Suicide

What Causes Suicide?

People suffering from certain mental disorders may be at increased risk of suicidal behavior. Suicidal thoughts may also arise in reaction to external factors and situations entirely separate from mental illness. Furthermore, research suggests that some people may be at increased risk of suicidal behavior because of an inherited genetic factor.

Some common risk factors of suicidal behavior and ideation include:

• Diagnosed mental illness such as major depression, bipolar disorder, or post-traumatic stress syndrome (PTSD)
• Previous suicide attempts
• Alcohol or drug abuse
• Death of a loved one
• Financial stress
• Divorce or end of a relationship
• Military service
• Sexual or physical abuse
• Family history of suicide, violence, or mental illness
• Chronic pain
• Terminal or chronic illness
• Social isolation or loneliness
• Being lesbian, gay, bisexual, transgender, or non-binary in an unsupportive family and/or community

Suicide risk in children and adolescents may also increase in the presence of factors such as:

• Bullying
• Depression or anxiety
• Loss of a friend or loved one, or even an acquaintance, especially to suicide
• Questions about sexuality or gender
• Family conflict
• Drug or alcohol abuse
• Beginning treatment with or changing the dosage of some antidepressant medications

Is Suicide Hereditary?

Research has found a connection between a particular gene and an increased risk of suicidal behavior. The gene in question controls the production of a protein called brain-derived neurotrophic factor (BDNF). This chemical may be a factor in developing disorders such as bipolar disorder and Alzheimer’s disease. A particular gene variation also seems to be linked to an increased risk of suicidal behavior; the gene may be passed on through families.

However, it is essential to understand that just because someone possesses this particular gene, there is no certainty that they will exhibit suicidal behavior or even develop any mental illness. The gene is likely only one of many genetic and neurological factors that contribute to the problems. The development of the illness is probably a result of a complex interaction of all the elements.

It’s also likely that external factors can influence the ways that genes behave. Even if you possess the gene that increases your risk, it may be an outside event that triggers the suicidal behavior.

How is Suicidal Behavior Detected?

Spotting the earliest signs of suicidal thoughts or suicidal behavior in loved ones may be difficult, especially if they attempt to hide what they’re feeling. Some sufferers are open about their suicidal thoughts and seek help, but others keep their ideas a secret until it’s too late.

Some warning signs to watch for include:

• Talk of hopelessness
• Talk of feeling unloved or being a burden on loved ones
• Talking about suicide or researching suicide methods
• Fatigue or excessive sleeping
• Insomnia
• Irritability, anger, or moodiness
• Withdrawal from family or social interaction
• Violent or aggressive behavior
• Loss of interest in pleasurable activities
• Sudden change from a depressed mood to one that seems happy or relieved

How is Suicidal Behavior Diagnosed?

Anyone who experiences suicidal thoughts–or anyone whose child or loved one exhibits any warning signs–should not hesitate to seek diagnosis or treatment from a professional healthcare provider.

The diagnostic process for a patient exhibiting suicidal thoughts or who has attempted suicide will usually include steps meant to identify the cause of the suicidal thoughts. When a likely cause is identified, a treatment plan to control the suicidal behavior can be made.

• Physical exam and health history. A thorough physical exam may be aimed at ruling out health conditions that can cause suicidal ideation. A health history can spot exposure to risk factors or medication side effects that could be contributing to the problem.
• Laboratory tests. Blood tests can look for chemical imbalances that can have neurological effects. Drug screening can also identify problems with substance abuse, a common factor in suicidal behavior.
• Psychological testing. Your medical doctor may refer you to a mental health professional who may conduct exams and assessments to look for conditions such as depression, anxiety, bipolar disorder, or PTSD, which may trigger suicidal behavior.
• Family history and interviews. Especially in children or adolescents who exhibit suicidal behavior, healthcare providers will usually want to learn more about the sufferer’s situation from parents, teachers, and others.

How is Suicidal Behavior Treated?

The treatment plan for suicidal behavior will vary depending on the underlying cause diagnosed by your healthcare provider.

• Psychotherapy. A short-term course of psychotherapy is often prescribed for people who attempt suicide as a way to get suicidal behavior under control. Cognitive-behavioral therapy (CBT) is commonly used.  Dialectical behavioral therapy (DBT) is sometimes used in cases of repeated suicide attempts.
• Medications for mental illness. Many different drug treatments are available to treat suicidal behavior when it arises in conjunction with an underlying mental illness. Antidepressants may be prescribed to treat major depression; antipsychotics or mood stabilizers may be used if the underlying condition is bipolar disorder or schizophrenia.
• Care must be taken when initiating treatment (or changing dosages) of children or adolescents with certain antidepressants. In the short term, these medications may increase the risk of suicidal thoughts.
• Substance abuse or addiction treatment. In cases where substance abuse is the trigger for suicidal thoughts or behavior, a treatment program is typically recommended.
• Ongoing psychotherapy and family therapy. A combination of drug treatments and long-term psychotherapy is often effective in decreasing suicidal behavior. In many cases, the involvement of the sufferer’s loved ones in the treatment program is beneficial.

How does Suicidal Behavior Progress?

Beyond the obvious risk of death from a successful suicide attempt, long-term suicidal thoughts and behaviors can have lasting and severe health impacts. The effects of a chronically depressed mood can get in the way of daily functioning, leading to a cycle of destructive behaviors.

Risky and dangerous behaviors that sometimes go along with suicidal thoughts can threaten the sufferer’s health and safety and those around them.

And the physical damage caused by an unsuccessful suicide attempt can linger, even long after the suicidal behavior is treated.

Suicide Caregiver Tips

Caring for someone who is exhibiting suicidal behavior is terrifying and exhausting. Not only are you tasked with reacting appropriately in times of crisis, but you’re also expected to remain constantly on guard until an often-chronic problem gets better. To help both yourself and your loved one to cope, keep these tips in mind:

• Take suicide warning signs seriously. Know how you’ll need to respond in an emergency, and don’t hesitate to seek help when you think your loved one is in danger. Don’t leave the sufferer alone, and call for help immediately.
• Be frank about the problem. Don’t try to ignore your loved one’s suicidal behavior in the hope that it will go away or in fear that you’ll spur them to make a suicide attempt. Be sympathetic, supportive, and honest about your concern for them.
• Do what you can to encourage treatment. Your loved one may be resistant to seeking treatment, but you should let them know that you are supportive and help them get the treatment they need.
• Take care of yourself, too. The stress of caregiving will take a toll on you, and you’re likely to need help maintaining your own physical and mental health as you take care of your loved one. Be open with your family and friends about what you’re going through, and let them help. If you need more help, seek out a support group either locally or online.  

Suicide Brain Science

Scientists are trying to figure out why some people develop suicidal thoughts and behaviors while other people in similar situations don’t. Of special interest is the role that one particular protein plays in brain function.

Brain-derived neurotrophic factor (BDNF) is a protein that helps create new nerve cells in the brain and helps existing nerve cells survive and function. BDNF is produced inside brain cells at the direction of a specific gene referred to as, obviously enough, the BDNF gene.

Decreased levels of BDNF have been linked to the development of many different illnesses, including depression, schizophrenia, obsessive-compulsive disorder (OCD), and Alzheimer’s disease. Researchers have also discovered that some people possess a BDNF gene variant, called the BDNF Met variant, that may be less capable than other variants of producing the BDNF protein. Some scientists have suggested that people with the BDNF Met gene may be at higher risk of developing these illnesses, and at least one study has linked suicidal behavior to the BDNF Met gene, as well.

Suicide Research

Title: Peer to Peer Programs for Military Suicide Prevention (P2P)

Stage: Recruiting

Principal investigator: Craig J. Bryan, PsyD 

Whiteman Air Force Base

Whiteman, MO

In the current project, the investigators propose to test the efficacy of a peer-to-peer program entitled Airman’s Edge. The Airman’s Edge program plans to utilize peer mentors trained in specialized skills designed to impact suicide risk at multiple levels of the military community without creating “extra duties” that increase workload and interfere with mission demands. Peer mentors will introduce primary prevention strategies to their units that target broad-based risk factors across the entire population (i.e., sleep disturbance, social support, meaning in life, firearm safety) with secondary prevention strategies that target individual-level risk factors (i.e., crisis response planning, firearm safety counseling). Peer mentors will complete a structured training process using existing curriculum and procedures that have been tested and refined within military groups. Peers mentors will also participate in monthly consultation calls with the investigative team to receive ongoing support, share resources and lessons learned, and address challenges and barriers to program implementation.

The purpose of the Airman’s Edge peer-to-peer program is to influence indicators of suicide risk among military personnel at two levels, group and individual, consistent with the program’s hybrid design that combines group-based education and individual-level suicide prevention skills training. Therefore, the hypotheses are designed to examine outcomes and effects at multiple levels of the community, which could inform subsequent implementation and translational efforts. The following aims are proposed:

Aim 1: To test the efficacy of a peer-to-peer program to reduce suicidal behavior among military personnel.

Aim 2: To identify moderators and mediators of the peer-to-peer program’s effects on suicidal behavior.

Title: Combined TMS and Brief Cognitive Behavioral Therapy to Reduce Suicide

Stage: Recruiting

Principal investigator: Jennifer Marie Primack, Ph.D. MA 

Providence VA Medical Center

Providence, RI

High rates of Veteran suicide remain a tragedy. Rates of Veteran suicide have not decreased for ten years, despite the best efforts of the field. Those interventions that do exist have only modest effects, which are insufficient for the magnitude of the problem. This proposal will combine two treatments – brief cognitive-behavioral therapy (BCBT) and repetitive transcranial magnetic stimulation (TMS). Both interventions can reduce suicide and are available at Veterans Affairs Medical Centers across the country, yet to date, no one has combined these therapies. This proposal will test the effect of this combination and, if successful, will lead to a novel yet implementable new treatment to reduce Veteran suicide.

Title: CAMS Relational Agent System (CAMS-RAS) for Suicide Prevention (V-CAMS)

Stage: Recruiting

Principal investigator: Linda Dimeff, PhD 

Evidence-Based Practice Instituter

Seattle, WA

This Phase II study is a continuation of the Phase I feasibility study where the investigators fully met and exceeded project aims to design, build, and test the usability and acceptability of an avatar-based system, the Virtual-CAMS (V-CAMS, formerly called CAMS-RAS), for use by suicidal ED patients and medical personnel responsible for their care. Phase II includes a formative stage, during which the investigators will continue conducting usability and acceptability tests of new features, and a summative stage to conduct a clinical trial. SBIR Phase II project aims include: (1) Complete development of V-CAMS, including readiness for electronic health record integration; (2) Cultivate and utilize the advisory board so that V-CAMS is positioned to meet the needs of diverse healthcare systems and successful conduct of the proposed research; (3) Conduct usability/acceptability tests of new features with target end-users (suicidal patients, including those in the ED, medical providers) and key stakeholders (i.e., administrators); and (4) Conduct a randomized controlled trial (RCT; N=90) of suicidal ED patients comparing V-CAMS (n=45) to Care-As-Usual (CAU; n=45). Participants will be assessed at baseline while in the ED, and again at 7, 30, and 90 days. The investigators predict that V-CAMS participants will report a significantly greater decrease in suicidal behaviors and ED/hospital admissions and significantly greater increases in the use of behavioral coping skills, self-efficacy in coping with distress, and perceived helpfulness of patients’ ED experience and satisfaction with the app. This study, however, was paused due to COVID after February 2020, with a total of 31 participants recruited. The study later resumed at one site; however, because of COVID, there were fewer admissions for suicidal behavior to the ED; only 7 participants were enrolled before the study ended recruitment in December 2020. V-CAMS is now known as Jaspr Health (“Jaspr”). A telehealth clinical trial will be conducted with suicidal outpatients to compare the Jaspr-At-Home companion mobile app (JAH; n=30) and CAU (in addition to crisis safety planning; n=30). Participants will be assessed at baseline, 30- and 90-days after the initial session.