Print this page

The Director Discusses:

The search for understanding and prevention

Photo: John F. Greden, M.D.Messages such as this are always painful to write. Trying to make sense of a suicide or a suicide attempt, especially one involving a family member, friend, or other loved one is complicated, devastating, intense, wrenching, and prolonged. There are no easy answers about “why,” as those who have lived through an attempt and those who have survived the loss of someone close to them repeatedly convey.

Statistics demonstrate suicide’s pervasiveness: in the U.S., 30,000 - 35,000 people die by suicide each year, making it the third-leading cause of death among young people ages 15 - 24. Recent attention has centered on the elevated suicide rate among current and former military service members, who routinely deal with the stress of multiple deployments, living and fighting in combat zones, a high unemployment rate upon returning home, posttraumatic stress disorder (PTSD), traumatic brain injury, depression, and sleep disturbances. The same patterns are true for those in some other professions. For all who struggle, stubborn burdens of stigma hamper many from pursuing appropriate treatments.

Individuals and communities who have been touched by suicide understandably have wide-ranging reactions and ways of coping, and this is one of the most complex and difficult issues for our society to try to comprehend.  Yet we know some important facts that can guide us in working toward its prevention. We have the evidence and resources to begin to decrease suicide rates. It is time to do so.

As a starting point, we should recognize that suicidal thoughts are usually associated with underlying problems that can be treated. It has been demonstrated repeatedly that approximately 80% of those who died by suicide were struggling with depression. Recurring thoughts of death or suicide are characteristically a symptom of major depression. The same brain chemicals (neurotransmitters) such as serotonin are not only associated with depression and suicidal thoughts, they are also the focus of many treatments, such as selective serotonin reuptake inhibitors, the medications used most commonly to treat those with depression. Incidentally, despite concerns based on misinformation, antidepressants actually reduce long-term risks of suicide.

Our knowledge grows, yet the country has not successfully reduced rates of suicide. This calls for greater focus on detecting, treating, and counteracting underlying causes.

Prevention is our goal. But before any interventions can occur, awareness is fundamental. That is a focus of this newsletter. Training teachers, coaches, physicians, peers, and law enforcement experts to recognize signs that a person may be considering suicide is critical, explaining why we are so engaged in depression awareness and suicide risk education for school personnel, students, and communities.

What else can we do? We should be screening all high school students and those in medical settings for depression and related disorders and treating earlier. When coupled with effective interventions, these strategies work.

We know that psychotherapy can effectively reduce suicide risk by helping those struggling develop effective coping responses when thoughts of suicide arise amid stressful experiences. But as a nation, we need more experts to work psychotherapeutically with troubled youth. In response, our center, aided by the Frankel Psychotherapy Training Program, is seeking to fill at least part of this void.

Medications are essential for many with depression, bipolar, and related conditions. We should “spread the word” that for those with moderate or severe symptoms, those at highest risk, the combination of medications and psychotherapy is the most effective approach. And there are other steps, as described in the Depression Center’s Toolkit.

As a society, we must not accept either depression or suicide as unavoidable. We should emphasize that underlying causes of suicide can be treated. Learning from tragedies and working together, this major public health problem can be conquered.


John F. Greden, M.D.

John Greden, M.D., is executive director of the University of Michigan Comprehensive Depression Center, chair of the National Network of Depression Centers, and serves as vice president of the National Board of Directors for the American Foundation for Suicide Prevention (AFSP).


Read other messages from our director.