By Farrokh Alemi, Professor of Informatics, George Mason University
Suicide prevention is getting a bad rap. Many are frustrated by its lack of effectiveness. It seems effective in some countries and for males, but in the United States, flagship programs such as the Veteran Affairs Suicide Prevention program have been accompanied with increased suicides and not a decline.
There are a bunch of reasons for this and one could be that current suicide prevention efforts focus on the wrong things.
Recently, the U.S. Air Force ordered a “pause” in operations, during which all ranks were trained to listen for signs of suicide. These types of suicide prevention efforts are often called resilience training. The idea is that a person is less likely to commit suicide if he or she has a strong social network.
This Air Force effort reflects a widespread belief that suicide is caused by life stresses. Many suicides seem to occur after unemployment, divorce, family dissolutions, and other life stresses. In a paper published in the Drivers of Health theme issue of Health Services Research, colleagues and I set out to test these factors on suicide using the massive data available within VA health care system. We examined a variety of life stresses that clinicians had observed in their patients. The paper is coauthored by Farrokh Alemi, Sanja Avramovic, Keith Renshaw, Rania Kanchi, and Mark Schwartz.
Many life stresses are classified as social determinants of health. Poverty, family dissolution, isolation, homelessness, unemployment, family history of substance use, and other stresses were included in our index of social determinants of health. The index was predictive of suicide and, not surprisingly, we could conclude that life stresses are correlates of suicide. The higher the index on social determinants of health, the more likely the patient would commit suicide.
But are these social determinants cause of suicide? We examined the combined impact of social determinants on suicide and medical illness/injury. There is a great deal of evidence that major depression, psychiatric illness, history of self-injury, end-of-life physical illness, and many other illness/injury are also good predictors of suicide. The question we asked is whether illness/injury and social determinants are independent predictors of suicide. Social determinants of illness did not explain any variation in suicide rates beyond what could be explained by medical illness/injury variables. We concluded that the more likely explanation for why people commit suicide is that they are ill, particularly mentally ill.
Mental illness causes both adverse life events and suicide and this can make it appear that adverse life events occur prior to suicide, and are associated, with suicide. Life events do not cause suicide because these events are not related when we control for illness. Therefore, reducing adverse life events may not reduce suicides. It may improve wellness, and reduce illness, but it does not seem to prevent suicides. Improving the management of mental illness, better management of pain, and making sure that antidepressants are working correctly may reduce both adverse life events and suicide. You can read the full report here.
Farrokh Alemi is professor of informatics in the Department of Health Administration and Policy at George Mason University. Follow him on Twitter at @DrAlemi.