Suicide Prevention: Fundamental Considerations

September 4, 2014
J. John Mann, MD

Suicide is not being adequately addressed in terms of prevention, and part of that process is better education of mental health professionals and primary care physicians. More in this expert Q&A.

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Dr J. John Mann, presenter at the U.S. Psychiatric and Mental Health Congress, will be speaking in a symposium titled “Can Science Help the Clinician in Suicide Prevention?”

Q: Why does this topic continue to be important?

A: The suicide rate in the US is about the same today as it was in the 1950s. About 40,000 people died by suicide in 2011.1 It is the second leading cause of death in the age group 15 to 34 years. We need to do better at suicide prevention. About 20% of all suicides see a mental health professional within 30 days of their suicide. Most suicides have an untreated mood disorder. We need to improve the diagnosis and treatment of mood disorders.2 In the future, we expect biological tests will supplement clinical risk assessment.3

Suicide is not being adequately addressed in terms of prevention, and part of that process is better education of mental health professionals and primary care physicians.

Q: What aspects of this topic do you plan to cover?

A: I plan to describe a stress diathesis model of suicidal behavior4 and explain how prevention involves risk assessment and targeting aspects of both stressors such as an acute episode of major depression and the diathesis which includes mood regulation including pessimism, and reactive aggressive traits or decision-making. The impact on risk of access to lethal means, such as guns and alcohol use, are fundamental considerations in management of risk.

Q: How is this topic relevant to psychiatrists who consider themselves “medication management only” clinicians?

A: Use of antidepressants to treatment major depressive episodes is the single most effective suicide prevention measure in Western countries.2 Even when antidepressants are used, the dose and duration of treatment are frequently inadequate.

Risk reduction in depressed adults is largely determined by the degree of improvement in depression. Psychiatrists and other mental health professionals need to measure the degree of improvement by rating scales in order to optimize treatment response.

Dr Mann’s PsychCongress presentation takes place Monday, September 22, from 10:15 to 11:45 AM.

Disclosures:

Dr Mann is The Paul Janssen Professor of Translational Neuroscience (in Psychiatry and in Radiology) at Columbia University and Director, Molecular Imaging and Neuropathology Division at the New York State Psychiatric Institute. He is a Past President of the Society of Biological Psychiatry, the International Academy of Suicide Research and the American Foundation for Suicide Prevention. He is a member of Council and served as Program Chair for the SOBP. He is a Distinguished Life Fellow of the American Psychiatric Association and a Fellow of the American College of Neuropsychopharmacology.

Dr Mann received his medical degree from the University of Melbourne, and then completed his internship and residency at the Royal Melbourne Hospital. He was trained in Psychiatry and Internal Medicine and has a Doctorate in Neurochemistry. His research employs functional brain imaging, neurochemistry, and molecular genetics to probe the causes of depression and suicide. He has published 596 papers and edited 11 books on the subjects of the biology and treatment of mood disorders, suicidal behavior, and other psychiatric disorders and has been continuously funded by the NIH since 1984. In private practice, he specializes in the treatment of mood disorders and has been repeatedly named as America’s and New York Best Doctors by Castle Connolly.

Dr Mann has received numerous research and teaching awards, including the American Suicide Foundation Research Award, the American Association of Suicidology Louis I. Dublin Award, the New York State Office of Mental Health Research Award, the Klerman Senior Investigator Award from the National Depressive and Manic Depressive Association, the Columbia University Department of Psychiatry Medical Student Teaching Award, the Stengel Award from the International Association for Suicide Prevention, the Morselli Medal from the International Academy of Suicide Research, and the Mood Disorders Research Award from the American College of Psychiatrists.

Dr Mann is an Honorary Professor of the University “Ss. Cyril and Methodius,” Skopje, Macedonia, and received a Visiting Professor Award from the Royal Australian and New Zealand College of Psychiatrists.

References:

1. Centers for Disease Control and Prevention. Suicide and self-inflicted injury. http://www.cdc.gov/nchs/fastats/suicide.htm.
2. Mann JJ, Apter A, Bertolote J, et al. Suicide prevention strategies: a systematic review. JAMA. 2005;294:2064-2074.
3. Mann JJ, Currier D, Stanley Bet al. Can biological tests assist prediction of suicide in mood disorders? Int J Neuropsychopharmacol. 2006;9:465-474.
4. Heeringen K, Mann JJ. The neurobiology of suicide. Lancet Psychiatry. 2014;1:63-72. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2970220-2/abstract. Accessed September 2, 2014.