Any loss of life is tragic, but this is especially true when a person's death is self-inflicted. In the case of the Germanwings plane crash, the reported suicide by the co-pilot was even more tragic (and appalling) because in doing so the co-pilot also took the lives of so many innocent others aboard the plane. It's been widely reported that the co-pilot had sought treatment for depression and other health issues.
But despite all we know, why do so many people intentionally kill themselves every year and why can't we stop it? After all suicide is preventable.
Research suggests there is no one answer, but instead there may be several pathways to reducing suicide and suicide attempts. What clinicians really need are reliable predictors that will identify who will actually attempt suicide.
Approximately 90 percent of people who commit suicide have a diagnosable illness such as clinical depression or substance use disorders. These mental health disorders are treatable with medications and psychotherapy.
However, the vast majority of people with a diagnosable mental health or substance misuse condition will not contemplate or attempt suicide. Simply using a diagnosis as a risk factor for suicide will produce many false positives and does not go far enough for identifying those at highest risk for suicide. Ideally, clinicians need a set of reliable predictors that will identify who will attempt suicide.
This would involve a test of some sort such as a biomarker (gene expression) or a task that measures cognitive dysfunction (difficulty stopping impulsive behavior) that reliably predicts who is at highest risk for suicide. Many attempts have been made to develop this sort of test, but few tests with any clinical utility have emerged.
It is a combination of biological, psychological and social factors that all work in concert to produce suicidal behavior in a given individual. Although use of genetic information has been very successful in other complex conditions such as cancer, genetics may be only part of the equation for predicting who will attempt suicide.
For instance, twin studies suggest that genetic factors provide about 40 percent of the explanation for suicide and suicide attempts, leaving plenty of room for other factors to contribute to the onset of suicide. Much research effort is being devoted to identifying important predictors of suicide risk.
Ultimately, it may take the measurement of a variety of biopsychosocial risk factors (not just a single risk factor) and the development of a sophisticated statistical model that uses this data to reliably predict whether a person will attempt suicide.
Until such tests are developed, however, the presence of a diagnosable mental illness, and associated thoughts about suicide, may be the most useful predictor of potential for future suicide.
A coordinated effort is necessary from multiple sources to stop suicide. Rapid access to trauma services can reduce fatality following a suicide attempt. The availability of a 24-hour crisis team has been shown to be a very effective service for reducing rates of suicide.
Conducting multidisciplinary reviews, sharing results with the family and altering treatment based on these meetings can also reduce rates of suicide. Better follow-up and continued contact for those leaving health care facilities after a suicide attempt also make an important difference.
Friends and family will also play a large role in reducing suicide. Most adolescents who attempt suicide have previously received mental health treatment; however, most had not received treatment within the 12 months of their attempt.
Most youths and young adults contemplating suicide do not seek medical help. They instead seek the support of peers. Public awareness of suicide and making it more acceptable to seek help should be addressed as part of a comprehensive suicide prevention strategy so that those in distress and reluctant to seek care can be encouraged to do so.
Suicide is unfortunately a highly prevalent and complex problem in our society. To effectively reduce suicide, we will need a comprehensive approach that involves families, caregivers, politicians and society at large. Suicide is preventable, and we all need to do more to make it so.
Christopher Beevers is a professor of psychology and the director of the Institute for Mental Health Research at The University of Texas at Austin.
A version of this op-ed appeared in the San Angelo Standard Times.
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