The Suicidal Behaviour Research Lab have the pleasure of hosting Associate Professor Matthew Spittal from the University of Melbourne, who will be talking on 3.30pm on Wednesday 25^th September, in Lecture room 2 at Lilybank Gardens (University of Glasgow). 

Identifying patients at high-risk of suicide: the problems and pitfalls of using predictive instruments to make treatment decisions

Tools for assessing suicide risk are widely used in the emergency department and other settings to identify people at high risk of suicide. This classification then often informs treatment decisions, such as whether to admit a person as a psychiatric inpatient. In this talk I (1) describe a program of research that has examined the clinical utility of these risk prediction instruments; (2) explain why these tools don’t work, and why in the era of big data and machine learning, better tools are unlikely to be developed; and (3) offer suggestions for how we can do better.

Biography

Matthew Spittal is an Associate Professor and Australian Research Council Future Fellow at the University of Melbourne. He is a biostatistician by training. His research program crosses several areas of public health. His main area of research is on the role of individual practitioner performance on patient safety and quality of care. He also studies the epidemiology of suicide and self-harm and is developing a new area of research on traffic safety.

UPDATE:  The Son is now showing in the West End's Duke of York's Theatre (London). For more info click here.

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.

We first see Nicolas before the play ‘begins’, pacing the stage furiously and scribbling on the walls as the audience are taking their seats.  Pain etched on his face. We then meet Anne (the mother, Amanda Abbington), Pierre (her work-focused ex-husband, John Light) and Sofia (his new partner, Amaka Okafor) and their baby.  Nicolas hasn’t been to school for three months,  Anne is struggling; she’s at a loss and thinks he would be better off living with his father, Sofia and his little half-brother. Sadly, this solution doesn’t have the desired effect and over the next 1 hour and 45 minutes, we track Nicolas’ angst, his hoped for recovery, his relationship with Sofia and his mother’s forlorn efforts to keep hold of her cherished son. 

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. 

You really feel each family member’s angst and pain; right down to the pit of the stomach. It took my breath away in parts: in a not-able-to-breathe-sort-of-way. Incredible performances all round: Amanda Abbington and John Light are brilliant,  you get a sense of what bound them together in marriage, their helplessness to keep their son safe and Abbington’s thwarted desire to have her family back together. Both are utterly captivating.   Laurie Kynaston’s take on Nicolas is equally powerful.  It is vulnerable and nuanced, conveying the nothingness as well as overwhelmingness of depression and suicidal pain. Amaka Okafor’s Sofia is excellent also, as the new partner who is struggling to connect with Nicolas and understand his emotional pain.

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.

After the play, fortuitiously we banged into the cast and I asked Amanda Abbington how the cast deal with the emotional intensity every night, and as she also repeated in a tweet later, they are aware of the sensitivity of its content and make a real point of looking after each other.

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. 

Figure 2 is taken from Hawton, Saunders & O'Connor (2012). 

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.

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!