The annual crude rate of suicide has varied by less than 5 persons per 100,000 US population in the past six decades, and the approximately 30,000 suicides occurring annually in the past decade take an immeasurable emotional and social toll. In contrast to the stability of US rates, the number of suicides occurring in Great Britain in 2004 was at a 30-year low, and subsequent annual rates have thusfar repeated this achievement. The British success is likely partially due to aggressive pursuit of a series of prevention-related public health initiatives, informed by two powerful lines of research. A sophisticated epidemiologic tradition has contributed 15 years of information on UK population-based suicide patterns across time and geographic region, while longitudinal clinical surveillance of treatment-seeking suicide attempters has provided important insights into psychological attributes, reattempt rates, trends in post-attempt care and other important clinical issues.
The UK accomplishment is all the more significant because of the unique and challenging methodological issues inherent in suicide research. Despite their public health importance, suicides and suicide attempts are relatively rare events. Capricious fluctuations are sometimes observed over time in rates associated with infrequent events, making it statistically impossible to describe the impact of rate moderators. The need to accurately characterize infrequent, suicide-related phenomena has therefore produced hybrid breeds of research. Using nontraditional analytic strategies, suicide epidemiologists derive answers to otherwise unanswerable clinical questions, while clinical researchers amass and analyze datasets containing tens of thousands of patient records in search of generalizable clinical findings.
The tremendously successful UK research approaches have begun to energize strategic prevention initiatives across the world, and this represents a huge contribution to the field. However, additional progress is necessary to provide the kind of information required by the individual clinician sitting in a clinical setting assessing a specific suicidal patient. The development of novel research methodologies that permit detailed study of acutely suicidal states under scientifically rigorous and ethically sound conditions remains among the most important of challenges for suicide prevention science.
Not only the methodologies, but also the specific research questions which should be asked about heightened risk states are unclear at present. Recent biological and cognitive work has begun to contribute to a theoretical understanding of progression through near-term and imminent suicide risk states, but much work remains to be done. Characterization of these states is in its infancy, and little research exists to explain transitions between them. I began my work in suicide research four and a half years ago looking primarily at questions related to the epidemiology of nonfatal suicidal behavior in the US. I chose this initial focus because so few data-based studies had been published on this topic. Without careful epidemiological characterization, it seemed difficult to describe the public health importance of the problem. There is still a great deal of work to be done in this area, and I plan to maintain an epidemiologic focus as one branch of future work. However, my long-term research goal is to contribute to the conceptualization of near-term and imminent suicide risk states, as a way of supporting the development of more empirically informed risk assessment protocols and, ultimately, improved treatment models.
RESEARCH INTERESTS
Suicide
Psychiatric Emergencies
Psychological Aspects of Traumatic Injury
Brief Alcohol Interventions Among Trauma Patients
RECENT PUBLICATIONS
Claassen CA, Yip PS, Corcoran P, Bossarte RM, Lawrence BA, Currier GW, "National Suicide Rates a Century after Durkheim: A Staged Model to Estimate Mortality Rate Error" in press, Suicide and Life-Threatening Behavior,
Claassen CA, Bossarte RM, Stewart SM, Guzman E, Yip PS, "The Disease Burden of Suicide: Conceptual Challenges and Measurement Standards." Handbook of Disease Burdens and Quality of Life Measures, Springer: Heidelberg:in press
Claassen CA, Carmody T, Bossarte RM, Trivedi MH, Elliott S, Currier GW., "Do Geographic Regions with Higher Suicide Rates also have Higher Rates of Nonfatal Intentional Self Harm?" Suicide and Life Threatening Behavior, 38/6:637-649, December 2008
Wong JP, Stewart SM, Claassen C, Lee PW, Rao U, Lam TH, "Repeat suicide attempts in Hong Kong community adolescents" Social Science & Medicine, 66/2:232-41, January 2008
Claassen CA. Trivedi MH. Rush AJ. Husain MM. Zisook S. Young E. Leuchter A. Wisniewski SR. Balasubramani GK. Alpert J., "Clinical differences among depressed patients with and without a history of suicide attempts: findings from the STAR*D trial." Journal of Affective Disorders, 97(1-3):77-84, January 2007
SIGNIFICANT PUBLICATIONS
Claassen CA, Larkin GLL., "Occult suicidality in an Emergency Department Population." British Journal of Psychiatry., 186:352-353, April 2005
Claassen CA, Trivedi MH, Shimizu I, Stewart S, Larkin GL, Litovitz, T., "Epidemiology of nonfatal deliberate self-harm in the United States as described in three medical databases. Suicide and Life Threatening Behavior." Suicide and Life Threatening Behavior., 36/2:192-212, 2006
Claassen CA, Hughes CW, Gilfillan S, McIntire D, Roose A, Lumpkin M, Rush AJ., "Toward a redefinition of psychiatric emergency." Health Services Research., 35:735-754, 2000
Claassen CA. Lovitt R, "Solving ethical problems in medical settings during psychological assessment: a decisional model" Journal of Personality Assessment, 77(2):214-30, October 2001
Claassen CA, Adinoff B., "Alcohol withdrawal syndrome: Guidelines for Management." CNS Drugs., 12:279-291, 1999
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