MHANYS - Community Connections, Winter 2002/2003

Suicide Rates Fall Slowly Despite Advances in Effective Treatment, Studies Show
Reprinted with permission from Jennifer Tang, NY Academy of Sciences

More than 30,000 people commit suicide in the U.S. every year. Despite great advances in the psychopharmacologic treatment and psychotherapy of major psychiatric disorders, suicide remains a major cause of death for all age groups, according to studies newly published by the New York Academy of Sciences.

With the rise in the prescription of psychotropic prescription medications and other effective treatments for major psychiatric disorders, experts predicted that suicide rates would decline. They have fallen, but slowly. Why have effective treatments failed to make a greater impact on suicide rates? What can be done to bring about a higher reduction in the rate of suicide and attempted suicide?

"Most patients who commit suicide have not received adequate treatment," said Dr. J. John Mann of the New York State Psychiatric Institute. "For example, 60% of suicides occur in the context of a mood disorder and yet only about 12% of those suicides received a minimally effective dose of an antidepressant. Most depressed patients in the United States are not receiving adequate doses of antidepressants, even if they have a history of a prior suicide attempt, an indicator of higher risk for suicide."

In the past decade, however, specific treatments have been shown to reduce suicide and/or suicidal behavior in a variety of psychiatric conditions: bipolar disorder, schizophrenia, and borderline personality disorder. Experts predict that we should be able to learn how effective our treatments of depression are in preventing suicide and in what way they need to be supplemented by treatments aimed at regulating associated affects and other psychopathologies that complicate depressive disorders. According to Dr. Herbert Hendin, Medical Director of the American Foundation for Suicide Prevention, "Funding research aimed specifically at suicide prevention has now become the major focus of the foundation's activities.

These findings and other up-to-date information on the assessment and treatment of the suicidal patient are the focus of a recently published book, The Clinical Science of Suicide Prevention (Volume 932 of the Annals of the New York Academy of Sciences), co-edited by Drs. Mann and Hendin. Organized into five sections (Diagnostic and Clinical Considerations, Special Age Groups, Psychotherapy, Suicide Crisis and Psychosocial Influences), the volume offers a comprehensive look at suicide prevention from leading experts in the field. A combination of treatment strategies involving pharmacotherapy and psychotherapy as well as psychosocial and public health approaches is recommended:

Identifying those at risk for suicide
Recognizing and responding to a suicide crisis
Identifying when to hospitalize patients at risk for suicide
Treating impulsivity and anxiety in suicidal patients
Treating suicidal patients who have substance-abuse problems or suffer from psychiatric disorders such as schizophrenia, bipolar disorder, and borderline personality disorder
Treating suicidal elders and suicidal adolescents
The psychotherapist's experiences with suicidal patients
The media's influence on suicide
Firearms and the role they play in suicide

To order a review copy of The Clinical Science of Suicide Prevention, please call Jennifer Tang at (212) 838-0230, ext. 257