Role of Timely Intervention in Preventing Suicide
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Transcript of 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
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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
Attempt or Death by Suicide
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:
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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
Attempt or Death by Suicide
Constituents o the Desire for
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Death
Perceived urdensomeness
Thwarted Bel ngingness:
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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. .
Thwarted Bel ngingness:
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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 .
Thwarted Bel ngingness:
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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
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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
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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
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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
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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
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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.
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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.
-
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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
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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