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News and Opinion Dec 9, 2011

Dr. Kelly Posner Gerstenhaber Authors Landmark Study on Suicide Predictors

Kelly Posner Gerstenhaber

Rebekah McCabe (L) and Dr. Kelly Posner Gerstenhaber at the 2011 Turnaround Impact Awards Dinner.

On November 8, 2011, a new landmark study by Turnaround For Children’s Founding Chair, Dr. Kelly Posner Gerstenhaber, was published online in the American Journal of Psychiatry, backing use of the Columbia-Suicide Severity Rating Scale (C-SSRS) as a thoroughly reliable tool for suicide risk assessment. Dr. Posner, who is Director of the Center for Suicide Risk Assessment at Columbia University and also Associate Professor of Child Psychology at the University, says the results from the new survey demonstrate that, for the first time, suicides can be predicted now using the C-SSRS.

“Suicide is a leading cause of death across ages,” Dr. Posner explains. “It’s the third leading cause of death in adolescents, the second leading cause in college kids. The CDC has shown that among normal (non-depressed) high-schoolers, 10% report a suicide attempt in the past year…The good news is that it’s a preventable public health crisis, but we need to much better at screening and identification—prevention depends upon appropriate identification.”

Dr. Posner explains the scale’s background saying that, previously, researchers have tended to analyze someone’s likelihood of suicide by asking about his or her behavior and attempts at suicide, or only measuring suicidal “ideation”—a person’s talking about or thinking about suicide. The new scale, however, builds on such previous scales: the Beck scale, and the Columbia History scale, the latter of which is considered the seminal standard for suicide-predictor research. However, Posner explains, the C-SSRS scale rates both behavior and ideation. “It more clearly delineates the types of thoughts we need to get at,” Dr. Posner says.

Since the article’s publishing, the C-SSRS has received a flood of media attention, such as coverage by The Los Angeles Times, US News, and CBS . When the FDA commissioned Dr. Posner to establish practices for suicide assessment that are now required by most drug development programs, a New York Times front-page article called it “one of the most profound changes of the past 16 years to regulations governing drug development.”

Funded by The U.S. National Institutes of Health and the American Foundation for Suicide Prevention, the survey evaluating C-SSRS was given during three separate studies. One study used C-SSRS with adolescents who had attempted suicide, another with adults who went to a hospital emergency department for psychiatric reasons, and the third within a trial testing medication effectiveness for depressed adolescents.

The C-SSRS has also recently been praised by healthcare leaders across the country. Jeffrey Lieberman, M.D., Chairman of Columbia’s Department of Psychiatry and Director of the New York State Psychiatric Institute, extols the impact of the C-SSRS. “For the first time in as long as anyone can remember, we may be actually able to make a dent in the rates of suicide that have existed in our population and have remained constant over time,” Lieberman says. “And that would be an enormous achievement in terms of public health care and preventing loss of life.”

Michael Hogan, Commissioner of the Office of Mental Health, also praises the scale. “Dr. Posner and her colleagues have established the validity of The Columbia–Suicide Severity Rating Scale (C-SSRS),” says Commissioner Hogan. “This is a critical step in putting this tool in the hands of health care providers and others in a position to take steps for safety. We congratulate them on their efforts.”

The C-SSRS is used by a tremendous range of facilities across the world, and around the country—not only hospitals, and schools, but jails, the military, and local fire departments; further, the scale has been lauded for saving not only lives, but saving taxpayer money, as well. “Being able to predict who is most likely to commit suicide also creates cost-efficiency for public schools and other facilities that use it,” says Posner. “New York City public schools did a very successful pilot with school nurses. One district estimated that 60% of referrals/ hospitalizations from the schools were unnecessary (with a savings estimate of over a million dollars). This scale reduces a tremendous amount of unnecessary cost and burden—while saving lives!”

Dr. Posner also says that the results from the survey using C-SSRS support her belief that mental health examinations should be taken just as seriously as other physical health tests, and the survey is easy to integrate into medical practices. It also does not require a health field professional to administer it accurately—another reason the types of facilities utilizing the scale have been so varied. “Prevention depends on appropriate identification of phenomena,” she says. “If we can’t identify something, it limits our ability to understand, manage, and treat illness….Fifty percent of suicides see their primary care doctor the month before they die; we should be asking these questions the way we monitor for blood pressure.”

In 2011, Dr. Posner received a Turnaround Impact Award for her work on its Board and on behalf of children. As Founding Chair of Turnaround for Children, her experience in the worlds of psychiatry, philanthropy, and education reform has been vital to the organization’s growth since its establishment in 2002. Along with her professional positions at Columbia University, Dr. Posner is also a founder of the independent Speyer Legacy School. She is increasingly working towards political change for mental health awareness issues, working closely with New York State to identify patients at greatest risk of suicide and redirect scarce resources accordingly. In the coming year, she is scheduled to speak before leaders of the European Union on her work. Dr. Posner has been honored by New York magazine as one of the city’s most influential people, by New York Family as The Education Philanthropist of The Year, and by the Ferkauf Graduate School of Psychology at Yeshiva University, which named her its most influential graduate in the last 50 years.