Feature

Q&A: SAVE discusses the clinician's role in suicide prevention

Dan Reidenberg

Oct. 10 is World Mental Health Day, and WHO has declared suicide prevention as the focus for 2019. According to WHO, someone dies by suicide every 40 seconds, and it chose this year’s theme “to raise awareness of the scale of suicide around the world and the role that each of us can play to help prevent it.”

The overall suicide rate in the United States has increased significantly over the past two decades, and the reasons for this rise and potential responses to it are both complex and worth considering, according to Dan Reidenberg, PsyD, FAPA, executive director of the nonprofit Suicide Awareness Voices of Education.

Reidenberg spoke with Healio Psychiatry about fostering open communication on suicide between clinicians and patients, research priorities for prevention efforts and the importance of technology in suicide prevention. – by Joe Gramigna

Question: Why might the overall increasing suicide trend be occurring ?

Answer : According to the CDC, the suicide rate increased 30% between 1999 and 2016. There have been overall increases among all ages and demographics. No one knows exactly the reason(s) for the increases. Multiple factors are likely influencing different groups — seniors getting older and more ill; veteran suicides increasing; youth navigating social isolation/media or online bullying; the opioid crisis; the recession for adults.

Q: What are the major warning signs clinicians should look for to identify patients who might be at risk for suicide ?

A: Signs include communicating an intent to die (verbally direct and indirect statements) as well as behaviorally (looking for a way to die). Other include statements about feeling hopeless, like life has no meaning or purpose for them, or that they feel trapped or are in unbearable pain.

Q: Do you have tips for clinicians to help them have open and honest conversations about suicide and prevention strategies with patients ?

A: Clinicians should practice asking about suicide so it is a comfortable conversation for them to have with patients. They should be direct in asking the question. They should learn how to listen for clues that someone is thinking about suicide beyond a simple ‘yes’ answer. They need to know how to ask about lethal means that someone might have access to.

Q: What should clinicians prioritize in treatment to help decrease suicide trends ?

A: First would be to accurately identify someone at risk of suicide. Second would be to ensure that those patients are given the proper level of care that they need. Third would be to prioritize follow-up care after a discharge or appointment. More broadly, clinicians need to not assume that patients won’t die, because sadly, many do. Too often, they see suicide so rarely they don’t believe it will happen, so among all patients and all diagnoses they need to pay more attention to the warning signs and risk factors. Finally, they should prioritize treatment and bipolar disorder. Too often, clinicians treat patients with bipolar disorder with antidepressants rather than mood stabilizers because the patients don’t come in or talk about manic episodes, only depression.

Q: What areas of research concerning suicide prevention should be undertaken, in your opinion ?

A: All of the six major questions in the National Research Prioritization Project by NIMH are key questions that need to be undertaken — none more or less.

Q: Is there anything else you would like to add ?

A: We definitely need to find more ways that technology can be involved in suicide prevention. In fact, I believe it provides us the greatest hope for reducing the burden of suicide here and globally. Big data sets, rapid access to support and care, many networks of people involved, prevention opportunities and identifying risk as it increases are just some of the many ways I believe that technology can help save lives. We also need the entertainment industry to work with us to more accurately depict mental health, mental illness, suicide, suicide prevention, grief after suicide and treatment.

Disclosures: Reidenberg reports no relevant financial disclosures.

Dan Reidenberg

Oct. 10 is World Mental Health Day, and WHO has declared suicide prevention as the focus for 2019. According to WHO, someone dies by suicide every 40 seconds, and it chose this year’s theme “to raise awareness of the scale of suicide around the world and the role that each of us can play to help prevent it.”

The overall suicide rate in the United States has increased significantly over the past two decades, and the reasons for this rise and potential responses to it are both complex and worth considering, according to Dan Reidenberg, PsyD, FAPA, executive director of the nonprofit Suicide Awareness Voices of Education.

Reidenberg spoke with Healio Psychiatry about fostering open communication on suicide between clinicians and patients, research priorities for prevention efforts and the importance of technology in suicide prevention. – by Joe Gramigna

Question: Why might the overall increasing suicide trend be occurring ?

Answer : According to the CDC, the suicide rate increased 30% between 1999 and 2016. There have been overall increases among all ages and demographics. No one knows exactly the reason(s) for the increases. Multiple factors are likely influencing different groups — seniors getting older and more ill; veteran suicides increasing; youth navigating social isolation/media or online bullying; the opioid crisis; the recession for adults.

Q: What are the major warning signs clinicians should look for to identify patients who might be at risk for suicide ?

A: Signs include communicating an intent to die (verbally direct and indirect statements) as well as behaviorally (looking for a way to die). Other include statements about feeling hopeless, like life has no meaning or purpose for them, or that they feel trapped or are in unbearable pain.

Q: Do you have tips for clinicians to help them have open and honest conversations about suicide and prevention strategies with patients ?

A: Clinicians should practice asking about suicide so it is a comfortable conversation for them to have with patients. They should be direct in asking the question. They should learn how to listen for clues that someone is thinking about suicide beyond a simple ‘yes’ answer. They need to know how to ask about lethal means that someone might have access to.

Q: What should clinicians prioritize in treatment to help decrease suicide trends ?

A: First would be to accurately identify someone at risk of suicide. Second would be to ensure that those patients are given the proper level of care that they need. Third would be to prioritize follow-up care after a discharge or appointment. More broadly, clinicians need to not assume that patients won’t die, because sadly, many do. Too often, they see suicide so rarely they don’t believe it will happen, so among all patients and all diagnoses they need to pay more attention to the warning signs and risk factors. Finally, they should prioritize treatment and bipolar disorder. Too often, clinicians treat patients with bipolar disorder with antidepressants rather than mood stabilizers because the patients don’t come in or talk about manic episodes, only depression.

Q: What areas of research concerning suicide prevention should be undertaken, in your opinion ?

A: All of the six major questions in the National Research Prioritization Project by NIMH are key questions that need to be undertaken — none more or less.

Q: Is there anything else you would like to add ?

A: We definitely need to find more ways that technology can be involved in suicide prevention. In fact, I believe it provides us the greatest hope for reducing the burden of suicide here and globally. Big data sets, rapid access to support and care, many networks of people involved, prevention opportunities and identifying risk as it increases are just some of the many ways I believe that technology can help save lives. We also need the entertainment industry to work with us to more accurately depict mental health, mental illness, suicide, suicide prevention, grief after suicide and treatment.

Disclosures: Reidenberg reports no relevant financial disclosures.