Psychological Self-Help

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The frequency of suicide among teenagers has doubled in the last
30 years but has held steady or declined slightly in the last 10 years
between 1994 and 2001. However, we should be aiming to do much
better at prevention in the future. A national suicide prevention
program, TeenScreen, will survey 13,000 teenagers in 2004, but there
are many more to screen. If the family physicians who are heavily
prescribing anti-depressants to teens would also push psychotherapy
(regretfully less than a third of teens with major depression are in
therapy), more suicide could be prevented. If more public education
openly connects the treatment of mental-emotional problems with the
prevention of suicide and, thus, enlightens the teenagers’ parents, the
result will be much better treatment. And, if research of detection,
treatment, and prevention methods were sharply increased, we would
save many of our best young minds. 
Hospital treatment
Katherine Anne Comtois (2002) reviewed the 1970 to 2001 studies
of the treatment of parasuicides (defined as any non-fatal intentional
self-injury, including more or less lethal suicide attempts and self-
mutilation). Such a review is important to determine how well we are
handling suicide attempts and to figure out how we can respond to
them better in the future. It is estimated that 5% to 10% of the US
population will reach the point of attempting suicide sometime in their
life—this percent may go up as we get better records. Without any
doubt, a history of parasuicide (prior attempts) is a very important
factor in predicting suicide. Amazingly, not much is known about the
“usual treatment” in terms of what treatment or care is usually given
(a) before parasuicides, (b) while the patient is in ER, (c) while in the
hospital or (d) when doctor’s orders are given at discharge. Comtois
reports that there are few studies with adults. Some studies have
shown that a much higher percentage of persons destined to
parasuicide have seen their family physician in the previous year than
is true of the general population. So, persons at high-risk for self-
injury often have access to the medical services…and they are not
reluctant to see a doctor. Apparently, their depression and suicidal
thoughts are not communicated as they should be. 
Certainly, quick and secure hospitalization in an inpatient
psychiatric unit is a critical step in saving lives but little is known about
how effective it is in reducing depression or subsequent attempts or in
getting the patient to seek effective outpatient treatment. We do know
it is terribly expensive. We don’t yet know how effective alternative
treatments to typical short-stay hospitalization might be. But we have
some hints. 
Only a few studies of alternative hospital or post-hospital
treatments have been done following the 500,000 suicide attempts per
year in the US. In general, although some individual physicians do a
good job, most studies have found that the typical hospital and post-
hospital treatment programs did not lower the subsequent suicide rate.
Comtois (2002) looked closely at this topic and found five limited
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