The Intersection of Suicide Research and Public Health Practice: Exploring Research and Practice for Populations at Increased Risk of Suicidal Behaviors

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Presenter: DeQuincy Lezine, PhD

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Our Presenter

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DeQuincy Lezine, PhD

P O P U L A T I O N S A T I N C R E A S E D R I S K O F S U I C I D A L B E H A V I O R S – S U I C I D E A T T E M P T S U R V I V O R S

EXPLORING RESEARCH AND PRACTICE

AIM: ADDRESS RESEARCH AND PRACTICE

• Review research related to individuals who have survived a suicide attempt (i.e., attempt survivors)

• Review clinical / public health practices that help attempt survivors

• Suggest concepts / challenges for the field based on lived expertise – the combination of professional background and lived experience

AIMS: CROSSROADS, TELESCOPES, BINOCULARS

• Connections • Trade • Conveyance

• Spotting • Distance • Stability

• Portable • Wide view • Depth / 3D

EPIDEMIOLOGY OF SUICIDAL BEHAVIOR

• CDC: 38,364 suicides (2010 data) • NVDRS (17 states): 11,958 suicides (2011) • States (ex. OK): 664 suicides (2012)

• CDC: 483,596 self-harm injury (2012 ED visits) • NSDUH: 1.3 Million adults attempted (2012)

• Approximately 515,000 attempt with medical attention • YRBSS: 1.2 Million HS students attempted (2011)

• Approximately 369,000 attempt with medical attention

POPULATIONS AND TERMINOLOGY

Suicide Suicide attempt

Suicide Attempts

Suicide attempt fatalities

Suicide attempt survivors

Suicide Suicide attempt

WHY CHANGE THE TERMINOLOGY THIS WAY?

Risk / Protective Factors

Suicidal Event

Risk / Protective Factors

Medical severity of Suicidal

Event

Prevent attempts

Reduce severity

Prevent suicides

PRIORITIZED RESEARCH AGENDA

Stakeholder Survey Results

• Top Tier: prevent re-attempts, continuity of care, provider training, affordable care

• Second Tier: ideator treatment, risk and protective factors, reduce stigma, community-level interventions, predict imminent risk

• Final Tier: biological treatments, lethal means, lifetime risk

Final Report (temporal ordering)

• Question 1: Why do people become suicidal?

• Question 2: How can we more optimally detect/predict risk?

• Question 3: What interventions prevent suicidal behavior?

• Question 4: What services are most effective?

• Question 5: What other types of preventive interventions?/

• Question 6: What existing or new infrastructure can be used?

SHIFT(ING) TO FOCUS ON IMPACT

Research Prioritization Task Force (Action Alliance)

• high-priority goals which – if met – could substantially reduce suicide burden

• define and articulate viable research pathways to reach those goals • identify and sequence the required studies • address the critical methodological and conceptual barriers to

these goals

• prioritize research needed across goals and pathways

• disseminate the final agenda & cultivate funding

EXAMPLES – PRACTICAL RESEARCH

• PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) • Care managers help physicians recognize depression, offer

recommendations, offer therapy, provide follow-up. • Reduced suicide risk

• ED-SAFE (Emergency Department Safety Assessment and

Follow-up Evaluation) • Brief, standardized screening for ED patients with suicide risk • Initiate intervention in ED, follow-up telephone calls • Results forthcoming

• Pediatric Suicide Prevention in Emergency Departments

(NIH RFA – to be awarded summer 2014).

COMMUNITY BASED SUICIDE PREVENTION RESEARCH

• Defined: Suicide prevention research conducted in partnership with community members, in particular the intended recipients of prevention (i.e., individuals at high risk such as attempt survivors).

• Improved cultural and internal validity, minimize harms, maximize community benefit (Macaulay et al, 1999)

• More salient and relevant, more meaningful, more likely to create social and policy change (Cahan, 2004; Wells et al, 2004)

• Improved understanding while producing action to promote community health (Israel et al, 1998)

• Also potential benefits for attempt survivors who are engaged – • decreasing depression (Li & Ferraro, 2005; Lum & Lightfoot, 2005) • Increasing life satisfaction (Thoits & Hewitt, 2001; Greenfield & Marks, 2004)

RESEARCH IN COMMUNICATIONS – WHO IS YOUR “AUDIENCE”?

Audience &

Exchange

Product

Price

Promotion

Place

WHERE ARE THOSE KEYS?

I’m looking for the keys to suicide prevention

Where did you last see them?

In the darkness of despair, pain, and hopelessness

Why are you looking over there?

The light is better over here.

I can offer the flashlight of lived experience.

PRACTICE IDEAS AND THEIR RESEARCH

Effective ideas

• Send a short caring letter (Motto & Bostrom, 2001; Kapur et al, 2010)

• Brief therapy and follow-up (Pan et al, 2012)

• Crisis support hotlines (Kalafat et al, 2007; Gould et al, 2007)

Possibly unhelpful or iatrogenic

• School-based suicide awareness programs (Gould et al, 2003)

• Screening without resources (Gould et al, 2003)

• D.A.R.E. (Drug Abuse Resistance Education) (Ennett et al, 1994)

POTENTIAL IMPACT OF CHANGING WHAT’S ALREADY THERE

• Mental / Behavioral Health Systems • Collaborative care in assessment, treatment • Zero Suicide approach

• Social marketing, communications, media

• Action Alliance effective messaging • Changing the public conversation

• Health in workplace settings

• “Mental health friendly” workplaces

WHAT SHOULD WE EVALUATE? – ASK THE COMMUNITY

• Peer support groups • Crisis respite care • Self-help resources • Technology-based supports • Speakers bureaus

INDIVIDUAL OR COMMUNITY?

Individual focus

• At risk of suicide / death • Completed suicide

• Failed suicide attempt • Stop their goal (death)

Community focus

• At risk of loss • Failed to keep them

alive and well • Successful recovery • Achieve our goal (life)

WHAT DOES EFFECTIVENESS MEAN?

Survival (suicide prevention)

Stop suicide attempt

Recovery

Post-traumatic growth

WHAT ARE OUR DESIRED OUTCOMES?

• “Help-seeking” = Receiving professional services • “Help-seeking” = (persistent) looking for community supports

or services

• Lower risk • Enhanced protection • Improved mental health / quality of life • Mental / emotional growth; finding meaning

CONTACT INFORMATION

DeQuincy A. Lezine, Ph.D. President & CEO

Prevention Communities drlezine@gmail.com

https://www.linkedin.com/in/drlezine Twitter: @drlezine

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