ATLAS study to examine how major life transitions relate to suicide risk
Q&A with Briana Mezuk
Associate Professor of Epidemiology
Briana Mezuk, associate professor of Epidemiology at the University of Michigan School of Public Health, studies the interrelationship between physical and mental health. Recently, the social epidemiologist was awarded a grant by the National Institute of Mental Health to better understand this interrelationship, particularly as it related to suicide risk. In the Aging, Transitions over the Lifespan, and Suicide (ATLAS) Study, Mezuk and colleagues will look at how major life transitions can impact suicide risk behavior over an individual’s lifespan. Suicide is one of the leading causes of deaths in the United States, with almost 46,000 deaths in 2020 according to the CDC.
We spoke with Mezuk, who shares details about her research, the ATLAS Study, and why mental health promtion is a critical element in suicide prevention stratgies.
How would you describe your research focus?
Most of my work is focused on mid-life. I am particularly interested in the ways mental health shapes physical health as people age. Maybe an individual has started to develop health problems, they are thinking about retiring, or they have newly-found functional limitations and need to move into a house that doesn’t have stairs. These are just a few examples of life transitions that I’m interested in. These experiences are at the intersection between mental health, physical health and functioning.
What is the ATLAS Study?
The ATLAS Study will examine how major life transitions relate to suicide risk, with emphasis on identifying modifiable determinants that can inform prevention efforts over an individual’s lifespan. We want to better understand what key moments in someone's life impact suicide risk, and how individual characteristics such as socio-economic status, education, race, and others impact these outcomes.
In order to investigate this, we plan to examine both ‘proximal’ and ‘distal’ risk factors, where proximal includes events that occur, more or less, in a distinct period of time (a relationship breakup, a recent job loss, or a hospital discharge). Distal risk factors include more ongoing circumstantial factors, such as long standing financial difficulties or ongoing substance misuse. Integrating these two types of life circumstances will allow us to understand how risk of suicide emerges in someone’s life, as well as how it can persist over the lifespan. We hope that this unique approach will help us identify opportunities for prevention that incorporate a lifecourse perspective of suicide risk.
Our study will utilize data from two nationally-representative, longitudinal studies run here at the University of Michigan. This will enable us look at an individual’s suicide risk at different ages and stages in their life: the Health and Retirement Study and the Americans’ Changing Lives Study. Additionally, we will use data from the National Violent Death Reporting System, the nation’s most comprehensive suicide mortality registry, which includes detailed quantitative and qualitative information about suicide deaths.
I think that one of the strongest aspects about the ATLAS Study is that it is inherently interdisciplinary. Our research team includes collaborators from Michigan Medicine, and the University of Michigan’s Institute for Social Research (ISR), School of Public Health, and School of Information. We will also seek out partnerships with organizations such as the Institute for Healthcare Policy & Innovation and have already been working with the American Foundation for Suicide Prevention.
You are an advocate for implementing public health promotion into suicide prevention strategies. What is it and why is it so important?
Prior to the COVID-19 pandemic, suicide was the tenth leading cause of death in the United States, with 45 to 50 thousand people dying each year of a preventable death.
Right now in this country, the primary way we handle suicide is through a crisis management approach—advertising crisis hotlines, gatekeeper training to assess suicide risk, etc. These are vital tools that help save lives, but these approaches don’t really focus on the history behind one’s reason for a suicide attempt. Suicide is a discrete event that is coming on the heels of a history or background, and we need to understand that history to truly build a systematic strategy for prevention.
This is why it’s important to include mental health promotion in the suicide prevention conversation. Put simply, mental health promotion aims to foster positive mental health over the life course by addressing the root causes or determinants of poor mental health. These determinants can be addressed by structural changes, such as improving food security, promoting safety at home and at school, and creating supportive workplaces. Therefore, mental health promotion is built upon the notion that mental health is not simply the absence of illness, but instead reflects the overall wellbeing, connectedness, and resiliency of the individual. In accordance with former Surgeon General Dr. David Satcher’s lasting remarks, there is no health without mental health. We believe that focusing research and prevention efforts on mental health promotion is a way to both prevent suicide and allow people to thrive and live healthier lives.
Recently, I authored an editorial in the American Journal of Preventive Medicine that addresses the importance of mental health promotion in a response to President Biden’s call for national efforts to improve public mental health. In it, we discuss the proposed White House Strategy and emphasize the importance of addressing the nation’s mental health challenges with a systems-level approach. Mainly, while the proposed strategy places adequate emphasis on addressing the workforce challenges that our mental health system faces—including lessening the impact of provider burnout and increasing the nation’s behavioral health workforce—it fails to address some of the systemic issues that impact Americans and prevent them from seeking or accessing care.
For example, a majority of mental health care providers in the US are disincentivized to accept insurance coverage for their services due to inadequate reimbursement by private health insurance and public payers, including Medicare and Medicaid. This prevents Americans, particularly those of lower socioeconomic status, from accessing mental health services due to high out-of-pocket costs. So, even if there are more behavioral health specialists available, they may not be accessible to many individuals due to financial strain.
In order to make meaningful efforts to support public mental health, our mental health care system needs to undergo significant reform, especially in terms of the payment models. Mental health promotion is a core component of a public health approach to suicide prevention. Addressing the state and national policies that cause unnecessary barriers to care can support the overall well-being of all communities.