NIH Funds Continued Research in Suicide Prevention in China

Oct. 4, 2011
Grant will enable expansion of program in region and training of more investigators
Eric Caine, M.D.

The National Institutes of Health Fogarty International Center has awarded $1.1 million to the University of Rochester Medical Center in support of a program that for the last 10 years has been training people in China to investigate the causes and prevention of suicide.

“Across China, a cadre of people has developed who now are becoming rigorous researchers,” said Eric Caine, M.D., chair of the Medical Center’s Department of Psychiatry and principal investigator for the program. “It has been our goal to train researchers, engage partners and build a more effective training infrastructure that would help produce more sophisticated science.’

“The research that is occurring in China is public health oriented,” Caine said. “There are lessons to learn in public mental health and preventive psychiatry that are transportable to the United States despite cultural differences.”

Yeates Conwell, M.D.

Suicide is a major public health problem in China. It is the fifth leading cause of death overall, and the leading cause of death for individuals in the 15-to-34-year-old age range. Although China accounts for approximately 21 percent of the world’s population, according to a recent study, 44 percent of the world’s suicides among males and 56 percent of suicides among females in one year occurred there.

Caine and Yeates Conwell, M.D., professor of Psychiatry, who are co-founders of the University’s Center for the Study and Prevention of Suicide, began visiting China in 1999, initially collaborating with colleagues in Hong Kong to conduct psychological autopsies of people who had killed themselves.

In 2001, the Fogarty Center awarded a $1.2 million grant to the Medical Center that helped establish the China-Rochester Suicide Research Training Program, which is headed by Caine. Fogarty renewed the grant in 2006, funding an expansion of the network from Hong Kong to multiple centers in China. The new grant, the third in support of the program, will continue this work.

As a part of the program, researchers come from China to Rochester and the Department of Psychiatry, where they work with U.S. post-doctoral fellows and junior faculty. After a year, they return to China where they receive additional mentoring through visits by Caine, Conwell or other faculty and meet regularly over the Internet. So far, more than 20 Chinese researchers have been trained through this program.

In another program funded by a separate NIH Fogarty grant, Caine and other Rochester faculty have trained more than 30 researchers, who remained in China.

“All these researchers now are moving up the academic ranks and conducting investigations across China,” Caine said.

During the decade of work in China, Conwell said he has seen remarkable changes “in terms of the explicit commitment of our colleagues there to improving the care for people with mental illness in China and to addressing suicide as a public health problem, the resources they bring to bear, and the collaborative relationships that have developed over time.”

“Suicide requires a multidisciplinary approach, and we have been privileged to work with people from a wide range of disciplines all over the country and at all levels of service delivery, from the highest levels of government to the practitioners delivering care in neighborhood clinics,” he said. “We do this work because we learn in the process about service system design and, in particular, the population-based approach that is their typical orientation. It has been a real privilege to work with these talented and dedicated people, and to see the impact that collaboration and training can have.”

Recent published studies of which Caine is a co-author with researchers in China, for example, include a study of suicidal ideation and suicide attempts among rural Chinese aged 16 to 34 and a report on depression among migrant workers in China. Important studies also have come from the ongoing collaboration in Hong Kong that examine the relationship between suicide and employment status, using coroner data and regional employment data that would be very difficult to collect in the United State.

Conwell has been co-author with researchers in China on an article that investigated an increase in suicides among the elderly during the 2003 outbreak of Severe Acute Respiratory Syndrome in Hong Kong and another on mortality among people with schizophrenia in rural China. He now is involved in new studies using collaborative care models for the treatment of older urban dwellers suffering clinical depression.

The China-Rochester Suicide Research Training Program has developed alliances with major academic institutions and psychiatry departments in several cities across China, including Beijing, Hangzhou, Chengdu, Changsha, Shanghai and Hong Kong.

Caine said the new grant will allow the program to expand to more rural areas, add more mentors and increase the number of applicants. He also hopes to expand the program to other countries in the western Pacific region.

“There are questions than can be asked in China about public health approaches to suicide prevention that have potential applicability around the world. There are programs that we can develop there and bring back to the United States,” Caine said.

The Medical Center’s Department of Psychiatry has a unique group of experts who not only study the causes of suicide but also investigate and implement ways to prevent suicide. In addition to the research in China, faculty members have initiated suicide-prevention programs in dozens of high schools in New York and Georgia as well as among gay adolescents and young adults. Other faculty members study connections between childhood abuse, depression and suicide, domestic partner abuse and suicide and innovative ways to identify problems and prevent suicides.

A major collaborative undertaking with the U.S. Department of Veteran Affairs, the Veteran Affairs Center of Excellence for Preventing Suicide in Canandaigua, includes several Medical Center faculty members. In addition to his work in China, Conwell, along with other faculty members, is involved in several programs aimed at preventing suicides among the elderly. And several faculty members investigate ways to reduce post-traumatic stress and prevent suicide by veterans.

The five-year grant to the Medical Center is one of 14 valued at a total of $14.4 million awarded by the Fogarty International Center to research institutions to reduce the impact of the ongoing global epidemic of non-communicable diseases in developing countries.