Eric Brandon Ngaba

EVALUATING SUICIDE INTERVENTION METHODS IN THE U.S.A Running Head: SUICIDE INTERVENTION METHODS IN THE U.S.A Evaluating Suicide Intervention Methods in the U.S.A: A research proposal. Within the United States of America, the youth are finding it increasingly difficult to cope with the stresses encountered in their lives; which is leading to some of them contemplating to end their lives through a process referred to as suicide ideation that often leads to suicidal attempts, with an even lesser chunk following through on these feelings by committing fatal suicide. While suicide happens across a wider age range, youth suicide is of particular interest because this is considered a malleable period of one's life, when they can still make something better out of themselves. For the purposes of this study, the term youth will encompass the statistically uniform range put forward by the United Nations: 15 years to 24 years (UNDESA). This range is meant to boost compatibility of studies whose topics spill into international territories so as to allow for comparison. It is important to understand the motivation for this act of desperation because it will help determine sound prevention measures for those involved. Of special importance will be the healthcare industry, specifically those involved in the diagnosis and treatment of mental disorders that are a major precipitator of suicide ideation. Currently, suicide among youth involves defining the following terms; suicide ideation, suicide attempt, and suicide death. The first, suicide ideation, refers to entertaining a "desire to end one's own life" which can vary from simply wishing for death to actively seeking methods of achieving it. (Cha et al., 2017). Suicide attempt, on the other hand, is when the person decides to act out the method they thought about during the ideation stage but is unsuccessful in fatally wounding himself/herself. A clarification is encountered in my reading that distinguishes suicide attempt from deliberate self-harm which is when someone injures themselves lacking suicidal intention. Finally, suicide death is defined as a "fatal action to deliberately end one's own life, as frequently determined by a medical examiner" (Cha et al., 2017). Research on youth suicide shows that it is on the rise in the United States, with various factors that will be introduced in later sections to blame. Highlights include a generally cynic attitude towards the current healthcare system, and society at large, in its ability to isolate and prevent a suicide-inclined individual from going through with the act. With this in mind, my research seeks to expand on existing work by looking at indications of suicide ideation leading to a suicide attempt in youths and using this to develop a model for the risk factors that turn ideation into the attempt. This is because the time between ideation and attempt presents a brief window for intervention which is often missed, yet can be worked on to improve the accuracy of predictions concerning when a youth under study will move from simply considering suicide to trying to take their own life. The purpose of my study is to conduct a survey on the effectiveness of current suicide prevention methods and address the underlying reasons for their relative success/failure in curbing suicide. It will involve quantitative questions revolving around what efforts yield most results in intervening a suicidal person's decision. These questions will be designed using the risk factors the literature review will have highlighted to hasten suicidal thoughts intensifying into actual attempts at cutting short one's life. This study is important because it will help streamline intervention efforts within the country by identifying what can be done to renew suicidal youths' will to live. The proposal begins with a literature review that will narrow down the scope of my research proposal, followed by the methodology which will outline the proposed data collection process. Literature Review: Looking at current research on the topic, youth suicide can be considered according to; what brings about its occurrence, trends in existing statistics that point towards its uprising, and the effect that various preventative efforts offer. Various academics have researched on the topic of youth suicide, but not always within the limits of the age definition being used in this proposal. For example, Gould et. al (2003) considered youth between the ages of 10 and 19 while Walker et. al (2017) considers individuals between 10 and 24 years of age. Nonetheless, synthesizing their contributions is a good way to grasp the essentials currently at play within the current epidemic of young. What causes the youth to commit suicide? While seemingly straightforward, this is a question that introduces a lot of variables each of which could influence one towards the act. In the end, any that are given cannot be referred to as 'causes' in a foolproof way because suicide is an act that leaves uncertainty in its trail; the people who go through with it cannot reasonably be called forth to explain their justifications. This leaves many of these 'causes' hinging on evidence some victims left behind or worse; accounts of suicide attempt which while generally indicative of the victim's mental working, do not always result in the final fatal act. For this reason, the factors that lead to suicide in youth are referred to as risk factors because they still warrant further experimental investigations to clarify whether or not such risk factors are purely coincidental with when the concerned starts to think about suicide. In trying to encompass these broad risk factors, Cha et, al. (2018) come up with three distinct frames under which suicide ideation can be considered; psychological risk-factors, environmental risk factors, and biological correlates. They break psychological risk-factors down into those that affect the victim emotionally, cognitively and socially. This is further explained using examples of how an emotionally affected individual might perceive themselves as worthless, or how socially isolated individuals might find themselves discouraged leading to suicidal thoughts cropping up. The preceding point is better explained by Walker et, al., who clarifies that in cases of loneliness, "the desire to die emerges from experiences of diminished or thwarted belongingness." (2017). Moving on, Cha et, al., define environmental risk factors as those that externally affect the individual's will to live and can range from bullying to sexual abuse from those close to them. They also touch on biological correlates; including how the hippocampus "has been found to be structurally abnormal in suicide attempters." (Cha et, al., 2018). Earlier research on the topic relates similar risk-factors while offering other additions. One of this is violence or a tendency to engage in violent behaviors with Pena et, al., introducing us to the fact that violent behavior like "weapon carrying and fighting is likely to contribute to stressful life events such as legal problems, psychological trauma, injury, or being concerned over physical safety, which increases strain." (2012). Another important side of the youth suicide risk, as touched upon by both Pena et. al., and Gould et, al., (2003) is substance abuse. The authors list substance abuse as a contribution to youth suicide because it compounds existing anxieties or depressive disorders within the victim, resulting in the person being more susceptible to the onset of suicide ideation. While knowing the risk factors is an important first step, current statistics show that a lot more needs to be done to stem the increase in youth suicide. Trends in youth suicide indicate that it is on the rise. The latest statistics that show this was arrived at using data from the Center for Disease Control and Prevention by use of the Web-based Injury Statistics Query and Reporting System available on their website. The CDC maintains a database of all fatal injuries and allows them to be narrowed down depending on select criteria. Using this database, the following graphs we obtained by filtering death records for youth aged 15 to 24 years within the united states and plotting the crude rate against year of tally: Graph 1: Female suicide crude rates for the period 2011 – 2016. (CDC) Graph 2: Male suicide crude rates for the period 2011 – 2016. (CDC) Graph 3: Combined suicide crude rates for the period 2011 – 2016. (CDC) The preceding graphs help communicate the general increase in the incidences of youth suicide by use of an evaluation that does not factor in aspects of ethnicity or race. The crude rate here refers to the portion of the population that is claimed by youth suicide when compared with the prevailing population numbers at the midpoint of the concerned year. In general, the rate of male suicides is not only more than that of females, but also increasing at a higher gradient as the years go by. There is research that attempts to explain this disparity. Walker et, al. for one, argues that "boys are more likely to experience fatal suicide attempts relative to girls who engage in more non-fatal attempt behavior." (2017). Gould et, al. chips in with the knowledge that "completed suicide is often associated with aggressive behavior and substance abuse… (which) are more common in males." (2003), before introducing the idea that a varying lethality in preferred means of achieving suicide often results in many female attempts failing to prove fatal. For example, overdosing medication is a resort commonly seen in female suicide attempters, yet easily treatable here in the United States thus contributing to the varied death rates by conversely improving occurrences of non-fatal death that adjusts for the gender differences observed in the above graphs (Walker et, al., 2017). All this shows how important intervention is, effectively eliciting concerns about what is currently being done to stem this tide of premature mortality. Methodology: The purpose of this study is to weigh the effectiveness of various intervention programs based on their perceived benefits to those in need of suicide intervention. In the preliminary exercise; various questions be important to the design of the survey – the most important of which is whether or not an interviewee has contemplated suicide in his past. This particular question will allow for a follow-up about their experience seeing others struggle with suicide in the absence of a personal stake. This study is aimed at invoking the following questions in its participants: What would I personally want someone/society to do as a way of mediating my personal desire for suicide? Why do I keep such feelings hidden or inadequately pass them across, thereby potentially leaving others in the dark about how I feel? Who do I feel comfortable approaching to discuss suicidal ideation? These questions will inform a majority of the responses, and in the event that a person lacks their own stake, they'll be allowed to emphasize with others through recalling their memory of others they have seen struggle with suicide ideation. By the time of completing this preliminary exercise, we aim to have singled out a considerable number of participants for our study who will meet the following criteria; be aged between 15 – 24 years and residing within the United States of America, while having a confirmed history of dealing with suicide ideation and/or suicide attempt. For purposes of the study, we aim to utilize quantitative means in achieving our goal of gauging the effectiveness of current intervention methods. The study will take place in the United States of America, and involve a sample group of American youth aged between 15 to 24 years of age who have remained alive following prior incidences of suicide ideation/suicide attempt. In the preceding paragraph, a preliminary exercise was introduced. This exercise is intended to serve two purposes, the first of which is to help narrow down a specific group of participants from whom the study feels it will receive reliable data. These are those youth who experienced documented instances of suicide ideation possibly leading up to suicide attempts, and have consequently been able to live in the duration since absent any regard whether their suicide ideation eventually subsided or is still active. This will be achieved by careful monitoring of open-ended questionnaires handed to willing interviewees digitally via a survey software called SurveyMonkey that feature questions meant to nudge information that fits within the questions outlined in the preceding paragraph. The feedback from this survey will serve a second purpose, consolidating answers that clue us to all the current intervention efforts that each of the online correspondents have been exposed to for the creation of the final survey instrument – a Likert scale. The Likert scale will be important because the quantitative aspect of our study relies on gauging responses on a changing scale instead of relying on an in-depth opinion. This is why it will be crucial to confirm the incidences of the participants shortlisted for receiving the Likert scale, so that we can improve the likelihood that opinions reflected are on the scale are consistent with their own experiences. The preliminary survey's usefulness will not stop there, for the same accounts will come into play when considering the bias towards one particular intervention method. On the Likert scale, available intervention methods will be listed along with a short summary of what they entail to boost understanding for everyone. Underneath each summary shall be five fixed responses; from which the participant shall be required to select a single one. These fixed responses, in order of increasing effectiveness, shall be; impractical, practical, average, effective, and highly effective. While the preliminary surveys are to be handed out online, the Likert scale will be made available as per the participant's qualification. This means the study will require suitable academic premises where the participant can avail themselves to share in data collection, but only after having introduced substantial evidence to follow up on their earlier claim that they have the first-hand experience with suicide ideation. A good location for the study would be the Massachusetts Institute of Technology. References: Cha, C. B., Franz, P. J., M. Guzman, E., Glenn C. R., Kleiman, E. M., & Nock, M. K. (2018). Annual Research Review: Suicide among youth – epidemiology, (potential) etiology, and treatment. Journal of child psychology and psychiatry, 59(4), 460-482. Gould, M. S., Greenberg, T.E.D., Velting, D. M., & Shaffer, D. (2003) Youth suicide risk and preventive interventions: a review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, 42(4), 386–405. National Center for Injury Prevention and Control- United States Suicide Injury Deaths and Rates per 100000 for ages 15 to 24. Center for Disease Control and Prevention. Datasheet. O'Donnell J., & Saker A. "Teen suicide is soaring. Do spotty mental health and addiction treatment share blame?" USATODAY. March 19, 2018. https://www.google.com/amp/s/amp.usatoday.com/amp/- Pena, J.B., Matthieu, M. M., Zayas, L. H., Masyn, K.E., & Caine, E. D. (2012). Co-occurring risk behaviors among White, Black, and Hispanic US high school adolescents with suicide attempts requiring medical attention,-: Implications for future prevention initiatives. Social psychiatry and psychiatric epidemiology, 47(1), 29-42. Walker, R., Francis, D., Brody, G., Simons, R., Cutrona, C., & Gibbons, F. (2017). A longitudinal study of racial discrimination and risk for death ideation in African American Youth. Suicide and Life-Threatening Behavior, 47(1), 86-102. United Nations Department of Economic and Social Affairs (UNDESA). Definition of Youth. United Nations. Fact Sheet.