Advocacy Forum 2011
Dr. Paula J. Clayton, Medical Director
American Foundation for Suicide Prevention
120 Wall Street, 22nd Floor
New York, NY 10005
1-888-333-AFSP
www.afsp.org
Facts about Suicide
Facts
 More than 34,598 people in the United States died by suicide in 2007.
About every 15 minutes someone in this country intentionally ends his/her
life.
 Although the suicide rate fell from 1992-1999, it was steady for 5
consecutive years despite all of our new treatments. The number of deaths
rose by 955 in 2004, by 118 in 2005, by 663 in 2006 and rose even more,
by 1298, in 2007.
 Although the rate in adolescents and the elderly is falling, alarmingly, the
rate in middle age men and women (46-64) is rising.
3
U.S. Suicide Rates by Gender & Age
(with special attention to those 65+)
45
Males
65+
40
35
Male All
Ages
Rate per 100,000
30
Total 65+
25
All Ages
&
Gender
Female
All Ages
20
15
10
Females
65+
5
0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Centers for Disease Control, WISQARS.
http://www.cdc.gov/injury/wisqars/index.html
Year
4
Prevention
Prevention
 AWARENESS
 SCREENING
 EDUCATION
 MEANS RESTRICTION
 MEDIA GUIDELINES
 SIMPLE INTERVENTIONS
 TREATMENT
6
Awareness
 Primary risk factor for suicide is psychiatric illness: “depression can be





lethal”
Depression is treatable
Destigmatize the illness
Destigmatize the treatment
Encourage help-seeking behaviors and continuation of treatment
Proposed:
 Billboard campaign
 AFSP: Depression and Bipolar Awareness: From Diagnosis to Remission
Civnar, JG, Perspectives in Psychiatric Care, 2005
7
Professional Education
 One of 3 Studies
 In the Swedish county of Jämtland the use of antidepressants in 1994
was 25% below the Swedish average and the average suicide rate
during 1970-1994 was 10% above the national average.
From 1995 to 2005, GPs were offered a two day seminar on treating depression which
consisted of lectures, case discussions, and videotape presentations. There was an
option to continue one day seminars in future years.
 Suicide rates per 100,000
1974-1994
1995-2002
Jämtland
27.7
17.3
Sweden
25.0
17.6
Decrease seen mostly in women
Henriksson S, Isacsson G, Acta Psychiatr Scand, 2006
8
Professional Education
Sales of antidepressants in Jämtland, Sweden
9
Suicide Prevention Strategies:
A Systematic Review (2005)
Intervention
Education
Public
Primary care physician
Gatekeeper
US Airforce
Norwegian Army
Increasing antidepressant prescriptions*
Chain of care
Restricting lethal means
Guns
Domestic gas
Barbiturates
Vehicle emissions
Analgesics
Media blackouts
Suicides, % Decline in Annual Rates
Not available
22-73
40
33
3.2
Not available
1.5-9.5
19-33
23
Not available
Not available
Not available
*There was a 414% increase in antidepressant prescriptions 1987 – 1999
Mann J, et al, JAMA, 2005
10
Treatment and Dissemination
National Network of Depression
Centers
2929 Plymouth Rd., Suite 300
Ann Arbor, MI 48105
www.nndc.org
Purpose
NNDC’s Mission
To conquer depressions, bipolar illnesses and related
diseases so millions can live better lives by developing,
disseminating and translating standardized, sustainable,
evidence-based, large-sample research advances into
clinical care via a national network
Four INTEGRATED domains




4/8/2015
Research Translation
Clinical Care
Education of a New Generation
Public Policy
12
Timeline and Progress
Center of Excellence Membership
The nation’s leaders in depression & bipolar care, research and education
1.
2.
3.
4.
Columbia University
Duke University
Emory University
Brigham & Women’s Hospital,
Partners Healthcare & Harvard
5. Johns Hopkins University
6. Massachusetts General Hospital,
Partners Healthcare & Harvard
7. McLean Hospital, Partners
Healthcare & Harvard
8. Stanford University
9. University of California Los
Angeles
10. University of California San
Francisco Depression Center
4/8/2015
11.
University of Cincinnati &
Lindner Center of HOPE
12. University of Colorado Denver
Depression Center
13. University of Iowa
14. University of Louisville
Depression Center
15. University of Michigan
Depression Center
16. University of Pennsylvania
17. University of Texas Southwestern
Medical Center
18. Weill Cornell Medical College
14
Vision and Roadmap
Our Clinical Reach
Patients Treated Annually
• Outpatient ~ 526,000
• Inpatients ~ 29,000
Current Staffing
• Clinical Psychiatrists ~ 1,000+
• Clinical Psychologists – 336
• Social Workers – 300
• Nurses – 600
Current Facilities
• Inpatient Beds – 1023+
• Child/Adolescent Beds – 276+
• 1028+ treatment rooms available for
adult outpatient
• 298+ treatment rooms available for
child/adolescent outpatient
4/8/2015
16
Committees & Task Groups
Over 400 individual members from multiple
disciplines participating
Domain Committees
•
Clinical Care
•
Research
•
Education
•
Public Policy
Task Groups Underway
•
Women & Mood Disorders
•
Child & Adolescent Mood
Disorders
•
Primary Care Outreach
•
Bipolar Disorder
•
Suicide Prevention
•
rTMS (repetitive Transcranial
Magnetic Stimulation)
•
Health Services & Intervention
Dissemination
•
Biosignatures &
Pharmacogenetics
•
Electroconvulsive Therapy
•
Geriatric Depression & Bipolar
School-Community Depression
& Suicide Prevention
•
College Mental Health
•
4/8/2015
17
Board of Directors
Officers
Founding Chair: John F. Greden, M.D., University of
Michigan Depression Center
Vice Chair: J. Raymond DePaulo, Jr., M.D., Johns Hopkins
University
Treasurer: Frank deGruy, M.D., M.S.F.W., University of
Colorado Denver Depression Center
Secretary: Terence Ketter, M.D., Stanford University
4/8/2015
*The NNDC Executive Committee includes members who are starred (*), in addition to officers.
18
Selected Projects
Research & Clinical Care
•
Common Assessment Package: providing standardized
•
Women & Mood Disorders Registry, Database, & Pending Clinical
Trial (10 member sites)
Bipolar Genetic Repository (6 sites)
rTMS Dose Enhancement/Outcome Project & communication with
FDA (14 sites)
Intervention Dissemination Task Group for Evidence-Based
Chronic Care For Bipolar Disorders (8 sites)
NNDC Data Coordinating Center (DaCC)
NNDC Data Registry
Joint research recruitment program with DBSA
•
•
•
•
•
•
assessments for depression (“vital signs” of Psychiatry)
4/8/2015
20
Collaborative Grant Projects or
Submissions Involving NNDC
Centers
• EMBARC (Establishing Moderators/Mediators for a
Biosignature of Antidepressant Respeonse in Clinical
Care) – NIMH-funded U-01 (contract) involving
Columbia, Michigan, UT Southwestern, and Mass
General-Funded
• RAPID (Rapidly Acting Treatments for Treatment
Resistant Depression ); NIMH-funded U01 to develop
truly innovative treatments capable of improving
Treatment Resistant Depression within 72 hoursSubmitted
4/8/2015
21
Education and Public Policy
Education
 Moodbook – a clearinghouse providing up-to-date,
evidence-based information on mood disorders
 Adolescent Depression Awareness Program (ADAP)
 College Mental Health Task Force
Public Policy
 White Paper produced for U.S. Senate
 Consultation with U.S. Senator to write legislation
 Support funding for the ENHANCED Act
 Position Statements from the NNDC
4/8/2015
22