What is suicide?

Definitions Suicidal ideation Suicidal thoughts May be passing or serious, may or may not be accompanied by intent Suicide attempt "self-influcted, potentially injurious behavior with a nonfatal outcome for which there is evidence (either explicit or implicit of intent to die“ 1 Suicide (or Death by Suicide) A death caused by a suicide attempt

Grey Areas Indirect Self-Destructive Behaviors Non-Suicidal Self-Injury Defining suicide is not an easy task

Epidemiology There were 38,364 suicides in the United States in 2010 Around 49 deaths due to lightning ( average) 3,195 deaths due to fire (2009) 4,211 drowning deaths (2009) 16,799 deaths due to murder (2009) 36,399 automobile deaths (2009) Suicide is the 10 th leading cause of death in the US Mississippi had the 30 th highest suicide rate in the US, with 388 deaths due to suicide in (WISQARS, 2014)

Suicide rates are increasing

Suicide Research Retrospective Utilizing individuals who have died by suicide in the past Prospective Following individuals to see who dies by suicide Psychological Autopsy Reconstructing what a person was like before the suicide through interviews with family, friends, and co-workers. Correlational Looking at how variables relate with each other at any given moment

Prospective Research Screen individuals and follow them (often for years to decades) Strengths The researcher selects the questions to be asked The decedent is the one who answers the questions Weaknesses Requires huge Ns Huge costs (time and money) How do you determine who died by suicide?

Psychological Autopsy Interview family members and friends of the decedent after a suicide. Comparison group formed by decedents of other causes. Strengths The researcher picks the questions to be asked Much smaller Ns and less time required Weaknesses Often relies upon coroner’s reports Getting records may not be easy Death records are privileged information Still involves a lot of time, effort, and resources

Treatment Records Examining the treatment records of decedents in relation to a comparison group (non-fatal suicide attempters or patients with affective disorders) Strengths Less time, money, and resources needed Weaknesses Researcher cannot pick the questions Data was not designed for research Convenience sample Likely to be biased

National Registries/Databases Some large databases (public and private) exist allowing researchers the benefits of prospective studies without the massive investment Strengths Ability to study death by suicide prospectively Weaknesses Access to the data may be limited The researcher has no control over what was asked Many stakeholders

Interviewing Suicide Attempters One significant step removed from suicide, but a good ancillary. Strengths Researcher selects the questions More feasible than many of the suicide research methods Weaknesses May differ from suicides Still a difficult group to sample

Suicidal Ideation Two significant steps from suicide Often correlational, but can be longitudinal Strengths Feasibility Weaknesses Removed from suicide Current suicidal ideation still has ethical/logistical concerns

Treatment Studies Must use comparison groups instead of waitlist control groups or placebos Why? Treatment is often compared with “treatment as usual” Outcome may be death by suicide, future suicide attempts, or suicidal ideation Each have limitations

Ethical Issues in Suicide Research Individuals with suicidal ideation must be treated Those at imminent risk must receive treatment immediately If assessing current suicidal ideation there must be a psychologist or psychiatrist available to do assessments Cannot use waitlist control groups Cannot use experiments Ethical to test a new treatment?

Conclusions Suicide research is challenging Hard to access the population High Ns required for some methods Many years of follow-up Funding often required Clinical credentials often required