Understanding Suicide: Ian Hussey ! PhD student ! Dept of Psychology - PowerPoint PPT Presentation

Understanding Suicide: Ian Hussey ! PhD student ! Dept of Psychology ! (very little) ! Progress to Date 5pm Monday 24th March ! Teaching Lab

Suicide is unique to language-able humans This fact is rarely recognised, nor have its implications been realised 01

Scale of the problem 1 in 55 deaths 1.8% of all deaths ! Too many scales: I’ll use 2010 statistics and US Dollars

Who 82% male in 2010 (National Office of Suicide Prevention, 2013)

Who (National Office of Suicide Prevention, 2013)

Who (National Office of Suicide Prevention, 2013)

Health Spending Benchmarks: $/QALY No one can put a dollar value on human life …Except governments, of course $50,000/QUALY is the international benchmark $61,294 per QUALY (Lee, Chertow & Zenios, 2009)

Health Spending Benchmarks: $/QALY Rationale spending model assumes a flat curve $80,000 $60,000 $40,000 $20,000 $0 +50 years +10 years +1 year +1 month +1 week Money to be spent on prevention & treatment

Health Spending Benchmarks: $/QALY Rationale spending model assumes a flat curve $80,000 $60,000 $40,000 $20,000 $0 +50 years +10 years +1 year +1 month +1 week Money to be spent on prevention & treatment

Price of a Death by Suicide in Ireland Suicide is unbelievably expensive in terms of $/QUALYs Per marginal suicide: $2,500,000 $2,425,000 $2,000,000 $2,022,702 $1,500,000 $1,000,000 $500,000 € 10,700 $0 Rational spending on suicide Cost to Irish economy NOSP budget (National Office of Suicide Prevention, 2013; HSE, 2004)

“You can also collect butterflies and make many observations. If Where’s the you like butterflies, that’s fine; but such work must not be science? confounded with research, which is concerned to discover explanatory principles of some Suicide as a scientific question depth and fails if it does not do so” ! ! (Chomsky, 1979; see also Barnes-Holmes, Hussey, McEnteggart, Barnes-Holmes & Foody, in press) 01

“You can also collect butterflies and make many observations. If Where’s the you like butterflies, that’s fine; but such work must not be science? confounded with research, which is concerned to discover explanatory principles of some Suicide as a scientific question depth and fails if it does not do so” ! ! (Chomsky, 1979; see also Barnes-Holmes, Hussey, McEnteggart, Barnes-Holmes & Foody, in press) 01

The current state of suicidology is to Where’s the treat it like a disease. ! ! science? Study how it spreads, and what techniques are best curb this spread ! ! Suicide as an epidemiological question When formulated as an epidemiological question, we require health & social policy answers 01

Health & Social Policy ! • What works: ! ! • Physical barriers ! • Railings at railway stations ! • Purchasing limits on over the counter drugs ! ! • Information barriers - journalistic guidelines 01

Where’s the Psychology is concerned with psychology??? measurement and treatment: ! • Does/will this person have ‘it’? ! • How do we change ‘it’? ! 1000s of published papers: ! • Short term risk assessment ! • Long term risk factor research ! • Meditational analysis ! • Scale development 01

Where’s the Psychology is concerned with psychology??? measurement and treatment: ! • Does/will this person have ‘it’? ! • How do we change ‘it’? ! 1000s of published papers: ! • Short term risk assessment ! • Long term risk factor research ! • Meditational analysis ! • Scale development 01

Measurement n o i Scales t a i d e M

Why is measurement so difficult?

Why is measurement so difficult? ! • “Proxy” behaviours ! • When our behaviour of interest is hard to study we look at other behaviours that predict it ! ! Rate of “Completed” suicide 1.8% ! Previous attempts 2 - 7% ! Intent ?? ! Planning 3 - 30% ! ! Ideation 8 - 50% ! • “Mediation” analyses: variable Y explains relationship between variables X and Z ! • “Just as correlation does not equal causation, mediation does not equal mechanism” (Nock, 2007, p. 5)

‘Implicit’ Measures ! • We need a functional analysis of human language within suicide ! ! • Used in thousands of published studies ! ! • Used to study most DSM IV categories (Roefs et al., 2011)

‘Implicit’ Measures • “My Death is distressing” 1500 1250 1000 750 Tiny reaction time differences 500 250 0 TRUE FALSE milliseconds

‘Implicit’ Measures ! • Nock (2010): ! ! • Individuals attending A&E clinical for self-harm ! ! • IAT predicted future suicidal behaviour within 6 months far better than traditional measures or clinician assessment • Randall & Nock (2013): ! ! • Integrative model (IAT + questionnaires) that had either 90% specificity or 90% sensitivity

IRAP vs IAT IAT: Self-Death/Others-Life

IRAP vs IAT Self - Death Others - Death Self - Life Others - Life

IRAP vs IAT ! ! ! ! ! ! ! ! ! ! ! • Theories of suicide emphasise role of complex propositions and evaluations (e.g. Joiner et al., Williams et al., Abramson et al.)

Implicit Death - Positive Attitudes 0.50 0.40 0.43 0.30 0.20 0.10 0.00 Hussey & Barnes-Holmes (Individuals attending St Patricks with suicidal ideation)

Implicit Death - Positive Attitudes 0.50 0.40 0.39 0.30 0.20 0.10 0.00 Hussey, Barnes-Holmes & Gallagher

Implicit Death - Positive Attitudes 0.50 0.40 0.30 0.20 0.20 0.10 0.00 Hussey, Barnes-Holmes & Dennehy I

Implicit Death - Positive Attitudes 0.50 0.40 0.30 0.20 0.23 0.10 0.00 Hussey, Barnes-Holmes & Dennehy II

Implicit Death - Positive Attitudes 0.50 0.40 0.38 0.30 0.20 0.10 0.00 Hussey, Barnes-Holmes & Fawcett I

Implicit Death - Positive Attitudes 0.50 0.40 0.30 0.20 0.17 0.10 0.00 Hussey, Barnes-Holmes & Fawcett II

Implicit Death - Positive Attitudes 0.50 0.40 0.30 0.33 0.20 0.10 0.00 Hussey, Barnes-Holmes & Cahill

Not Attributable to Mortality Salience 0.50 0.40 0.30 0.33 0.20 0.10 0.00 Hussey, Barnes-Holmes & Fawcett (Post Mortality Salience Induction)

Not Attributable to Mortality Salience 0.50 0.40 0.30 0.30 0.20 0.10 0.00 Hussey, Barnes-Holmes & Dennehy (Post Mortality Salience Induction)

Attitudes to death & suicide are not what we assume ! • Contemplating the reinforcing properties of suicidal ideation is a very recent idea ! ! - e.g. Williams et al., 2007 ! ! • This coincides with a gradual reorientation towards behavioural and functional psychology ! ! • Need to focus on ‘suicidality’ as a form of suffering to be relieved, not just because it is a risk factor for suicidal acts 01

Understanding Suicide: Help & Support: ! Aware.ie ! Samaritans.ie ! (very little) Pieta.ie ! Progress to Date Console.ie ! PleaseTalk.ie