Role of Timely Intervention in Preventing Suicide

7/23/2019 Role of Timely Intervention in Preventing Suicide

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Wh

Tho

Distinguish

The Bri

Depart

Flori

joi

People Die BySuicide

as Joiner Ph.D.

ed Research Professor &

ht-Burton Professor

ent of Psychology

a State University

[email protected]


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On February 1,

2003, thespace shuttleColumbia

disintegratedas it flew ovethe western

UnitedStates

r


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finallyshoweringdown overEast Texasand Louisian

of pieces,killing allseven crewmembers.


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The cause was adense, dry,

brownish-orangepiece of foamweighing about 1.

pounds, 19 incheslong and 11 inche

Columbias leftwing traveling 54mph, causing wha

investigators nowknow was asignificant breachthe wing.

in


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One of the memb

investigating thexcitement that

is danger was k

though the danNASA adminis

getting in-fligh

left wing, in paof danger abou

eroded over the

experience with

ers of the panel

e accident said Theonly exists when there

nd of gone even

er was not gone. Keyrators decided against

satellite images of the

t because their sensefoam strikes has

years,due to repeated

them.


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Relevance to S

A key point of my tget used to dangelose the excitem

there is danger icatastrophe is laidadministrators be

danger, to the poiworrying about foargue, do potentiathe danger signals

should accompan

icide

eory is that when peopleous behavior when theynt that only exists when

the words of the accident

down. Just as NASAame inured to a very real

t of no longer evenam strikes, so too, I willlly suicidal people loseand alarm bells that

self-injury.


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The Acquired

When self-injuryexperiences becand mundane

used to its threawhen we might

when they haveacquired abilityinjury.

bility for Suicide

nd other dangerousome unthreatening

when people work up

and danger that islose them. That is

developedtheto enact lethal self-


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A Good Theor

Popper: Intefollows laws

deductive tes

Parsimony: OOmne superfludispliceat(Ev

is displeasing

nally coherentof logic

s.

ccams razor Dante:um Deo et Naturaerything superfluous

o God and Nature).


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A Good Theor

Also, eere o

unexpla

plains there

ined.


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Why.?

. do female pprostitutes have

.of national crisicitys sports tea

. have societacross culture ssuicide?

ysicians andhigh rates of suicide?

and increase when adashes expectations?

es across history andnctioned ritual


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How.?

. to understacults?

nd mass suicides in


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How.?

. to und rstand suicide


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Tall Order for

Theory of

Not only

and othermust alsowith these

a Comprehensive

Suicide

ust the

questions, itbe compatible

facts:


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Facts

Suicide rates hipeople

and in men

and in CaucU.S.

Suicide is asso

et very few Suicide is more

anorexia tha

ghest in older

except in China)

sian eo le in the

iated with impulsivity,

die on a whim.associated withwith bulimia.


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More Facts

Death by s

die in U.S.,

1,900 per ddisease.

icide is

compared to

y from heart


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More Facts

Death by suic

$10 billion a

lost wa es aldeath per yea

This does no

Lawsuits, insinvestigations

productivity,

de is costly.

nually in the U.S. in

ne $350,000 er.

include other costs:

rance settlements,, effects on survivors

tc.

Sk h

f h Th


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Those Who

Desire Suici

Perceived

Sketch

Serious

Bur ensomene

Thwarted

Belongingnes

e

of the Theory

Attempt or Death by Suicide

Those Who Are

Capable of Suicide

s


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The Acquired

Lethal Sel It seems rather absu

himself through weacan surmount the monature Voltaire.

experiences invosuch as

Past suicidal behavio

Repeated injuries (e.

Repeated witnessingphysicians).

Any repeated exposu

apability to Enact

-Injuryrd to say that Cato slewness. None but a strong man

st powerful instinct of

ving pain and provocation,

, but not only that

., childhood physical abuse).

of pain, violence, or injury (cf.

e to pain and provocation.


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The Acquired C

Lethal Self-

Habituation:

Response

due to

repeatedstimulation.

pability to Enact

Injury: Habituation


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The Acquired

Lethal Sel

Habituation c

(i.e., through o

The fact thatemotional rea

inflicted on ot

from the simp[in the cingul

apability to Enact

-Injury

n occur vicariously

bservation).

we have s ecifictions to seeing pain

er people may result

e simulation producedte cortex].


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The Acquired

Lethal Sel

the experi

peoples pain

some extent

of ones own-Pascal Boyer,

apability to Enact

-Injury

nce of other

, as handled by the

,verlaps with that

pain.001.


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The Acquired

Lethal Sel With repeated

habituates thprohibited qua

e av or mthe fear and pa

self-harm.

Relatedly, oppbe involved.

apability to Enact

-Injuryexposure, one

taboo andity of suicidals es, an so may

in associated with

nent-processes may


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The Acquired

Lethal Sel

Briefly, oppon

(Solomon, 198

re etition theprovocative sti

habituation in

BUT.

apability to Enact

-Injury

nt process theory

0) predicts that, with

ffects of amulus diminish.

ther words.


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The Acquired

Lethal Sel

Opponent palso predict

,effect, or op

becomes astrengthene Example of sk

apability to Enact

-Injury

ocess theorythat, with

onent process,

plified and.diving.

h A i d bili


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The Acquired

Lethal Sel

The opponen

suicidal peop

fearless, and

experience inreinforcemen

practice at su

apability to Enact

-Injury

process for

e may be that they

ay even

creasing, with repeated

cidal behavior.


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Empirical Evi

Lethality of meth

intent increase wit

People who have

suicide prostitut

abusers, people li

physicians.

Those with a histo

higher pain tolera

ence

d and seriousness of

attempts.

xperienced or witnessed

s, self-injecting drug

ing in high-crime areas,

y of suicide attempt have

ce than others.


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Why I Jumped

In the midst of(at times near-ca

depression, Zah

She fled relativ

police. Police cl

Still, she is amb

which show up i

by Tina Zahn

recurrent, very severeatonic) postpartum

decided to jump off a

, .s in her car, who called

cked her at 120 mph.

valent, some signs of

the following video.


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Anecdotal Evi

Cobain was teafraid of needleand, crucially, a

afraid of needlelater became a d

user, someonedangled from 30concerts, and so

shooting guns.

ence: Cobain

peramentally fearful , afraid of heights,raid of guns. Through

,, heights, and gunsaily self-injecting drug

ho climbed andfoot scaling duringeone who enjoyed


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Anecdotal Evi

Regarding guns,they were barbaricdo with them late

friend to shoot guof the car on laterthe car but wouldstill later trips, he

show him how toself-inflicted gunsage of 27.

ence: Cobain

obain initially felt thatand wanted nothing tohe agreed to go with his

s but would not get outexcursions, he got out ofot touch the guns and ongreed to let his friend

im and fire. He died byot wound in 1994 at the

A d t l E id M i th


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Anecdotal Evid

Lewis (of Lewi

From Stephen ALewis, Undaunted

Lewis paced for s

others could hearcreaked.

Two self-inflicted

Servants found hi

head to foot. Lewis said to serv

strong, it is so harlater.

nce: Meriwether

& Clark fame)

broses biography ofCourage:

veral hours (agitation), as

im all night as the floorboards

gunshot wounds, neither fatal.

busily cutting himself from

nts, I am no coward, but I amto die. He died a few hours


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Suicide in An

Mortality is extrwomen (SMR =

It is an under-aps ou an anore

prematurely, thelikely to be suic

arising from costatus.

rexia Nervosa

mely high in anorexic~60).

reciated fact that,c pa en e

cause of death is morede than complications

promised nutritional


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Suicide in An

There are at lea

accounts of the

between AN ananorexic wome

rates because th

survive relativelattempts and/or

to be rescued aft

their socially iso

rexia Nervosa

t two possible

igh association

suicide. In one view,die by suicide at high

y are unable to

low lethalityhey may be less likely

er an attempt due to

lated status.


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Suicide in An

In another view

theory of suicid

women die by sbecause their hi

starvation habit

inure them to fetherefore make

with high intent

rexia Nervosa

, informed by my

l behavior, anorexic

icide at high ratestories of self-

ate them to pain and

r of death, and theyigh lethality attempts

to-die.


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Suicide in An

We pitted these

each other, in a

with AN, follow 9 died by suici

death among the

Of these 9, werlethal methods o

rexia Nervosa

two accounts against

tudy of 239 women

ed over ~15 years.e, the leading cause of

sample.

they mostly highlyr not?


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Suicide in An

Theleastlethal

oz. of a househo

along with an upowerful sedati

0.16%). Cause o

hemorrhaging din the cleaning

Might Bitrix ha

rexia Nervosa

ethod: Ingestion of 12

ld cleaning product,

known amount of ae and alcohol (BAC =

f death was gastric

e to hydrochloric acidroduct.

e prevented this?


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Provocative

Behaviors

NonEDPB

.73**

ANR versus

ANBP

.73**

.20* (.40*)

Number ofAttempts

EDPB

Lethality

.46**

.66**

.78**.98**

Extreme

Suicidal

Behavior

Intent

Premeditation

Violent

Attempt

.98**

.90**

.33**

Those Wh


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Desire Suici

Perceived

Burdensomene

Serious

Thwarted

Belongingnes

de

Those Who Are

Capable of Suicide

s


Constituents o the Desire for


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Constituents o

Death

Perceived

the Desire for

urdensomeness


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Perceived Bur

Essential

than my li

ones/famil

ensomeness

alculation:

e to my loved

/society.

Perceived Bur ensomeness:


42/72

Empirical Evi

Five studies totested this view For example, we trai

suicide notes regardi

generalized emotionhalf of the notes wersuicide, and half wersuicide and survived

by suicide containedthan notes from atteregarding hopelessn

Joiner et al. (2002). Perceivedstudies on the suicide notes

suicide. Journal of Social

ence

ate have directlyall support it.ed raters to evaluate actualg the following dimensions:

l pain. Unknown to the raters,from people who died by

e from people who attempted. The notes from those who diedmore perceived burdensomenesspters no effects were foundss and emotional pain.

burdensomeness and suicidality: Twoof those attempting and those completing

Clinical Psychology, 21, 531-545

Perceived Bur ensomeness: Self-


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Sacrifice Acro

Fire ants.

Pea aphids.

.Spiders

. even a pal

ss Species

tree.


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St th i

B l i


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Strengthening

New CDC vision:

The degree to wh

socially close, int

with other erson Between individ

Between individ

organizations

Among communiinstitutions

Belongingness

Promote connectedness

ch a person or group is

rrelated, or shares resources

or rou sals

als/families and community

ty organizations and social


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Those Wh

Desire Suicide


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Desire Suici

Perceived

Burdensomene

Serious

Thwarted

Belongingnes

de

Those Who Are

Capable of Suicide

s


Constituents o the Desire for


51/72

Death

Perceived urdensomeness

Thwarted Bel ngingness:


52/72

Empirical

Hoyer and Luna million wome

course of a 15-

, e y sthat women wit

had one-fifth th

suicide as comp

Hoyer, G., & Lund, E. (1993).

children in marriage. Arch

Evidence

(1993) studied nearlyin Norway over the

ear follow-up, over

c e. ey repor esix or more children

risk of death by

ared to other women.

Suicide among women related to number of

ves of General Psychiatry, 50, 134-137. .



53/72

Empirical

Twins die bythan others de

higher rates oTomassini et al. (2003). Ris

British Medical Journal,

Evidence

uicide at lower ratespite having slightly

mental disorders.k of suicide in twins: 51 year follow up.

327, 373-374 .



54/72

Empirical

The camarabelongingne

considerable,

conditions o

Evidence

erie and sense ofs from being a fan

especially under

success

Thwarted Bel

i i l

ngingness:

id


55/72

Empirical

as many whuniversity town

themselves whe

na ona c ampfootball, say in

Evidence

have lived incan observe for

the university wins a

ons p, say, n993 or 1999.

Thwarted Bel

E i i l

ngingness:

E id


56/72

Empirical

It is interestinwhether teams

suicidality fr

perspective, it

increased belo

associated wit

Evidence

g to consider, then, success affects

m the present

might, in that

ngingness should be

lower suicidality.

Thwarted Bel

E i i l

ngingness:

E id


57/72

Empirical

Several studithis associatio

Joiner, T., Van Orden, K., & Ho

the Miracle on Ice, and Su eAssociated With Lower Suic

Psychology.

Fernquist, R.M. (2000). An agg

suicide, and homicide rates:

Aggression & Violent Beha

Steels, M.D. (1994). Deliberate

Football Club and F. A. Cup

Medicine, 11, 76-78.

Trovato, F. (1998). The Stanle

1951-1992. Social Forces, 7

Evidence

s have documented.

llar, D. (2006). On Buckeyes, Gators,

Bowl Sunda : Pullin To ether Isde Rates. Journal of Social & Clinical

regate analysis of professional sports,

0 U.S. metropolitan areas, 1971-1990.

ior, 5, 329-341.

self poisoning - Nottingham Forest

defeat. Irish Journal of Psychological

Cup of Hockey and suicide in Quebec,

7, 105-126.

Thwarted Belon ingness:


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Thwarted Belon

Poor Red S

ingness:

x Fans

Thwarted Belon ingness:


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Poor Red S

2004 and 2

x Fans (Well, Until

07)

Thwarted Bel

P C b

ngingness:

F


60/72

Poor Cubs Fans


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Miracle on Ice,February 22, 19 0

100


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80

90

fDailySuici

des

1972

Missing

1976

1978

19

February

60

70

Number

80

1982

1984

1986

1988

Missing

22 (1972-1989)


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Thos

DesireDi

Who

Suicide


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Perc

Burden

i

s

ta

l

SS

Th

Belon F

a

c

t

o

r

s

Those Who Are

Capable of Suicide

eived

omeness

rious Attempt or Death byicide

arted

ingness

Prevention/Tr

I li i

atment


66/72

Implicatio

The models l

prevention of

o ur ethwarted bel

prevent seriou

Belongingnes

malleable and

s

gic is that

acquired ability

someness ongingness will

s suicidality.

may be the most

most powerful.


67/72

Prevention/Tr

I li ti

atment


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Implicatio

CBT ->

low belo

s

ging.


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Available at places like amazon.com

The book goes

ell beyond this talk.


70/72

g

9/11, World Tr Suicide in inse

but true)

H h m rminds of suicid

Lying about su

Why we scramlightning strikedeath by suicid

y

de Centerts and spiders (weird

i h lif in hl people

cide

le to prevent deaths byut do less to prevent

The book goes ell beyond this talk


71/72

g

What I told mysuicide runs in

The role of ser

and other serotoin suicidal beha

Why women w

and borderline

so vulnerable to

y

young sons about howur family

tonin-system genes

nin-system parametersior

th anorexia nervosa

ersonality disorder are

death by suicide

Thank you for your attention


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y

o ner

y

psy. su.e u

Documents

Role of Timely Intervention in Preventing Suicide