$3.2 Million Boosts Center Devoted To Suicide Study, Prevention

October 29, 2001

Researchers at the nation's leading center for the study and prevention of suicide received a major boost this month when they learned they will receive $3.2 million from the National Institutes of Health to conduct research and training, expand their team, and establish a new venture with counterparts in China, where more than half the suicides among women worldwide occur each year.

The psychiatrists and psychologists doing the research are part of the Center for the Study and Prevention of Suicide at the University of Rochester Medical Center. The center was established three years ago and has quickly emerged as an international leader on suicide study and prevention. In the last two years its scientists have attracted $6 million in funding for the study of suicide, which costs the U.S. economy more than $100 billion annually.

A team led by Yeates Conwell, M.D., professor of psychiatry, will receive $2 million from the National Institute of Mental Health over the next five years to train researchers who focus on suicide. The funds will help attract doctors and scientists to study suicide, and to support their research efforts. The training program is the largest in the country devoted to suicide and will support the work of about one dozen specialists. Also taking part in the program are the University of Pittsburgh, University of Pennsylvania, University of Washington, and Weill Medical College of Cornell University.

The types of projects will depend on the scientists to be recruited. A researcher might identify a group at particularly high risk (for instance, men over age 75 are six times more likely than others to kill themselves), then design a specific treatment to reduce the likelihood of suicide in that group. Or a psychologist might come up with a general education program that aims to lower the overall risk in the general population.

"Suicide is a common and yet unrecognized behavior with tremendous public health significance," says Conwell, a geriatric psychiatrist who specializes in studying suicidal thoughts, suicide attempts, and completed suicides in older adults. "It's difficult to study, because of the stigma often attached to suicide. It can be difficult to find people willing to share their experiences in ways that we can learn from them. But often, people who do share their experiences benefit greatly."

Conwell credits a report earlier this year by U.S. Surgeon General David Satcher for increasing public awareness about suicide. At the same time, many people affected by suicides or who have tried to kill themselves are understandably reluctant to talk about their experiences. Nevertheless, Conwell says, "When there has been a suicide in the family, it can be helpful and important to talk about it and understand it the best one can."

While the raw number of completed suicides may seem low -about 75 in Monroe County each year, and about 30,000 in the nation - it's the third leading cause of death among young adults, and the eighth leading cause of death among all people in the United States. "More people die from suicide than by homicide, yet we all understand that homicide is a major assault on our communities," Conwell says. "Each suicide clearly influences many people, the survivors left behind. Every completed suicide has a profound impact on an average of six people in the immediate social network of the victim. And for every completed suicide, there are perhaps 20 or 25 attempted suicides."

An important resource for the group is its collaboration with Monroe County's office of the medical examiner. In the last 14 years university scientists have performed "psychological autopsies" on more than 300 people in Monroe County who killed themselves. Once survivors grant permission to participate in a study, the process includes interviews with family members and friends and analysis of other records in an attempt to discover what made that person vulnerable, and thus to identify factors that might make others susceptible.

A second grant recently received by researchers, for $1.2 million, focuses on suicide in China. The China-Rochester Suicide Research Center is headed by Eric Caine, M.D., the John Romano Professor and Chair of the Department of Psychiatry, and will include visits to Rochester by Chinese scholars who study suicide in that country, as well as visits by Rochester researchers to China. Collaborations are being established with the Chinese University of Hong Kong, the University of Hong Kong, and Dalian Medical School in north China.

The China connection opens up a new vista for researchers, says Caine. China is one of few places in the world where the suicide rate among women is as high as among men; it's also a culture with a much lower rate of homicide than in the United States. "We know that cultural and social factors play a huge role in suicide, and it's helpful to compare trends in the United States to those in another setting, like China."

The Rochester group is also leading a nationwide effort to identify and then publicize the best ways to prevent suicide. Caine and Conwell last year received a grant from NIH to bring experts together in a five-year process to review current efforts, develop a consensus of best practices, and discuss future research initiatives to reduce suicide.

"Medicine has really failed to look at suicide as a public health problem," says Caine. "If you take heart disease as a model, we addressed heart attacks by building expensive coronary care units during the 1960s. But that's really like closing the barn door after the horse ran out. To have an impact on heart disease, the country had to address smoking, diet, cholesterol levels and other lifestyle factors, which prevent the disease from emerging in the first place. Now we're trying to do something similar with suicide. We need to develop the knowledge and tools to prevent it."

It's the most comprehensive effort yet to pull together current findings about suicide. Among the factors researchers have discovered: Females are more likely to attempt suicide, but males are more likely to complete the act; the elderly are most at risk; access and experience with firearms, which are used in the majority of suicides, play a role, as do substance abuse and personality factors. Most important, nearly every person who attempts suicide has some form of mental illness, such as depression, which is usually treatable.

The group is looking at broad questions, such as how the media covers suicide and how coverage affects survivors and others. Researchers are also developing guidelines for people who suspect that a friend or loved one may be thinking about attempting suicide. An important audience will be doctors: In one study, among elderly people who killed themselves, 75 percent had seen a doctor within the previous month.

The university is home to an array of other studies on suicide. Kathryn Castle, Ph.D., is looking at suicide factors among minority groups. Caine and Conwell focus on suicide among the elderly; people older than 80 are most likely to take their own lives. Paul Duberstein, Ph.D., studies how personality and social factors play a role, and has found that people who have a wide range of interests and are more open to new experiences are less likely to kill themselves. Other researchers include Ken Conner, Psy. D., who studies the role of alcohol; Kerry Knox, Ph.D., who is evaluating a suicide-prevention model used in the Armed Forces; Scott Kim, M.D., Ph.D., who is looking at the ethical issues surrounding the study of suicide; and Valerie Borum, Ph.D., who is preparing to study suicide among African-Americans and in the deaf population.

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