Thursday, October 6, 2011

Bending the Curve on Suicide By Thomas Insel, M.D. NIMH Director There has been so much concern in the mental health community about cutbacks in services and potential changes in funding, it’s easy to overlook an important, positive change in policy. Earlier this month, the White House announced that henceforth, soldiers who die by suicide while deployed in a war zone will be recognized just as others who die in service to this country. In an extraordinary statement, the President noted, “They didn’t die because they were weak.”

 This statement was followed by a White House Blog post from the Army Vice Chief of Staff General Peter Chiarelli, who stated, “Many are struggling with the ‘invisible wounds’ of this war, including traumatic brain injury, post-traumatic stress, depression and anxiety. Any attempt to characterize these individuals as somehow weaker than others is simply misguided.”

Why this change in our approach to soldier suicides? Partly, this reflects recognition of the increasing rates of suicide in the military, rates that have doubled for the Army since 2004. While soldiers traditionally have lower rates of suicide relative to age and gender-matched civilians, the rates in the Army began exceeding civilian rates in 2008. Since 2010, more soldiers have died from suicide than in combat. What is driving this increase in suicide? An NIMH-Army collaboration, the Army Study to Assess Risk and Resilience in Soldiers (Army STARRS), has been reviewing recent suicides, as well as mounting a prospective study of new and active duty soldiers, to answer this question.

The results from reviewing 389 suicide deaths defy any simple or single explanation. There has been an understandable tendency to attribute the increasing rate to the rigors of a continuing war, with many soldiers experiencing multiple deployments and many affected by post traumatic stress disorder and traumatic brain injury. The risk for suicide has risen for all soldiers, regardless of whether they have been deployed, but the data show that a soldier’s risk for suicide is greatest while deployed. Army STARRS, modeled on the Framingham Heart Study, is still in its early phase, but over 17,000 soldiers have now enrolled.

We expect that the prospective study can build on these retrospective results to define risk factors for suicide, just as the Framingham study identified risk factors for cardiovascular disease…. By Thomas Insel, M.D. NIMH Director

The Weekly Spark – Week of November 11, 2011


SPRC has an immediate opening for a communications specialist supporting the National Action Alliance for Suicide Prevention
The person filling this position will be part of a nine-person team supporting the operations of the National Action Alliance for Suicide Prevention, the public-private partnership advancing the National Strategy for Suicide Prevention. The communications specialist will help increase the effectiveness and reach of the Action Alliance by promoting its goals and accomplishments among key stakeholders as well as the general public. Experience in developing and implementing print, internet, broadcast, and social media communications and strategies, and in developing and writing promotional materials (including press releases), is required.

For more information
Webinar discusses resilience in the aftermath of a traumatic event, Monday, November 14, 2011, 2:00- 3:00 p.m. ET
Following the experience of a traumatic or victimizing event such as combat or natural disaster, many individuals suffer some impact from the exposure but over time demonstrate resilience or the ability to “bounce back.” Others experience persistent adjustment problems and may go on to develop post-traumatic stress disorders. The webinar, Road Map to Resilience: Ways to Bolster Resilience and Well-Being,, discusses what distinguishes these two groups and examines specific ways to bolster resilience in six areas (physical, interpersonal, emotional, thinking, behavioral and spiritual domains).

For more information
“Place Matters” - webinar on addressing behavioral health needs of children and families in rural communities, Wednesday, November 16, 2011, 3:00-4:30 p.m. ET 
“Place Matters” A Conversation about Rural America and Social Determinantsexamines the impact of social determinants of health and effective practice to promote children's behavioral health in rural communities. Presenters Jessica Ulrich of the Carsey Institute and Joyce Sebian of the National TA Center for Children's Mental Health will introduce four broad types of rural places and explore their relationship to social determinants of health. Registration deadline is November 15.

For more information
University of Michigan Depression Center hosts 10th Annual Depression on College Campuses Conference, March 7-8, 2012, Ann Arbor, Michigan
This conference will focus on new research findings and innovative strategies to help college campuses integrate prevention, resilience, and positive mental health into their ongoing efforts to support student mental health. Agenda topics include: building strength and resilience in college students; addressing the needs of veterans and returning service members; and using educational theater to promote mental health awareness. Registration is free for students from any campus. The registration fee for non-students is $130 before February 1st, and $145 after February 1st.

For more information


Latina Adolescents and Suicide
Zayas, L. H., Hausmann-Stabile, C., & Kuhlberg, J. (2011). Can better mother-daughter relations reduce the chance of a suicide attempt among Latinas?Depression Research and Treatment, 403602. doi:10.1155/2011/403602.

Concerned that adolescent Latinas have a higher suicide attempt rate than their peers from other ethnic groups, a research team from Washington University explored the relationships among Hispanic cultural involvement, mother-daughter relations, and the risk of suicidal behavior among young Latinas living in the United States. Given that family conflict is a risk factor for suicide, and family communication and connectedness protects against suicide, the team theorized that Latina girls who were less involved with Hispanic culture (and more involved in the mainstream culture of the United States) would experience more family and maternal conflict, based on the differences between the two cultures, which in turn would raise their suicide risk.

The team interviewed and assessed 232 adolescent Latinas between the ages of 11 and 19, 122 of whom had attempted suicide in the previous six months. The mother-daughter relationship was based on an assessment of “muturality” – that is, “how attuned girls felt with their mothers” across six variables: empathy, engagement, authenticity, diversity, empowerment, and zest. An “acculturation” assessment was used to measure involvement in Hispanic (and U.S.) culture.

Previous research has indicated that “among Latina adolescents, low levels of family support and high levels of family conflict are associated with more internalizing behaviors” which raise the risk of suicidal behaviors. These internalizing behaviors include “withdrawn behavior (i.e., prefers being alone; does not enjoy very much; lacks energy; shy or timid), anxious depressive (i.e. frequently crying; feels unloved, worthless; worries), and somatic complaints (i.e., nightmares; constipation; headaches; tired).”

An analysis of the assessments revealed that Latina adolescents who had attempted suicide reported less mutuality with their mothers and higher levels of the internalizing behaviors associated with suicide risk. Girls with more Hispanic cultural involvement had better relations with their mothers, lower levels of the internalizing behaviors associated with suicidality, and a lower risk of attempting suicide. However, withdrawn-depressive behaviors were associated with in a statistically significant increase in suicide attempts even for Latina adolescents who had good relations with their mothers.

The research did not find any differences among the girls based on the country of origin of their families.

The authors of this study suggest that therapies traditionally used in the United States, which often stress individualism, may conflict with the family-centered values of Latino culture. The authors recommend using family therapies to treat Latina adolescents at risk for suicide. These therapies promote communication in the family, strengthen the mother-daughter relationship, and thus may reduce the risk of suicide for young Latinas. The authors also recommend helping Latino families understand how adolescent development and the acculturation process can strain the relationship between Latina adolescents and their parents, and how family engagement and communication can help relieve this conflict – and reduce the risk of a suicide attempt.

Link to Full Text


National News

Family crisis therapy helps suicidal teens, Psych Central, Nov. 3, 2011
A family-based intervention for suicidal adolescents in the emergency department can significantly improve rates of mental health follow-up treatment after youth are discharged, according to a new UCLA study. The researchers studied 181 youth who were admitted to one of two emergency departments in Los Angeles County due to a suicide attempt or because they had thoughts of suicide. Youth received either treatment as usual or an enhanced mental health intervention. The intervention included a family-based crisis therapy session designed to increase motivation for outpatient follow-up treatment, as well as supplemental post-discharge telephone contacts to support families in linking to outpatient treatment. Ninety-two percent of participants in the enhanced intervention group received follow-up care after discharge, compared with 76 percent of those receiving standard care (a clinically significant difference). The program was developed in response to the U.S. Department of Health and Human Service’s National Strategy for Suicide Prevention, which calls for increased rates of mental health follow-up care after treatment for suicidal behavior in the ED.
Link to Article
Spark Extra! Read the abstract of “An Emergency Department Intervention for Linking Pediatric Suicidal Patients to Follow-Up Mental Health Treatment”

State and Tribal News

Idaho :  Suicide prevention group releases new guide , The Idaho Statesman , Nov. 5, 2011 
The Idaho Council on Suicide Prevention has just released a new suicide prevention plan for Idaho. The guide contains information about Idaho suicide prevention goals as they relate to: public awareness; stigma reduction; gatekeeper education; behavioral health professional readiness; community involvement; access to care; survivor support; establishment of a suicide prevention hotline; leadership; and data.
Link to Article
Spark Extra! Check out Idaho Suicide Prevention Plan: An Action Guide
Illinois :  Helping heroes: Fighting suicide, not just fires, The Chicago Tribune, Nov. 4, 2011 
This Chicago Tribune article highlights the efforts of a Palatine-area firefighter who is working to make sure that appropriate mental health care is available for firefighters in need. Jeff Dill, a battalion chief with Palatine Rural Fire Protection District, founded the Firefighter Behavioral Health Alliance(FBHA) to educate firefighters and other emergency response personnel about mental health issues such as depression, post-traumatic stress disorder, and suicide. Dill founded the Alliance after Hurricane Katrina, when he tried to find counseling help to support local firefighters who had traveled south to help with disaster recovery efforts - and found that there were no local counseling services specifically geared to firefighters. “We get frustrated when counselors don’t understand our job,” said Dill. Workshops offered through the FBHA teach fire officers to recognize the signs of behavioral health issues among their staff and to provide guidance and resources. Dill, who returned to school to get a master’s degree in counseling, also offers counseling to firefighters and educates other counselors about firefighter culture.
Link to Article
Spark Extra! Learn more about the Firefighter Behavioral Health Alliance

International News

Ireland:  Students Beat World Record to Raise Mental Health Awareness, The University [University College Dublin] Observer, Nov. 2, 2011 
Nine hundred and thirty-five people took part in an unusual effort to raise awareness about mental health issues: a successful bid to break the Guinness World Record for “most people to write a story.” Students from universities across the country took part in the project, each one hand-writing one sentence on the manuscript being used for the story. The event came about partly through the efforts of See Change, a non-governmental organization that works to bring about positive change in attitudes toward people with mental health problems. “Stigma and silence around mental health problems are still huge issues even for this nation of storytellers,” said See Change campaign manager Kahlil Thompson-Coyle. “We’re using this literary theme to send the message that everyone had the power to re-write the story of how mental health is perceived.” The other organizations involved in the project were Fighting Words, an organization that promotes creative writing; the Union of Students Ireland, a national representative body for students; and Trinity Students’ Union.
Link to Article
Spark Extra! Check out the multi-authored story, which begins with University students Sarah and Sparky as the two main characters and then takes many twists and turns