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Research into Suicide




Reflections on Professor Rory O'Connor's presentation at the Baton of Hope Conference by Jacquie Shanahan


At the recent Baton of Hope conference in Sheffield I attended for The Learn Network, keynote presenter Professor Rory O’Connor (Professor of Health Psychology and head of the University of Glasgow’s Suicidal Behaviour Research Laboratory) outlined some of the research into suicide prevention.



He began by summarising the rather depressing statistics - over 700k suicides globally per year, with 20 times that figure in terms of attempts. It was worrying to hear that suicides increased last year by 6%. Professor O’Connor observed that 75% of suicides are by men and that research into this group is consequently a priority. However, he also showed that the body of global suicide research overall is still tiny when compared with other areas of health-related research.


Research into the different stages of suicidal thoughts was an area of particular focus for him (something touched on in my ASIST training - the internationally recognised qualification in suicide intervention - but not in great depth). O’Connor talked about the lack of knowledge around what he called ‘crossing the precipice’. What is it that takes people from suicidal thoughts to actions? It seems that our ability to predict suicide is little better now than it was 50 years ago. Often people mask their true feelings and so this is an area that isn’t well studied.


Factors in suicidal thinking

He introduced his ‘IMV’ (integrated motivational-volitional) model of suicidal behaviour which identifies factors at each stage of suicidal thinking. For example, in the early stages, people may be influenced by life events and their environment. If they then start to experience feelings of defeat/humiliation and entrapment, this can make them more vulnerable to other factors that may lead them into suicide planning – for example access to means, impulsivity, fearlessness when visualising suicide. The research indicates that intervention is critical when people express feelings of defeat and entrapment.


From thoughts to actions

Feeling defeated and trapped (especially inside themselves) are particularly serious factors for men at risk of suicide. They can feel powerless to change things and want to escape.

Additionally in research into LGBT groups, suicide has been identified as one response to what is described as ‘queer entrapment’.  In this instance, suicide may be seen as a means of escaping, eg if a person feels that their identity is something unresolvable for them, or when they see suicide as a means to stop all of the ‘fuss’ they perceive around it, for themselves and others.


Stress responses and cortisol

He went on to describe some fascinating endocrinological (the study of hormones) research led by his namesake, Rory C. O’Connor - an unrelated academic based at Leeds University - regarding the role of cortisol and stress responses in relation to suicide. Cortisol is released during a fight or flight response to circumstances. There is evidence that people who have attempted suicide release much lower levels of cortisol compared with the general population.

Those with suicidal thoughts tend to have moderate levels of cortisol, while those with no thoughts of suicide have the highest cortisol levels. Cortisol levels can easily be monitored in saliva tests. If people with suicidal tendencies experience lower levels of cortisol then this may be a factor in their ability to self-regulate that needs to be considered in approaches to suicide prevention. Exposure to trauma in childhood is also cited as a risk factor.


Interventions

As the understanding of the transition from suicidal thoughts to actions is better understood then intervention and timing become essential to interrupt this process.

Developing a safety plan is a key form of intervention. O’Connor outlined six steps which can help someone to reduce their risk of suicide – for example, identify warning signs, use coping strategies, engage social contacts, contact social supports. This can help the individual to reduce their risk. He highlighted the work of Tony Morrison at Manchester University in this regard.



In summary, at the end of his presentation, O’Connor outlined the 4 Cs of suicide prevention:

·      Compassion

·      Complexity

·      Connection

·      Care




(See Rory O’Connor’s Twitter/X feed - @suicideresearch)

 

Resourcing research and services

Something that chimed especially with me was O’Connor’s assertion that we can’t just expect people to go and find care for themselves, particularly when talking about suicide is still a taboo for many. It’s important to be proactive and go where people are. This is why linking up with, for example, sports clubs/football, and workplaces may be a more effective route towards suicide prevention in men.

Professor O’Connor highlighted the disparity between the amount of research and healthcare services relating to other conditions such as cancer treatments. Both suicide research and related healthcare are very under resourced. For example, someone in the early stages of cancer would not be told to go home and wait until they were at stage three – but the equivalent happens regularly to those expressing thoughts of suicide.


Question on the statistics

There was no time for questions after the presentation, but in the break I asked Professor O’Connor about the statistics he presented on suicide. It bothered me that if we only look at the final statistics then we could potentially ignore the warning signs contained in statistics on attempts. And was there a similar gender split reflected in the data on attempts? He estimated that the level of attempts was around 60%, instead of 75%, by men and commented that there was a worrying increase in the numbers of women, which may be affected by their choice of means, and also in the LGBTQ+ community.

We also discussed his comment about being proactive in suicide prevention rather than expecting people with suicidal thoughts to come forward. It was refreshing to hear this viewpoint - as often people in the darkest of places* are expected to take the first step to find help for themselves, when in reality they are dependent on someone noticing and responding to them first.


Further information: See also Rory O’Connor’s book, When it is darkest, and the interview he gave to Grassroots Suicide Prevention about it, including his assessment of the myths surrounding suicide.


Finally

It occurred to me that trying to identify the right setting for proactive approaches can also be problematic if simplistic gender assumptions are made – such as targeting men going to football/sports grounds, although there has been a recent positive example of this. The charity R;pple has made progress in reaching a wider audience by developing a browser extension that points people towards support when entering suicide-related search terms, and promotes this to work (and study) places.

As Baton of Hope has identified with its taboo-breaking ‘workplace pledge’ scheme, launched at the same conference, taking it to the work environment (employing 33 million people) surely has to be the next bastion for scaling up proactive suicide prevention.

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