Hard Truths About Suicide Prevention
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Suicide accounts for nearly 50?000 deaths annually in the US, making it the second leading cause of death among persons 10 to 34 years of age. Although psychiatric illness is associated with elevated rates of death from a range of causes, from cardiovascular disease to cancer, suicide stands out: it occurs precipitously, disproportionately involves younger individuals, and is generally viewed as more preventable.

Suicide represents a particular challenge in the military because soldiers are placed in extremely stressful situations, often without adequate physical or emotional support. Their risk remains elevated even after they leave active service. For this reason, the US Department of Defense and the US Department of Veterans Affairs (VA) have invested billions of dollars to reduce the incidence of suicide. Despite these heroic efforts, the number of veterans who die by suicide every year has actually increased during the past decade.

These circumstances highlight how difficult and complex a task it is to prevent suicide more broadly and why limiting interventions to the moment when individuals present with suicidal thoughts does not suffice. Accordingly, suicide has come to be viewed as a public health challenge for which the solution begins with screening and prevention.

In outpatient settings, primary screening results for suicidality were positive in 3.5% and secondary screening results for suicidality were positive for 0.4% of 4.1 million patients. Among 1 million patients in emergency departments, rates of positive screening results were 3.6% and 2.1%. These numbers provide a useful reference for estimating the yield of routine screening in these settings.

Researchers also describe another approach to screening, based on extraction of data from electronic health records to identify high-risk individuals. Their model is characterized as highly accurate but also embodies key challenges in suicide screening. The positive predictive value of their model is 6%, which means that 17 individuals would need to receive an intervention to prevent a single suicide attempt. High false-positive rates have been a persistent challenge in screening efforts.

Identifying such effective interventions represents another major challenge because suicide prevention studies face substantial feasibility hurdles.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771928