by Michael D. Anestis, M.S.
A colleague, Tracy Witte, alerted me to a news story yesterday that was interesting in a variety of ways. Officials in southeast China have made several attempts to reduce the rate of suicide attempts on a particular bridge. Guards have been stationed on either side of the structure and fences were erected, but neither effort impacted the rate of individuals who threatened to jump from the bridge. Recently, however, they did manage to find a method that worked: they covered the accessible areas of the bridge with butter. Believe it or not, making the metallic structure slippery has managed to successfully address the problem. Indeed, this is further evidence that butter is a wonderful thing. This aspect of the story is uplifting and provides further evidence that reducing access to targeted means of attempt can significantly impact suicide rates.
Unfortunately, the story does not end on that uplifting note. At the end of the article, the bridge guard interviewed for this story provided the following quotes:
"Each time somebody threatens to commit suicide to get media attention or sympathy over personal problems we end up with several hours of tailbacks and there were lots of complaints. Since we put up the butter there have been no problems with these attention seekers."This quote, quite frankly, represents a shocking amount of ignorance, callousness, and self-absorption. The guard assumes that individuals who climb the bridge with the intent of jumping do so to get attention and quickly dismisses them as nothing more than an inconvenience to commuters. Rather than simply leave my review of this guard's unimpressive viewpoint at that, however, I would like to spend the rest of today's article providing a review of a small sampling of the evidence indicating that suicide attempters are not simply trying to selfishly manipulate others and that, no matter how inconvenient a traffic jam might be - or in the case of this guard, no matter how inconvenient being forced to do his job might be - the individual who felt compelled to attempt suicide was experiencing substantially more distress.
I myself have been caught in a traffic jam prompted by an individual on a bridge being talked out of jumping. Much like you, I am not a fan of being caught in traffic and, more often than not, when I am, I end up missing out on something I had planned for my day. Nobody will dispute that being caught in traffic is inconvenient for everyone involved and people are certainly entitled to their frustrations about the situation. That being said, the idea that those of us who get caught in those situations are the victims of some form of manipulation brought upon us by a selfish individual who should be subsequently criticized in media reports seems hollow to me.
Before moving on to a discussion of the research on suicide that so directly contradicts the bridge guard's view, let me provide you with some basic data on suicide as a means to clarify why this concept is so meaningful to me and why I devote so much of my professional time to studying this topic.
- Each year, approximately 32,000 individuals in the United States die by suicide. That computes to approximately 1 person every 16 minutes and 88 per day.
- Death by suicide is more common than death by homicide.
- For every death by suicide, there are an additional 25 attempts, meaning approximately 800,000 suicide attempts occur in the United State each year.
- Despite a popular conception that the holidays represent the time of year with the highest suicide rate, spring actually has the highest rate, with June serving as the month with the highest individual rate of death by suicide.
- Although women are three times more likely to attempt suicide than are men, men are substantially more likely to die by suicide, with this difference mostly accounted for by the fact that men tend to use more lethal means of attempt (2 of 3 male suicides occur by gunshot as opposed to 1 of 3 for women, with overdose being the most common method of attempt for women).
- White males above the age of 65 are the demographic with the highest rate of death by suicide.
- The sex differences in suicide rates is universal across the globe with one exception - China.
Having covered some basic data on suicide, let's move on to a discussion of what we know about why people attempt suicide. We have, of course, covered Joiner's interpersonal-psychological theory of suicidal behavior in great depth on PBB and tomorrow's post - the September 2009 Psychotherapy Brown Bag featured article by Chad Morrow of the United States Air Force - will provide further data on this concept. Nonetheless, I feel compelled to again point your attention to how this conceptualization of suicidal behavior has been supported by empirical data and, as such, provides clear evidence that contradicts the viewpoints of individuals like the Chinese bridge guard quoted above. In particular, the evidence provided by studies of this theory have clearly shown that the desire for suicide is comprised of perceived burdensomeness (an individual's sense that he or she fails to make meaningful contributions to others) and thwarted belongingness (an individual's sense that he or she lacks meaningful connections to others). There is no evidence supporting a model that suicide attempts are predominantly motivated by the desire for attention. Much like the evidence we mentioned recently indicating that non-suicidal self-injury is far more often motivated by the desire by the individual to regulate his or her own emotions than to manipulate others, studies on suicide can serve to counteract harmful myths and attitudes.
Studying suicide and the motives behind attempts is tricky as we obviously can not ask questions of individuals who have died by suicide. That being said, several studies have used interesting methods of attaining this information. In 2002, Thomas Joiner and colleagues designed a study in which they examined suicide notes from a number of individuals, some who had died by suicide and some who had attempted but survived. The authors rated the degree to which each note included signs of burdensomeness with no knowledge as to whether or not the individual had died by suicide or simply attempted. Once ratings were completed, the authors were given access to information regarding survival status as well as method of attempt and found that those who had died by suicide and used more lethal means of attempt (e.g., gunshot versus attempted overdose) exhibited greater levels of burdensomeness in their suicide notes than did individuals who survived or used less lethal means of attempt. In other words, the more serious the attempt, the more the individual felt that he or she was a burden upon others. Similarly, Van Orden, Hollar, and Joiner (2006) found that burdensomeness predicted whether or not an individual had previously attempted suicide and whether or not that individual was experiencing thoughts of suicide above and beyond the effects of hopelessness. In other words, individuals who feel like a burden upon others were more likely to be thinking about suicide and more likely to have attempted suicide in the past.
The evidence for the role of thwarted belongingness in suicidal desire is equally compelling. For example, in a study of individuals with opiate dependence, Connor, Britton, Sworts, and Joiner (2007) found that individuals who felt that they lacked meaningful connections to others were more likely to have attempted suicide. At the same time, individuals with low levels of belongingness were no more likely to have accidentally overdosed than were individuals with high levels of belongingness, indicating that belongingness impacts intentional self-harm and does not simply increase the likelihood of destructive behaviors in general.
In another study, Joiner, Hollar, and Van Orden (2006) found that local suicide rates correlated with the final national rankings of local college football teams. In other words, in areas in which there was a shared positive experience in which individuals who did not necessarily know one another could nonetheless all identify with a group, there were fewer suicides. Similarly, the authors found that there were fewer suicides on the day of the "Miracle on Ice" than on any other February 22 and fewer suicide attempts on Super Bowl Sundays than on non-Super Bowl Sundays.
Van Orden and colleagues (2008) provided even further empirical support for the importance of feeling connected to others when they published a study that found college students were more likely to experience thoughts of suicide during the summer than during the fall or spring when enrollments were higher and that these differences were accounted for by belongingness. In other words, seasonal patterns in suicidal thoughts could be predicted by students' perceptions that they were meaningfully connected to others.
You will notice that none of these studies found any evidence that, when individuals attempt suicide or contemplate attempting, they do so primarily to influence others. Suicide is, in fact, not generally an attempt to harm or communicate with others. Rather, it is a behavior motivated by distorted beliefs on the part of the individual that leave him or her thinking that they are a burden to others, thereby making their death convenient for those left behind, and that they lack meaningful connections to others, thereby assuring that their death will have little or no emotional impact on survivors.
Just because the evidence indicates that suicide is not an act of manipulation does not mean that the bridge guard is obligated to feel empathy for attempters. The idea of feeling anything else is foreign to me, but I respect others' rights to their own emotional responses. That being said, when individuals make comments based upon uninformed emotional opinions rather than an understanding of actual evidence, this can do harm and perpetuate ignorance. If the bridge guards directly responsible for intervening when individuals attempt suicide at that location are so uninformed about the nature and causes of suicidal behavior, the Chinese government might want to consider providing educational materials and requiring that their guards spend more time learning factual information than spewing misinformation to the media. After all, their ignorance could delay the learning of others and the guard has already expressed his feelings regarding people who allow their emotions to cause delays for other people.
If you would like to learn more about suicide, we recommend the following resources, all of which are based on evidence, not just theory, and are available through our online store:
- Why People Die by Suicide
by Thomas Joiner
- Treating Suicidal Behavior: An Effective, Time-Limited Approach
by David Rudd, Thomas Joiner, and Hansan Rajab
- The Interpersonal Theory of Suicide: Guidance for Working With Suicidal Clients
by Thomas Joiner, Kim Van Orden, Tracy Witte, and David Rudd
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