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Published in News Stories on September 10, 2015

Suicide researcher ponders not just why, but when

Media Contact: Ruth Cummins at 601-984-1104 or ricummins@umc.edu.

When a person is considering suicide, they often grapple with depression, troubling life events or feelings of hopelessness - all considered common symptoms for those at risk. 

But what's the final trigger that will push a particular person to a suicide attempt? What causes that person to make the attempt tonight, but not yesterday, or instead, an hour from now?

The imminent risk factors of suicide and how understanding them can save lives is part of the cutting-edge research of Dr. Courtney Bagge, a University of Mississippi Medical Center associate professor of psychiatry. An expert serving on a National Action Alliance for Suicide Prevention task force, Bagge is sharing her findings on an international scale.

"My research identifies factors that may trigger someone to attempt suicide," Bagge said. "Why did someone attempt now instead of another day? We have lists of warning signs, but actually, there is very little research on this topic."

As the nation observes National Suicide Prevention Week Sept. 6-12, the latest statistics show that death by suicide in Mississippi is slowly rising and remaining just about the national rate. For 2013, the most recent data available from the Centers for Disease Control, the nation's suicide rate was 12.6 deaths per 100,000 population. Mississippi's rate was slightly higher at 13.01 deaths per 100,000 residents. In 2005, it was 12.5 deaths per 100,000 population, and 13.0 in 2010.

In 2013, 388 Mississippians took their lives, the statistics show.

Bagge
Bagge

Past studies on suicide focused on "who is likely to attempt suicide, but not when," Bagge said. "As clinicians, that's what we really want to know, and there's a paucity of research in that area."

Much of her work examines what occurs on the day a person makes an attempt, compared to days when the person didn't. Among her findings: "You are at increased risk for attempting soon after experiencing an interpersonal life event - say, a fight with a romantic partner or friend. If you are drinking alcohol, you are at increased risk for attempting soon after drinking, and this is regardless of whether you have a problem with alcohol, or your usual frequency or quantity of use. 

"We aren't sure exactly what all the (triggers) are, but we can't rely on having someone tell us they are thinking about or planning suicide. The majority of recent attempters tell us that in the week before their attempt, they didn't think of any plan or decide to act until three hours before the event."

Her research suggests someone treating a patient for mental health issues should design a distress coping plan personalized to that patient, even if he doesn't seem to fit the typical profile for someone at risk or denies thinking of suicide. A distress coping plan is similar to a suicide safety plan, but focuses on coping with distress in general "so that we can ultimately prevent suicidal acts," Bagge said.

Personalized warning signs should be detected and may include "a stomach ache or sweating," Bagge said. "It might be thoughts like, 'This is going to be a bad day,' or behaviors such as wanting to stay in bed, or emotions such as anger or shame."

The plan should include "ways to cope - a walk, a bubble bath, reading," Bagge said. "And they can hold ice in their hand. It's a very good strategy. It's very hard to think when you are holding ice."

If such coping strategies don't work, Bagge said, patients should "contact friends or family to serve as a distraction, and get out of the house to be around people. Try to list something on your plan that is open 24 hours, like Waffle House."

The next step addresses professional help, including a crisis line, therapist or physician. The final step is making the home environment safe, Bagge said. That can include having a friend temporarily take possession of firearms, or place them separately from ammunition under lock and key. 

"Sometimes, clinicians won't actually do a formal suicide safety or distress coping plan, and will just provide patients with the crisis line," she said.

Mann
Mann

De-stigmatizing suicide and regarding it as a public health issue also is important, said Dr. Joshua Mann, professor and chair of the Department of Preventive Medicine. "A large proportion of those who die by suicide have either mental illness or substance abuse issues," he said. "We need to try to reduce the stigma so that people can feel comfortable talking about suicide."

There's a death by suicide in Mississippi every 22 hours, statistics from the American Foundation for Suicide Prevention show, placing the state at 30th nationally. It's the third-leading cause of death in Mississippi for ages 15-24, and the fourth-leading cause of death for ages 10-14 and 25-44, the Foundation says.

Researchers say in the September 2014 issue of the American Journal of Preventive Medicine that there's no real evidence that research into suicide prevention over the past several decades has resulted in an overall decrease in suicide deaths or attempts. "More money is needed for suicide research so that we can look into not just the risk factors, but what triggers a suicide," Bagge said. "That's what I've been doing for the past five years.

"The next step in suicide prevention is to understand how the combination of historical and traditional risk factors can interact with triggers for the suicide attempt," she said.

In the September 2014 issue of the American Journal of Preventive Medicine, researchers cited 12 goals of the National Action Alliance for Suicide Prevention. They included ensuring those getting care for suicidal thoughts and behaviors are followed during treatment so that they don't fall through the cracks.

"People might go to the ER after a suicide attempt, and after they're discharged, many will not attend an outpatient counseling visit, and many more will not stay in treatment for more than a month," Bagge said. "We need to think of new ways of reaching individuals and securing ongoing treatment."

In April, Bagge was one of only three American researchers to present findings at a meeting of a World Health Organization (WHO) task force on health hazards. In October, she will present her findings on imminent risk factors for suicide attempts, with a special focus on acute substance abuse, at a WHO meeting in Geneva.

"I've interviewed over 450 attempters, all UMMC patients, about the 48 hours prior to their attempt and in excruciating detail," Bagge said. "When did they wake up? What did they do next? When did they first start thinking of suicide? Did any important life events happen to them? What happened the day before, when they could have been stressed, but they didn't make an attempt on their life?"

That questioning yields vital information for Bagge's ongoing research.

"Ultimately, we want to make sure patients have the strategies to deal with the stress and the triggers, even if they say they've never been suicidal," she said "It could save a life."

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