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Blog by Tiago Zortea of his experience of the 18th Conference of the Portuguese Society of Suicidology
Expanding suicide prevention: Inside the 18th Conference of the Portuguese Society of Suicidology Tiago Zortea Portugal is a beautiful country. Full of history, culture, architecture, music and it has some of the warmest people in Europe. Sadly though, a large number of people in Portugal are affected by suicide. Committed to promoting suicide prevention nationally, the Portuguese Society of Suicidology (PSS) has been working intensely for more than twenty years, to bring together people from different fields with a range of diverse perspectives on suicide and its prevention. Among its many activities, the PSS holds an annual conference, which this year (2019) took place in the beautiful city of Beja (region of Alentejo), on the 12th and 13th of April. I was kindly invited by the PSS to give a talk on attachment as a vulnerability factor for suicide risk, the main topic of my PhD*. Attending the event was also an excellent opportunity to learn about the work Portuguese scientists, clinicians, and activists have been undertaking in the country.  Figure 1 – Photos of the city of Beja, the conference opening session, and a picture featuring Dr Ana Matos Pires, host of the event. The conference was comprised of several parallel sessions. However, the opening symposium entitled “Places and Sites: Geography, Architecture, and Multidisciplinary Work in Suicide Prevention” demonstrated the PSS’s commitment to understanding suicide risk and prevention from a broader perspective, moving beyond the well established psychopathological approach. In this symposium, geographers from the University of Coimbra presented a study showing that suicide rates are overrepresented in rural, less populated and more deprived areas of the country, mainly among men [1] (Fig. 2). Their findings have important implications for public health policies and the promotion of suicide prevention. Other topics such as the identification of areas of concern and means restriction, and the architects’ views on safety in public areas/buildings were also presented in this symposium.  Another impressive symposium included the work of the Observatory of Suicidal Behaviour (OSB) led by Dr Ana Matos Pires, Director of the Psychiatry Department of the Health Unit Service of Baixo Alentejo (who was also responsible for hosting the conference in Beja). Dr Pires chaired the symposium in which her psychiatry trainees and colleagues presented some of their recent work. The region of Alentejo has the highest suicide rates in Portugal (Figure 3), and the OSB team are trying to meet the challenge of tackling the high rates of suicide there. If it were a country, Alentejo would have one of the highest suicide rates in the world (43,6 deaths per 100,000 people). Alongside Dr Pires and without any public resources and investment, the mental health professionals Paulo Barbosa, Rodrigo Mota Freitas, Daniela Lascasas, and Joana Neto have been promoting and implementing suicide prevention campaigns, in a concerted effort to reduce suicide rates in the region.  In the opening session of the conference, Dr Pires also presented a series of observations on the Portuguese National Suicide Prevention Plan proposed in 2017. She acknowledged that the suicide prevention plan itself is a good one, but the challenge lies in its implementation. Several barriers for the strategy implementation were discussed. Dr Pires’ considerations resonate with a recently published editorial on the implementation of national suicide prevention strategies by Platt and colleagues [3]. In the editorial, the authors mention that unsupportive political, social, or legal environment, and limited capacity to monitor implementation progress constitute challenging barriers for the successful implementation of any national suicide prevention strategy. Another important highlight of the conference was a session of talks sharing experiences of public suicide prevention campaigns in Spain and Brazil presented by the president of the Spanish Society of Suicidology (Andoni Anseán), and the president of the Latin American Association of Psychiatry (Antônio Geraldo da Silva), respectively. Both speakers shared the current activities in their countries; their successes and challenges, as well as plans for suicide prevention at the national level. I was saddened to learn about the extent of suicide in Portugal, the huge challenges to be overcome in the region of Alentejo, but I was inspired by the tireless efforts of Portuguese colleagues to save lives despite the lack of financial and political support. The broad view that suicide is a multifaceted phenomenon which needs to be considered from a multidisciplinary perspective was one of the key messages of the event. The Portuguese Society of Suicidology has been doing a brilliant job in Portugal, bringing people together to understand, intervene, and prevent the deaths of thousands of Portuguese people. --- * I would like to thank Dr Inês Rothes (University of Porto; Portuguese Society of Suicidology) of the kind invitation to speak at their annual conference. References [1] Santana, P., Costa, C., Cardoso, G., Loureiro, A., & Ferrão, J. (2015). Suicide in Portugal: Spatial determinants in a context of economic crisis. Health & place, 35, 85-94. [2] Portugal. (2017). National Programme for Mental Health 2017. Lisbon: Ministry of Health. Retrieved from https://www.dgs.pt/pns-e-programas/programas-de-saude-prioritarios/saude-mental.aspx [3] Platt, S., Arensman, E., & Rezaeian, M. (2019). National Suicide Prevention Strategies – Progress and Challenges. Crisis, 40(2), 75–82. |
The Son: a portrait of emotional pain and its devastating consequences
I spent the weekend in London catching
up with a close friend from my university days.
The highlight, without doubt, was seeing The Son, the final part of a trilogy from French playwright Florian Zeller, on Friday night.  Perhaps highlight is the wrong word, I left the Kiln Theatre emotionally drained; The Son is immersive, uncompromising, raw and visceral. I am still reflecting on it. The audience is taken on an emotional
tsunami of teenage depression, self-harm and suicidality. It focuses on one family’s attempt to deal
with the unravelling of their son, Nicolas (Laurie Kynaston), against the backdrop
of divorce and new family relationships.  Alongside exploring the relationships among the family, old and new, there are brief moments of light; when egged on by Sofia, Nicolas mocks Pierre’s dad-dancing with his father responding by throwing amusingly impressive shapes. This juxtaposition serves only to illuminate their struggle more profoundly; providing a glimpse of happier times.  The staging is exquisite; the clean, sharp lines and white walls of the Parisian apartment help to illuminate the emotional turmoil of this teenage life which is metaphorically strewn across the stage.  If you are in London soon, try to
catch The Son which is showing in The Kiln until
6th April 2019.
If you are affected by suicide or
you are worried about someone, Samaritans is available 24/7 on 116 123 or via
email jo@samaritans.org. More crisis information is available here. Rory O'Connor Director, Suicidal Behaviour Research Lab 18th March 2019 |
New Blog: “We love data” - Using data to inform suicide and self-harm prevention, Royal Statistical Society, London
By Cara Richardson (PhD Student in SBRL) As part of NatCen’s 50th anniversary celebrations, the Royal Statistical Society hosted “Using data to inform suicide and self-harm prevention” in London on Monday 25th February. The question of the day was “How do we ensure the right data are available, analysed and communicated to address the major questions in suicide and self-harm reduction policy and practice?” The presentations covered a variety of research areas, datasets and methods of analysis. The day started with a welcome from the chair Prof Louise Arseneault (Kings) and an overview from Prof Louis Appleby (Manchester) on the use of data in Suicide Prevention Strategies and a welcome reminder that “Behind the data there is tragedy to individuals and loved ones”. Then Liz Scowcroft (Samaritans, @Liz_Samaritans) made the case for accessible data as “Suicide is everyone’s business”. Following this general population and cohort surveys were covered; with Sally McManus from NatCen, who did an excellent job of organising this meeting, detailing the various datasets that are available and how to access these. Patience is key, though, as accessing the Adult Psychiatric Morbidity Survey (APMS) 2014 can take up to one year! The process involved in accessing the APMS 2014 is summarised below:   Caroline Turley, Head of Qualitative Research at NatCen, presented her research on self-harm interventions for mid-life men. This research led to recommendations for what men would like from services: Ask Don’t Assume, Recovery Takes Time and Be Mindful of Language and Imagery in the Media. Prof Ann John (Swansea) explained the various “big data” projects she is involved in and the importance of and utility of such data linkage. She also provided an overview of some exciting developments including artificial intelligence, specifically artificial neural networks, with routine health data to aid identification of those at risk of suicide and self-harm. Following this Dan Collinson from NHS Digital provided an overview of the datasets available in relation to mental health, suicide and self-harm, how to access these as well as the possibilities for data linkage. Finally Helen Garnham and Cam Lugton from Public Health England described the Fingertips tool which collates and presents a range of publicly available data including facets of suicide prevalence, associated risk factors and service contact among groups at increased risk. This provides planners, providers and stakeholders with a means to profile their area and benchmark against similar populations. Overall, the conference was a great experience and left everyone feeling excited and motivated about the future of research in suicide and self-harm. The take home messages from Prof Louise Arseneault, summarised by The Mental Elf (@Mental_Elf) were: Now let’s start analysing! (After we receive the data that is) @_CaraRichardson |
Youth suicide prevention needs more than social media regulation
Youth suicide prevention needs more than social media regulation 
I have also been incredibly moved by the personal stories of loss that so many heartbroken loved ones have shared. Indeed, if it wasn’t for these vital contributions and the advocacy of those bereaved by suicide, I doubt that suicide prevention would be the leading political priority that it has become. The governments across the UK (and the many advocates who campaign tirelessly) should be commended for prioritising suicide prevention which culminated in a global first – the appointment of a first-ever Minister for Suicide Prevention announced in England last year on World Suicide Prevention Day.  However, as I illustrated in a recent tweet, my concern is that we may miss this golden opportunity to really move our suicide prevention efforts forward by blaming social media companies. By focusing too much attention on social media, we run the risk of ignoring the social, clinical, cultural and psychological causes of youth suicide. It is too easy, and inaccurate, to level the blame for youth self-harm/suicide at the apps of social media organisations. My fear is that ‘the social media and suicide’ headlines are hiding the fact that most people who die by suicide are trapped by disadvantage and/or emotional pain, have often experienced early life trauma and/or did not receive the timely and tailored mental health treatment that they so badly needed. That should be our focus – how do we keep our young people safe – offline as well as online – especially the most vulnerable? Tackling social inequality and adequately funding mental health services will save countless more lives than regulating social media companies. It shouldn’t be an either-or, though; it should be both. In all of the recent media coverage, rarely has the complexity of suicide risk been conveyed (see Panel 1 below from Hawton, Saunders & O'Connor, 2012). Tackling social media use is only one part of the puzzle. The fact that mental health services have been cut, that the most disadvantaged are not protected and that there are unacceptably long waiting lists is at the heart of suicide prevention.  Of course, we should ensure that graphic images of self-harm and suicide are removed from social media platforms like Instagram. And I welcome the UK government’s efforts to ensure that Instagram (and other platforms) removes all such content – and NSPCC’s call to help keep young people safe online. These efforts are important because we know there is an association between suicide/self-harm and social media. Indeed, a few years ago, we asked adolescents about the factors that influenced their self-harm and about 1 in 5 mentioned social media/internet as a factor. This number has likely grown since. So I am not questioning the relationship itself. But the relationship between social media use and suicide/self-harm is weak and complicated; it is not the key driver for suicide; and for many young people, social media acts as a safety net in times of crisis when mental health services are not available. We need to be careful not to demonise all aspects of social media and inadvertently remove this vital source of support for our young people. Another challenge is that the evidence for what works – in terms of treatments for suicidal young people – is severely lacking. As a matter of urgency, we need to fund more suicide prevention research.   If you are affected by suicide or you are worried about someone, Samaritans is available 24/7 on 116 123 or via email jo@samaritans.org. More crisis information is available here. Professor Rory O'Connor Director, Suicidal Behaviour Research Laboratory 12/02/2019 14/02/2019 update: In response to requests, I've added Figure 2 from tweet to the end of blog and corrected a typo on paragraph 5. Re-publication policy: I am happy for this blog to be re-published in part or in full as long as it is fully attributed. |
Safety planning (SAFETEL) & suicidal behaviour study: January 2019 update
We are happy to confirm that recruitment for Phase 3 of the study concluded in September 2018. Our follow up telephone calls to participants concluded in October 2018. For more information on the progress of the Phase 3, click here.   |
Early & Mid-Career Researchers' (EMCR) Forum 2019
We are pleased to confirm that registration and abstract submission is now open for the 4th Suicide & Self-harm Early and Mid-Career Researchers' Forum (EMCRF19) in Glasgow on 6th & 7th June. EMCRF19 is open to all working in the field of suicide and self-harm research, but it is specifically targeted at Early and Mid-Career Researchers. It will provide a space for support, networking, and collaborations among Masters, PhD, and Post-doctoral research students as well as more established researchers. |
SBRL Blog: Getting to know the world of suicide research
Getting to know the world of suicide research Some reflections from Anabel Soehlemann (Technical University of Dresden)  In the Lab, I was welcomed so warmly by everyone that I quickly felt part of the team. Still not expecting too much and figuring on making coffee and typing in data for most of the 8 weeks ahead, I was slightly overwhelmed, but excited by the idea of analysing a dataset of around 1,500 participants and writing a paper on my findings. Being busy on “my own project” and always having so many lovely people around to answer my questions, having a lunch or coffee break, or just a little chat, the 8 weeks just flew by. After getting to know the dataset and conducting a brief literature research, I decided to investigate the relationship between negative mood regulation expectancies (NMRE), a construct having its origins in Rotter’s Social Learning Theory, and suicidal ideation. Furthermore, I was interested in how perceived stress and depressive symptoms might explain (mediate) part of this relationship. My findings suggested that higher expectancies in one’s abilities to regulate a negative mood state may lead both directly and indirectly to lower suicidal ideation. Indirectly, high levels of NMRE were associated with less perceived stress and, in turn, to fewer depressive symptoms which again were associated with lower suicidal ideation. Watch this space as I finish the write up of the results! Even though my time in Glasgow went by far too quickly and I am now back in Dresden, there is still a lot of work ahead in editing and submitting the paper, and whether it gets published in the end or not, it was a great experience for me and I learned a lot, not only about statistical practice and suicide theory, but also a little about how it feels to be part of a scientific community. I am now motivated to think beyond my Master’s thesis, perhaps to do a PhD afterwards and stick with research for a little longer than I had imagined. I would like to thank Professor Rory O’Connor for giving me this opportunity and the whole SBRL team for all their support and for making this internship such a great experience and time! |
SBRL Blog: ESSSB17 - It’s great to feel part of the suicide research community
  , the opening ceremony included a very personal talk and performance from Belgian musician Selah Sue, patron of the “Te Gek!?” campaign to get young people to talk about mental health, highlighting her own battles with depression and suicidal thoughts. This was very touching and a fitting opening to Europe’s leading suicide research conference that attracted more than 600 delegatesMusician Selah Sue, patron of "Te Gek?!" As an early career researcher (ECR) attending conferences such as these can be daunting, as often you feel overwhelmed and out of place among more experienced researchers. However, the conference felt very inclusive, had a relaxed atmosphere that made it easier to talk to and interact with other researchers. This was aided by ECR-specific events, organised by IASP ECR group and Net ECR respectively, bringing together ECRs from different research labs and universities to support each other as well as have some fun! The oral parallel and poster sessions included work from many PhD and post doc researchers, and this added to feeling valued and included in what can be an intimidating setting.  A number of talks focussed on the media reporting of suicide and the negative effect that this can have upon subsequent suicide trends, although cautionary there was some hopeful discussion of the Papageno effect (Thomas Niederkrotenthaler, Vienna), whereby positive reporting can have a protective influence. Indeed, a highlight of the conference was a symposium organised by Ellen Townsend (and including Rory O’Connor, Tiago Zortea, ex-SBRLer Olivia Kirtley) on engaging the public with research, highlighting the potential benefits of blogs, twitter, TV appearances and public engagement initiatives such as Café Connect. It was clear that there was much to be gained from harnessing both traditional and social media platforms to promote and disseminate research to help shape how society views and understands suicide and self-harm. As well as helping break down the stigma attached to suicide, it can help people know how to talk to those who are suicidal and hopefully change how people think about and communicate about suicide.  Tiago Zortea presenting his PhD findings on attachment. As well as talks by Rory O’Connor, the conference included talks and posters on the research of other SBRL members. This included findings from Tiago Zortea’s research on how perceptions of past parenting influenced future attachment styles and how this influences feelings of defeat and entrapment. Seonaid Cleare discussed her findings of an experimental study investigating how a self-compassion meditation influences autobiographical memory in those who have a self-harm history. I also presented my own PhD research which highlighted that among those with a suicidal history making unfavourable social comp  arisons on socialmedia may lead to feelings of defeat. Additionally, Dave Sandford presented a poster of his systematic review on the impact that losing a patient to suicide can have on mental health professionals. The opportunity to present our research was appreciated and the feedback received from others was positive, which is very motivating and validating. Dave Sandford's poster on the impact of the death of a patient by suicide upon mental health practicioners  Seonaid Cleare presenting her PhD findings on self-compassion.  Karen Wetherall presenting her PhD findings on social comparison on Facebook. Overall, the conference was a really enjoyable experience that exposed me to a wide range of interesting, rigorous and thoughtful research that spanned the many different disciplines that make up the field of suicide research. Often the difficulty was on deciding which session to attend! The social highlight of the event has to be the ESSSB band comprised entirely of suicide researchers (including ex-SBRL member Olivia Kirtley on drums together with Kees van Heeringen, Ellen Townsend, Derek de Beurs and Erkki Isometsa) who made their debut performance at the conference dinner; it was a great surprise and they were brilliant! (Check them out on twitter). It is great to see how researchers of different countries, stages and disciplines come together at conferences - it really helps ECRs to feel part of a supportive suicide research community.
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Our mental health: We need more stories like Ruth Davidson's
 I awoke this morning to see a timeline full of tweets about Scottish Tory leader Ruth Davidson’s admission (in a Sunday Times Magazine interview including an extract from her forthcoming book) that she struggled with her mental health 20 years ago; that she had self-harmed and had been suicidal. Here are some quick thoughts. Irrespective of your political allegiance (incidentally, I have never voted Conservative), this feels important. Someone who could potentially be First Minister of Scotland talking openly about her mental health, this is another step forward in our national discourse. Mental health problems can and do affect all of us. Sadly, self-harm and suicidal thoughts are all too common in Scotland. In a recent study of ours, one in nine 18-35 years olds reported having attempted suicide and one in six told us that they had engaged in self-harm at least once in their lives. Part of me was surprised by Davidson’s admission given her public persona but another part of me wasn’t – about a decade ago she interviewed me for BBC Radio Scotland about a study on adolescent self-harm. I remember being struck by her self-assured smile and also that she got-it; she seemed genuinely interested in adolescent mental health. It is evident now that she had personal insight. Like many of us, Davidson’s outward public persona – gregarious, strong and driven – masks (or is a consequence of) a history of psychological pain. It is worth reminding ourselves every now and then that none of us know what is hidden behind a smile. The ripples following suicide are vast, stretching way beyond close family and friends. Davidson talks about a boy from her village who took his own life when she was 17 and although she doesn’t know why his death affected her so deeply she “went into a total tailspin.” The fact that someone’s death, not a relative or a close friend can have such a profound impact on Davidson is consistent with the research evidence on ‘exposure to suicide’. The latest research estimates that, for every suicide death, 135 people are ‘exposed’ (knew the person who died) and some may need clinical help or support. Also, the effect of this exposure can be long-lasting. Today is especially poignant for me. 10 years ago to the day, I lost a close, close friend to suicide. Even after all these years, the pain of this loss is still raw; such that I’ve been taken aback by how emotional I’ve been in the lead up to the anniversary. Davidson’s story and my own personal experience remind me why it is so important that we support those bereaved by suicide and never assume anyone’s mental health. “It was like a smothering black blanket over my head, cutting out the sky. It was heavy, constricting, suffocating. It took away hope and energy and life” Ruth Davidson Davidson’s description of her depression as a black blanket powerfully captures the cognitive constriction or tunnel vision that often characterises those who are suicidal: being overwhelmed, exhausted, trapped, without any hope of rescue. Sadly for approximately 700 people in Scotland each year, the impossibility of seeing a positive future, of perceiving no reasons to live, of feeling a burden on others and this unrelenting sense of disconnection come together in a perfect storm of entrapment that contributes to their suicide. As today marks the end of World Suicide Prevention Week, it is timely to highlight this year’s theme: Working Together To Prevent Suicide. We all have a role to play in reducing entrapment, reaching out, promoting connectedness and challenging mental health stigma. Davidson has made a welcome contribution to challenging that stigma by speaking out. We need more stories like Davidson’s. Ultimately Davidson’s story is one of hope. If you are reading this and are in a dark place, overwhelmed by the ‘black blanket’; though it is hard to believe it now, convinced that things will never change, that you’ll never recover and that the pain will never end. It does. It can. And it will. The last line of the interview, to me, is the show-stopper: “It’s being happy, Decca. That’s what it’s about. I haven’t always been happy. And what a difference it makes.” It is vital, truly a matter of life and death, that we do not take our mental health for granted. Without our mental health, what do we have? We need to work on it, nurture it, protect it. Rory O'Connor 16th September 2018 |
Horizon: Stopping Male Suicide
Update: The Horizon: Stopping Male Suicide documentary is being broadcast again on 15th May 2019 BBC2 23.15 and on the BBC iPlayer thereafter As part of the new Horizon: Stopping Male Suicide documentary, Dr Xand Van Tulleken travelled to Scotland (to a wet and cold Loch Lomond) to interview Rory O'Connor about why three quarters of all suicides in the UK are by men. The programme was first broadcast on 22nd August 2018 on BBC2. Rory talks briefly about some of the work being conducted within SBRL and about the importance of asking directly whether someone is suicidal or not. It could save their life! |
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