Suicide study takes statistical approach

In a plain fifth-floor office, probably not much different than any other clerical room at the University of Nevada's School of Medicine, two doctors and four assistants are hoping to find the answer to a question that has plagued generations:

How do you stop suicide?

There's not much to the office, just a few rooms -- one with enough computer and wiring equipment to launch a satellite, the staff says -- some tables, desks and lots of books. It doesn't even offer much of a view.

But it's a fitting home to a first-of-its-kind study that aims to take a methodical, and some might say detached, approach to a subject that dramatically and violently changes so many families' lives.

Nevada is a sadly logical location for the new Suicide Prevention Center. The state has the highest rate of suicide nationwide. Suicide is the sixth leading cause of death in the Silver State, and more than 63 percent of the people who take their own lives in Nevada do so in Clark County.

The three-year study that workers in the center are about to embark upon will focus on suicide as something that can be prevented, not just the tragic result of a behavior that must be analyzed. The doctors, researchers and computer programmers will be looking beyond the personal stories of victims and poring over medical reports and statistics, looking for trends and possible solutions.

"An analogy would be how traffic accidents are approached," Dr. John Fildes, co-director of the Suicide Prevention Center, said. "... You have to create a science to deal with the problem."

The question to be answered isn't necessarily why do people take their own lives, said Dr. G. Tom Shires, the center's other co-director, but how do we stop them from trying.

"Some of the whys will come out," Shires said, but that's not the first goal of the study.

As veteran trauma surgeons, Fildes and Shires have spent decades trying to heal the bruises, broken bonds and wounds people cause themselves and others.

Before coming to the University of Nevada as director of the Trauma Institute, Shires held a number of prestigious surgical positions, including dean of Cornell University Medical College and chairman of the University of Texas' surgery department at Parkland Memorial Hospital in Dallas. While in Texas in November 1963, Shires was called to operate on both Lee Harvey Oswald and Gov. John Connally.

As chief of trauma surgery at University Medical Center, Fildes handles the most serious injuries that come into the hospital, which has the only top-level trauma center in a 300-mile radius. While only 4 percent of trauma cases at UMC involve self-inflicted injuries, Fildes sees the worst cases.

At the Trauma Institute where they work, the two doctors say they have a chance to step back from the operating theater and try to find ways to stop the accidents and assaults that bring so many victims to their surgery tables. They've looked at domestic abuse and car accidents. But for the next three years, suicide prevention will take up the majority of their time.

"Everybody wants to prevent it and everybody knows someone in their family who's done it," Shires said. "Everybody's in favor of doing something about it, but nobody knows how to do that."

Last September, the Centers for Disease Control and Prevention awarded the School of Medicine $1.5 million to set up the Suicide Prevention Center. The goal: create a database of suicide attempts and completions in six Western states, including Nevada, develop prevention techniques and train people how to use them.

It sounds like a simple notion. But the doctors say there has never been a comprehensive effort to clearly define what constitutes a suicide attempt and then count their numbers and try to offer a way to stop them.

Experts believe that for every person who commits suicide, known by those in the field as a "completor," there are five to 15 people who have tried and still others who have thought seriously about it. Many people who try to kill themselves once will eventually try again, experts say.

Those are the people Fildes and Shires want to find.

"We need to expand the study of suicide beyond the completors," said Fildes. "The people who complete suicides are only the tips of the iceburg. There are many, many other people who have attempted suicide or who have had ideations (about suicides)."

Sen. Harry Reid lobbied to have money for the center included in the 1998 appropriations bill. Reid, whose father committed suicide 28 years ago, has spoken frequently about the need for prevention efforts, particularly those targeted at the elderly.

The problem of suicide was placed on a national stage last month when Surgeon General David Satcher declared suicide a serious public health threat. Satcher called for an effort to educate people who work with the public, including school counselors and hairdressers, to spot those who might want to hurt themselves.

Satcher's comments marked the first time a surgeon general has addressed suicide as a major issue.

Fildes and Shires have created a five-step plan of attack for the next three years of work. In the first months, researchers will try to define just what constitutes a suicide attempt and use the computer-filled room to analyze attempt and completion numbers.

Those involved in the study will then look at other suicide prevention strategies to see what has worked and what hasn't and try to to put together a list of factors that determine whether someone is at risk of suicide. The final step -- the one that will determine success -- will be to come up with prevention strategies and to train people on how to use them.

"Hopefully you will have enough methodology worked out (by then) to see if those interventions are working," Shires said.

The researchers will focus on suicide in Nevada their first year and then gradually include five more Western states in the study. The eight-state region has the highest suicide rates in the country.

In addition to the work here in Las Vegas, groups in Montana and elsewhere will be studying suicides among Native Americans, teens and the elderly.

For all the personal tragedy suicide leaves behind, the research project will devote little time to interviewing the family or friends of victims. It's not that the researchers aren't interested in those people. But the doctors say they hope to reduce the number of victims, and their grieving families, by focussing on the numbers and the trends they reveal.

"The thing that is missing in nearly all these injury prevention studies is data," Shires said. "You get lots of anecdotes, but very little data."

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