Suicide is one of those problems that a lot of smart minds have thought about, yet few answers satisfy. Instead, we rely on a patchwork of suicide prevention methods (like fences on bridges) and suicide hotlines, staffed by ordinary people trained in crisis interventions.
And while the number of people committing suicide over the past two decades has remained consistent (around 30,000 people a year commit suicide in the U.S.), the suicide rate has enjoyed a steady decline of approximately 0.7% per year (a 13% drop from 1985 to 2004)(Barber, 2004). The decline hasn’t been brought about by superior public health policy, government action, or even the Internet. It’s largely been brought about by the decline in firearm suicides, the leading method of suicide (followed by suffocation and then poison). Men are 3 1/2 times more likely to commit suicide than women.
Guns are a huge risk factor for a successful suicide, because they are one of the most lethal methods available. 90% of those who survive a nonfatal attempt do not go on to die by suicide, meaning that the impulsive, irrational act of a suicidal attempt is what we must try and stop. Hence the reason for the fences and suicide hotlines. If we can get most people past the crisis point, the vast majority of them will live.
But what about those people who are suicidal and make it to the emergency room after a failed attempt? Could we do something more to help the 10% of people who do end up successfully committing suicide?
A column in today’s Boston Globe Magazine today presents the poignant story of the writer, Peter Bebergal, who lost his brother to suicide, and how a group of researchers at Harvard are working to better identify people who are still suicidal when in a hospital:
What clinicians need is some other measure beyond external evidence that could assess whether someone like Eric is capable of suicide in the near future. Four years after my brother’s death, Harvard researchers at MGH are experimenting with a test they think could help clinicians determine just that. It focuses on a patient’s subconscious thoughts, and if it can be perfected, these researchers say it could give hospitals more of a legal basis for admitting suicidal patients.
Of course, I can’t help thinking about whether such a test could have saved my brother. But I also wonder: Would it have been ethically right – or even possible – to save him even if he didn’t want to save himself?
This missing piece in the suicidal puzzle is what prompted the innovative research study now in its final phase at MGH. The study, led by Dr. Matthew Nock, an associate professor in the psychology department at Harvard University, is called the Suicide Implicit Association Test. It’s a variation of the Implicit Association Test, or IAT, which was invented by Anthony Greenwald at the University of Washington and “co-developed” by Dr. Mahzarin Banaji, now a psychology professor at Harvard who works a few floors above Nock on campus. The premise is that test takers, by associating positive and negative words with certain images (or words) – for example, connecting the word “wonderful” with a grouping that contains the word “good” and a picture of a EuropeanAmerican – reveal their unconscious, or implicit, thoughts. The critical factor in the test is not the associations themselves, but the relative speed at which those connections are made.
The research is still ongoing, so we don’t know whether this type of psychological testing will actually work or not. But it’s intriguing to imagine that our unconscious minds might give away our “true” thoughts when it comes to something like suicide. It could become as valuable a test as the ones we use to assess whether someone had a stroke and is at greater risk for a future stroke.
The next step, Nock realized, was to use the test to determine, from a person’s implicit thoughts, whether someone who had prior suicidal behavior was likely to continue to be suicidal. It would give doctors a third component, along with self-reporting and clinician reporting, and result in a more complete picture of a patient. Nock doesn’t assume that a test like the IAT would be 100 percent accurate, but he believes it would have predictive ability.
I believe any tool that can be used to better predict future behavior is a potentially valuable one. Especially when that future behavior might be the taking of one’s own life.
Read the full article: On the Edge
Barber, C. (2004). Trends in rates and methods of suicide: United States, 1985-2004 (PowerPoint presentation). Harvard Injury Control Research Center.