptinyurlcomy4tmxazmUseofsocialmediacanhelpsometeensdealwithdepressionbutinothercasesitcanmakementalhealthproblemsworsepediatricianssay

SingerNatashaldquoInScreeningforSuicideRiskFacebookTakesOnTrickyPublicHealthRolerdquoTheNewYorkTimesDec312018httpstinyurlcomy9r67cmeFacebookisusingalgorithmstoanalyzeusersactivitiesinanefforttodetectandpreventpossiblesuicides

Gototop

Contacts

AmericanAssociationofSuicidology5221WisconsinAveNWWashingtonDC20015202-237-2280wwwsuicidologyorgAdvocacygroupfocusedonsuicidepreventionresearchandtraining

HarvardInjuryControlResearchCenter677HuntingtonAveBostonMA02115617-495-1000wwwhsphharvardeduhicrcfirearms-researchResearchgroupatHarvardUniversitysSchoolofPublicHealththatstudiestherelationshipbetweenfirearmsandsuicide

LiveThroughThishttpslivethroughthisorgGrassrootsorganizationthatprovidespeersupportforpeoplewhohaveattemptedsuicide

NationalActionAllianceforSuicidePrevention1025ThomasJeffersonStNWSuite700WWashingtonDC20007theactionallianceorgPublic-privatepartnershipthatworkswithhealthcareprofessionalsandcommunitiestoimplementtheUSsurgeongenerals2012strategyforreducingthenationssuiciderate

NationalInstituteofMentalHealth6001ExecutiveBlvdRoom6200BethesdaMD20892866-615-6464wwwnimhnihgovindexshtmlFederalgroupthatresearchessuicideandsuicideprevention

NationalSuicidePreventionLifeline800-273-8255suicidepreventionlifelineorgNationalnetworkofcrisiscentersthatoffercounselingandeducationalmaterialsforcallerswhoareconsideringsuicideorareconcernedlovedonesmayattemptsuicide

SuicidePreventionResourceCenter43FoundryAveWalthamMA02453877-438-7772wwwsprcorgFederallysupportedcenterthatprovidessuicidepreventiontrainingandresources

Gototop

Footnotes

[1]JenniferBrownldquolsquoHeseemedtohaveitallrsquoArapahoeHighSchoolseniorssuiciderattlesemotionallyfatiguedfrightenedcommunityrdquoTheColoradoSunOct252018httpstinyurlcomy4sfybvf

[2]ldquoAftersonssuicideparentsofColoradoteensharehisstrugglesandmessageofawarenessrdquoABCDenverNewsJan42019httpstinyurlcomyyfxdyudJeffToddldquoMomWhoLostSonToSuicideWantsToTakeStigmaAwayFromMentalIllnessrdquoCBSDenverMay162019httpstinyurlcomy2aeh39z

[3]MonteWhaleyldquolsquoItsjustheartbreakingrsquoArapahoeHighSchoolcancelsclassesinwakeofsecondstudentdeathinthreedaysrdquoTheDenverPostOct32018httpstinyurlcomy4d6ptyr

[4]JamieDucharmeldquoUSSuicideRatesAretheHighestTheyveBeenSinceWorldWarIIrdquoTimeJune202019httpstinyurlcomyxl6oz8sMeganBrooksldquoUSSuicideRatesHitRecord-HighLevelsCDCSaysrdquoMedscapeJune202019httpstinyurlcomyxlrd87dandldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoHealthlineundatedhttpstinyurlcomyyc9varv

[5]ldquoSuiciderdquoNationalInstituteofMentalHealthApril2019httpstinyurlcomy6p827qfElenaWeissmanldquoTheglobalsuicideratehasseenanetdeclineWhatcauseditrdquoTheChristianScienceMonitorJan142019httpstinyurlcomyyupszfk

[6]ldquoSuiciderdquoibid

[7]ldquoSuicideMortalitybyStaterdquoCentersforDiseaseControlandPreventionhttpstinyurlcomybrlcju3KenAlltuckerandLillyPriceldquoSuicideratesmdashastatebystatelookrdquoUSATodayDec132018httpstinyurlcomyy34lo5f

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 26: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2630

[8]TaraBahrampourldquoBabyboomersarekillingthemselvesatanalarmingrateraisingquestionWhyrdquoTheWashingtonPostJune32013httpstinyurlcomyymh2wgvldquoSuiciderdquoopcitHollyHedegaardSallyCCurtinandMargaretWarnerldquoSuicideMortalityintheUnitedStates1999-2017rdquoDataBriefNo330NationalCenterforHealthStatisticsNovember2018httpstinyurlcomyxc74ovbandMelissaHealyldquoSuicideratesforUSteensandyoungadultsarethehighestonrecordrdquoLATimesJune182019httpstinyurlcomy3gdz3t7

[9]Healyibid

[10]ScottRodrickldquoAll-AmericanDespairrdquoRollingStoneMay302019httpstinyurlcomy66chr9sJayneODonnellldquoAlcoholiskillingmorepeopleandyoungerThebiggestincreasesareamongwomenrdquoUSATodayNov162018httpstinyurlcomy7otytclandldquoOpioidsPlayingKeyRoleinRisingSuicideOverdoseRatesrdquoPsychiatryampBehavioralHealthLearningNetworkJan232019httpstinyurlcomy37wn2bb

[11]LeoShaneIIIldquoVASuiciderateforyoungerveteransincreasedbymorethan10percentrdquoMilitaryTimesSept262018httpstinyurlcomyxtkhjtv

[12]ldquoAreWeHeadingTowardaSuicideCrisisinAmericardquoopcit

[13]DonaldSShepardetalldquoSuicideandSuicidalAttemptsintheUnitedStatesCostsandPolicyImplicationsrdquoSuicideandLifeThreateningBehaviorOct292015httpstinyurlcomy38vbc4k

[14]ldquoAASCallsforBillionDollarWaronSuicideasDCDReportsRecord-SettingIncreaserdquoAmericanAssociationofSuicidologyNov292018httpstinyurlcomy3cy35op

[15]ldquoEstimatesofFundingforVariousResearchConditionandDiseaseCategories(RCDC)rdquoNIHResearchPortfolioOnlineReportingToolsUSDepartmentofHealthandHumanServicesApril192019httpstinyurlcomy47v23gq

[16]RichardAFriedmanldquoOpinionSuicideRatesAreRisingWhatShouldWeDoAboutitrdquoTheNewYorkTimesJune112018httpstinyurlcomyygwsljk

[17]ErrkiTIsometsaumlldquoPsychologicalautopsystudiesAreviewrdquoEuropeanPsychiatryNovember2001httpstinyurlcomy32fc889AlltuckerandPriceopcitandDeborahMStoneetalldquoVitalSignsTrendsinStateSuicideRatesmdashUnitedStates1999-2016andCircumstancesContributingtoSuicidemdash27States2015rdquoMorbidityandMortalityWeeklyReportJune82018httpstinyurlcomy3ubtfzv

[18]ldquoDoesdepressionincreasetheriskforsuiciderdquoUSDepartmentofHealthandHumanResourcesSept162014httpstinyurlcomyy2qdgtz

[19]KatieZezimaldquoFacinglittlemovementinCongressgun-controlgroupsturnfocustowardpreventingsuicidehandgunviolencerdquoTheWashingtonPostMarch262019httpstinyurlcomy4942qp3

[20]ldquoInformationonExtremeRiskProtectionOrdersorGunViolenceProtectionOrdersrdquoNationalConferenceofStateLegislaturesApril2019providedtoauthor

[21]BenedictCareyldquoDefyingPreventionEffortsSuicideRatesAreClimbingAcrosstheNationrdquoTheNewYorkTimesJune72018httpstinyurlcomy5tsrylqBenedictCareyandRobertGebeloffldquoManyPeopleTakingAntidepressantsDiscoverTheyCannotQuitrdquoTheNewYorkTimesApril72018httpstinyurlcomyxnhssoh

[22]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyxhcbz9mChristopherRDeCouKatherineAnneComtoisandSaraJLandesldquoDialecticalBehaviorTherapyIsEffectivefortheTreatmentofSuicidalBehaviorAMeta-AnalysisrdquoBehaviorTherapyJanuary2019httpstinyurlcomyyzrpsuoandAJWillinghamandElizabethElkinldquoTheresasevereshortageofmentalhealthprofessionalsinruralareasHereswhythatsaseriousproblemrdquoCNNJune222018httpstinyurlcomy5o2w2lj

[23]MahitaGajananldquoGunDeathsintheUSAreatTheirHighestRatesinDecadesCDCSaysrdquoTIMEDec142018httpstinyurlcomyxotgrcd

[24]SaraBVyrostekJosephLAnnestandGeorgeWRyanldquoSurveillanceforFatalandNonfatalInjuriesmdashUnitedStates2001rdquoMorbidityandMortalityWeeklyReportSept32004httpstinyurlcomy28ydcspRebeccaSSpicerandTedRMillerldquoSuicideActsin8StatesIncidenceandCaseFatalityRatesbyDemographicsandMethodrdquoAmericanJournalofPublicHealthDecember2000p1887httpstinyurlcomy2xwl7qy

[25]MichaelDAnestisGunsandSuicideAnAmericanEpidemic(2018)p63

[26]ldquoTheRelationshipBetweenFirearmAvailabilityandSuiciderdquoinAndrewRMorralTheScienceofGunPolicyACriticalSynthesisofResearchEvidenceontheEffectsofGunPoliciesintheUnitedStates(2018)pp215226-227httpstinyurlcomy3cm6vuy

[27]ldquoFallinparacetamoldeathslsquolinkedtopacklimitsrsquordquoBBCNewsFeb82013httpstinyurlcomy225z2gc

[28]DGunneletalldquoTheimpactofpesticideregulationsonsuicideinSriLankardquoInternationalJournalofEpidemiologyAug272007httpstinyurlcomy3vn7uo3

[29]RichardHSeidenldquoWherearetheynowAfollow-upstudyofsuicideattemptersfromtheGoldenGateBridgerdquoSuicideandLifeThreateningBehaviorWinter1978httpstinyurlcomy3s5hdk3

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 27: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2730

[30]ldquoSuicideandFirearmInjuryinUtahLinkingDatatoSaveLivesrdquoHarvardTHChanSchoolofPublicHealthOctober2018httpstinyurlcomy576x84j

[31]SeeColinLoftinetalldquoEffectsofrestrictivelicensingofhandgunsonhomicideandsuicideintheDistrictofColumbiardquoTheNewEnglandJournalofMedicineDec51991httpstinyurlcomy5wb653r

[32]MichaelDAnestisJoyeCAnestisandSarahEButterworthldquoHandgunLegislationandChangesinStatewideOverallSuicideRatesrdquoAmericanJournalofPublicHealthApril2017httpstinyurlcomy2ljj89b

[33]AaronJKivistoandPeterLeePhalenldquoEffectsofRisk-BasedFirearmSeizureLawsinConnecticutandIndianaonSuicideRates1981-2015rdquoPsychiatricServicesJune12018httpstinyurlcomy4tmr6yx

[34]JeffreyWSwansonetalldquoImplementationandEffectivenessofConnecticutsRisk-BasedGunRemovalLawDoesItPreventSuicidesrdquoLawandContemporaryProblems2017p208httpstinyurlcomy5cs2kgm

[35]DavidBKopeltestimonyonldquoRedFlagLawsExaminingGuidelinesforStateActionrdquoUSSenateJudiciaryCommitteeMarch262019httpstinyurlcomyy7oa7au

[36]JohnRLottJrandCarlisleEMoodyldquoDoRedFlagLawsSaveLivesorReduceCrimerdquoCrimePreventionResearchCenterDec282018httpstinyurlcomyxqmc7kq

[37]JeanMTwengeetalldquoIncreasesinDepressiveSymptomsSuicide-RelatedOutcomesandSuicideRatesAmongUSAdolescentsAfter2010andLinkstoIncreasedNewMediaScreentimerdquoClinicalPsychologicalScienceNov142017httpstinyurlcomy63ewt7e

[38]JeanMTwengeetalldquoAgePeriodandCohortTrendsinMoodDisorderIndicatorsandSuicide-RelatedOutcomesinaNationallyRepresentativeDataset2005-2017rdquoJournalofAbnormalPsychologyMarch142019httpstinyurlcomy5o867ta

[39]LydiaDenworthldquoTheKids(WhoUseTech)SeemtoBeAllRightrdquoScientificAmericanJan152019httpstinyurlcomy79jwc99

[40]RobbieGonzalezldquoScreensMightBeasBadforMentalHealthashellipPotatoesrdquoWiredJan142019httpstinyurlcomy9yxtm6u

[41]ArmyOrbenTobiasDienlinandAndrewKPrzybylskildquoSocialmediasenduringeffectonadolescentlifesatisfactionrdquoProceedingsoftheNationalAcademyofSciencesMay62019httpstinyurlcomyyuloo58

[42]ChristopherJFergusonldquoEverythinginModerationModerateuseofScreensUnassociatedwithChildBehaviorProblemsrdquoPsychiatricQuarterlyFebruary2017httpstinyurlcomy62jjwp2ChloeBerrymanChristopherJFergusonandCharlesNegyldquoSocialMediaUseandMentalHealthAmongYoungAdultsrdquoPsychiatricQuarterlyNov12017httpstinyurlcomyas2hbdm

[43]MoniqueKLeBourgeoisetalldquoDigitalMediaandSleepinChildhoodandAdolescencerdquoPediatricsNovember2017httpstinyurlcomyyqt9qweRebeccaABernertetalldquoObjectivelyAssessedSleepVariabilityasanAcuteWarningSignofSuicidalIdeationinaLongitudinalEvaluationofYoungAdultsatHighSuicideRiskrdquoTheJournalofClinicalPsychiatry2017httpstinyurlcomy3zo4rtw

[44]RuoyinLinandSonjaUtzldquoTheemotionalresponsesofbrowsingFacebookHappinessenvyandtheroleoftiestrengthrdquoComputersinHumanBehaviorNovember2015httpstinyurlcomy22nm7hg

[45]EthanKrossetalldquoFacebookUsePredictsDeclinesinSubjectiveWell-BeinginYoungAdultsrdquoPLoSOneAug142013httpstinyurlcomyy6l2dl9MortenTromholtldquoTheFacebookExperimentQuittingFacebookLeadstoHigherLevelsofWell-BeingrdquoCyberpsychologyBehaviorandSocialNetworkingNov12016httpstinyurlcomy569b9ygHollyBShakyaandNicholasAChristakisldquoAssociationofFacebookUseWithCompromisedWell-BeingALongitudinalStudyrdquoAmericanJournalofEpidemiologyJan162017httpstinyurlcomy2ckr5xnandldquoStatusOfMindSocialmediaandyoungpeoplesmentalhealthandwellbeingrdquoRoyalSocietyforPublicHealthhttpstinyurlcomy99op9oj

[46]AngusCrawfordldquoInstagramlsquohelpedkillmydaughterrsquordquoBBCJan222019httpstinyurlcomy48fhccl

[47]DonnaARuchArielleHSheftallandPaigeSchlagbaumldquoTrendsinSuicideAmongYouthAged10to19YearsinUnitedStates1975to2016rdquoPsychiatryMay172019httpstinyurlcomyyofv2hf

[48]SashaIngberandRhituChatterjeeldquoSuicideRateForGirlsHasBeenRisingFasterThanForBoysStudyFindsrdquoNPRMay172019httpstinyurlcomy34ls7uc

[49]MirandaBryantldquoWhataresocialmediacompaniesdoingaboutsuicidalpostsrdquoTheGuardianJan102019httpstinyurlcomyao87gjd

[50]Ibid

[51]NicoleOgryskoldquoPredictiveanalyticspointingVAtoveteransatriskofsuiciderdquoFederalNewsNetworkApril202018httpstinyurlcomy4vs5mon

[52]IbidldquoREACHVETProgramEvaluation(REACHVET)rdquoUSNationalLibraryofMedicineaccessedJune262019httpstinyurlcomy4t7pf54

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 28: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2830

[53]GregoryESimonetalldquoPredictingSuicideAttemptsandSuicideDeathsFollowingOutpatientVisitsUsingElectronicHealthRecordsrdquoAmericanJournalofPsychiatryMay242018httpstinyurlcomyxjsxtja

[54]BrianKAhmedanietalldquoHealthCareContactsintheYearBeforeSuicideDeathrdquoJournalofGeneralInternalMedicineFeb252014httpstinyurlcomy3rnuw33

[55]MartinKasteldquoFacebookIncreasinglyReliantonAIToPredictSuicideRiskrdquoNPRNov172018httpstinyurlcomyxwrs954

[56]MatthewLargeetalldquoMeta-AnalysisofLongitudinalCohortStudiesofSuicideRiskAssessmentamongPsychiatricPatientsHeterogeneityinResultsandLackofImprovementoverTimerdquoPLOSOneJune102016httpstinyurlcomyymgpcrz

[57]JosephCFranklinetalldquoRiskFactorsforSuicidalThoughtsandBehaviorsAMeta-Analysisof50YearsofResearchrdquoPsychologicalBulletinNov142016httpstinyurlcomy3tuej7j

[58]MasonMarksldquoArtificialIntelligenceBasedSuicidePredictionrdquoYaleJournalofHealthPolicyLawandEthicsFeb112019httpstinyurlcomy54ufp64

[59]HowardIKushnerSelf-DestructioninthePromisedLandAPsychoculturalBiologyofAmericanSuicide(1989)pp28-58

[60]SeeAshleyCrossmanldquoTheStudyofSuicidebyEmileDurkheimrdquoThoughtCoJan142019httpstinyurlcomy5daxfq4

[61]BayardWebsterldquoTheMenningerClinicAFarmhousein1925NowaWorldCenterrdquoTheNewYorkTimesNov131975httpstinyurlcomy52znsl8MichaelHooperldquoMenningerleaveslastingmarkonTopekardquoTheTopekaCapital-JournalOct82016httpstinyurlcomy6jpxtyp

[62]Ducharmeopcit

[63]ThomasCurwenldquoEdwinSShneidmandiesat91pioneerinthefieldofsuicidepreventionrdquoLosAngelesTimesMay182009httpstinyurlcomyxlzd7sz

[64]ldquoSuicideintheUnitedStates1950-1964rdquoUSDepartmentofHealthEducationandWelfareAugust1967httpstinyurlcomy32neghe

[65]SKGoldsmithetaledsReducingSuicideANationalImperativeInstituteofMedicine2002httpstinyurlcomyy42pomb

[66]ldquoTable290rdquoNationalCenterforHealthStatisticshttpstinyurlcomy2592b5nRobertEMcKeownStevePCuffeandRichardMSchulzldquoUSSuicideRatesbyAgeGroup1970-2002AnExaminationofTrendsrdquoAmericanJournalofPublicHealthOctober2006httpstinyurlcomy6a68qfz

[67]ldquoYouthSuicideIsRisingrdquoTheNewYorkTimesFeb221987httpstinyurlcomy6julajw

[68]DanielGolemanldquoPatternofDeathCopycatSuicidesAmongYouthsrdquoTheNewYorkTimesMarch181987httpstinyurlcomy6drepum

[69]SeeforexampleMadelynSGouldandDavidShafferldquoTheImpactofSuicideinTelevisionMoviesrdquoTheNewEnglandJournalofMedicineSept111986httpstinyurlcomy3c6ojohStephenFarberldquo3TVFilmsonSuicidebyYouthsrdquoTheNewYorkTimesOct111984httpstinyurlcomy3dmcd46

[70]ldquoAdolescentSuicidesTheGrimStatisticsrdquoTheNewYorkTimesJan131986httpstinyurlcomy3razlbf

[71]BarbaraMantelldquoTeenSuiciderdquoCQResearcherSept122014Vol24Issue32

[72]Golemanopcit

[73]CynthiaKoonsandRobertLangrethldquoKetamineCouldBetheKeytoReversingAmericasRisingSuicideRaterdquoBloombergBusinessweekFeb52019httpstinyurlcomy7hupqcc

[74]PWOCarrollandLBPotterldquoSuicideContagionandtheReportingofSuicideRecommendationsfromaNationalWorkshoprdquoCentersforDiseaseControlMorbidityandMortalityWeeklyReportApril221994httpstinyurlcomyxkrckga

[75]DeCouopcitldquoDialecticalBehaviorTherapyrdquoPsychologyTodayundatedhttpstinyurlcomy7v4rscm

[76]DavidAJobesManagingsuicidalriskAcollaborativeapproach(2006)ldquoAboutCAMSrdquoPreventingSuicideCAMScareundatedhttpstinyurlcomyxdeydtj

[77]DavidAJobesetalldquoTheKurtCobainSuicideCrisisPerspectivesfromResearchPublicHealthandtheNewsMediardquoSuicideandLife-ThreateningBehaviorSeptember1996httpstinyurlcomy69vd68x

[78]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoPreventionofSuicideGuidelinesfortheformulationandimplementationofnationalstrategiesrdquoDepartmentforPolicyCoordinationandSustainableDevelopmentUnitedNations1996

[79]EdwinSShneidmanTheSuicidalMind(1998)p135

[80]ldquoTheSurgeonGeneralsCalltoActiontoPreventSuicide1999rdquoDepartmentofHealthandHumanServices1999httpstinyurlcomy23s4lzdldquoSurgeonGenerallaysoutsuicideprevention

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 29: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 2930

planrdquoCNNcomMay32001httpstinyurlcomyy5n9xtm

[81]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[82]IbidMadelineLevinetalldquoDoAntidepressantsIncreaseSuicideAttemptsDoTheyHaveOtherRisksrdquoNationalCenterforHealthResearchundatedhttpstinyurlcomy9y5ysjs

[83]ldquoAntidepressantsandsuiciderdquoHarvardMentalHealthLetterJuly2007httpstinyurlcomy6reqmes

[84]ThomasEJoinerWhyPeopleDiebySuicide(2005)

[85]ldquoAntidepressantUseinChildrenAdolescentsandAdultsrdquoUSFoodandDrugAdministrationMay22007httpstinyurlcomyxcrbdce

[86]RichardAFriedmanandAndrewCLeonldquoExpandingtheBlackBoxmdashDepressionAntidepressantsandtheRiskofSuiciderdquoTheNewEnglandJournalofMedicineJune72007httpstinyurlcomyy7bzohr

[87]ldquoDeathsPercentofTotalDeathsandDeathRatesforthe15LeadingCausesofDeathUnitedStatesandEachState1999-2015rdquoNationalCenterforHealthStatisticsCentersforDiseaseControlandPreventionhttpstinyurlcomy3nkq8ds

[88]LisaWFoderaroldquoPrivateMomentMadePublicThenaFatalJumprdquoTheNewYorkTimesSept292010httpstinyurlcomy3on33vz

[89]ldquo2012NationalStrategyforSuicidePreventionGoalsandObjectivesforActionrdquoOfficeoftheSurgeonGeneralandNationalActionAllianceforSuicidePreventionUSDepartmentofHealthandHumanServicesSeptember2012httpstinyurlcomyxrnow78

[90]ldquoVeteranSuicidePreventionrdquoC-SPANMarch52019httpstinyurlcomy526slmlShaneIIIopcit

[91]DebbieAndaloldquoAntidepressantsassociatedwithincreasedriskofsuicidalthoughtsinhealthadultsrdquoThePharmaceuticalJournalOct172016httpstinyurlcomy6zsbruhKatherineSchreiberldquoWhyAreSuicideRatesHigherAmongLGBTQYouthrdquoPsychologyTodayOct122017httpstinyurlcomy52pd9el

[92]ldquoSuicideRatesSpikeNationallyAmongYouthAfterlsquo13ReasonsWhyrsquoReleaserdquoNationwideChildrensApril292019httpstinyurlcomy5rxdmv7

[93]ldquoStudyHowteensparentsrespondedtoNetflixserieslsquo13ReasonsWhyrsquordquoCenterforMediaandHumanDevelopmentMarch212018httpstinyurlcomy4jjbm3b

[94]PatriciaKimeldquoActive-DutyMilitarySuicidesatRecordHighsin2018rdquoMilitarycomJan302019httpstinyurlcomyycs5lnv

[95]ldquoVAHealthCareImprovementsNeededinSuicidePreventionMediaOutreachCampaignOversightandEvaluationrdquoGovernmentAccountabilityOfficeNovember2018httpstinyurlcomy6qe7r9wLeoShaneIIIldquoVAleftmillionsforsuicidepreventionunspentreportfindsrdquoMilitaryTimesDec182018httpstinyurlcomy4ll9ngr

[96]Shaneibid

[97]JonahEngelBromwichVanessaFriedmanandMatthewSchneierldquoKateSpadeWhoseHandbagsCarriedWomenIntoAdulthoodIsDeadat55rdquoTheNewYorkTimesJune52018httpstinyurlcomy45ebez7KimSeversonMatthewHaagandJuliaMoskinldquoAnthonyBourdainRenegadeChefWhoReportedFromtheWorldsTablesIsDeadat61rdquoTheNewYorkTimesJune82018httpstinyurlcomyxnbfpp6andVivekaeKimldquoAscallstotheSuicidePreventionLifelinesurgeunder-resourcedcentersstruggletokeepuprdquoPBSNewshourAug52018httpstinyurlcomy2v6ew9r

[98]ldquoTheAmericanFoundationforSuicidePreventionThanksCongressforDedicatingResourcestotheFightforSuicidePreventionrdquoAmericanFoundationforSuicidePreventionSept282018httpstinyurlcomy2cyecamNatalieTietjenandConnorJobesldquoFightingforSuicidePreventionResearchonCapitolHillrdquoAmericanFoundationforSuicidePreventionOct12018httpstinyurlcomy3jx843k

[99]ldquoVANationalSuicideDataReport2005-2016rdquoOfficeofMentalHealthandSuicidePreventionUSDepartmentofVeteransAffairsSeptember2018p3httpstinyurlcomyy7yp8rk

[100]ldquoFY2020PresidentsBudgetRequestrdquoUSDepartmentofVeteransAffairsMarch112019p8httpstinyurlcomy2v9qqwr

[101]NicoleGaudianoldquoUnderpressureNRAvoicessupportforgunviolencerestrainingordersrdquoUSATodayMarch192018httpstinyurlcomy2hswdyc

[102]HollyYanandMadisonParkldquo1week3suicides1tragicconnectiontoschoolmassacresrdquoCNNMarch262019httpstinyurlcomy2jce2xw

[103]BrakktonBookerldquoIntheshadowofsuicidesSenatepanelmakesraremovetoconsiderguncontrolrdquoNPRMarch262019httpstinyurlcomy4h46spt

[104]ldquoSensMoranTesterIntroduceLandmarkVeteransMentalHealthandSuicidePreventionLegislationrdquonewsreleaseOfficeofJerryMoranMarch192019httpstinyurlcomy39gp2ppldquoBennetReintroducesBipartisanBicameralLegislationtoStudyEffectsofTechnologyandMediaonChildrenrdquonewsreleaseOfficeofMichaelBennetFeb262019httpstinyurlcomy68623oo

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc

Page 30: library.cqpress.com/cqresearcher/document.php?action=print ......those ages 15 to 24 reached the highest level in 2017 — 14.6 per 100,000 — since the government began collecting

7152019 Suicide Crisis CQR

librarycqpresscomcqresearcherdocumentphpaction=printampid=cqresrre2019071200 3030

[105]ldquoStateLawsTrainingforHealthProfessionalsinSuicideAssessmentTreatmentandManagementrdquoAmericanFoundationforSuicidePreventionupdatedSept72017httpstinyurlcomyyqszg4s

[106]KimPowellldquoSuicidepreventiontrainingbillheadingtotheGovernorsdeskrdquoAZFamilycomMay32019httpstinyurlcomy34xmxwcKirkSieglerldquoHowOneColoradoTownIsTacklingSuicidePreventionmdashStartingWiththeKidsrdquoNPROct232018httpstinyurlcomy5hwfp56

[107]ScottJaschikldquoTheDutytoPreventSuiciderdquoInsideHigherEdMay82018httpstinyurlcomy6dfdmjhNgyuenvMassachusettsInstituteofTechnology479Mass43696NE3d128142-43(2018)

[108]JulieColemanldquoHearingsetforWednesdaycanceledinlawsuitagainstPennoverOliviaKongsdeathrdquoTheDailyPennsylvanianMarch212019httpstinyurlcomyyp2el9ySusanSvrlugaldquoFormerstudentwhoattemptedsuicidesuesWashingtonandLeeUniversityallegingnegligencerdquoTheWashingtonPostJan92019httpstinyurlcomy5thcptkandJohnMonkldquoLawsuitFatherchargesUSCwithnegligenceingraduatestudentsdeathrdquoTheStateFeb132019httpstinyurlcomy259zpmo

[109]ldquoDeansLeaveofAbsencerdquoStanfordUniversityhttpstinyurlcomy25dl99uEthanBaronldquoLawsuitclaimsStanfordforcedsuicidalstudentsoutofschoolandhousingrdquoTheMercuryNewsMay182018httpstinyurlcomy2l7wo6dElenaShaoldquolsquoInhumaneanddeficientrsquostudentgroupsrallyagainstlsquodiscriminatoryrsquoleaveofabsencepoliciesrdquoStanfordDailyFeb212019httpstinyurlcomy2epf6ojandAnemonaHartocollisldquoFeelingSuicidalStudentsTurnedtoTheirCollegeTheyWereToldtoGoHomerdquoTheNewYorkTimesAug282018httpstinyurlcomycooq4ls

[110]MitchellArmentroutldquoMomslsquodesperatepleasrsquoignoredbeforefourthgraderattemptedsuicidesuitrdquoChicagoSunTimesApril182019httpstinyurlcomy47rgygz

[111]ReedAbelsonldquoMentalHealthTreatmentDeniedtoCustomersbyGiantInsurersPoliciesJudgeRulesrdquoTheNewYorkTimesMarch52019httpstinyurlcomy4orrwo7DavidWitvUnitedBehaviorHealthhttpstinyurlcomyx9a394m

[112]LindaADimeffetalldquoAnovelengagementofsuicidalityintheemergencydepartmentVirtualCollaborativeAssessmentandManagementofSuicidalityrdquoGeneralHospitalPsychiatryMay202018httpstinyurlcomyytstuc8

[113]RobinSeatonJeffersonldquoResearchersAttemptToPredictampPreventSuicideUsingDeepLearningAndMathrdquoForbesApril152019httpstinyurlcomyxjrxjmz

[114]FranKritzldquoProgressinpredictingsuiciderdquoAAMCNewsNov272018httpstinyurlcomy2ugtffu

[115]ldquoWeneedyourhelprdquoQntfyhttpstinyurlcomy5gqyp88

[116]ldquo$38millionNIMHgranttodiagnosesuicidalthinkingusingbrainimagingrdquoCarnegieMellonUniversityAug292018httpstinyurlcomy4we3a6k

[117]JulieCereletalldquoHowManyPeopleAreExposedtoSuicideNotSixrdquoSuicideandLifeThreateningBehaviorMarch72018httpstinyurlcomy6a3ao4x

[118]Weissmanopcit

[119]MeganGrahamldquoHereshowadvertisersaregettingtechcompaniestocleanuptheiractorrisklosingbillionsrdquoCNBCApril202019httpstinyurlcomy6k328zo

Gototop

AbouttheAuthor

ChristinaLLyonsafreelancejournalistintheWashingtonDCareawritesprimarilyaboutUSgovernmentandpoliticsSheisacontributingauthorforCQPressreferencebooksincludingCQsGuidetoCongressandwasacontributingeditorforBloombergBNAsInternationalTradeDailyAformereditorforCongressionalQuarterlyshealsowasco-authorofCQsPoliticsinAmerica2010ShehasamastersdegreeinpoliticalsciencefromAmericanUniversity

Gototop

DocumentAPACitationLyonsCL(2019July12)SuicidecrisisCQresearcher291-60Retrievedfromhttplibrarycqpresscom

DocumentIDcqresrre2019071200DocumentURLhttplibrarycqpresscomcqresearchercqresrre2019071200

Feedback|SuggestaTopic|GeneralTermsofService|CopyrightNoticeandTakedownPolicy|Masthead|PrivacyPolicy

copy2019CQPressAnImprintofSAGEPublishingAllRightsReservedCQPressisaregisteredtrademarkofCongressionalQuarterlyInc


14.6. infierno y purgatorio

Convegno Cagliari 14.6

API Mpms Chapter 14.6 (1998)

Palestra hotel show eduardo faraco 14.6

CQResearcher - Maxwell School

Konzum 14.6. do 27.6.2010

14.6 energy and mass budgets

11 17-14.6 km

LED for Display, Cabinet, Furniture & Cove · 2017-01-24 · 30.6 30.6 30.6 12.3 12.3 12.3 14.9 14.9 14.9 15.6 15.6 15.6 14.6 14.6 14.6 17 17 17 16.6 16.6 16.6 95 286 572 121 312

14.2-14.6 historia

CITTI Markt DE Tilbudsavis 8.6.-14.6. Ost

2016 Survey of Innovation and Entrepreneurship...valid college of ag hum nat res sci 276 14.6 14.6 14.6 college of arts and sciences 416 22.0 22.0 36.6 college of business 72 3.8 3.8

14.6 Construction and Animation via Hierarchical Modelingorca.st.usm.edu/~jchen/courses/graphics/resources/book/TEXT__Intro... · 14.6 Construction and Animation via Hierarchical

CITTI Markt DE Tilbudsavis Cocktail 8.6.-14.6

Spot'it- 14.6-18.6 - שבוע שלישי

14.6 Triple Integrals

sol-ejercicios-Capitulo 14.5-14.6

Sect. 14.6: Bernoulli’s Equation

Pamphlet PDF (14.6 MB)

MANIFESTATIONEN, DIE AUS MEHREREN ... - RDA …access.rdatoolkit.org/document.php?id=nlgpschp3.pdf · Begleitmaterial mit eigenem Titel Hat das Begleitmaterial einen eigenen aussagekräftigen

Maailman tuulipäivä, toimittajatilaisuus 14.6

14.6. EVAPORATOR OPERATION

Lake County, FL 14.6

14.6 Page 1 of 1

14.6 Synthesis of Alcohols Using Grignard Reagents

14.6 Bernoulli’s Equation

9.1 mi, 14.6 km Haeckel - whitehorsewalks.com

Capitulo 14.6 Parte 1

アンカー・インサートW5/16 W3/8 W1/2 12.7 12.7 19.1 12.7 12.7 19.1 21.7 24.6 47.9 21.7 24.8 43.0 14.6 14.6 28.6 14.6 14.6 28.6 31 31 42 31 31 42 20 10 24 20 10 24 50 50 60

TEMS Investigation 14.6 - What's New

A Reading of John 14.6

14.6. SISTEMA DE TRANSMISIÓN - Interempresas

Health Business 14.6

14.6 Commissioning Rev1

14.6. EL SIMBOLISMO DE LOS ANIMALES DEVORADORES