Better data systems, study designs needed to advance youth suicide prevention research

By Will Boggs MD

NEW YORK (Reuters Health) - Improved data systems, enhanced data collection and analysis methods, and better communication between research and practice communities are needed to advance youth suicide prevention research, according to a position paper from the National Institutes of Health Pathways to Prevention workshop.

"We have to destigmatize suicide to get accurate data," lead author Dr. Todd D. Little from Texas Tech University in Lubbock told Reuters Health by email. "Accurate data begets accurate evidence-based guidance."

Many risk factors contribute to suicide, the second-leading cause of death in youth (10 to 24 years of age) and young adults (aged 25 to 34 years), and new research strategies are needed to enhance youth suicide prevention.

Dr. Little and colleagues in the NIH Pathways to Prevention Workshop "Advancing Research to Prevent Youth Suicide" aimed to explore strategies for guiding future research on youth suicide.

Their position paper, online October 4 in Annals of Internal Medicine, presents three sets of recommendations to support that effort.

First, they recommend that data systems be enhanced in order to improve the ability to identify persons at risk for suicide. This should include standardized measures to identify these individuals across settings, communities, and cultures.

Second, they propose four ways to improve study design and analysis:

* Design studies to ensure adequate coverage of data at multiple levels and longitudinally.

* Design studies and primary data collection efforts to facilitate data integration, linking, and pooling data across multiple studies.

* Use principled, valid, and current missing data techniques to adjust for the effects of missing data mechanisms.

* Broaden methods for drawing valid conclusions to inform policy and practice.

Finally, they support cross-sector collaboration, as well as education, training, and dissemination of research findings, as means for building and strengthening the research and practice community.

Dr. Little said that "coordination among stakeholders to allow linking data across all possible sources" deserves greatest emphasis. "A coordinated and concerted effort to tie all data sources together will give us the information we need to identify those at risk and ways to intervene," he concluded.

In a related report, Dr. Holly C. Wilcox from Johns Hopkins School of Medicine in Baltimore, Maryland, and colleagues provide detailed results from a systematic review that sought to identify and describe data systems that can be linked to data from prevention studies to advance youth suicide prevention research.

"Data linkage offers the potential to evaluate and enhance suicide prevention efforts and could allow for the longer term study of the impact of suicide prevention efforts on suicide outcomes," Dr. Wilcox told Reuters Health by email. "Data linkage could also allow for the identification of novel predictors or combinations of predictors to target to prevent suicide."

The team identified 153 unique data systems, but they found only six of 47 studies that assessed outcomes by linking their prevention data to external data systems at the individual or ecological level.

Overall, 19% of the data systems were developed primarily for research, 11% were developed for clinical care or operations, 29% were developed for administrative services, and 52% were developed for surveillance, with some systems having multiple uses.

Over a third (37%) provided national data, 12% provided regional data, 63% provided state data, and 41% provided data below the state level.

The issue, then, appears not to be a lack of data systems, but rather a lack of awareness of the accessible data systems, the researchers say.

"Ideally, the integration of existing data sets from healthcare systems and other sources could be used to identify individuals as they enter high-risk periods for suicide to initiate outreach and intervention to prevent suicide," Dr. Wilcox said.

"The Zero Suicide initiative (see https://zerosuicide.sprc.org/) is building momentum in health care systems across the country. Linking healthcare system data to mortality data could provide insights into the timing and nature of predictors as well as healthcare gaps to inform healthcare system policies and protocols to enhance patient safety," she said.

SOURCE: https://bit.ly/2dFaZtP and https://bit.ly/2dF9E6n

Ann Intern Med 2016.

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