Pitt professor researching the causes of suicide

About 30,000 people end their own lives in the United States each year, according to the… About 30,000 people end their own lives in the United States each year, according to the American Association of Suicidology, and up to 760,000 people are estimated to make attempts.

Among American youth aged 15 to 24, it ranks as the third most common cause of death, claiming almost 4,000 lives a year.

For Dr. David Brent, these numbers mean that suicide, and its accompanying behavior, deserves much closer investigation than it has received in the past.

Brent is the Academic Chief of Child and Adolescent Psychiatry for the Western Psychiatric Institute and Clinic and serves as a professor of psychiatry, pediatrics and epidemiology at Pitt’s School of Medicine.

On Nov. 25, 2003, Provost James Maher named him the inaugural endowed chair in suicide studies. It was a first-of-its-kind position, providing Brent with valuable funding for research into a subject that he described that day as “easy to avoid, because the act of suicide goes against the thing we hold most dear: the preciousness of life.”

Former Surgeon General Dr. David Satcher, reports by the Institute of Medicine and the National Institute of Mental Health all call for the creation of suicide research centers, drawing attention to the subject in the medical community.

During a recent interview Brent said that research in the field today, while valuable, is still very conservative in its aims.

“For the most part, the way peer review works is that they want to bet on things that are pretty sure things, and that tends to be not that innovative,” he said. “Therefore, it’s great that [Pitt] has that kind of faith in me, because what it allows me to do is to sometimes bet on my instincts and do something that is a little more out of the box.”

Such “out of the box” thinking includes investigations not only into known risk factors, such as mood disorders, but also focusing on the familial and genetic aspects of suicide and how such behaviors are passed down. Brent said that he has found there to be a vulnerability to suicidal behavior that can’t be explained away by mood disorders alone. A history of trauma in a family and a difficulty in regulating emotions and aggression are large factors as well.

“So, somebody is sad, they may have thoughts about suicide, but with this additional vulnerability they may be more likely to actually do something,” he said. “Some of it is probably genetic, some not. But if we can understand more about that, then we may be able to prevent the onset in the next generation.”

Building on these findings, Brent is currently using the financial clout of his newly endowed chairmanship to fund a unique study in Israel. The study involves interviewing and taking genetic samples from people in a large extended family, all of whom live in a village there that happens to have a high rate of suicide.

For Brent, his work has always revolved around the exploration and treatment of suicidal behavior in young people. He founded and directs a program for suicide prevention, professional education and at-risk youth and parent treatment called Services for Teens at Risk (STAR).

According to Brent, the road to focusing on this population segment was first paved by the children he saw during his training at Children’s Hospital in the late 1970’s who had intentionally overdosed on drugs. He said that the available information and medical literature about what caused such behavior, especially among young people, was severely lacking at the time.

“I realized that I didn’t have a very good way to assess them or treat them, and it seemed like a very frequent and important problem,” he said. “By focusing on suicide, you’re really focusing on something that’s rather general, because there are many pathways to it.”

Following a 200 percent increase in suicide rates between the 1950’s and the 1970’s among Americans aged 15 to 24, according to the AAS, there was stabilization or slight decrease in those rates in recent decades, with 13.2 deaths per 100,000 people in 1990 compared to 9.9 per 100,000 in 2001. But Brent thinks that the depression that causes suicidal thoughts is a much larger problem.

“Ten per 100,000 means it’s very hard to find the people you really think are at risk,” he said. “You need to identify people who have other problems, you know, alcohol problems or depression, even if they aren’t going to commit suicide, they still need help.”

According to the AAS, in 2001 Pennsylvania had 1,276 reported deaths by suicide with a rate of 10.4 deaths per 100,000 people, which is slightly below the national rate of 10.8. The highest rates of suicide on a state-by-state basis were found in the Western and Mountain zones of the United States, which accounted for 9 of the top 10.

According to Brent, cultural changes can be a factor in suicide rates. An example of this can be found in groups like the Native Americans, who have the highest overall suicide rate of any ethnic group in the United States.

“If you look among Native American tribes, the suicide rates are quite high among the tribes that have the least amount of traditional cultural affiliation,” he said. “If you look in Micronesia, in studies that have been done there, the suicide rate is the highest among those that are under going the most cultural transition.”

Brent is also set to do a study that will look at the psychological and pharmacological treatments for people who have previously attempted suicide. According to the AAS, there are an estimated 5 million such Americans living today.

He said such individuals tend to be excluded from many clinical trials because their participation is generally considered to be too much of a risk. This was an issue he focused on during the lecture, titled “The Risk of Doing Nothing,” that he gave at the Frick Fine Arts auditorium upon his installment in November.

“The main challenge is dealing with the ethical issues of treating people who are at very high risk, but the flip side is that it’s also unethical not to study these people because, in essence, you’re condemning them and their treatment to perpetual ignorance,” he said.

“So there has to be some way to do things in an ethical manner, and yet move the field forward, although it’s not easy.”