RESEARCH
Researching the causes of suicide
About 30,000 people end their own lives in the United
States each year, according to the American Association of Suicidology,
and up to 760,000 people are estimated to make attempts. Among American youth aged 15 to 24, it ranks as the
third most common cause of death, claiming almost 4,000 lives a year.
For Dr. David Brent, these numbers mean that suicide,
and its accompanying behavior, deserves much closer investigation than
it has received in the past. Brent is the Professor of Psychiatry, Pediatrics, and
Epidemiology for the Western Psychiatric Institute and Clinic and serves
as a professor of psychiatry at Pitt's School of Medicine.
On Nov. 25, 2003, Provost James Maher named him the
inaugural endowed chair in suicide studies. It was a first-of-its-kind
position, providing Brent with valuable funding for research into a
subject that he described that day as “easy to avoid, because the act of
suicide goes against the thing we hold most dear: the preciousness of
life.”
Former Surgeon General Dr. David Satcher, reports by
the Institute of Medicine and the National Institute of Mental Health
all call for the creation of suicide research centers, drawing attention
to the subject in the medical community.
During a recent interview Brent said that research in
the field today, while valuable, is still very conservative in its aims.
“For the most part, the way peer review works is that
they want to bet on things that are pretty sure things, and that tends
to be not that innovative," he said. "Therefore, it's great that [Pitt]
has that kind of faith in me, because what it allows me to do is to
sometimes bet on my instincts and do something that is a little more out
of the box.”
Such “out of the box” thinking includes investigations
not only into known risk factors, such as mood disorders, but also
focusing on the familial and genetic aspects of suicide and how such
behaviors are passed down. Brent said that he has found there to be a
vulnerability to suicidal behavior that can't be explained away by mood
disorders alone. A history of trauma in a family and a difficulty in
regulating emotions and aggression are large factors as well. “So, somebody is sad, they may have thoughts about
suicide, but with this additional vulnerability they may be more likely
to actually do something,” he said. “Some of it is probably genetic,
some not. But if we can understand more about that, then we may be able
to prevent the onset in the next generation.”
Building on these findings, Brent is currently using
the financial clout of his newly endowed chairmanship to fund a unique
study in Israel. The study involves interviewing and taking genetic
samples from people in a large extended family, all of whom live in a
village there that happens to have a high rate of suicide. For Brent, his work has always revolved around the
exploration and treatment of suicidal behavior in young people. He
founded and directs a program for suicide prevention, professional
education and at-risk youth and parent treatment called Services for
Teens at Risk (STAR).
According to Brent, the road to focusing on this
population segment was first paved by the children he saw during his
training at Children's Hospital in the late 1970's who had intentionally
overdosed on drugs. He said that the available information and medical
literature about what caused such behavior, especially among young
people, was severely lacking at the time. “I realized that I didn't have a very good way to
assess them or treat them, and it seemed like a very frequent and
important problem,” he said. “By focusing on suicide, you're really
focusing on something that's rather general, because there are many
pathways to it.”
Following a 200 percent increase in suicide rates
between the 1950's and the 1970's among Americans aged 15 to 24,
according to the AAS, there was stabilization or slight decrease in
those rates in recent decades, with 13.2 deaths per 100,000 people in
1990 compared to 9.9 per 100,000 in 2001. But Brent thinks that the
depression that causes suicidal thoughts is a much larger problem. “Ten per 100,000 means it's very hard to find the
people you really think are at risk,” he said. “You need to identify
people who have other problems, you know, alcohol problems or
depression, even if they aren't going to commit suicide, they still need
help.”
According to the AAS, in 2001 Pennsylvania had 1,276
reported deaths by suicide with a rate of 10.4 deaths per 100,000
people, which is slightly below the national rate of 10.8. The highest
rates of suicide on a state-by-state basis were found in the Western and
Mountain zones of the United States, which accounted for 9 of the top
10.
According to Brent, cultural changes can be a factor
in suicide rates. An example of this can be found in groups like the
Native Americans, who have the highest overall suicide rate of any
ethnic group in the United States. “If you look among Native American tribes, the suicide
rates are quite high among the tribes that have the least amount of
traditional cultural affiliation," he said. "If you look in Micronesia,
in studies that have been done there, the suicide rate is the highest
among those that are under going the most cultural transition.”
Brent is also set to do a study that will look at the
psychological and pharmacological treatments for people who have
previously attempted suicide. According to the AAS, there are an
estimated 5 million such Americans living today. He said such individuals tend to be excluded from many
clinical trials because their participation is generally considered to
be too much of a risk. This was an issue he focused on during the
lecture, titled “The Risk of Doing Nothing,” that he gave at the Frick
Fine Arts auditorium upon his installment in November.
“The main challenge is dealing with the ethical issues
of treating people who are at very high risk, but the flip side is that
it's also unethical not to study these people because, in essence,
you're condemning them and their treatment to perpetual ignorance,” he
said.
“So there has to be some way to do things in an
ethical manner, and yet move the field forward, although it's not easy.”
By Christina Niedan
8 March 2004
http://www.pittnews.com/vnews/display.v/ART/2004/03/04/4047405e8e9a4
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