In 1997 more than 30,000 Americans committed suicide. Accounting for 1.3 percent of all deaths in the United States that year, suicide was the eighth-leading cause of death. Among those 15 to 24 years old, suicide was the third-leading cause of death, with more youth taking their own lives than dying by all natural causes combined. The suicide rate for young men (aged 15 to 24) has tripled since 1950; for young women (aged 15 to 24), the rate has doubled during the same period.

These frightening statistics were the basis of the 1999 report "The Surgeon General’s Call to Action to Prevent Suicide". The report labeled suicide a public health problem similar to an infectious disease and called for a public-private partnership in combating the problem.

At a press briefing March 8 in Washington D.C., the American Foundation for Suicide Prevention (AFSP) announced new initiatives as part of its response to the Surgeon General’s call to action.

According to Herbert Hendin, M.D., the AFSP’s medical director and a professor of psychiatry at New York Medical College, the key to reducing the suicide rate in the United States will be in a three-pronged approach: educating, intervening, and committing to more research.

Researchers already have a core of basic knowledge about suicide and some of its causes. Hendin detailed that research has shown that 90 percent of individuals who commit suicide had a psychiatric disorder, most commonly depression or bipolar disorder, and were seen by a health care provider in the four weeks preceding their death.

"We will need to implement what we already know," Hendin told members of the press, "by educating health care professionals, the public in general, and suicide attempters and survivors; by intervening to more accurately screen for suicidal ideation; by more effectively treating these individuals; and by conducting more research to advance treatments and understanding the causes of suicide."

Robert F. Gebbia, executive director of the AFSP, announced the details of the foundation’s new public service campaign. Three new public service announcements (PSAs), two 30 seconds long and one 60 seconds long, began airing in mid-March on television and in movie theaters. Each features teens who have lost a family member or friend to suicide and focuses on the slogan "Suicide shouldn’t be a secret." Teens will often keep suicidal discussions secret for fear of the friend turning against them for having not kept the conversation in confidence. One segment poignantly shows a teen talking about a friend’s suicide. "I wish I had told somebody," the teen says to the camera, "It would have been better to lose the friendship than the friend."

Gebbia also displayed a new card titled "Preventing Teen Suicide—Today" that will be distributed to teens in schools throughout the country, as well as to school officials, guidance counselors, health care professionals, and youth groups. The card presents the risk factors and warning signs of teen suicide and gives steps that parents and teens can take to prevent suicide. Identifying those at risk for suicide is the key, according to Gebbia. The card provides the public with the information necessary to make that identification.

Research has shown that the teens at greatest risk for suicide are those who have attempted suicide previously, who are currently thinking about or discussing suicide, and who have depression or are abusing drugs and/or alcohol. Because so many with suicidal ideation and many who have attempted suicide go unnoticed and therefore untreated, researchers have been working on accurate and effective screening programs.

David Shaffer, M.D., the Irving Phillips Professor of Child Psychiatry at Columbia University and chief of child psychiatry at Columbia Presbyterian Medical Center, has been on the forefront of research into screening for these risk factors.

"Suicide is a severe, irreversible side effect of disorders that are not being effectively treated." Shaffer said. "Screening is the key; then we can case manage and treat effectively."

Shaffer’s research group has developed the Columbia TeenScreen, a self-completion questionnaire that screens for suicidal ideation, a recent suicide attempt, and a mood and/or substance abuse disorder. The TeenScreen is used in conjunction with the National Institute of Mental Health Diagnostic Interview Schedule for Children (DISC). Because of the association between suicidality and psychiatric disorders, those who screen positive on the TeenScreen are administered the DISC to determine whether a psychiatric disorder is present.

In a study announced at the AFSP briefing, Shaffer looked at 1,729 ninth- through 12th-grade high-school students in the New York City area. Students completed the TeenScreen in their classrooms. Shaffer found that 475 students, 27 percent of the original group, screened positive for suicidality, mood disorder, or substance abuse; of these, 319 were followed up for four to six years following their high-school screening.

Shaffer found that two-thirds of young people who experience suicidal ideation or depression in their 20s screened positive in high school. However, the reverse was not true: screening positive in high school did not mean the students’ problems will last. Also, the study found that students who did screen positive and were then found to have a psychiatric disorder by the DISC were significantly more likely to have suicidal or mood problems in their 20s. Interestingly, Shaffer found that requiring both a positive screen and a DISC-generated diagnosis may miss up to half of those individuals who will eventually have a poor outcome. However, the screening identified 73 percent of those who went on to be seriously depressed and 64 percent of those who later made a suicide attempt.

The AFSP is the only national private foundation that funds research into the cause and prevention of suicide. To date, the AFSP has funded more than 200 studies. A significant partner in this effort is Solvay Pharmaceuticals Inc. Two years ago Solvay President and CEO David A. Dodd committed Solvay to a $1 million pledge in the AFSP’s effort to build up a $5 million research fund.

At the March 8 briefing, Dodd presented Gebbia with a check for $250,000, the last installment on the pledge. Dodd then surprised Gebbia by presenting the AFSP with an additional $250,000 to cement the company’s commitment to continued funding in the future.

"We must not be shy about suicide;" Dodd said. "Research is the linchpin of treatment."