Category: Something to talk about…

What did Chat GPT 3.5 and GPT 4 answer to a prompt“What are the recent advances in suicide research?”

Disclaimer: “recent” is a relative term, and current chat GPT models have a knowledge cutoff in September 2021.

Chat GPT 3.5

Here are a few areas of recent research and advances in suicide prevention:

  1. Predictive modeling: Researchers are exploring the use of predictive modeling and machine learning algorithms to identify individuals at high risk of suicide. By analyzing various factors such as social media activity, electronic health records, and other data sources, these models aim to detect patterns that may indicate suicidal ideation and allow for early intervention.
  2. Neurobiology and genetics: There is ongoing research into the neurobiological and genetic factors associated with suicide. Studies have identified potential biomarkers and genetic variations that may contribute to an individual’s vulnerability to suicidal behavior. By understanding these underlying mechanisms, researchers hope to develop targeted interventions and treatments.
  3. Digital interventions: The rise of digital technology has opened up new possibilities for suicide prevention. Mobile apps, online platforms, and virtual communities offer opportunities for early intervention, crisis support, and access to mental health resources. Researchers are studying the effectiveness of these digital interventions and exploring innovative ways to leverage technology for suicide prevention.
  4. Means restriction: Restricting access to lethal means, such as firearms, pesticides, or medications, has been shown to be an effective strategy in reducing suicide rates. Recent research continues to emphasize the importance of means restriction as a preventive measure, highlighting the need for policies and interventions that address access to lethal methods.
  5. Collaborative care models: Collaborative care models involve integrating mental health services into primary care settings and improving coordination between different healthcare providers. Recent research has shown promising results in reducing suicide rates through the implementation of collaborative care models, which aim to provide comprehensive and timely support for individuals at risk.

It’s important to note that suicide prevention is a multifaceted issue that requires a comprehensive approach encompassing various factors, including mental health awareness, access to care, stigma reduction, and social support. Ongoing research and advancements in these areas continue to contribute to our understanding of suicide and inform prevention efforts. If you or someone you know is struggling with suicidal thoughts, it’s crucial to reach out to a mental health professional or a helpline in your country for immediate support.

Chat GPT 4

As of my knowledge cutoff in September 2021, I don’t have real-time updates on suicide research. However, I can provide information about the trends and advances in suicide research that were notable up to that point:

  1. Use of Machine Learning: Machine learning algorithms are increasingly being used to predict suicidal thoughts and attempts, using information like electronic health records, genetic data, and social media activity. However, the models’ accuracy and ability to generalize across different populations require further evaluation and refinement.
  2. Biological Markers: Research into the biological basis of suicide has made some progress. In some studies, certain genetic markers and irregularities in the brain’s serotonin system have been associated with increased suicide risk. Inflammatory markers and hormones related to stress response (like cortisol) are also being studied.
  3. Role of Mental Health Disorders: Many studies have confirmed the high co-occurrence of mental health disorders (like depression, bipolar disorder, and anxiety disorders) with suicide attempts and completion. As a result, efforts are being made to improve the detection and treatment of these disorders to prevent suicide.
  4. Role of Social Factors: Research has confirmed the role of various social factors in suicide risk, such as isolation, bullying, unemployment, and substance abuse. There is ongoing research into effective societal-level interventions to address these risk factors.
  5. Digital Interventions: With the rise of telemedicine and digital health, research is being done on online interventions to prevent suicide. This includes apps for crisis intervention, online therapy programs, and automated text messaging services.
  6. Means Restriction: Studies have shown that restricting access to lethal means of suicide can help prevent suicide. This includes measures like safe storage of firearms and medications, and barriers on bridges.
  7. Ketamine and Psychedelic Therapy: Ketamine, a fast-acting antidepressant, and certain psychedelic substances have shown promise in reducing suicidal ideation in some patients. These treatments are still being actively researched.

Remember that this information might have changed after my last training data in September 2021. Please consult reliable sources or professionals in the field for the most recent updates.

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Representation of phases of mourning in media: depression

3.DEPRESSION

Overwhelmed, helplessness, hostility, flight

Dead Poets Society (1989) -Dead Poets Society is a 1989 film directed by Peter Weir and starring Robin Williams. The film tells the story of a teacher, with particular and stimulating teaching methods, who is transferred to a school for wealthy kids. In his class there are particularly culturally lively boys and among these there is Neil Perry, a boy who has family problems, especially with his father. When Neil decides to attend a theatre course, his father expresses his disagreement, without hearing replies, and at last presents Neil with what he has decided for his son’s future. Of course this plan does not include theatre, and Neil eventually decides to commit suicide, feeling entrapped because he cannot have what he wants. After this fact, the school institute opens an investigation and the blame for Neil’s suicide falls on Professor Keating and his too liberal teaching methods, inciting the students to go beyond ordinary life.

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Representation of phases of mourning in media: anger

2. ANGER

Frustration, irritation, anxiety

Remember me (2010) -this movie takes place in New York City, where a young male character played by Robert Pattinson has to deal with his brother’s suicide. His brother worked in their father’s office when he committed suicide, therefore he blames his father for the death, accusing him of driving his brother into burnout. The relashionship between father and son is based on anger, partially containing the projection of guilt for not having helped his brother by acknowledging his suffering.

The whale (2022) – The Whale, a 2022 film directed by Darren Aronofsky, tells the story of Charlie, a severely obese weighing 270 kilos, who has been spending his life within four walls since the death of his partner. A sense of oppression and claustrophobia permeates the whole story: slowly you enter the protagonist’s dark house, on tiptoe, until you find yourself immersed in all the feelings of the various characters. We find ourselves experiencing empathetically anger, sense of guilt; but also, loneliness, the desire to make up for lost time with loved ones, regret for unspoken words and sincerity which we can no longer do without.

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Representation of phases of mourning in media: denial

Clinical empathy plays a role in medical care, particularly in the psychiatric field where it is intuitive that the relationship between the patient and the doctor has a therapeutic meaning, too. Empathy is not easy to teach as it’s an innate personal skill (1). Screen fiction, movies and films can be helpful to reflect on this complex topic, as “it is through emotion, whose power is to disturb the equilibrium of psyche that screened fiction stirs people’s psyche […] the emotions aroused by cinema refer to a virtual world and therefore have the potential to increase the individuals’ self-awareness while making them feel relatively “safe”.

[Gramaglia, C., Jona, A., Imperatori, F. et al. Cinema in the training of psychiatry residents: focus on helping relationships. BMC Med Educ 13, 90 (2013). https://doi.org/10.1186/1472-6920-13-90%5D

For this reason we suggest a list of movies that allow a reflection on survivors’ feelings and emotions and the different ways in which everyone faces mourning. We will follow the model suggested by the psychiatrist Kübler-Ross, who has proposed 5 phases for the mourning process: denial, anger, depression, bargaining, acceptance.

Today we will focus on denial. What’s next? Stay in touch for the next phases, which we will publish in the next weeks.

1. DENIAL

Avoidance, confusion, elation, shock, fear

13 reasons why (2017) – this series, based on the book by Jay Asher, describes a group of survivors: each received a tape recorded by Hannah, the suicide victim, created to explain how all of them contributed to her suicidal act. None of these survivors expected to have a role in Hannah’s decision to end her own life, so when they receive the records, they go through confusion, shock, fear, and avoidance. According to the Kübler-Ross model, this series allows us to think about the denial phase. This TV show was controversial, especially for the decision to show the explicit suicide scene in a bathtub with Hannah cutting her own veins; for this reason, Netflix deleted it by releasing this public statement: «Our creative intent in portraying the ugly, painful reality of suicide in such graphic detail in Season 1 was, to tell the truth about the horror of such an act, and make sure no one would ever wish to emulate it. But as we ready to launch Season 3, we have heard concerns about the scene from Dr. Christine Moutier at the American Foundation for Suicide Prevention and others, and have agreed with Netflix to re-edit it. No one scene is more important than the life of the show, and its message is that we must take better care of each other. We believe this edit will help the show do the best for the most people while mitigating any risk for especially vulnerable young viewers». Many studies have been conducted in order to understand if the suicidal behaviour in young people changed after the episode of Hannah’s suicide aired. They all registered an augmentation of suicide and access to the Emergency Department (ED) for self-harm.

[Sinyor M, Williams M, Tran US, Schaffer A, Kurdyak P, Pirkis J, et al. Suicides in Young People in Ontario Following the Release of “13 Reasons Why.” Can J Psychiatry. 2019;64(11):798–804.

Sinyor M, Mallia E, de Oliveira C, Schaffer A, Niederkrotenthaler T, Zaheer J, et al. Emergency department visits for self-harm in adolescents after release of the Netflix series ‘13 Reasons Why.’ Aust N Z J Psychiatry. 2022;56(11):1434–42.]

Bram Stoker’s Dracula (1992) – In this 1992 version of Dracula, surely the closest to the book and probably one of the greatest, thanks also to the stellar cast and direction of Francis Ford Coppola, the theme of the survivors, or in this case The Survivor par excellence, given his eternal life, is addressed from the very first minutes of the film. Here, the first phases of the Kubler-Ross Grief Cycle are well represented: from the Denial, with the great shock of Prince Vlad Draculea returning from the battle against the Turkish infidels (we are at the end of the 15th century), who finds out about the suicide for love of his beloved. Denial soon gives way to the explosive Anger phase, particularly conveyed by the tactlessness of the priest present (whom no one would want at the bedside of a loved one, except that he is Anthony Hopkins) who is quick to tell the grieving man that the soul of his beloved cannot be saved, given the deed done, and will therefore burn eternally in the flames of hell. Nothing remains for the Prince, not even the consolation of the salvation of Princess Elisabeth’s soul. Denying God and the Church for which he fought, he unleashes the forces of evil, thus transforming himself into the vampire Dracula. He will consequently cross the centuries (‘I have crossed oceans of time to find you’), taking several lovers and victims but hoping to somehow find his beloved. He will, in fact, reach the modern era, when as a young Londoner he discovers the face of his Elisabeta and does everything he can to have her, only to realize too late that it was a selfish and destructive love that moved him and brought only more pain to his new (is she?) beloved. Only after centuries does he then arrive at Acceptance, which will also symbolically coincide with his death and, finally, the peace of his soul.

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Ideation to action theories

By Nathan Risch, PhD student, Montpellier, France

In the last decade, ideation-to-action theories of suicide have been very popular among researchers. Those theories posit that suicidal ideation and attempt are two distinct processes.
Suicidal ideation would emerge from:
– Thwarted belongingness and perceived burdensomeness for the interpersonal theory of suicide (Van Orden et al., 2010) ,
– Humiliation, defeat, and entrapment for the integrated motivational-volitional (O’Connor, 2011) ,
– Psychological pain and hopelessness for the three-step theory (Klonsky & May, 2015).

When patients have suicidal ideation, only those who have the acquired capability of suicide and the practical capacity of suicide will attempt suicide. Acquired capability refers to fearlessness about death and higher physical pain tolerance (Van Orden et al., 2010).

Fearlessness about death facilitates suicide attempts, whereas higher pain tolerance allows one to endure pain during the suicidal act and not stop during this aversive action. Meta-analysis reported higher acquired capability in past suicidal attempters compared to non-attempters (Chu et al., 2017) .

Practical capacity refers to access to lethal means, knowledge and familiarity with suicide methods (Klonsky et al., 2021). For example, patients who have access to lethal means such as fire guns are at higher risk of death (Conner et al., 2019). Patients who know how to attempt properly are at risk of death such as doctors, veterinarians or military (Hawton, 2000; Tomasi et al., 2019; Anestis & Bryan, 2013). Patients who practice non-suicidal self-injury have a familiarity with lethal means and could be prone to use lethal means. To date, reducing access to lethal means is one of the best way to prevent suicide (Mann et al., 2005) .

References:

Anestis, M. D., & Bryan, C. J. (2013). Means and capacity for suicidal behavior: A
comparison of the ratio of suicide attempts and deaths by suicide in the US military and
general population. Journal of Affective Disorders, 148(1), 42–47.
https://doi.org/10.1016/j.jad.2012.11.045

Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R.,
Rogers, M. L., Podlogar, M. C., Chiurliza, B., Ringer, F. B., Michaels, M. S., Patros, C. H.
G., & Joiner, T. E. (2017). The interpersonal theory of suicide: A systematic review and meta-
analysis of a decade of cross-national research. Psychological Bulletin, 143(12), 1313–1345.
https://doi.org/10.1037/bul0000123

Conner, A., Azrael, D., & Miller, M. (2019). Suicide Case-Fatality Rates in the United States,
2007 to 2014: A Nationwide Population-Based Study. Annals of Internal Medicine, 171(12), 885 https://doi.org/10.7326/M19-1324

Hawton, K. (2000). Doctors who kill themselves: A study of the methods used for suicide. QJM, 93(6), 351–357. https://doi.org/10.1093/qjmed/93.6.351

Klonsky, E. D., & May, A. M. (2015). The Three-Step Theory (3ST): A New Theory of
Suicide Rooted in the “Ideation-to-Action” Framework. International Journal of Cognitive
Therapy, 8(2), 114–129. https://doi.org/10.1521/ijct.2015.8.2.114

Klonsky, E. D., Pachkowski, M. C., Shahnaz, A., & May, A. M. (2021). The three-step theory
of suicide: Description, evidence, and some useful points of clarification. Preventive
Medicine, 152, 106549. https://doi.org/10.1016/j.ypmed.2021.106549885

Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., Hegerl, U.,
Lonnqvist, J., Malone, K., Marusic, A., Mehlum, L., Patton, G., Phillips, M., Rutz, W.,
Rihmer, Z., Schmidtke, A., Shaffer, D., Silverman, M., Takahashi, Y., … Hendin, H. (2005).
Suicide Prevention Strategies: A Systematic Review. JAMA, 294(16), 2064.
https://doi.org/10.1001/jama.294.16.2064

O’Connor, R. C. (2011). The Integrated Motivational-Volitional Model of Suicidal Behavior.
Crisis, 32(6), 295–298. https://doi.org/10.1027/0227-5910/a000120

Tomasi, S. E., Fechter-Leggett, E. D., Edwards, N. T., Reddish, A. D., Crosby, A. E., & Nett,
R. J. (2019). Suicide among veterinarians in the United States from 1979 through 2015.
Journal of the American Veterinary Medical Association, 254(1), 104–112.
https://doi.org/10.2460/javma.254.1.104

Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner,
T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600.
https://doi.org/10.1037/a0018697

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Media and suicide prevention: what’s going on?

It is know that media play a key role in suicide prevention, we talked about this in many previous posts (Thirteen reasons why: new episodes, debate still ongoing; Robin Williams’ death and copycat suicides; TV Series & Suicide: The End Of The F****ing World & 13 Reasons Why; Echoes of the TV series “13 reasons why” release: an ongoing scientific debate.).

Many recent articles have been published about this topic in the recent scientific literature . 

In “Media depictions of possible suicide contagion among celebrities: A cause for concern and potential opportunities for prevention” (https://journals.sagepub.com/doi/abs/10.1177/0004867419846390?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=anpa) it is explained the concept of copycat suicide and Werther effect: celebrities suicide, but also TV series or movies about suicide, can raise awareness about the topic. Generally, celebrities’ suicides are particularly likely to be associated with increased suicide rates. The article “Increases in Demand for Crisis and Other Suicide Prevention Services After a Celebrity Suicide” (https://www.ncbi.nlm.nih.gov/pubmed/31035892) , published on Psychiatric Services in August, examines data on acute (i.e., within 30 days) increases in suicides, help and information seeking, and service capacity after a celebrity suicide (Robin Williams’ death on August 11, 2014). In conclusion, “Dramatic increases in all three measured outcomes in the days after a celebrity suicide were noted, suggesting the need for contingency plans to meet immediate increased demand”.

An important debate took place in the scientific community following the release of the show

Thirteen Reasons Why, a Netflix Drama dealing with Anna Baker’s suicide. The article “13 Reasons Why Not: A Methodological and Meta‐Analytic Review of Evidence Regarding Suicide Contagion by Fictional Media” (https://www.ncbi.nlm.nih.gov/pubmed/30318609) analyzes the possible effect of the serie on the population: the study results “suggest that current data do not support the theory that suicide contagion by fictional media occurs”, anyway “it is recommended that individuals exercise caution in public statements linking suicide‐themed fictional media to suicide contagion as data may not be able to support such claims”. 

Sources:
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#CrazySocks4Docs

On the web you can find many articles, blogs about suicide among doctors.

There are also many related initiatives which have been implemented: for example June 1st is the #CrazySocks4Docs Day, an initiative started by an Australian physician in 2017 (a cardiologist who suffered from severe depression). The initiative now involves doctors in Canada, the UK, the US, New Zealand, Spain, France, and Ireland. It is not only for doctors but also for nurses, paramedics, medical students, veterinarians and all other specialties that work in the health care field: this is a way in which it is possible to talk about the health of the Health Care Professionals, fighting the stigma.

LINK:  

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“Il primo giorno della mia vita”

Have you ever dreamed of being alive at your funeral? That’s the main theme of the novel written by Paolo Genovese “Il primo giorno della mia vita”. The protagonists are four people with suicidal intent: Emily, a young ex-athlete girl who is disable after a bad injury during a competition; Aretha, a police woman who lost her child; Daniel, a young boy suffering from diabetes and bullied at school; Napolen, a motivator who has no apparent reason to feel hopeless and depressed. All of them want to end up their lives, but, right in the moment they commit suicide, they meet a stranger who offers them the opportunity of seeing their future, as if they were still alive. The man picks up all of
them in an old-style station wagon and guides them in a journey where they assist to their funeral and see their future. Aretha, Emily and Daniel begin to be friends, and they find out that there is a lot of love and opportunities in their future lives, despite the sufferings they are experiencing at the moment. They eventually find the strength to face their difficulties with new hope in the future and decide to take the chance to came back and live their lives. Napoleon, the only character who apparently doesn’t live any difficult existential condition, but is probably affected by major depression, doesn’t change his mind and decides to go on with his suicidal project. At the end of the story, Napoleon takes the place of the mysterious man and guides people who are going to commit suicide through the same experience of seeing their future lives, just as he did earlier.

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Suicide and Ballet

Throughout ballet history, several characters die by suicide, such as Giselle, or (in some versions) Odette and the prince in Swan Lake. In the past centuries, ballet was mainly entertainment, and the protagonists’ suicide could seem somehow in contrast with the ideal of the romantic ballet. Only later (18th century) ballet became an independent art form, which could be used also as an instrument to communicate social messages. Famous example of ballets that represent suicide and suicide struggles include Giselle, Swan Lake, La Bayadère, Romeo and Juliet, Don Quixote, where the main reason for suicide is unhappy love. There is often a poor lady who has been abandoned or betrayed by her lover and commits suicide; consequently the “survivor” men have to face the burden of their beloved loss. Some ballets also deal with homicide-suicide cases and double suicide. Sometimes the theme of suicide permeates the whole representation, and the idea of suicide haunts the protagonist, who designs and programs it in detail, while other times suicide is represented as an impulsive gesture. Different suicide methods can be represented, including violent ones, but the most frequent is suicide by poisoning. Sometimes viewers find out that a character died by suicide, but are left to imagine about it, while in other works suicide is represented in detail, albeit always in elegant manners, for example using specific steps, that can simulate the act. Dancers that have to play the role of characters that commit suicide may live and perform these dramatic moments in different ways,  deeply moved by their feelings, in particular when the decision to commit suicide accompanies the characters for all the opera.

Swan lake is a ballet composed by Pyotr Ilyich Tchaikovsky in 1875–76; the choreographer of the original production was Julius Reisinger. Since then, Swan Lake has been one of the most performed ballets all over the world. Outstanding dancers, such as Carla Fracci and Rudolf Nureev performed this masterpiece in theaters, which in 2010 inspired also the movie “Black Swan” by Darren Aronofsky (see Movie of the Month).

The opera, generally presented in four acts, tells about Odette, a princess turned into a swan by an evil sorcerer’s curse. Prince Siegfried must choose a bride at the royal ball and he is really upset that he cannot marry for love. He goes out with his friends and reaches the lakeside where there are many swans and one of them transforms into a beautiful maiden, Odette, who explains that she and her companions are victims of a spell cast by the sorcerer Rothbart. The spell can only be broken if one who has never loved before swears to love Odette forever. Rothbart goes to the royal ball with his daughter Odile, transformed to look like Odette and they deceive Siegfried who proclaims to the court that he will marry “Odette” (Odile). When he realizes his mistake, he goes back to the lake to apologize with Odette, who has chosen to die, rather than remaining a swan forever. Siegfried chooses to die with her and they leap into the lake. This action breaks Rothbart’s spell over the swan maidens, causing him to lose his power over them. Rothbart eventually dies, and the swan maidens watch Siegfried and Odette ascending into the Heavens together, forever united in love.There are also many alternative endings in which Odette and Siegfried live happily ever after or kill Rothbart, and also tragic endings in which Rothbart fights with Siegfried, who is defeated and dies, leaving Rothbart to take Odette triumphantly up to the heavens.

References: 

To know more, contact EPA- SSSP e-mail address:

epasectionsuicidology@gmail.com

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Suicide Hotspot: “A Long Way Down”

A Hornby’s novel, published in 2005. 

On the night of the 31th December four people, apparently with nothing in common, find themselves involved in a strange and unusual adventure. They met for the first time on the top of “The House of Suicide”, a skyscraper in London, where they went up with the intention of committing suicide. The protagonists are: Maureen, a lonely woman taking care of a seriously disabled son named Matt; Martin, a journalist who spent a period in jail after having a sexual intercourse with a 15 years old girl, and, after this fact, lost his family, friends and job; Jess, a problematic adolescent girl, with a tragic history in her past and JJ, an American pizza-boy, who was a musician in his country, but his band dissolved and he broke up with his girlfriend. All these people have different tragic past  stories and live in difficult conditions, but, when they start talking on the roof of the skyscraper and sharing their problems, they decide not to commit suicide in that moment. They start a strange friendship, and, in an unusual way, they help each other, talking with honesty, frankness and true empathy. They start to meet periodically, and everytime they postpone the decision about suicide, sharing and comparing their life problems. On the 14th February they decide to go up on the skyscraper “House of suicide”, where they find a man. They try to talk to him, but he commits suicide in front of their eyes. After that, they understand they don’t really want to end their life, and, likewise, they need to stay together, and through their particular friendship, they start to look in a different way to their life and start giving themselves a chance. They go on with a new point of view: although life is not always beautiful and easy, they try to face it step by step, and continue postponing the decision of suicide, never saying “I’ll never do that”, but just waiting for taking this decision, and, in this way, they continue with their life and friendship.

To know more about suicide hotspot visit our post about it!

To know more, contact EPA- SSSP e-mail address:

epasectionsuicidology@gmail.com

 

 

 

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