Telling the Stories behind Suicide

The last session of CTSI Grand Rounds featured two assistant professors in the Department of Psychiatry at the University of Rochester Medical Center with strong ties to the VA Center of Excellence for Suicide Prevention at the Canandaigua VA Medical Center. The pair discussed using psychological autopsy to better understand the circumstances leading up to a suicide death.

Kimberly Van Orden, Ph.D., assistant professor of Psychiatry and former CTSI KL2 Career Development awardee at URMC, started the hour by examining the last words of local philanthropist and legend, George Eastman. Before taking his own life in 1932, Eastman left a note that read, “My work is done. Why wait?”

According to Van Orden, “a note like that doesn’t tell the whole story.”

Looking beyond that note, you can see that Eastman struggled with several issues that we now recognize as risk factors for suicide: social isolation, physical pain, and functional decline. Unfortunately, it is too late for us to save Eastman, but learning from his life and death could help researchers and clinicians save others who are at risk today.

The psychological autopsy is a way to learn from suicide deaths by looking at the constellation of circumstances a person faced prior to their death by suicide. The autopsy typically involves reviewing the victim’s medical records and speaking with their loved ones. Getting a more complete picture of a person’s life leading up to their death by suicide can help identify risk factors and barriers to care, with the ultimate goal of improving suicide screening and prevention.

Suicide is the tenth leading cause of death in the U.S., taking many more lives each year than homicide, and U.S. veterans are at particularly high risk.  According to VA data, an average of 20 veterans die by suicide every day, accounting for one in five suicides nationally.  

That is why Stephanie Gamble, Ph.D.,  assistant professor of Psychiatry at URMC became a research psychologist at the Center of Excellence for Suicide Prevention at the Canandaigua VA Medical Center. VA’s Office for Suicide Prevention started the Behavioral Health Autopsy Program in 2012 to standardize the way information about veteran suicide deaths was collected. The program reviews the medical records of veterans who have died by suicide and conducts semi-structured interviews with their bereaved loved ones to drill down to the root cause of veteran suicide deaths.

Some of the most interesting data to come out of this program were that approximately one-third of veterans who died by suicide received outpatient care within 30 days of their death, suggesting a large missed opportunity for intervention. In addition, 57 percent had no known prior suicide attempts and a vast majority had regular contact with family, which does not jive with stereotypes about veteran suicide. These findings highlight how difficult it can be to recognize signs of suicide risk and prevent death.  

Due to the way these data were collected, almost all veterans examined through this program accessed care in the Veterans Health Administration. Thanks to interviews with veterans’ loved ones, the VA was able to amass a list of recommendations to improve suicide prevention efforts across the VA. Those recommendations, which include reducing wait times, adding personnel, and improving communication are just the first step to making changes that can save lives.

If you missed this session of CTSI Grand Rounds, you can access the full presentation here.

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You can join us every Tuesday at noon for CTSI Grand Rounds to learn about collaborations and research projects fostered by the CTSI as well as resources we offer to the University community and beyond. This semester (Fall 2016) highlights collaborations between URMC and the Canandaigua VA Medical Center and provides information on how you can develop such a collaboration.

Michael Hazard | 11/17/2016

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