means used in about half of all suicides, with firearms ac-counting for the vast propor-tion of suicides in males across all ages categories. Poisoning is the most common method

Suicide ranks as the 2nd lead-ing cause of death in adoles-cents and teens and 10th among all cause deaths in the U.S., with nearly 43,000 people dying annu-ally. Considerable age, gen-der and racial/ethnic dis-parities exist with regard to its relative age-specific rank among all cause deaths.

Suicide rates have risen nearly 25% over the last 15 years. It is currently the second leading cause of death overall in the ages categories of 10-34 years and in every 5 year catego-ry: 10-14, 15-19, 20-24, 25-29 and 30-34 years. For males and females, aged 10-

74 years, U.S. suicide rates rose from 10.5 to 13.0/100,000 population between 1999 and 2014. Rate increases were highest among those aged 10 to 24.

Firearms continue to be the

SUICIDE IN THE U.S.: TRENDS, MEANS AND DISPARITIES

CENTER FOR INJURY EPIDEMIOLOGY AND PREVENTION AT COLUMBIA UNIVERSITY

THE INJURY TIMES

POLICY AND LEGISLATIVE INITIATIVES FOR PREVENTION

Dr. David Hemenway, Catherine Barber and Dr. Matthew Miller of the Har-vard Injury Control Re-search Center offer a unique and promising perspective on suicide prevention: The Means Matter Campaign. Hemenway and colleagues note that suicide prevention efforts have traditionally focused on improving men-tal health treatment; howev-er, the major successes in suicide reduction have had less to do with improving mental health and more to

INSIDE THIS ISSUE :

SUICIDE AND INJURY

PREVENTION

SUICIDE TRENDS 1

MEANS MATTER 1

SUICIDE MONTH 1

DRUG OVERDOSE 2

AMERICAN INDIANS 2

VETERANS 3

MILITARY DEPENDENTS 3

CTE 6

PTSD 6

TECH ENDS SUICIDE 7

UPCOMING RESEARCH 7

BULLYING 8

THE MEANS MATTER CAMPAIGN

do with limiting access to lethal means. How people attempt suicide plays a critical role in whether they survive, and limit-ing access to especially common and lethal means of suicide can have dramatic effects on the sui-cide rate in that population.

Hemenway notes that roughly 50% of suicidal crises are situa-tional and last for fewer than ten minutes, so the potential inter-vention period is brief. Further, while suicide attempt is a risk factor for subsequent suicide, only 10% of serious attempters end up dying by suicide. Ready

access to lethal means during a suicidal crisis, then, is a significant determinant of whether one lives or dies.

Hemenway notes that prior to 1960, the leading method of suicide in the U.K. was domestic gas. By 1970, how-ever, all domestic gas in the U.K. was non-toxic with a 33% drop in suicide rates. While there was a slight in-crease in non-gas suicides, the overall drop was driven by the fall in gas suicides.

(Continued on page 5)

(Continued on page 4)

SEPTEMBER IS

SUICIDE

PREVENTION

AWARENESS MONTH

World Suicide Prevention Day, September 10, 2016, is observed as a means of raising awareness, reaching out to those affected by suicide and connecting individu-als with suicidal ideation to treat-ment services. It is also a time to highlight the need to ensure that individuals, friends and families have access to the resources they need to address suicide preven-tion. - See more at: http://www.nami.org/Get-Involved/Awareness-Events/Suicide-Prevention-Awareness-Month#sthash.sGeOIAaS.dpuf

September 2016

ADDICTION , UNINTENTIONAL OVERDOSE AND SUICIDE RISK

risen steadily since 1999, with approximately 100 people now dying due to suicide every day.4 Understanding how and to what extent these parallel epidemics overlap, however, can be difficult as significant comorbidity exists between substance abuse disorders and other psychological disorders, such as depression.5

The precise epidemiological relationship between opioid abuse and suicide remains un-clear. Some fatal overdoses are unintentional; some are con-scious acts of suicide; and some

opioid abusers commit sui-cide through other means. Many intentional and unin-tentional overdoses may also be misclassified or of unde-

One-third of people who abuse opioids have reported a suicide attempt over their lifetime 1 with 20% of people who commit suicide testing positive for opiates, including heroin and prescription pain killers.1

Opioid addiction, including illegal drugs, such as heroin, as well as and prescription opiate painkillers, has risen dramatically in recent years with approximately 100 peo-ple per day dying due to opi-oid overdose.3 Suicide rates in the United States too have

PAGE 2 THE INJURY T IMES

termined intent. 6

Both opioid abuse and suicide disproportionately affect males,

Readily available, more dangerous substitutes may impede impact of the prescription drug initiative

(Continued on page 4)

EFFECTIVE SUICIDE PREVENTION APPROACHES INDICATED FOR AMERICAN INDIAN/

ALASKA NATIVES

Suicide means varies across race/ethnicity and gender. The suicide rate for American Indian/Alaskan Native males aged 15-24 is 2.1 times higher than that of other similarly-aged males.

Among the 12 Indian Health Service (IHS) areas, Alaska and Tucson tended to have the highest American Indian/Alaskan Native suicide mortality rates, 38.5 and 23.1/100,000, respectively.

Females comprise 56% of all suicidal behaviors --ideation with plan, intent and attempt, while males comprise 73% of suicide completions.

It is reported that a comprehensive sui-cide prevention program using local epi-demiological data has identified firearms as a risk factor in two thirds of the re-gion’s suicides. A program of safe firearm storage was developed.

Rigorous surveillance coupled with strong evaluation of culturally suitable intervention programs aim to address the racial disparities that persist in suicide rates in American Indian/Alaskan Native communities. Limita-tions of epidemiological methods, specifically small sample size and pow-er, have proved to be obstacles.

While some studies have reported age and gender adjusted American Indian/Alaskan Native suicide rates that are only slightly higher than the reported all races age and gender-adjusted sui-cide rate, studies comparing self-reported racial classification to racial classification on death certificates found a 30% underreporting rate among American Indian/Alaska Na-tives. While aiming to find large effect sizes is important in epidemiological research, this can have the unintended consequence of ignoring issues affect-ing smaller communities. Suicides and other public health concerns within

(Continued on page 5)

Male Female

Firearms Suffocation Poison Firearms Suffocation Poison

White 1 2 3 2 3 1

Black 1 2 3 1 3 2

Hispanic 1 2 3 3 1 2

Asian 2 1 3 3 1 2

American Indian/

Alaska Natives 1 2 3 3 1 2

RELATIVE RANK OF SUICIDE MEANS BY GENDER, RACE

AND ETHNICITIES

PAGE 3

INCREASED SUICIDE ATTEMPTS IN MILITARY DEPENDENTS COMPARED TO SIMILIARLY

-AGED NON-MILITARY ADOLESCENTS AND TEENS

Attempted suicide in U.S. military dependents is report-edly nearly double that of sim-ilarly aged, insured non-military dependents with rates of 23.1/1,000 injury-related hospitalizations compared to 12.2/1,000 in non-military dependents.1

While the psychosocial effects of parental military deploy-ment have been studied and documented including lower school performance; increased sleep difficulties; behavioral difficulties such as acting out, aggression, displays of uncon-trolled anger and an increase in mental health conditions such as anxiety, the relation-ship and links to suicide at-tempts in military dependents need further study.2-4

Less well understood are risk

factors related to suicides and types of parental deployment, social support and preventive measures that might mitigate or lessen attempted and com-pleted suicides in this popula-tion.

In 2014, the Pentagon’s De-fense Suicide Prevention Of-fice submitted a report to Congress detailing a proposal for further tracking of suicide related deaths. The National Center for Health Statistics

data on U.S. suicide could be compiled and compared with Defense Department data on military family members en-rolled in an ID card program. The duration for completion of the endeavor was estimated at 18-24 months at a cost of $1.2M. Stigma is one obstacle cited to gathering additional epidemiologic data on attempt-ed and completed suicides in military dependents that might be used to support community or school-based intervention efforts.

While the Army maintains a system for tracking data on suicide among family mem-bers, and it is on the radar of at least one other military branch, a mechanism to assure that “this information” will not be used to deny promotions and

advancement of the enlisted parents is needed to ensure the uptake of the program.

Additional work is needed to develop and evaluate effective interventions aimed at address-ing this disparity between mili-tary and nonmilitary adoles-cents and teens.

References: 1. Pressley, JC, Dawson PT and Carpenter, DJ.

Injury-related hospital admissions of military dependents compared with similarly aged nonmilitary insured infants, children, and adolescents. J Trauma Acute Care Surg. 2012 Oct;73(4 Suppl 3): S236-42.

2. Chandra A, Martin LT, Hawkins SA, Richard-son A. The impact of parental deployment on child social and emotional functioning: per-spectives of school staff. J Adolesc Health. 2009;46:218Y223.

3. Chartrand MM, Frank DA, White LF, Shope TR. Effect of parents’ wartime deployment on the behavior of young children in military families. Arch Pediatr Adolesc Med. 2008;162:1009Y1014

4. Jensen PS, Watanabe HK, Richters JE, Cortes

R, Roper M, Liu S. Prevalence of mental

disorder in military children and adolescents:

findings from a twostage community survey. J

Am Acad Child Adolesc Psychiatry. 1995;34:

1514Y1524.

VETERANS AND SUICIDE : TWENTY PER DAY , MOSTLY BY FIREARMS

Veterans groups are lauding a recent report from the U.S. Department of Veterans Af-fairs as a critical step in high-lighting a significant need among veterans. According to the recent, most compre-hensive report it has under-taken, the Department found that approximately 20 veter-ans committed suicide per day in 2014. These 7,400 individuals comprised 18% of all suicides in the U.S. despite veterans accounting for only 8.5% of the population. Ac-cording to the report, only 6 per 20 (30%) were enrolled to receive care in the Veter-ans Health Administration healthcare system.

The Veterans Administration hopes to use this new data to expand the support and assis-tance that is available to veter-ans. Lack of reliable data on the scope of the problem has hin-dered such efforts in the past.

Approximately 65% of those committing suicide were aged 50 or older, though rates were highest among those aged 18-29. Among those older than 70, rates were actually lower than in civilians of the same age group.

The disparity in veteran and non-veteran suicide has widened. From 2001 to 2014, the rate in males increased more than 32%, compared to a approximately 23% increase among civilian males. Female rates increased

more than 85%, compared with an approximately 40% increase among civilian fe-males.

Although deployments are up, the precise reasons for the es-calated risk among veterans are not fully understood. Dr. William Nash, a retired mili-tary psychiatrist, and col-leagues attribute it, in large part, to what they call the “moral injury” of war, the damage that can happen to one’s sense of moral certainty because of things one might have done, or not done, in war.

Because fewer than one third of the veterans committing suicide were enrolled in the

In 2014, 20 veterans committed suicide every day—comprising 18%

of all suicides nationally

VA healthcare system, an effective outreach program is likely going to be needed to have a significant impact on overall veteran suicide rates. Also worth noting is the particularly lethal means used by veterans. Two thirds of the 2014 veteran suicides were by firearm, a particularly lethal means. References:

http://www.va.gov/opa/publications/factsheets/Sui-cide_Prevention_FactSheet_New_VA_Stats_070616_1400.pdf h t t p : / / w w w . m i l i t a r y t i m e s . c o m / s t o r y /ve te ran s/2016/07/07/va -su ic ide -20-da i l y -research/86788332/

Suicide attempts in military

adolescents and teens are twice that

of non-military dependents

in white women, with suffo-cation being a more common-ly used method in Latino, Asian and American Indian/Alaska Native women.

While male suicide rates ex-ceed female rates across all ages, rising female rates are narrowing this gap. Between 1999 and 2014, the ratio of male to female suicides

PAGE 4 THE INJURY T IMES

with men committing suicide at approximately four times the rate of women. Men too are more likely not only to abuse opiates, but also for their opiate use to require emergency room visits or to end in overdose death.7

Understanding which opioid drug users are at risk for ei-ther suicide or accidental overdose is critical to offer-ing appropriate interven-tions. While those at risk for suicide require appropriate mental health care to address

underlying conditions, those at risk for uninten-tional overdose also need to

be offered harm and risk re-duction strategies.1 Research is continuing on correlates and individual traits that put individuals at risk for either suicide or accidental over-

SUICIDE IN THE U.S.: TRENDS, MEANS AND DISPARITIES

(Continued from page 1)

ADDICTION , UNINTENTIONAL OVERDOSE AND SUICIDE RISK

(Continued from page 2)

changed from 4.5 to 3.6.

American Indian/Alaska Na-tives and Whites have the high-est male and female suicide rates until age 65. Male suicide

rates were consistently lowest among Hispanics, Asians, and Blacks to age 65. Hispanic and Black females tended to exhibit the lowest rates. There are re-ported disparities in the recogni-tion of suicide risks as well as access to and reimbursement for mental health professionals once risks have been identified.

(Based on 2015 CDC “Facts at a Glance” and WISQARS data)

dose, including pain manage-ment, drug use patterns and underlying mental health condi-tions.1

It is critical that policies de-signed to address opiate abuse through limiting access also include features to treat those addicted and monitor substitu-tion effects that may be equally or more fatal.

References:

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730501/ (Published 9/2009)

Males Females

2. http://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.PDF(2015 Report)

3. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates (Data revised as of 12/2015)

4. http://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.PDF (2015 Report)

5. https://www.drugabuse.gov/publications/drugfacts/comorbidity-addiction-other-mental-disorders(Revised March 2011)

6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546666/ (Published 8/2015)

7. https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use (Accessed 8/2016)

Suicide ranks as the 2nd leading

cause of death in adolescents and teens and 10th

among all cause deaths in the

U.S.

Suicide rates are 3.6 times higher

in males than females

PAGE 5

THE MEANS MATTER CAMPAIGN

ference; numbers of sui-cides by other methods were roughly the same between high and low gun states, while suicide at-tempts were actually 19% higher in the low (HI, NJ, MA, RI, CT, NY) com-pared to high gun states (LA, UT, OK, IA, TN, KY, AL, MS, ID, ND, WV, AR, AK, SD, MO, WY).

This data holds clues for prevention: Expanding firearm safety efforts in gun owning communities to include suicide preven-tion may reduce overall suicide rates.

There is a growing move-ment to engage gun retail shops in suicide preven-tion. The New Hampshire Gun Shop Project is a coa-lition of gun retailers, sui-cide prevention advocates and gun rights activists. The shop developed suicide prevention materials for distribution through gun shops. Additional efforts are underway to develop relationships between

those in the field of injury prevention, mental health and those in firearm instruc-tion and to disseminate an educational module on sui-cide prevention in the New England states.

Physicians also have a role to play: By speaking to at-risk patients in crisis and their families about gun safety, such as suggesting the storage of one’s gun with a friend or in a safety deposit box so that it is not accessible during a crisis, more suicide deaths might be averted. Barber and Hemenway suggest that the emphasis should not be on questioning a patient about whether s/he owns a gun, but rather on providing useful information in the

In the early 2000’s in Israel, 90% of the suicides in the Israeli Defense Force were by firearm, many during weekend leaves. Beginning in 2006, soldiers were re-quired to leave weapons on base during leave. The over-all suicide rate fell 40%, driven by the drop in week-end suicides, while weekday suicide rates remained con-stant.

In the U.S. today, firearms account for only 1% of all suicide attempts but for ap-proximately 50% of suicide deaths. Dr. Hemenway notes that guns are accessible in the U.S., highly lethal, fast and irreversible. Indi-viduals in “high gun” vs. “low gun” states were almost twice as likely to have a completed suicide. The dif-ference in prevalence of sui-cide by firearm (63% vs. 28%) accounts for this dif-

event that s/he does.

Public education efforts on this front are increasing as suicide prevention advocates attempt to identify and reach at-risk persons outside the health care system. For more information on the Means Matter Campaign, go to: h t t p s : / /www.hsph.harvard.edu/means-matter/

(Continued from page 1)

“Firearms account for only

1% of all suicide

attempts but for half of

suicide deaths”

EFFECTIVE SUICIDE PREVENTION APPROACHES INDICATED FOR AMERICAN INDIAN/

ALASKA NATIVES

American Indian/Alaskan Native nations and communities are among such issues.

References:

Olson, L.M. and Wahab, S. “American Indians and Suicide: A Neglected Area of Research.” Trauma, Violence, & Abuse Vol 7 No 1, January 2006, 19-33.

http://www.cdc.gov/nchs/data/hestat/suicide/rates_1999_2014.htm#Fig2

Great Lakes Inter-Tribal Council, Inc. Suicidal Behaviors Among American Indian/Alaska Native Populations: Indian Health Service Resource Patient Management System Suicide Reporting Form Aggregate Database Analysis, 2003-2012 funded by the Indian Health Service, Division of Behavioral Health. Lac du Flambeau, WI: Great Lakes Inter-Tribal Epidemiology

Center, Great Lakes Inter-Tribal Council, Inc.; 2013.

(Continued from page 2)

Studies comparing self-reported racial classification to racial

classification on death certifi-cates found 30% underreporting

among American Indian/Alaskan Natives

ers indicate that their recent numbers are very consistent with past research on the link between football and trau-matic brain injury.

The disease can be difficult to pinpoint as onset often occurs several years after brain injury and, while brain scans have been used to identify the signs of CTE in living players, autopsy is still consid-ered the gold standard for diagnosis.

It is thought that the development of CTE is linked more closely to repeated minor injuries rather than to compara-tively few severe ones. Symptoms in-clude memory as well as concentration and attention problems, aggressive tendencies, as well as several symptoms which led to increased suicide—mood swings, impulsivity and depression.

The NFL has publicly stated that it is dedicated to improving the safety of

football and taking “steps to protect play-ers, including rule changes, use of tech-nology for detection, and expanded medi-cal resources.” The league has also revised safety rules in an effort to minimize head-to-head hits and made contributions to the research at Boston University, the NIH, and other related organizations.

The numbers of suicides linked to CTE and their high profile nature are catalyz-ing a larger body of research with more methodological rigor.

References: http://www.ncbi.nlm.nih.gov/pubmed/24178363

http://www.ncbi.nlm.nih.gov/pubmed/24328030

http://www.forbes.com/sites/alicegwalton/2012/12/05/the-stages-of-repetitive-brain-injury-learning-from-the-brains-of-athletes-veterans-and-one-head-banger/#5e257c2048f1

http://www.pbs.org/wgbh/frontline/article/new-87-deceased-nfl-players-test-positive-for-brain-disease/

The connection between Chronic Trau-matic Encephalopathy (CTE), a poten-tial consequence of traumatic brain inju-ry, and suicide has received much atten-tion following the suicides of multiple NFL players and U.S. war veterans from Iraq and Afghanistan.

Researchers at Boston University and the Department Veterans Affairs have identified CTE in 131 of 165 individuals whose brain tissue they have examined who had played football either profes-sionally, semi-professionally, in college or in high school. CTE was identified in 96% of the NFL football players and in 79% of football players more generally.

Those who have donated their brains for testing tend to be families of or those who suspected they had CTE while liv-ing, potentially giving researchers a skewed sample. Nonetheless, research-

PAGE 6 THE INJURY T IMES

CHRONIC TRAUMATIC ENCEPHALOPATHY

Based on data from the 2001-2003 Na-tional Comorbidity Survey Replication, the adult twelve-month prevalence of post-traumatic stress disorder (PTSD) is 1.8% among men and 5.2% among women. However, the prevalence among high-risk subgroups is much higher. A 2008 study estimated the current prevalence of PTSD to be 13.8% among veterans deployed in Operation Enduring Freedom and Op-eration Iraqi Freedom (Afghanistan and Iraq).1

A systematic review of the relationship between PTSD and completed suicide examined 22 studies of attempted sui-cide and noted an increased risk of at-tempted suicide among those with PTSD.2 A study published last year using data from the National Epidemio-logic Survey of Alcohol and Related Conditions found that the risk of sui-

cide attempt differs depending on the number and types of trauma experi-enced. Increased suicide attempts rang-ing from a 28%-37% increases have been reported for those attacked, beaten or injured by a caregiver as a young minor; sexually assaulted, molested, or raped. In contrast, only 0.9% of those with no history of trauma reported having at-tempted suicide. In addition, the rate of suicide attempt was found to be a func-tion of the number of separate traumas; 3.3% of subjects with one or two trau-mas reported having made a suicide at-

tempt, compared with 36.9% of subjects who experienced ten or more traumatic events. 3

Mental health professionals and injury prevention advocates are working to ad-dress and elucidate the relationship be-tween PTSD and suicide, the role of comorbid psychiatric disorders as well as personality traits and pre-trauma psychi-atric states. 4

References: 1. Gradus JL. “Epidemiology of PTSD.” PTSD:

National Center for PTSD website. http://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp.

2. Krysinska K, Lester D. Post-traumatic stress disorder and suicide risk: a systematic review. Arch Suicide Res.2010;14(1):1-23.

3. LeBouthillier DM, McMillan KA, Thibodeau MA, Asmundson GJG. Types and number of traumas associated with suicidal ideation and suicide attempts in PTSD: Findings from a U.S. nationally representative sample. J Trauma Stress. 2015;28:183-190.

4. Krysinska, 2010.

POST-TRAUMATIC STRESS DISORDER AND SUICIDE

History of child abuse is linked to

increased suicide risk in adults

Currie notes that statistically most students who commit suicide have not come to the attention of college counseling centers, “so if we’re sit-ting in the counseling center, waiting for those students to come to us, we’re in big trouble.” 2

Dr. Eric Caine, director of the CDC-funded Injury Control Research Cen-ter for Suicide Prevention at the Uni-versity of Rochester Medical Center (ICRC-S), notes the need to develop new public health, community-based approaches to preventing suicide. This is consistent with the goals of

Action Alliance, the Public-Private Partnership Advancing the National

College campuses have traditionally struggled with suicide prevention efforts as the majority of students who commit suicide do so without having come to the attention of the campus mental health services.

Georgia Tech is now addressing this issue with its newly introduced “Tech Ends Suicide Together” campaign, which aims to eliminate suicide on its campus. The school has reported lower rates of sui-cide, one per year on average, than the national average for schools of its size, but the school has taken the stance that even one suicide is too many.

The “Tech Ends Suicide Together” cam-paign derives from an international initia-tive, the Zero Suicide initiative, that has been implemented previously in healthcare settings. Lacy Currie, coordi-nator of the suicide prevention and crisis response program in the school’s counsel-ing center, and Toti Perez, director of the counseling center, began discussing what developed into the “Tech Ends Suicide Together” campaign after hearing a report on NPR last fall about the Zero Suicide initiative. While Currie notes that suicide prevention work has typically been “a lonely effort, with the responsibility fall-ing mostly on mental health profession-als,”1 this campaign looks to engage the Georgia Tech community very broadly in prevention efforts, in all departments from housing to athletics. Bringing pre-vention efforts beyond traditional mental health services to identify at risk individu-als may be a critical step in prevention.

PAGE 7

Strategy for Suicide Prevention. For suicide prevention efforts to prove successful, they cannot simply be relegated to the offices of mental health professionals. Community level outreach and awareness of risk-related behav-ior is a necessary element for improved and timely access to mental health services.

For additional information on the “Tech Ends Suicide Togeth-

er” campaign, go to: http://www.endsuicide.gatech.edu

To read Action Alliance’s Prioritized Research Agenda for Suicide Prevention, go to:

http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/Agenda.pdf

References: http://news.wabe.org/post/georgia-tech-launches-zero-suicide-campaign

THE “TECH ENDS SUICIDE TOGETHER” CAMPAIGN

The work of Columbia University Mailman practicum and thesis students who exam-ined suicide issues across data sources and in different populations will be forthcoming later in 2016 or early 2017. The work of Emily Cleveland Manchanda and Rebecca Sabo is currently embargoed pending agency reviews. Emily Cleveland's work will look at the issue in the context of firearm ownership among U.S. Veterans (Supervisors: Drs. Matthew Miller and Deborah Azrael, Harvard ); also currently em-bargoed, Rebecca Sabo's work examines racial and ethnic disparities in suicide be-tween 2005 and 2013 using data from the National Violent Death Reporting System (NVDRS) (Supervisor: Dr. Rashida Dorsey of HHS). Rebecca Sabo holds a Bachelor’s of Science in Foreign Service with a certificate in International Development from Georgetown University and is currently a second-year MPH student in Epidemiology. Prior to coming to Mailman, she was a consultant for the Inter-American Develop-ment Bank’s Emerging and Sustainable Cities Initiative, where she helped develop the Initiative’s methodology and brought technical experts and political stakeholders to-gether to create action plans for the cities of Montego Bay (Jamaica), Managua (Nicaragua), San José (Costa Rica), Santa Ana (El Salvador), Bridgetown (Barbados), and Nassau (The Bahamas).

COLUMBIA EPIDEMIOLOGY STUDENTS WORK ON SUICIDE TO

BE RELEASED IN FORTHCOMING PUBLICATIONS

‘This campaign looks to engage the campus

community very broadly in prevention efforts, in all depart-ments from housing

to athletics’

Most students who commit suicide have not come to the attention of college

counseling centers, “so if we’re sitting in the coun-seling center, waiting for those students to come to us, we’re in big trouble.”

Counselors developed the “Tech Ends Suicide

Together” campaign af-ter hearing a report on NPR last fall about the

Zero Suicide initiative

The Injury Times-Serving Public Health Service Region II and Beyond

722 West 168th Street Columbia University

New York, New York 10032

E-mail for news and comments: jp376@cumc.columbia.edu

CENTER FOR INJURY

EPIDEMIOLOGY AND PREVENTION

AT COLUMBIA UNIVERSITY

FACULTY EDITOR: Joyce C. Pressley, PHD, MPH

STUDENT EDITOR: Susannah Lewis

CONTRIBUTORS: Chang Liu, MPH, Sabrina Dane, Caroline Hugh, Rebecca Sabo and Carol Liang

HTTP :/ / CUINJURYRESEARCH . ORG/

The Injury Times is focused on the health impact of legislative and policy issues of national importance. Send topics and story leads, articles or news to the Facul-ty Editor.

About the Center for Injury Epidemiology and Prevention

The Center for Injury Epidemiology and Prevention at Columbia University (CIEPAC) is based in the Department of Epidemiology at the Mailman School of Public Health and the Department of Anesthesia at Columbia University Medical Center. The Center is funded in part by a grant from the National Center for Injury Prevention and Control, Centers for Disease Control and Preven-tion. Our mission is to improve population health by reducing the morbidity and mortality from unintentional and intentional injuries through research, dissemi-nation and translation of scientific discoveries, development of innovative train-ing and education programs and promotion of best practices and evidence-based interventions.

Our objectives are to integrate expertise and resources, facilitate interdiscipli-nary collaboration, forge diverse partnerships, thereby, accelerating the advance-ment of science and practice in the injury control field.

PAGE 8 THE INJURY T IMES

On August 10th, a 13 year-old Staten Island boy, Daniel Fitzpatrick, was found dead by his sister in the fami-ly’s attic. Daniel had hanged himself after being frequently bullied by a group of five boys at school. In June, after Daniel had failed the year at school and its administrators had recommended him repeating the year at another institution, he wrote a now widely publicized letter detail-ing the lack of support he had felt from the teachers and other adults around him at school. He wrote that he had “begged and pleaded” for them to do something and that they had done nothing. Finally, having failed the year, he wrote that he did not care as he had at gotten out of the school and that was “all [he] wanted.”

According to the CDC, while it can-not be said that bullying directly causes suicide, bullying and suicide-related behaviors are closely linked. Any involvement with bullying be-

BULLYING AND SUICIDE : CDC REPORT SHEDS LIGHT

havior, even as an observer, is a stress-or that is associated with greater feel-ings of helplessness and less connected-ness to support from responsible adults. Those who bully or are bullied are at high long-term risk for suicide-related behavior, and those who are both perpetrators and also the victims of bullying exhibit the highest rates of negative mental health outcomes, in-cluding suicide ideation.

While the attention focused on the relationship between bullying and sui-cide is important for increasing aware-ness about the effects of such behavior, for highlighting the risk to the most vulnerable youth, and for encouraging conversation about the problem, the CDC cautions against framing bullying as a single, direct cause of suicide. This has the potential to perpetuate the idea that suicide is a natural response to bullying and could contribute to nor-malization of the response. Finally, such a framing also draws attention from other critical risk factors for sui-

cide, which may co-occur with bullying, such as mental illness, coping problems, family dysfunction and substance abuse.

The relationship between bullying and suicide is not a simple one. Most have a combination of risk and protective fac-tors. The goal in the prevention of bully-ing and suicide-related behaviors, then, is to reduce risk factors and increase protec-tive factors as much as possible.

The full report can be found at: http://www.cdc.gov/violenceprevention/pdf/bullying-suicide-translation-final-a.pdf

(Daniel Fitzpatrick’s story as reported in the Wash-ington Post) https://www.washingtonpost.com/news/morning-mix/wp/2016/08/16/a-boy-who-killed-himself-wrote-a-letter-about-bullying-his-struggles-may-have-started-at-home/

National Academies of Sciences, Engineering, and Medicine (2016). Consequences of Bullying Behav-ior In Preventing Bullying Through Science, Poli-cy, and Practice. Washington, DC: The National Academies Press. doi: 10.17226/23482.