Kathryn Gordon is a clinical psychologist in NDSU’s Department of Psychology. Her program of research investigates the impact of emotion dysregulation and interpersonal stressors on disordered eating and suicidal behavior.
Q: Why is it important to conduct research on suicide prevention?
Suicide is a massive public health problem that takes the lives of an estimated 800,000 people around the world each year. This means that someone dies by suicide every forty seconds. At a broad level, suicide robs society of people who could have made valuable contributions if only their lives had not ended prematurely. At an individual level, suicide leaves bereaved loved ones in deep emotional pain. In addition to the excruciating emotional pain associated with suicide, the economic costs are also substantial. Approximately 35 billion dollars are incurred for suicide-related medical and work loss expenses in the U.S. each year. Prevention research is crucial for identifying strategies that effectively combat the devastating consequences of suicide. Simply put: suicide prevention research saves lives.
Q: What causes people to become suicidal?
There are many scientific theories about the causes of suicide. A leading theory that guides much of the research in my lab was proposed by my graduate school mentor, Dr. Thomas Joiner. His interpersonal theory of suicide draws upon the existing body of empirical research and identifies three specific factors that lead to death by suicide. Specifically, within his framework, the desire for suicide develops when a person: 1) feels disconnected from others (called thwarted belongingness, often experienced as extreme loneliness) and 2) mistakenly believes that people (e.g., friends, family, society) are better off without them (referred to as perceived burdensomeness). People who suffer from mental disorders such as mood, substance use, and eating disorders are at higher risk for experiencing thwarted belongingness and perceived burdensomeness, and therefore, are at elevated risk for contemplating and attempting suicide. In fact, the vast majority of people who die by suicide have diagnosable mental disorders at the time of their death. However, thankfully, the majority of people who desire suicide do not die by suicide. Estimates suggest that there are 25 suicide attempts for every death by suicide.
The interpersonal theory of suicide has especially advanced the field through its ability to predict who is at highest risk for death by suicide. For clinicians and scientists alike, it is extremely useful to identify who is at highest risk for suicide, such that prevention efforts can be most effectively targeted. Approximately 3.7% of the general U.S. population reports experiencing suicidal thoughts in the past year. However, the interpersonal theory of suicide hypothesizes that only people who have the capability to enact lethal self-harm will die by suicide. Acquired capability for suicide, the third factor in the interpersonal theory of suicide, is present when an individual has fearlessness about death and a high level of physical pain tolerance.
In summary, the interpersonal theory states that individuals who feel alone and disconnected from others (thwarted belongingness), feel that people are better off without them (perceived burdensomeness), and have the ability to fatally harm themselves (acquired capability for suicide) are at highest risk for death by suicide.
Q: How is the capability for suicide acquired?
Survival is a fundamental, innate human drive that is lifesaving for the many people who seriously contemplate suicide but who do not go through with it. The theory proposes that individuals can acquire the capability for suicide through repeated exposure to painful and provocative events that habituate them to physical pain and fear of death (e.g., prior suicide attempts, physical injuries, exposure to death via professional duties in the cases of physicians, veterinarians, military personnel, or police officers). In my lab’s research, we have found that people who have experienced more painful and provocative events (e.g., physical abuse, tattoos, piercings, excessive exercise to the point of injury, nonsuicidal self-harm) reported being less afraid of death and tolerated more physical pain. Physical pain tolerance has been assessed in my research through tasks that induce cold, heat, and pressure pain on the participants’ skin, and all modes have been linked to higher acquired capability for suicide.
Q: How can this information be used to prevent suicide?
It is important to note that many people who die by suicide were not enrolled in any type of mental health treatment when they died. This means that, many times, peers, family members, and other people who are not mental health professionals are the ones who observe warning signs. If you see someone expressing ways that they feel like a burden and/or disconnected from others, it is important to recommend that they seek professional help. This is particularly true if they seem to have a suicide plan and a lack of fear about dying. Immediately, the most important priorities are to listen nonjudgmentally to how they are feeling, so that they feel less alone and provide you with as much information as possible. Secondly, if they do have a suicide plan, it is important to do all that you can to restrict the means by which they are planning suicide (e.g., if it is a gun, try to convince them to remove it from their home until their risk has subsided; if they are planning an overdose, come up with a way to control the amount of medication that is accessible to them). Third, encourage them to seek professional help and offer to accompany them to make an appointment. A useful first step is to call the National Suicide Prevention Hotline at 1-800-273-TALK or to visit their website: http://www.suicidepreventionlifeline.org/. They can provide resources for referrals. You can provide real hope to people who are feeling suicidal by telling them that there are evidence-based treatments that are proven to be effective for various mental health problems. They can get better if they seek help.
Beyond dealing with the immediate crisis, research from my lab shows that contributing through helping others can reduce thwarted belongingness and perceived burdensomeness. For example, we found that people who did the most community volunteering during the 2009 Red River flood had the lowest levels of perceived burdensomeness and thwarted belongingness a few weeks later. This mirrors previous research indicating that, even during crisis, people pulling together can serve as a buffer to suicidal risk. Connecting with other people through volunteering, or a variety of others ways, can be lifesaving.
Q: Who is at greatest risk for suicide in the U.S.?
White men are most at risk for death by suicide, though it is important to note that women are three times more likely to attempt suicide. This may be due to the facts that women are twice as likely to experience depression and men tend to utilize more lethal methods when attempting suicide. It is not uncommon for people to believe that teenagers are at the highest risk for suicide of all age groups, but recent data show that twice as many suicides occurred among middle-aged (45-64) people as compared to the other age groups.
In addition, the field is increasingly paying much needed attention to lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth, who are at increased risk for suicide attempts as compared to peers who identify as heterosexual and cisgender (i.e., a person who identifies with his/her biological sex). Within this group, the factors that seem to contribute most to the elevated suicide risk are experiences of discrimination (e.g., verbal abuse, physical attacks, harassment, and family rejection). At an individual level, being a member of a supportive family seems to greatly reduce the risk of a suicide attempt, perhaps due to associated feelings of belongingness and a decreased sense of burdensomeness. At a broader societal level, mental health professionals and others working to reduce stigma associated with identifying as LGBTQ through educational outreach, legislative activism, and the promotion of understanding can have a positive impact on mental health. The Trevor Project is a suicide prevention hotline specializing in services for LGBTQ youth, and their contact information is available below.
Statistics and facts about suicide were derived from the following sources:
World Health Organization:
American Foundation for Suicide Prevention:
American Association of Suicidology:
More information about the interpersonal theory of suicide can be found in Thomas Joiner’s book, Why People Die By Suicide.
Help is available at the following places:
National Suicide Prevention Hotline: http://www.suicidepreventionlifeline.org/; 1-800-273-TALK (8255)
The Trevor Project (specializing in services for LGBTQ youth): http://www.thetrevorproject.org/; 1-866-488-7386
Veterans Crisis Line (specializing in services for veterans): http://www.veteranscrisisline.net/; 1-800-273-8255
More information about research from my laboratory can be found here: https://kgordonlab.wordpress.com/