Mood Disorders and Suicide 241
Despite such challenges in carrying out research, progress has been made in study-
ing suicide prevention; let’s review this progress.
Targeting Neurological Factors: Medication
Interventions that most commonly target neurological factors are medications (usu-
ally antidepressants) and, to a lesser extent, ECT for severe suicidal thoughts that do
not respond to other treatments. However, it is unclear to what extent medications
do prevent suicide. Khan and colleagues (2000) examined the U.S. Food and Drug
Administration database that compared RCTs (randomized clinical trials) of newer
antidepressants with placebos. The rates of both attempted and completed suicides
were essentially the same for both groups. Nonetheless, before deciding that antide-
pressants have no effect on suicide, remember that people with serious suicidal in-
tent are often excluded from RCTs that use placebo medications (see Chapter 4 for
a discussion about exclusion criteria in RCTs). Thus, participants in the government
database who attempted or completed suicide were probably not actively suicidal at
the time they enrolled in the study.
Targeting Psychological Factors: Reducing Feelings
of Hopelessness
For a person who is actively suicidal and who has contacted a mental health or
medical professional, the fi rst aim of suicide prevention is to make sure that the in-
dividual is safe. After this, crisis intervention helps the person to see past the hope-
lessness and rigidity that pervades his or her thinking, identifi es whatever stressors
have brought the individual to this point, helps him or her develop new solutions to
the problems, and enhances the ability to cope.
In addition, a clinician tries to discover whether the person is depressed orabusing substances; if so, these problems, which may lead to suicidal thoughts
or behaviors, should be treated (Reifman & Windle, 1995). Because most peo-
ple who die by suicide had untreated depression, treatment for depression that
targets psychological factors—typically CBT—can play a key role in suicide
prevention.
Targeting Social Factors: Social Programs,
Social Awareness
Ideally, prevention programs that decrease socially re-
lated risk factors and increase socially related protective
factors should decrease the suicide rate. Thus, programs
to prevent child abuse, to provide affordable access to
mental health care (and so make it easier to obtain treat-
ment for psychological disorders), to decrease substance
abuse, and to increase employment may all help prevent
suicides in the long term.
Part of the national suicide prevention plan in theUnited States is to increase awareness about suicide
(Satcher, 1999), both among individuals who may feel
suicidal and among the friends and family of someone
feeling suicidal. The hope is that suicidal individuals will
receive appropriate help before they commit suicide (see
Table 6.15).
FEEDBACK LOOPS IN PREVENTION: Suicide
To see how the three types of factors interact via feedback loops, let’s examine a
comprehensive suicide prevention program. From 1990 to 1995, the suicide rate
among U.S. Air Force personnel aged 24–35 increased signifi cantly. Recognizing
What can you do if someone you know seems to be suicidal? According to
the National Institute of Mental Health (Goldsmith et al., 2002), don’t leave the
person alone; get help by calling 911 or other trained emergency professionals.
Also, try to make sure that potential means for committing suicide such as
fi rearms or poisons are not easily accessible. Let the person know that you’re
concerned, and try not to be judgmental.
If you, or someone you know, are at risk for suicide, the following organizations
can help:- The National Hope Line Network
Phone: 800-SUICIDE. This will connect you with a crisis center in your area.
Website: http://www.hopeline.com/ - American Foundation for Suicide Prevention
Phone: 212-363-3500
Web site: http://www.afsp.org - Suicide Prevention Advocacy Network
Phone: 770-998-8819
Web site: http://www.spanusa.org
Table 6.15 • Suicide Prevention: What to Do
P SN