Chat transcript: U.S. surgeon general on suicide

July 30, 1999
Web posted at: 3:54 p.m. EDT (1954 GMT)

(CNN) -- Following is an edited transcript of a chat held Friday, July 30, with U.S. Surgeon General David Satcher.

Chat Moderator: Welcome, Surgeon General Satcher. Thanks for joining us today. Can you tell us briefly about this week's initiative to set in motion your suicide prevention program?

Dr. Satcher: This week's initiative was to announce the surgeon general's "Call to Action for Suicide Prevention." This call to action consists of a set of 15 recommendations that were developed in a conference which we had in the fall of 1998 in Reno, Nevada. These 15 recommendations fall into the three areas: awareness, intervention and new methodology. We think the most critical thing is to have the American people more aware of the magnitude of the problem of suicide and the fact that suicide is so often preventable. In addition to a campaign of awareness, we believe that we have an opportunity to significantly improve our interventions for the early recognition of persons at high risk for suicide, their referral for treatment, and the effectiveness of treatment when dealing with problems like depression and anxiety.

Dr. Satcher: Eighty-five people die in this country every day from suicide; about 2,000 people attempt suicide each day. It is time to act. This is our call to action.

Question from Nitro: Many people feel that the overall mental health of America has been deteriorating for many years. In your opinion, what is the main reason or reasons for this?

Dr. Satcher: First, we don't know the extent to which the mental health of Americans has been changing as opposed to our recognition of it. According to our data, suicide among teen-agers has tripled since 1950 and doubled among black teen-agers since 1980. But there are still many unanswered questions.

Dr. Satcher: We have the need to continue to do research to better understand mental health in general and suicide specifically. There will be a surgeon general's report on mental health issued by December 1999. Hopefully, we will encourage you to seek help. Our government program will provide resources near to you from which you can seek help.

Question from SquidOil: How can a government-backed suicide prevention act help me when I'm sitting alone at home with no television and a gun?

Dr. Satcher: Because of the stigma associated with mental health problems in this country, many people do not seek help that is available to them. We want to change that with our awareness and destigmatization campaign.

Question from HiF|yer: Isn't it true that intervention only works on people who threaten suicide, not those who are committed to it?

Dr. Satcher: No, that is not true. Threatening suicide is a very real cause for concern, and the whole community needs to take threats seriously. But there are many examples of people who felt that they were committed to suicide who, when treated for severe depression, changed their minds.

Chat Moderator: With yesterday's shootings in Atlanta -- and the subsequent suicide of the man who carried out the crime -- your announcement this week seems even more relevant to the problems going on in today's society. What were your thoughts when you heard about the Atlanta tragedy?

Dr. Satcher: During the "Call to Action" press conference on Wednesday, I mentioned that suicide and homicide are often interrelated and used the shooting at the school in Littleton, Colorado, as an example. Clearly, people who are suicidal can also be homicidal. But fortunately, most people who are suicidal do not seek to take the lives of other people. We must more aggressively seek out and ameliorate the risk factors for suicide while at the same time reducing the risk factors for homicide and violence in general. The easy access to weapons in this country is one of our concerns, as it relates both to suicide and homicide.

Question from HiF|yer: Is severe depression always a factor in suicide?

Dr. Satcher: No, but it's one of the great predictors, along with drug abuse and anxiety. Excessive, impulsive and aggressive behavior are also factors in suicide risk.

Chat Moderator: What can be done -- or could be done better -- to prevent this type of incident from happening again in our schools, office buildings, homes, or elsewhere?

Dr. Satcher: Part of what we hope to achieve with our outreach program is a significant improvement in the general community awareness. We hope that far more people will identify problems in their co-workers or students or close relationships very early and urge them to seek help and to foster an environment that is conducive for seeking help.

Dr. Satcher: However, it is critical that we limit the easy access to weapons and that we aggressively prosecute crime in this country, wherever it occurs. It is important that we reach out to everyone in the community who interacts on a regular basis with others: teachers, coaches, hairdressers. We cannot leave this problem to the health profession alone to address.

Question from HiF|yer: Why have hairdressers been targeted as potential suicide prevention aides?

Dr. Satcher: Hairdressers are in a profession in which they interact with many people, and many people share some of their most intimate concerns with their hairdressers. They are known as good listeners. Since 70 percent of the elderly who commit suicide had seen a physician within 30 to 60 days before committing suicide, it is clear that we need to improve awareness among health professionals, but we cannot stop there.

Question from Allen: Dr. Satcher, how are the suicide rates divided by racial lines ?

Dr. Satcher: Currently, our data suggest that suicide is more common among whites than among African-Americans. However, American Indians have a higher rate of suicide than a majority of the population.

Dr. Satcher: However, it should be pointed out that one of the fastest-growing groups for suicide risk are African-American teen-age males and young adults. We still have much to learn about this problem.

Question from Rory: Dr. Satcher: What warning signs are family members most likely to see? What should a family do if the potential suicide does not want to seek professional help?

Dr. Satcher: There are several things which should serve as potential warning signs for family members and others. Persons who become depressed and remain depressed for long periods of time to such an extent that it affects their normal functions such as sleeping, eating and work habits should be a cause for concern.

Dr. Satcher: Severely depressed people tend to feel guilty or worthless, generally tired, have difficulty enjoying anything in life, may be restless or irritable, tend to feel as if no one loves them, and generally that life is not worth living. Withdrawal and increased drinking or other forms of substance abuse are also very important warning signs.

Question from Sunny1: How can I find out what steps to take if I suspect someone is considering suicide?

Dr. Satcher: Begin by talking with the person and letting them know that you care about them and that you are concerned about their general state of depression or other signs. Offer to help them in any way that you can or to find help in your community if you are not able to provide that help.

Dr. Satcher: In some cases, it may be easier to have someone else talk with the person, if you feel uncomfortable doing so, or that you are not the best person to intervene. But by all means, don't abandon them; follow up and stay involved with them.

Question from Peepster: Dr. Satcher, it appears that you think suicide is a health issue, yet you proclaim that laws are a solution. Isn't this inconsistent?

Dr. Satcher: No. You may have misunderstood my comments about the need to limit access to weapons and prosecute crime. These are not substitutes for early identification and treatment of problems such as depression and substance abuse.

Dr. Satcher:It is important to point out, however, that a very depressed person who has easy access to a gun is much more likely to successfully commit suicide than someone who does not. In fact, 96 percent of the increase in suicide among African-American teen-age males was suicide by firearms.

Dr. Satcher: As a young physician working in emergency rooms in places such as Rochester, New York; Cleveland, Ohio; and Los Angeles, California, I treated many people who had attempted suicide by taking an overdose of some kind of pill or medication.

Dr. Satcher: In most of those cases, we were able to save the person's life and to get them involved in some form of psychological care to deal with their depression or related problems. With firearms, we very seldom get that opportunity.

Question from Bria: What should parents be doing to "suicide-proof" their kids?

Dr. Satcher: I'm not certain that we know enough about suicide prevention to prescribe a fail-safe strategy for "suicide-proofing" anyone. However, parents should make a point of staying involved with their children in all aspects of their lives, from their home, school and community interactions to changes in their personal lives, including sexual development. Parents should work to create environments where their children will feel that they can always talk with them regarding any issue, despite the degree of pain or embarrassment. Likewise, parents should not hesitate to seek help for their children when they feel it is indicated, and to use the community network of interactions as support.

Question from Allen: Dr. Satcher, is family history a significant influence on suicidal behavior ?

Dr. Satcher: Family history is a significant risk factor for suicide. While we know that this is true, we do not fully understand the relative influence of a genetic predisposition to depression or impulsive behavior as opposed to the environment of the person who survives a suicide in a close relative.

Chat Moderator: Dr. Satcher, do you have any final thoughts?

Dr. Satcher: "The Surgeon General's Call to Action" is a call to Americans in all walks of life to get involved in helping to create environments in which mental health problems are treated with caring and support as opposed to blame and stigmatization.

Dr. Satcher: It also provides some guidelines for improving awareness, intervening when appropriate, and continuing quality scientific research to learn more about the problem of suicide and strategies for suicide prevention.

Chat Moderator: Thank you for joining us today, Surgeon General David Satcher.

Dr. Satcher: Thank you. By the way, the "Call to Action" is available online at www.surgeongeneral.gov. Good day.