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Suicide rates in the United States have increased 25% to 30% since 1999. This is particularly true among youth aged 12 to 24, with increases of about 30% over the same period.
In Alachua County, Florida, where I teach and practice at the University of Florida, the baseline rate of suicides among youth ages 12 to 17 was about five. per 100,000 for many years, lower than the national rate of 13 per 100,000. However, by 2017, this completed suicide rate has increased to 27 per 100,000 and by 2018 we will reach a similar pace to 2017.
RELATED: More and more college students seek advice – but suicide remains a huge problem
Although mental health professionals are aware that depression and other mental and emotional disorders contribute to suicide deaths and have ideas or plans for suicide, stressors are more often cited, particularly because it is These include relationship problems, employment problems and financial problems, addictions and life crises. Suicides also take about twice as many lives as homicides, which attracts a lot more attention.
Our society is now aware that we are facing a national epidemic. The challenge is to identify and serve those at risk of suicide and suicide before this tragic outcome. In recent years, I have participated in important works that offer hope for early identification and prevention, including at the population level.
CURBING A HEARTBREAKING RECORD
Health care organizations have established a national patient safety goal to reduce suicide in health care, particularly in hospitals, promoted by the Joint Commission, a not-for-profit organization that certifies programs and programs. health professionals.
While I was working in Reading and at the Medical Center in Reading, Pennsylvania, from 2006 to 2011, I was approached by the nursing leaders about the tools and process of suicide screening for admitted patients , in accordance with the national security goal. While searching the literature, I identified the Columbia Suicide Severity Scale (C-SSRS) as a possible tool. It was primarily developed by Dr. Kelly Posner as a screening tool for suicidal tendencies in drug-seeking trials. She is now mandated by the FDA for psychiatric, neurological and endocrinological testing. This came after concerns about suicidal thoughts and risk behaviors associated with the use of these drugs.
The suicide severity scale of Columbia's suicide was one of a kind because it had predictive value for future suicide attempts, but I found that it was too much heavy to administer as a brief assessment. Convinced of the potential of the tool, I approached Dr. Posner to develop an abbreviated version of the test. She accepted the proposal and my research assistant, Udema Millsaps, and I developed an abbreviated six-point version. Posner's approval asked five questions about the idea of suicide and a question about previous suicide attempts.
In 2009, we implemented the first C-SSRS screening, integrated with the initial assessment of nursing in the electronic medical record, for all patients admitted to the Reading Hospital. We also developed a response algorithm for referral to mental health services or urgent security measures and a psychiatric response during hospitalization. We have also trained more than 600 nurses in his administration, with the help of Dr. Posner. The results, including feasibility and results, were very encouraging, including the reliability of the administration and the effective identification of patients at risk, and we presented them at national meetings.
Since then, I have also worked with nursing leadership at Cooper University Hospital over the years 2011-2013 to implement routine suicide screening using the C-SSRS screening as part of the program. initial assessment of nursing care. At that time, Dr. Posner had continued his work on the scoring of the C-SSRS screening and had developed a new official version that we happily adopted. Both Reading Hospital and Cooper University Hospital have adopted this new approach to suicide prevention.
However, the Columbia team has gone much further in promoting the implementation of C-SSRS screening, now recommending it for wide use in many settings, including our armed forces and the general public. . There is now a community version recommended for friends and family members if they identify someone close to them as being at risk of suicide.
THE SIX QUESTIONS
The first five questions focus on a person's feelings in the past month. These questions can be asked to people aged eight and over. They must be included in an emphatic conversation indicating the concern of the person and asked in a non-disarming manner.
• Did you wish to be dead or did you want to be able to sleep and not wake up?
• Have you ever thought of killing yourself?
If the loved one answers "yes" to question 2, ask questions 3, 4, 5 and 6.
If the person answers "no" to question 2, go directly to question 6.
• Have you thought about how you could do this?
• Have you intended to act on these thoughts to kill you, contrary to what you think, but you will certainly not act accordingly?
• Have you started to develop or elaborate the details of how to kill yourself? Do you intend to realize this plan?
• Always ask question 6: In the past three months, have you done anything, started doing something or prepared to do something to end your life?
Here are some examples you could mention: Have you collected pills? got a gun; given valuables; write a will or suicide note; held a gun but changed his mind; cut yourself; tried to hang you.
The potential of this work has only touched the surface of this critical problem, and it has many wider applications and possibilities for implementation. These include the combination of C-SSRS screening with risk monitoring training for implementation by teachers, counselors and student organizations, ranging from the intermediate to the college level. This includes in particular minority and culturally diverse populations, where the number of suicide attempts has also increased dramatically.
I am currently pursuing such opportunities for this tool as well as suicide awareness to be widely available with the ultimate goal of saving young lives.
If you have suicidal thoughts, call the National Suicide Prevention Service at 1-800-273-8255 (TALK). The website is National Lifeline Prevention Lifeline.
Andres Pumariega, professor of psychiatry, University of Florida
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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