Suicide is often seen as the tip of the iceberg. When Mr Ruelas', a Los Angelos teacher, died by suicide last week, it is acknowledged that the motives are far from clear. However some have associated Mr. Ruelas' love of teaching, his despair about the recent release of teacher performance ratings and his shame at being listed as a "less than effective" teacher compelled him to take a fatal jump. I also have the experience losing someone I love to suicide and searching for answers that can bind my anguish. My mother killed herself when I was four years old and as a child psychiatrist, mother, daughter I spent 18 years asking the impenetrable question of "Why?"
The lessons learned for those of us who lose someone to suicide is that it is usually a complex set of events, biological, cultural, conscious, unconscious motives. In ninety percent of suicides there is an underlying mental illness that exacerbates how someone responds to an immediate crisis whether it is a loss of a job, a divorce, the vicissitudes in life that can leave us bereft. In "psychological autopsies" when researchers interview friends and family, someone often has suffered from depression or bipolar disorder.
When someone is depressed and suicidal they can often have lethal misperceptions. Their desperate misery can be fueled by the faulty logic that their problem is permanent and that ending their life is the only solution. If I had climbed next to Mr. Ruelas on the remote forest bridge, the kind of metaphorical outreach that I do with my patients in my office, I would have counseled him in the words of Galway Kinell in his poem to a suicidal friend, "Wait, Wait for now, the need for new love is faithfulness to the old." I would have asked him to look at the evidence that a bad report card can permanently derail a career or can he recognize that this is the "faulty logic" of depression. When someone is suicidal they can see themselves as a perceived burden and that they will not be missed.
The aftermath of Mr. Ruelas' death is a stark reminder that none of us are expendable. As an extension of Mr. Ruelas' love for his students, I want each of them to get the message that depression is a treatable illness. We have life sustaining support to help those in their darkest hours find another way.
Blog by: By Nancy Rappaport, M.D - A Teacher's Suicide: Lessons Learned
Showing posts with label suicide. Show all posts
Showing posts with label suicide. Show all posts
Friday, October 8, 2010
Tuesday, April 13, 2010
New Research on Suicidal Behavior
Determining who is at risk for suicide is an arduous and inexact endeavor. Even trained clinicians can miss warning signs.
Researchers have now developed an instrument they believe will help predict those at risk.
Matthew Nock of Harvard University, along with colleagues from Harvard University and Massachusetts General Hospital, modified a well-known word-association test to measure associations between life and death/ suicide and examined if it could be effective in predicting suicide risk.
The Implicit Association Test (IAT) is a widely used test that measures automatic associations people hold about various topics. Participants are shown pairs of words; the speed of their response indicates if they unconsciously associate those words.
In the IAT version used in this study, participants classified words related to “life” (e.g., breathing) and “death” (e.g., dead) and “me” (e.g., mine) and “not me” (e.g., them).
Faster responses to “death”/”me” stimuli than “life”/”me” stimuli would suggest a stronger association between death and self.
People seeking treatment at a psychiatric emergency room participated in this study. They completed the IAT and various mental health assessments. In addition, their medical records were examined six months later to see if they had attempted suicide within that time.
The results, reported in Psychological Science, a journal of the Association for Psychological Science, revealed that participants presenting to the emergency room after a suicide attempt had a stronger implicit association between death/ suicide and self than did participants presenting with other psychiatric emergencies.
In addition, participants with strong associations between death/ suicide and self were significantly more likely to make a suicide attempt within the next six months than were those who had stronger associations between life and self.
These results suggest that an implicit association between death/ suicide and self may be a behavioral marker for suicide attempts. These findings also indicate that measures of implicit cognition may be useful for identifying and predicting clinical behaviors that tend not be reported.
As Nock explains, “these results are really exciting because they address a long-standing scientific and clinical dilemma by identifying a method of measuring how people are thinking about death and suicide that does not rely on their self-report.”
He adds, “we are hopeful that this line of research ultimately will provide scientists and clinicians with new tools for measuring how people think about sensitive clinical behaviors that they may be unwilling or unable to report on verbally.”
Mahzarin Banaji, also of Harvard University and a co-author of this study, adds that this work presents a strong argument for the importance of funding basic behavioral research.
“These results are an example of basic research helping to solving a troubling and devastating problem in every society. The method we used was designed to understand the mind, but it turned into a technique that can predict disorders of a variety of sorts. One wonders why funding agencies that should know better about the value of basic research seem so naive when it comes to decisions about what is in the public’s interest.”
By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on April 13, 2010
Researchers have now developed an instrument they believe will help predict those at risk.
Matthew Nock of Harvard University, along with colleagues from Harvard University and Massachusetts General Hospital, modified a well-known word-association test to measure associations between life and death/ suicide and examined if it could be effective in predicting suicide risk.
The Implicit Association Test (IAT) is a widely used test that measures automatic associations people hold about various topics. Participants are shown pairs of words; the speed of their response indicates if they unconsciously associate those words.
In the IAT version used in this study, participants classified words related to “life” (e.g., breathing) and “death” (e.g., dead) and “me” (e.g., mine) and “not me” (e.g., them).
Faster responses to “death”/”me” stimuli than “life”/”me” stimuli would suggest a stronger association between death and self.
People seeking treatment at a psychiatric emergency room participated in this study. They completed the IAT and various mental health assessments. In addition, their medical records were examined six months later to see if they had attempted suicide within that time.
The results, reported in Psychological Science, a journal of the Association for Psychological Science, revealed that participants presenting to the emergency room after a suicide attempt had a stronger implicit association between death/ suicide and self than did participants presenting with other psychiatric emergencies.
In addition, participants with strong associations between death/ suicide and self were significantly more likely to make a suicide attempt within the next six months than were those who had stronger associations between life and self.
These results suggest that an implicit association between death/ suicide and self may be a behavioral marker for suicide attempts. These findings also indicate that measures of implicit cognition may be useful for identifying and predicting clinical behaviors that tend not be reported.
As Nock explains, “these results are really exciting because they address a long-standing scientific and clinical dilemma by identifying a method of measuring how people are thinking about death and suicide that does not rely on their self-report.”
He adds, “we are hopeful that this line of research ultimately will provide scientists and clinicians with new tools for measuring how people think about sensitive clinical behaviors that they may be unwilling or unable to report on verbally.”
Mahzarin Banaji, also of Harvard University and a co-author of this study, adds that this work presents a strong argument for the importance of funding basic behavioral research.
“These results are an example of basic research helping to solving a troubling and devastating problem in every society. The method we used was designed to understand the mind, but it turned into a technique that can predict disorders of a variety of sorts. One wonders why funding agencies that should know better about the value of basic research seem so naive when it comes to decisions about what is in the public’s interest.”
By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on April 13, 2010
Thursday, March 25, 2010
Suicide Among the Young: How to Try to Prevent It
To the Editor:
Re “After Three Suspected Suicides, a Shaken Cornell Reaches Out” (front page, March 17):
Suicide is a tragedy, made worse when occurring in youth. Many university campuses, not only Cornell, are beleaguered by this excruciatingly painful problem. After all, they have our youth and promise in their classes, seminars and dormitories.
The continuing neglect of the major cause of suicide among youth is shocking. The bulk of coverage in the media largely misses it. It is not only about stress, long winter nights, school challenges or failures, loneliness or social isolation. After all, most people who face these stressors do not kill themselves.
Thus, although stress might precipitate it, it is about mental illness, most commonly mood and substance abuse disorders. Until we as a country face the challenge of reaching our youth and providing high-quality mental health services, until we can reduce the stigma of seeking help for psychiatric conditions, we are crippled in our efforts to stem this scourge.
Our future is our youth. We are duty-bound to reach them and maximize the likelihood not only of their survival but also of their success.
Maria A. Oquendo
New York, March 17, 2010
The writer is a professor of clinical psychiatry and vice chairwoman for education in the department of psychiatry at Columbia University.
•
Re “After Three Suspected Suicides, a Shaken Cornell Reaches Out” (front page, March 17):
Suicide is a tragedy, made worse when occurring in youth. Many university campuses, not only Cornell, are beleaguered by this excruciatingly painful problem. After all, they have our youth and promise in their classes, seminars and dormitories.
The continuing neglect of the major cause of suicide among youth is shocking. The bulk of coverage in the media largely misses it. It is not only about stress, long winter nights, school challenges or failures, loneliness or social isolation. After all, most people who face these stressors do not kill themselves.
Thus, although stress might precipitate it, it is about mental illness, most commonly mood and substance abuse disorders. Until we as a country face the challenge of reaching our youth and providing high-quality mental health services, until we can reduce the stigma of seeking help for psychiatric conditions, we are crippled in our efforts to stem this scourge.
Our future is our youth. We are duty-bound to reach them and maximize the likelihood not only of their survival but also of their success.
Maria A. Oquendo
New York, March 17, 2010
The writer is a professor of clinical psychiatry and vice chairwoman for education in the department of psychiatry at Columbia University.
•
Monday, November 30, 2009
Why the holiday suicide myth persists
By Kim Painter, USA TODAY
You could blame George Bailey. In the 1946 holiday film It's a Wonderful Life, that fictional character contemplated suicide on Christmas Eve, possibly giving birth to the idea that suicides climb during the winter holidays.
But moviemaker Frank Capra had it wrong: Study after study shows no such link; in fact, suicide numbers peak in the spring and may even dip in December, according to the U.S. Centers for Disease Control and Prevention. Still, the holiday suicide myth has amazing staying power.
For the past decade, Dan Romer, a researcher at the Annenberg Public Policy Center of the University of Pennsylvania, has been tracking mentions of suicide and the holiday season in stories published in U.S. newspapers from mid-November to mid-January. His first study, covering the 1999 holiday season, found that just 23% of stories debunked the myth and the rest reinforced it. By 2006, 91% of stories debunked the myth, and Romer took some credit: Publicizing the facts had nearly killed the myth, he thought.
He was wrong. In the 2007 season, the myth was back in half of stories, he says. And Romer just completed his analysis of 2008 holiday coverage. He found that 38% of stories supported the myth and 62% debunked it – an improvement he attributes partly to a myth-busting report published last December in the British Medical Journal.
He can't explain why nearly four in 10 stories still linked suicide and the holidays. "No one does it maliciously," he says. "I think they are trying to help people."
But the myth may harm people instead.
"It might unnecessarily put people on their guard or increase their anxiety," says Ronald Pies, a psychiatrist at Tufts University School of Medicine, via e-mail. Worse, he says, some people "on the brink" of self-harm might feel encouraged to follow through when they read or hear that holiday suicides are common. The myth might become a self-fulfilling prophecy.
Romer agrees: "You don't want to convey the message that this is acceptable or that there's a good reason to do it."
But why does this particular myth persist?
One reason may be that the holidays fall during a time of year that can be trying for many people, says Paula Clayton, medical director of the American Foundation for Suicide Prevention. People with seasonal affective disorder (SAD) tend to become depressed as days get shorter and darker. They come out of their depression in the spring.
Meanwhile, some people do suffer short-term blues linked directly to the hubbub and stress of the holidays, she says. People in mourning for a loved one can feel especially sad as special days come and go without that person, she says.
Pies adds: "I certainly would expect that, in the present financial crisis, the usual blues would be intensified for many families facing loss of savings, unemployment, etc."
But, experts say, suicide is almost always the act of someone who has endured deep depression or another mental illness for months or years – not someone with a passing case of the blues.
The holiday suicide myth may detract attention from the real needs of people who might consider suicide at any time of year, Clayton says: "There are a lot of untreated people out there."
Meanwhile, researchers continue to look for the real patterns in suicidal behavior, says Alexander Crosby, a CDC researcher. "That can help us in terms of finding protective factors," he says.
And one protective factor, he says, is "connectiveness" – that is, how connected people are to friends, families and communities.
Fittingly enough, that was the very thing (along with an angel) that saved George Bailey after all.
You could blame George Bailey. In the 1946 holiday film It's a Wonderful Life, that fictional character contemplated suicide on Christmas Eve, possibly giving birth to the idea that suicides climb during the winter holidays.
But moviemaker Frank Capra had it wrong: Study after study shows no such link; in fact, suicide numbers peak in the spring and may even dip in December, according to the U.S. Centers for Disease Control and Prevention. Still, the holiday suicide myth has amazing staying power.
For the past decade, Dan Romer, a researcher at the Annenberg Public Policy Center of the University of Pennsylvania, has been tracking mentions of suicide and the holiday season in stories published in U.S. newspapers from mid-November to mid-January. His first study, covering the 1999 holiday season, found that just 23% of stories debunked the myth and the rest reinforced it. By 2006, 91% of stories debunked the myth, and Romer took some credit: Publicizing the facts had nearly killed the myth, he thought.
He was wrong. In the 2007 season, the myth was back in half of stories, he says. And Romer just completed his analysis of 2008 holiday coverage. He found that 38% of stories supported the myth and 62% debunked it – an improvement he attributes partly to a myth-busting report published last December in the British Medical Journal.
He can't explain why nearly four in 10 stories still linked suicide and the holidays. "No one does it maliciously," he says. "I think they are trying to help people."
But the myth may harm people instead.
"It might unnecessarily put people on their guard or increase their anxiety," says Ronald Pies, a psychiatrist at Tufts University School of Medicine, via e-mail. Worse, he says, some people "on the brink" of self-harm might feel encouraged to follow through when they read or hear that holiday suicides are common. The myth might become a self-fulfilling prophecy.
Romer agrees: "You don't want to convey the message that this is acceptable or that there's a good reason to do it."
But why does this particular myth persist?
One reason may be that the holidays fall during a time of year that can be trying for many people, says Paula Clayton, medical director of the American Foundation for Suicide Prevention. People with seasonal affective disorder (SAD) tend to become depressed as days get shorter and darker. They come out of their depression in the spring.
Meanwhile, some people do suffer short-term blues linked directly to the hubbub and stress of the holidays, she says. People in mourning for a loved one can feel especially sad as special days come and go without that person, she says.
Pies adds: "I certainly would expect that, in the present financial crisis, the usual blues would be intensified for many families facing loss of savings, unemployment, etc."
But, experts say, suicide is almost always the act of someone who has endured deep depression or another mental illness for months or years – not someone with a passing case of the blues.
The holiday suicide myth may detract attention from the real needs of people who might consider suicide at any time of year, Clayton says: "There are a lot of untreated people out there."
Meanwhile, researchers continue to look for the real patterns in suicidal behavior, says Alexander Crosby, a CDC researcher. "That can help us in terms of finding protective factors," he says.
And one protective factor, he says, is "connectiveness" – that is, how connected people are to friends, families and communities.
Fittingly enough, that was the very thing (along with an angel) that saved George Bailey after all.
Thursday, November 19, 2009
Copycat effects after media reports on suicide: A population-based ecologic study.
Authors: Niederkrotenthaler, D., Till, B., Kapusta, N., Voracek, M., Dervic, K., & Sonneck, G. (2009). Social Science and Medicine, 69(7), 1085-1090.
The authors explored whether the risk of an increased number of suicides after a media report on suicide is associated with the social characteristics of the person whose suicide was reported. Celebrity status of the person whose suicide was reported was the only variable associated with an overall increase in the number of suicides after the media report of a suicide. That is, a suicide report involving a celebrity resulted in an increase in the total number of suicides in the 29 days following the report. However, the study also revealed three factors associated with an increase in the risk of “similar” suicides (that is, suicides of persons of the same sex, in the same age group, or who use the same method as the person whose suicide was reported in the media) over that same time period.
The study also revealed that media reports of the suicide of an individual convicted of, or suspected of, crimes were associated with a decrease in similar suicides. None of the variables were found to be associated with a post-media report increase in “dissimilar” suicides (that is, suicides by people in another age group, of the other sex, or who chose a different method). Nor was the density of media suicide reports found to be associated with an increase in suicides.
The authors concluded that increases in suicides after a media report of a suicide is most pronounced for:
The study also found that reports of the suicide of middle-aged people were more likely to be followed by similar suicides than reports of suicides of people in other age groups. The authors speculated that this may be a consequence of the fact that the study utilized newspaper reports and that most newspaper readers are middle-aged. They suggested that additional research should be conducted on media that target children, adolescents, and the elderly. The authors also noted that only a limited fraction of suicide reports in the media were followed by an increase in suicides. The research team used data on suicides from the nonprofit information center Statistics Austria during the period July 1996–September 2006 and reports on suicide in the 13 most widely read Austrian newspapers (which reach 74.2% of that country’s population) during the same time period. Among the celebrity suicides reported during this period were those of rock stars Falco and Michael Hutchence and British weapons expert David Kelly.
The authors explored whether the risk of an increased number of suicides after a media report on suicide is associated with the social characteristics of the person whose suicide was reported. Celebrity status of the person whose suicide was reported was the only variable associated with an overall increase in the number of suicides after the media report of a suicide. That is, a suicide report involving a celebrity resulted in an increase in the total number of suicides in the 29 days following the report. However, the study also revealed three factors associated with an increase in the risk of “similar” suicides (that is, suicides of persons of the same sex, in the same age group, or who use the same method as the person whose suicide was reported in the media) over that same time period.
- The first factor is celebrity status.
- The second factor is whether the person who was reported to have died by suicide was in the same age group as the people exposed to the support (that is, people seem to be more likely to imitate a suicide if the person who died by suicide was in their age group).
- The third factor was definitiveness. Definitively labeling a death as a suicide in a media report (rather than reporting it as a suspected suicide) increased the risk for similar suicides.
The study also revealed that media reports of the suicide of an individual convicted of, or suspected of, crimes were associated with a decrease in similar suicides. None of the variables were found to be associated with a post-media report increase in “dissimilar” suicides (that is, suicides by people in another age group, of the other sex, or who chose a different method). Nor was the density of media suicide reports found to be associated with an increase in suicides.
The authors concluded that increases in suicides after a media report of a suicide is most pronounced for:
- (1) people with social characteristics similar to the person whose suicide was reported, because they are more likely to identify with the deceased than other people; and
- (2) persons seen as socially superior (celebrities) and thus as role models to be imitated. Reporting a suicide of persons of whom society disapproves (i.e. criminals) was associated with a lower risk of copycat suicides.
The study also found that reports of the suicide of middle-aged people were more likely to be followed by similar suicides than reports of suicides of people in other age groups. The authors speculated that this may be a consequence of the fact that the study utilized newspaper reports and that most newspaper readers are middle-aged. They suggested that additional research should be conducted on media that target children, adolescents, and the elderly. The authors also noted that only a limited fraction of suicide reports in the media were followed by an increase in suicides. The research team used data on suicides from the nonprofit information center Statistics Austria during the period July 1996–September 2006 and reports on suicide in the 13 most widely read Austrian newspapers (which reach 74.2% of that country’s population) during the same time period. Among the celebrity suicides reported during this period were those of rock stars Falco and Michael Hutchence and British weapons expert David Kelly.
Thursday, September 24, 2009
8.3 Million U.S. Adults Considered Suicide Last Year
THURSDAY, Sept. 17 (HealthDay News) -- A national survey has found that more than 8 million adults in the United States seriously considered suicide last year, with younger adults the most likely to contemplate taking their own lives.
In addition to nearly 8.3 million thinking about committing suicide, 2.3 million made a plan to do so, and 1.1 million actually attempted it, according to a federal government study released Thursday.
The findings are from data collected in a 2008 survey of 46,190 people aged 18 or older. It's the first national scientific survey of its size to examine this public health issue, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
The study found significant age-related differences in the risk of suicidal thoughts, planning and attempts. For example, adults aged 18 to 25 were far more likely (6.7 percent) to have seriously considered suicide than those aged 26 to 49 (3.9 percent) and those aged 50 and older (2.3 percent). Similar disparities were found in suicide planning and attempts.
Females had marginally higher levels of suicidal thoughts and behaviors than males. Only 62.3 percent of those who attempted suicide received medical attention for their suicide attempts, while only 46 percent of those who attempted suicide stayed in a hospital overnight or longer for treatment of their suicide attempts.
Substance abuse was associated with increased risk of seriously considering, planning or attempting suicide, the report showed. People with substance abuse disorders were more than three times as likely to have seriously considered suicide as those without substance abuse disorders -- 11 percent versus 3 percent. Those with substance abuse disorders were four times more likely to have planned a suicide (3.4 percent versus 0.8 percent) and nearly seven times more likely to have attempted suicide (2 percent versus 0.3 percent).
"This study offers a far greater understanding of just how pervasive the risk of suicide is in our nation, and how many of us are potentially affected by it," Eric Broderick, SAMHSA acting administrator, said in a news release from the agency.
"While there are places that people in crisis can turn to for help like the National Suicide Prevention Lifeline [1-800-273-TALK], the magnitude of the public health crisis revealed by this study should motivate us as a nation to do everything possible to reach out and help the millions who are at risk -- preferably well before they are in immediate danger," Broderick said.
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