There are multiple risk factors for self-harm, including a history of abuse, trauma, physical and mental illness, and bullying. Identifying these factors is a key part of prevention, ensuring that those at risk receive appropriate support as early as possible — but despite this, predicting who may end up engaging in self-harming behaviour is still tricky.
But we may be able to identify these risks earlier than we thought, a new study from a University of Cambridge team suggests. Stepheni Uh and colleagues report that some at-risk adolescents could be identified ten years before they self-harm — offering what the team says is an “extended window” during which help and support can be offered.
Exactly how the media discusses suicide is a topic of frequent debate. Plenty of research has linked media reporting of suicide with an increase in suicidal behaviour, and both the Samaritans and the World Health Organization (WHO), amongst others, have clear (and frequently promoted) guides for journalists on how to report suicide.
But such guidelines are often ignored in favour of insensitivity or sensationalism — especially when the person at hand is a celebrity. Take the recent coverage of the death of Caroline Flack: explicit, deeply intimate details were plastered across tabloids for weeks, with seemingly no thought for how those details would impact readers.
Now a new review, published in the British Medical Journal, has taken a closer look at just how serious the problem is.
Deliberate self-injury (without the intent to commit suicide) is widely thought to be a way that some people, especially teenagers and young adults, cope with or express feelings that they find overwhelming. However, a set of three studies published as a preprint at PsyArXiv by psychologists at Swansea University, reveals that difficulties with perceiving and interpreting the bodily signals of emotion may also play a role – a finding that could help inspire new treatment approaches.
Every year three quarters of a million people take their own lives, and suicide is the leading cause of death in adolescents. Non-lethal self-harm is also prolific, leading annually to around 300,000 UK hospital visits, with even more going unreported. Knowing who is at most risk can inform support and prevention efforts. The higher rates of self-harm in LGBT and minority groups are well-established, and now a new review article in the British Journal of Clinical Psychology identifies other groups, including goths, emos and metalheads, who may also be at increased risk.
According to the World Health Organisation, someone takes their own life every 45 seconds. To help prevent future tragedies, we need to know more about the factors that make some people especially vulnerable to suicidal thoughts and acting on those thoughts. One candidate is perfectionism: the tendency some people have to hold themselves to consistently impossible standards and/or feeling the need to meet or surpass the lofty expectations of others.
In 1995 the late psychologist Sidney Blatt highlighted the apparent link between perfectionism and suicide in an influential article for American Psychologist titled “The Destructiveness of Perfectionism” in which he profiled three highly talented, ambitious but harshly self-critical individuals all of whom took their own lives: Vincent Foster, a deputy counsel to President Bill Clinton; writer, singer and broadcaster Alasdair Clayre; and athlete and scholar Roger D Hansen.
“Because of the need to maintain a personal and public image of strength and perfection, [perfectionists] are constantly trying to prove themselves, are always on trial, feel vulnerable to any possible implication of failure or criticism, and often are unable to turn to others, even the closest of confidants, for help or to share their anguish” Blatt wrote.
However, since Blatt’s paper, research progress on the topic has been slow, hampered in part by a confusing multitude of definitions of perfectionism and a paucity of studies with the longitudinal methodology needed to establish that perfectionist tendencies increase suicidal risk. But now, writing in Journal of Personality, a team led by Martin Smith at the University of Western Ontario say there is enough data to conduct a “meta-analysis”, which is what they’ve done, producing “the most comprehensive test of the perfectionism-suicidality link to date”.
“There is but one truly serious philosophical problem and that is suicide” the French author and philosopher Albert Camus stated. But it is not only philosophers who are moved by this issue. Psychologists are seeking ways of preventing this tragic death, and health care organisations are sounding the alarm. Around a million people die at their own hand every year, which makes suicide the tenth most common cause of death. Additionally, for every completed suicide, there are 10 to 40 survived attempts, which means that in the USA alone 650,000 people each year are taken to emergency rooms following an attempt on their own life. Yet what is most disturbing is that the number of suicides is continually rising. The WHO reports that since the 1960s this number has grown over 60 per cent.
Is psychology capable of identifying the risk factors that can push people to take their own lives? Joseph Franklin at Florida State University and his research team at the Technology and Psychopathy (TAP) Lab have provided an answer, but it is a disappointing one. Our capacity to predict whether someone will make a suicide attempt is no better than chance. What is worse, we have not made any progress in this area in the last half-century. These striking conclusions come as the result of a meta-analysis of 365 studies into suicide risk conducted over the last 50 years and published recently in Psychological Bulletin (pdf).
It is a sad fact that we can never ask of the hundreds of thousands of people around the world who take their own lives each year – why did you do it? Instead, psychologists talk to people who have survived suicide attempts, and they also look into the minds’ of suicide victims through the notes that they leave. But in fact only a minority of suicide victims leave notes, and the validity of studying these notes depends in part of the assumption that victims who leave notes are the same as those who don’t. A new analysis, published in Archives of Suicide Research, of all the suicides that occurred in Queensland Australia during 2004, questions this very assumption.
Belinda Carpenter and her colleagues were given access to the coronial files of the 533 suicides that took place that year, and the associated police reports, autopsy reports, and coroner’s findings gave them unusual insight into the background to the victims. This detail also allowed the researchers to look beyond traditional, written suicide notes (left by 39 per cent of the victims) and to also identify instances where victims had made verbal or electronic warnings of their intent (a further 22 per cent had done this).
Matching trends around the world, the majority of the suicide victims in this study were male (83.1 per cent) and the average age at death was 43.8 years. The most common method of suicide was by hanging; just over half of the victims had known mental health issues; and a little over 5 per cent were from Indigenous Aboriginal communities.
Turning to the main question, the researchers found, contrary to the limited prior research on this topic, that women were less likely to have left a note (or made a verbal warning) than men, as were victims from indigenous communities and victims who killed themselves through gassing (by contrast, those who took their lives under a train or in a car were less likely to have left a note).
Among those victims who did leave a note or warning of some kind, women were more likely to leave a written note, as were victims from more affluent areas, while those with known mental health problems were more likely to have made verbal warnings.
The researchers advised that their results be interpreted with caution since some of the subcategories they looked at ended up consisting of very few cases. That said, they concluded that the findings suggest that “there are some significant differences” between suicide victims who leave notes and those who don’t, and that this needs to be taken into account by future research. “This is particularly important for research that uses suicide notes to gain insight into the motivation for suicide more generally,” they said.
_________________________________ Carpenter, B., Bond, C., Tait, G., Wilson, M., & White, K. (2016). Who Leaves Suicide Notes? An Exploration of Victim Characteristics and Suicide Method of Completed Suicides in Queensland Archives of Suicide Research, 20 (2), 176-190 DOI: 10.1080/13811118.2015.1004496
To psychologists, there’s nothing boring about boredom. Among other things, they’re beginning to realise just what an especially aversive state it is to be in. A new study in Psychiatry Research brings this home – the researchers found that student participants were more inclined to give themselves unpleasant electric shocks when they were provoked into feeling bored (a negative, low arousal state) than when they were provoked into feeling sad (a negative, but high arousal state, meaning that it is unpleasant but stimulating). This was especially the case for students with a history of self-harm, suggesting the research may have implications for understanding why people resort to deliberately hurting themselves in real life.
Chantal Nederkoorn at Maastricht University and her colleagues allocated the 69 participants, 19 per cent of whom were men, to one of three hour-long conditions: one involved watching a film about a girl who needed a bone marrow transplant and was designed to provoke sadness; another involved watching a documentary about the memory researcher Eric Kandel and was designed as a neutral/control condition; and the final condition involved watching an 83 second segment from that Kandel documentary (in which he is playing tennis with a friend) on repeat for one hour, which was designed to provoke boredom. Emotion questionnaires confirmed that the conditions had the desired effects. Prior to viewing the videos, participants in all conditions were wired to an electric shock machine and were told that, if they wanted, they could administer shocks to themselves of varying intensities whenever they liked.
The researchers tallied up the number of times the participants had chosen to shock themselves after 15 minutes and after one hour, and the intensity of the strongest shock they’d chosen (the machine’s highest setting was 20 milliamps – painful but not dangerous). There was no difference between the neutral and sad condition in the number or intensity of shocks that participants gave themselves. However, after one hour, participants in the boredom condition had given themselves more shocks than those in the neutral condition, and on average, the strongest shock they’d given themselves was higher in the boredom condition.
This contrast between conditions was especially apparent for the participants who had a history of self harm in real life. For example, after one hour, participants with a history of self harm and who were in the boredom condition had given themselves an average of just over 20 shocks (the strongest at just under 10 milliamps on average), whereas those in the neutral condition had given themselves an average of less than 2 shocks (with the strongest at less than 4 milliamps on average). The effect of boredom was also more immediate among the participants with a history of self-harm – just 15 minutes in, they had already shocked themselves more times in the boredom condition than in the neutral condition.
The researchers were cautious about over-interpreting their findings – for example, they pointed out that unlike in real life, the participants weren’t given any other way, besides the electric shocks, to distract themselves from the sadness or boredom. And they admitted the study involved a small, non-clinical sample.
Nonetheless, the finding that boredom was especially effective at provoking people into self-administering painful electric shocks does tally with some past research into real-life self-harming – for example, people have previously described hurting themselves for stimulation and to “feel something”, and boredom has previously been linked with suicidal thoughts. “Solitary confinement in jail has [also] been associated with increased risk of self-harm in jail,” the researchers said. “As the same mechanism can already be provoked in non-clinical undergraduate students within one hour, it seems that the negative effects of boredom and monotony should not be taken lightly.”
_________________________________ Nederkoorn, C., Vancleef, L., Wilkenhöner, A., Claes, L., & Havermans, R. (2016). Self-inflicted pain out of boredom Psychiatry Research, 237, 127-132 DOI: 10.1016/j.psychres.2016.01.063
Suicidal thoughts are relatively common whereas acts of suicide are, thankfully, far more rare. But this creates a dilemma – how to judge the risk of thoughts turning into action? A new study claims that an objective way is to use a computer programme to analyse a person’s writing style. People who are having suicidal thoughts and who use more pronouns relating to the self (I, me, myself) than pronouns relating to others, are likely to take more time to recover, meaning they will be at risk for longer.
Mira Brancu and her colleagues investigated 114 US students who’d referred themselves to an outpatient counselling centre at their university, and all of whom said they were having suicidal thoughts. When the students started therapy they completed a measure of suicidal risk which involved them writing about what they found most painful, pressing, agitating, and if and why they felt hopeless and self-hating. They also wrote about their reasons for living and dying and about “one thing that would help me no longer feel suicidal”.
A computer programme analysed the students’ answers to these questions, counting the relative number of mentions of first-person pronouns compared with mentions of other people, including friends and family and people’s names. Based on this, the students were categorised as either self-focused or other-focused. The important finding was that this categorisation was related to how the students progressed through therapy, based on their session-by-session self-ratings of their frequency of suicidal thoughts and their assessment of their own suicide risk. Students who were more self-focused at the study start took longer to recover – their suicidal thoughts resolved, on average, in 17 to 18 sessions, compared with 6 to 7 sessions for the students who were categorised as other-focused.
This finding does build on past research linking first-person pronoun use with personal distress, but as a diagnostic tool for suicidal risk it definitely needs replicating in other contexts – these were students who’d self-referred for treatment and all of them recovered, so it’s not clear whether the same results would apply with other, potentially more at-risk groups (but note, a prior study of suicidal poets [pdf] found that those who used more first-person pronouns were more likely to die by suicide).
Despite its limitations, this is an intriguing result that shows the possibility of a relatively quick, efficient and objective way to estimate the likely persistence of suicidal thoughts. The measure would be “bias-free” which is important because it’s known that clinicians’ own subjective judgments can be off-target. Indeed, Brancu and her colleagues note that an informal survey of clinicians at conferences found that they thought more self-focused versus other-focused writings would be a positive sign, indicating that patients were better able to articulate their feelings.
_________________________________ Brancu, M., Jobes, D., Wagner, B., Greene, J., & Fratto, T. (2015). Are There Linguistic Markers of Suicidal Writing That Can Predict the Course of Treatment? A Repeated Measures Longitudinal Analysis Archives of Suicide Research DOI: 10.1080/13811118.2015.1040935