Statement on Suicide Prevention

The American College of Surgeons (ACS) Committee on Trauma’s Committee on Injury Prevention and Control developed the following statement to educate surgeons and other medical professionals on the significance of suicide and evidence-based prevention activities. The ACS Board of Regents approved the statement at its February meeting in Chicago, IL.

The ACS recognizes the following:

• In 2017, 47,173 people in the U.S. died as a result of suicide, and more than half died as a result of firearm-related suicide.¹ In 2017, suicide was the 10th leading cause of death in the U.S.¹
• From 2001 through 2017, the total suicide rate increased 31 percent from 10.7 to 14.0 per 100,000.²
• In 2017, there were twice as many suicides (47,173) as homicides (19,510) in the U. S.¹
• Most people who take their own lives have contact with the health care system within the prior year.^3-5
• Firearm access is a risk factor for suicide.⁶
• Lethal means counseling can reduce access to firearms for those at risk.⁷

The ACS supports efforts to promote, enact, and sustain legislation and policies that encourage:

• Electronic health record-based suicide risk screening for all patients.⁸ Examples include the following:
  • Patient health questionnaire ²
  • Patient health questionnaire ⁹
  • Columbia-Suicide Severity Rating Scale
  • Ask Suicide Screening Questionnaire
• Lethal means counseling when a patient is struggling with a mental health problem, substance abuse, or painful life crisis. Resources available include the following:
  • Harvard School of Public Health: Recommendations for clinicians
  • Suicide Prevention Resource Center
  • American College of Surgeons Committee on Trauma: Gun Safety and Your Health
• Hospital-based mental health support for those individuals at risk.
• Proactive follow-up care to ensure that patients who are not recovering from a behavioral health problem receive effective care.

References

1. Kochanek KD, Murphy SL, Xu J, Arias E. Deaths: Final data for 2017. National Vital Statistics Report. 2019;68(9):1-77. Available at: www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf. Accessed February 25, 2020.
2. Hedegaard H, Curtin SC, Warner M. Suicide mortality in the United States, 1999–2017. National Center for Health Statistics Data Brief, no. 330. Available at: www.cdc.gov/nchs/data/databriefs/db330-h.pdf. Accessed February 25, 2020.
3. Ahmedani BK, Simon GE, Stewart C. Health care contacts in the year before suicide death. J Gen Intern Med. 2014;29(6):870-877.
4. Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: A review of the evidence. Am J Psychiatry. 2002;159(6):909-916.
5. Gairin I, House A, Owens D. Attendance at the accident and emergency department in the year before suicide: A retrospective study. Br J Psychiatry. 2003;183:28-33.
6. Harvard T.H. Chan School of Public Health. Firearms and suicide case control bibliography. Available at: www.hsph.harvard.edu/means-matter/useful-links/bibliography/firearms-and-suicide-case-control-bibliography/. Accessed February 24, 2020.
7. McManus BL, Kruesi M, Dontes AE, DeFazio CR, Piotrowski JT, Woodward PJ. Child and adolescent suicide attempts: An opportunity for emergency departments to provide injury prevention education. Am J Emerg Med. 1997;15(4):357-360.
8. The Joint Commission. Sentinel Event Alert, Issue 56: Detecting and treating suicide ideation in all settings. Available at: www.jointcommission.org/assets/1/18/SEA_56_Suicide.pdf. Accessed March 3, 2020.