NIH: Office of Disease Prevention

Pathways to Prevention Workshop: Advancing Research to Prevent Youth Suicide . March 29-30, 2016

Suicide was the second leading cause of death for youth (10- to 24-year-olds) in 2014, resulting in 5,504 deaths in the United States. This mortality has not decreased compared to other external causes of death, and youth suicide attempts have remained at consistent rates for decades. According to the 2011 Youth Risk Behavior Surveillance System, 2.4% of high school students received medical treatment for attempted suicide, and 7.8% attempted suicide one or more times within the year. Some groups (e.g., American Indian youth; young adults with substance use problems; children of depressed parents; youth and young adults who identify as a sexual and gender minority) are at increased risk for suicidal behaviors.

One of the challenges in suicide prevention research is that the primary outcome of interest is multidetermined and, depending on the target population, suicide can be a low base rate occurrence. Many studies examining risk in important subgroups (e.g., racial, ethnic, sexual and gender minorities) often lack sufficient power to accurately determine the effectiveness of the intervention. Because suicidal behavior is often multidetermined, it may be that interventions addressing suicide risk factors have benefits for suicide reduction, but these benefits are not obvious in research findings, nor can the larger community know of these benefits. Pooling studies and being able to link data from individual studies to multiple data surveillance systems would be important to better understand the effectiveness of prevention strategies on outcomes such as suicide, suicide attempts, and suicide ideation. Preventing attempts and self-harm ideation would likely result in a reduction in deaths, as well as reductions in health care and social burden associated with suicidal behavior.

Closing the research gaps related to youth suicide could lead to improved prevention strategies. The National Institutes of Health (NIH) engaged in a rigorous assessment of the available scientific evidence to better understand the importance of identifying efforts that could be effective in preventing suicidal thoughts and behaviors as early as possible. The National Institute of Mental Health, the National Institute on Drug Abuse, the National Center for Complementary and Integrative Health, and the NIH Office of Disease Prevention sponsored the Pathways to Prevention Workshop: Advancing Research to Prevent Youth Suicide on March 29–30, 2016, in Bethesda, Maryland. The workshop evaluated the current state of knowledge on youth suicide and identified opportunities for future research. Specifically, the workshop sought to clarify the following questions:

  • How can national, state, and community data systems be linked to existing data from suicide prevention efforts in order to add possible value for stakeholders? What methods are available to link the data systems?
  • Which statistical methods are reliable and valid for understanding possible mediators and moderators in suicide prevention programs to improve targeting interventions to populations?
  • Which statistical methods are reliable and valid for analyzing linked national, state, and community data systems and suicide prevention data to avoid misleading conclusions?
  • Given the current state of research, what types of methodological/analytic advances would promote further evaluation of youth suicide prevention efforts (e.g., new approaches to data linkage; increased use of common data elements; approaches to intervention harmonization) and facilitate intervention selection and implementation decisions by local community and state-level policymakers?
  • What is the way forward that will help the suicide prevention research community realize the potential benefits of early prevention? What are the immediate and longer-term research investments needed to accomplish this?

The goal of the Pathways to Prevention (P2P) program is to host workshops that provide an unbiased, evidence-based assessment of a complex public health issue. The workshops identify research gaps and methodological and scientific weaknesses and suggest research needs in a scientific area in order to move that field of science forward. Initial planning for each Pathways to Prevention workshop is coordinated by a Content-Area Expert Group that nominates panelists and speakers and develops and finalizes questions that frame the workshop. After the questions are finalized, an Evidence-based Practice Center conducts a literature review and prepares an evidence report through a contract with the Agency for Healthcare Research and Quality. During the 1½-day workshop, expert speakers directly address workshop questions in their presentations, and an open dialogue occurs among speakers, panelists, and attendees from the general public. Immediately following the workshop, and after weighing evidence from the evidence report, expert presentations, and public comments, an unbiased, independent panel prepares a draft report that summarizes the workshop and identifies research gaps and future research priorities.

The draft report is posted on the ODP website for public comment. After reviewing the public comments, the panel prepares a final report, which is also posted on the ODP website. The ODP then convenes a Federal Partners Meeting to review the panel report and to identify possible opportunities for collaboration.