Bourdain's CNN special — death by suicide is a serious public health issue

Bourdain's CNN special — death by suicide is a serious public health issue
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Today, CNN is paying tribute to Anthony Bourdain with a special episode of the late chef's hit Parts Unknown.  When news of the death by suicide of Bourdain, the chef, author and television host were revealed, food fans around the globe, international celebrities and even President Barack Obama, mourned his loss. 

It also seemed like many people who didn’t read Bourdain’s books or watch his show were drawn to candlelight vigils for him or those of other celebrities who die by similar means. Those people aren’t particularly fans or truly care about Bourdain. But their mood is lifted, by the camaraderie and support they find in this collective expression of grief.

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As psychologists who’ve studied depression and trauma over the past 60 years collectively, we have some thoughts on this we’d like to share. Our intention is to be respectful, recognizing that prevention or mourning events can serve important functions, without having any demonstrable effect on reducing suicide.

Death by suicide is a serious public health issue. It’s tragic and heartbreaking. Suicide is a particularly difficult issue for those who have survived attempting suicide and are frightened of what they will do if they ever confront such a situation again; loved ones of those who have attempted suicide and those who have died by suicide; and lots of people whose worldview has been shaken by the death by suicide of a celebrity whom they greatly admired and wished they could be like.

But suicide is still relatively infrequent and most importantly, predicting the time and place of the next suicide is almost impossible from known risk factors. In hindsight, loved ones and mental health professionals agonize over what signs they missed and if there was something they could have done to prevent such loss. But predicting the future, as well as where and how to intervene is so much more difficult. 

Calls for implementing programs to prevent suicide are often sincere and well-meaning. Understandably, there feels a sense of urgency to prevent another senseless death. We want to do something to show action and express support. But to our great dismay, popular strategies for preventing suicide are not effective. 

Fervently-appealing strategies, like marches, vigils and memorials, may be important for other reasons, like an expression of collective grief and support, but are unlikely to result in measurably fewer deaths by suicide. 

Dr. Stan Kutcher, a renowned expert in mental health research and policy, whose work has been conducted in over 20 countries, agrees. “I have never seen any evidence for this or any similar interventions that they lessen suicide rates. Nor have I seen any evidence that they may not increase suicide rates. We just don’t know.” 

Anti-stigma campaigns, like beyond blue in Australia or See Me in Scotland, abound. Despite extensive education targeted to the public to improve awareness of depression and suicide and combat the associated stigma, no study has demonstrated that this helps increase care seeking or decrease suicidal behavior. At best, awareness campaigns have temporary effects of the self-reported attitudes of the public who have been reached

 These facts are depressing — we know — but there are things we can do and not do to change this. 

The populations for which there are the most emotional appeals for reducing suicide are not necessarily the highest risk populations. Suicides among teens are particularly tragic, but relatively speaking this is not a high risk group.

We are often told that suicide accounts for about a quarter of deaths among teens. But in the vastness of Canada, that can translate into 140 boys and 58 girls per year. Some populations, like Native Americans have high rates of suicide and also low accessibility of acceptable, culturally appropriate services. We need to focus on these high risk groups. 

Relatedly, screening for depression and suicidal ideation in primary care or general medical clinics does not improve outcomes on population basis. Insisting on instituting this practice diverts scarce health care dollars. And, screening can be counterproductive. It can increase referrals of low risk persons, thus escalating already long wait times for those truly in need of immediate referral and follow-up.

Rather than screening everyone, we can concentrate on those already known to be at high risk who are in the critical junctures in their continuity of mental health care. Serious attempts and debts by suicide often occur at breakdowns in these connections. This means following up on those who have recently attempted suicide, or at particular risk of another attempt. If we focus on those who fall through the cracks and fail to attend follow-up, we have a real shot at saving lives. 

There are evidence-based, like means reduction, that could reduce death by suicide. For a variety of reasons, some sadly political, they don’t get used widely. We need to concentrate on implementation of these strategies known through rigorous research to be effective. Public health measures, like reduced availability of firearms — gun control — would not only be effective on the basis of productions suicide, but in reductions of other mortality.

We understand how disturbing death by suicide can be for the survivors: the family members and friends and even the loss to the greater society. But if we want to do something clinically effective as well as capitalize on financial and human resources, we need to be more strategic. Our best investments are not being made.

James Coyne is is an emeritus professor of psychology at the Perelman School of Medicine at the University of Pennsylvania, where he was a senior fellow at the Leonard Davis Institute of Health Economics. Joan Cook is a psychologist and associate professor at Yale University who researches traumatic stress and clinically treats combat veterans, interpersonal violence survivors and people who escaped the former World Trade Center towers on 9/11.