Suicide, Family History, and Genomics

We must continue to search for new methods to effectively address the tremendous problem of suicide. Despite recent interest, genomics does not provide the solution today, but there is a lot that we can do now using an established public health approach to prevention.

 

Millions were shocked by the news that comedian Robin Williams had died by suicide. The star is remembered for more than just his energetic roles but also his work to help charitable causes and to entertain U.S. troops abroad. But the joy he gave to others stood in sharp contrast to the challenges he faced in his own life: depression, addiction, and more recently Parkinson’s Disease. The revelations brought many to contemplate what more could be done to identify the risks and prevent suicide and what hope, if any, emerging fields of science like genomics might offer.

 

Suicide: A Substantial Public Health Problem

Williams’ suicide at the age of 63 will be recorded as one of thousands of deaths in the U.S. this year alone in his age group. Death from suicide among those aged 60-64 rose 37% from 1999 to 2010. In fact, suicide is the 5^th leading cause of death in the United States among middle-aged adults (ages 35-64 years). Suicide is far more common as a cause of death than homicide, HIV/AIDS, or hypertension, and in 2009, the number of deaths from suicide surpassed deaths from motor vehicle crashes in the U.S. Each year, more than 39,000 Americans take their own lives and about 487,000 people receive medical care for self-inflicted injuries. At the family level, suicide is a devastating tragedy with lasting implications for loved ones; at the population level it comprises an incomprehensible and needless loss of human life and capacity. By very definition suicide is preventable. Yet many people are uncomfortable even talking about suicide in part because of the blame, guilt, and stigma that often follows it.

 

Suicide: Depression But Also Many Other Factors

Major depressive disorder (MDD) is the second leading cause of disability worldwide and an important contributor to the burden of suicide. Millions of adults in the U.S. are considered to be in less than optimum mental health, largely because of depression and substance abuse problems. While there has been more focus on people with mental illness in recent decades, the proportion of individuals who actually receive care for depression and other conditions is low and those who do seek care usually do so many years after onset. In the U.S. it is estimated that 67% of persons suffering from mental illness are not treated, compared with a treatment gap of only 8% for diabetes. The U.S. Preventive Services Task Force recommends screening adults, and adolescents for depression in appropriate care settings.

Long-term studies of persons hospitalized at least once with MDD suggest that perhaps 1 in 10 will die by suicide. The rate of suicide in never-hospitalized persons with MDD may be lower.  However, if most people suffering from depression will never tragically end their own lives what are the other important contributing factors? Also, if most people suffering from depression are not diagnosed or receiving care, are there other ways to identify those at greatest risk?

Indeed the causes of suicide are often complex, and multiple. There are many other environmental stressors beyond depression that contribute to suicide including problems with relationships, career, other medical issues, and financial problems. All of the potential factors are important to understand including some controversial topics such as the effects of prescription SSRI medications; substance abuse; and the best ways to treat post-traumatic stress disorders including among veterans. Increasingly the desire to better understand the complicated causal relationships of suicide has led researchers to consider genomics as part of the equation.

 

Suicide, Genetics, and Family History

Research studies have been conducted in an attempt to identify genetic differences associated with suicide risk, and today, these efforts are in an exploratory stage. However, 200 genes have been associated with suicide risk, including results from 10 genome-wide association studies. While there are genetic tests presently marketed for the purpose of identifying people at risk, these applications have not yet been validated and do not contain enough information to accurately predict who will attempt suicide.  Despite research potential in an appropriate setting, there is inadequate evidence that genetic-based psychological tests are ready for use in practice.

Like most health issues, the best understanding of the causes of suicide comes through the broad prism of gene/environment interaction: that health outcomes and the choices people make are greatly influenced by the dynamic interaction of both genes and environment. It is therefore not surprising that risk factors include a family history of suicide. Immediate family members share not only genes but diet, living conditions, economic status, social values, and behavioral issues, which can all combine in a powerful way. It may be important for primary and mental health providers to know about a patient’s family history of suicide and depression.

 

The Best Prevention Strategy Today

CDC takes an evidence-based, public health approach to prevent suicide, which includes using data to: identify populations at higher risk of suicide and to support the development and evaluation of suicide prevention interventions. Promising interventions are best designed and evaluated with an understanding of the risk factors/warning signs and protective factors. Finally, the public health role includes promoting this knowledge to health care providers, special populations at highest risk, and the general public.

1 Know the Risk Factors

Risk factors include:

• History of previous suicide attempts
• Family history of suicide
• History of depression or other mental illness
• History of alcohol or drug abuse
• Stressful life event or loss
• Onset of physical illness including chronic disease
• Easy access to lethal methods
• Exposure to the suicidal behavior of others
• Self-harm behavior
• History of victimization

2 Know and Benefit From the Protective Factors/Get Long Term Help

Protective factors buffer individuals from suicidal thoughts and behavior. Some of the protective factors researchers have identified include:

• Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes
• Effective clinical care for mental, physical, and substance abuse disorders
• Easy access to various clinical interventions
• Family and community support (connectedness)
• Support from ongoing medical and mental health care relationships
• Cultural beliefs that discourage suicide and support instincts for self-preservation, including seeking help

3 Get Immediate Help When You Need It!

If you or someone you know is having thoughts of suicide, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

 

In the future, genetic research might offer greater understanding about preventing the tragedy of suicide. For now, there are no validated genomics tests for suicide prevention that are ready for practice. The best strategy for prevention today includes: knowing the risk factors including family history of suicide, recognizing the warning signs, supporting protective factors, decreasing the stigma of mental illness, and getting immediate help when needed.

Be kind, for everyone you meet is fighting a battle you know nothing about.

Common Adaptation of Quote by Ian Maclaren