Too long to watch
- 1 Suicide risk is a complex mutation system, and suicide prevention should abandon "solution-oriented" and shift to "process-oriented".
- 2 Not all suicidal people have psychological problems or mental problems.
- 3 people can go from "low suicide risk" to "high suicide risk" in a very short time (such as a few hours).
- 4 Don't look for "suicide high-risk groups", capture everyone's "suicide high-risk moments".
- 5 It is difficult to stop suicide by "detecting suicide alarms".
- 6 Therapies that "directly reduce suicidal thoughts and behaviors" are more effective. Therapies that indirectly reduce suicidal thoughts and behaviors by reducing mental illness are less effective.
- 7. Suicide prevention measures from the environment are useful.
- 8 Increasing the "willingness to live" is more important than reducing the "desire to die."
- 9 The focus is to improve the quality of life and create and build a "life worth living".
Psychologist who studies suicide in the military
Psychologist Craig Bryan had an unusual experience — in the military.
He spent more than four years as a military psychologist at Lachland Air Force Base in Texas and was deployed to serve six months at Joint Base Ballard, Iraq.
Craig Bryan (right), Ph.D. in psychology, enlisted in the army in 2009 and served in Iraq|health.osu.edu
He provides psychotherapy to military personnel, neurocognitive assessment to military personnel with head injuries, and expert advice to medics and commanders. At the same time, he inevitably confronts countless cruel tragedies - from war, from trauma, from ... Suicide.
Military personnel had easy access to firearms and ammunition, and when they decided to commit suicide, they often raised their guns to commit suicide. This is an almost irreversible drastic measure.
On one occasion, four servicemen at an Iraqi base shot themselves at a short time. Their brains are dead, but their bodies and organs are still alive on life support systems. Because of the organ donation agreement, they were placed together in intensive care units while waiting for a plane to transport them back to the United States for organ transplants.
That day, Brian stood in the intensive care unit, watching the four suicides lying side by side with sadness, frustration, doubt and anger. What kind of life did they lead? Why choose death? What happened that day and that moment? How has their lives changed compared to the previous week, the month before? If the situation changes a little, is it possible that they will choose to survive?
It was also on that day that Brian realized that the current suicide prevention program was clearly far from good. It's time to take a new perspective to understand and intervene in suicide.
People who do not have mental illness also commit suicide
Suicide prevention is now based on the "psychological/psychiatric disease model." To put it simply, it is believed that almost all people who commit suicide have mental illness, and psychological/psychiatric illness leads to suicide. Identifying the warning signs of mental illness and treating mental illness can prevent suicide.
The "psychological/psychiatric disease model" does not explain all suicides|Figureworm Creative
But Brian encountered several suicides at his base in Iraq that could not be explained by mental illness.
Pilot A, learning that he was going to be disciplined by the army again, called his girlfriend in the United States in frustration to confide in him. The girlfriend expressed frustration that he "screwed up again", saying she "can't go on like this anymore" and hung up. A continued to call his girlfriend, but her girlfriend did not answer. He sat alone in the room thinking, what's the point, I messed everything up. He took out the gun, loaded it, raised it to his head ... At this moment, a friend happened to come to A. Friends immediately took his gun, reported the incident and took him to the hospital. A said that if the friend had not come, he must have died, and everything happened too quickly.
A had no previous suicidal thoughts, no suicide plans, no psychological disorders, no mental illness, and no history of drug or alcohol abuse. He did have some "warning signs" – he had significantly increased stress and poor sleep in the previous week as a result of the punishment, blaming himself and worrying about his future. However, these reactions are normal responses to stress. A is not prevented from working properly or socializing with others as a result. If the previous A stood in front of a psychologist, the doctor would not have considered him to have a mental or psychiatric disorder, and would not even diagnose him as having an adjustment disorder.
Brian also noticed that "it just happened", everything happened too fast. A went from "low suicide risk" to "high suicide risk" in a very short period of time.
Later, when Brian practiced law in Utah, he also encountered a case of "just happened".
During a heated argument between Visitor B and his wife, he "felt completely overwhelmed and just wanted everything to stop", so he grabbed a pistol and pointed it at his head, only to stop dangerously before pulling the trigger.
B and his wife had a tense relationship, but he did not have any mental or psychiatric illness, nor had suicidal thoughts or plans. He felt "emotionally overwhelmed" during the argument, but this is also a normal human reaction, not a psychological or psychiatric illness.
Suicide due to quarrels feeling "emotionally overwhelmed" |
Such examples of "emotionally overwhelmed, so impulsive suicide" are also common in mainland scholar Wu Fei's "Floating Life and Taking Righteousness".
A young man named Fang Lin, his sister quarreled with his brother-in-law, he took his sister back to her mother's house, and persuaded her sister, "If he doesn't come to beg you to go back in two weeks, really divorce him." If you go back with him easily, your status in the family will be lower. We can't let people look down on our family so much. What's the matter, brother is behind to support you. However, the brother-in-law not only passed the deadline, but also came to the door with a proud attitude. And my sister actually followed back. Fang Lin was sad and angry, "No matter how poor our family is, we shouldn't let people bully them so low." "He committed suicide by drinking pesticides that night.
A woman named Jiao Lan is usually outgoing and loves to talk and laugh. During the years when her father-in-law's sister-in-law was ill, she relied on the two children to serve her until her death. Jiao Lan believes that since her father-in-law's sister-in-law only has two daughters, coupled with her and her husband's efforts, her husband should be eligible to play flags at the funeral. However, the son-in-law of the deceased suspected that she was plotting to seize the family property and cursed her on the street. Jiaolan ran home in a fit of anger and drank the pesticide, but fortunately was sent to the hospital to wash her stomach and save her.
This survey of suicides in a county in northern China shows that many suicides do not have mental illness, they often suffer setbacks in the power game, in order to "fight for breath" and save their personal values, and soberly, fiercely, and thoughtlessly go to suicide.
To emphasize, this is not to say that "suicide is a normal reaction" – suicide is definitely an extreme choice. Nor is it to say that "mental illness/psychiatric illness does not increase suicide risk" – illness certainly significantly increases suicide risk, and it is important to detect and treat it promptly.
It's just to say that perfectly normal people can also experience intense emotional distress, and this emotional distress may already be pushing them toward suicide.
Life is not as good as it should be. We will be rejected by our loved ones, we will argue fiercely with our families, we will be depressed and miserable by being blamed by our superiors, we will be frightened and desperate in the face of unemployment or debt... These intense emotional distresses are a natural, normal, and ordinary part of life. But these pains may also overwhelm a normal person at some point and become "the last straw that breaks the camel's back."
Some pain can become "the last straw that broke the camel's back" |
People who "do not have mental illness, but commit suicide because of severe emotional distress" are a difficult part of the current "suicide prevention system" to catch.
Suicide is like a multi-solution equation, like X+Y+Z=100. There are many solutions that satisfy this equation, X=50, Y=50, and Z=0. X=10，Y=10，Z=80。 X=100，Y=100，Z=-100...... These are the "correct solutions" of the equations. The same is true of suicide, with many "risk factors" that promote suicide and many "protective factors" that prevent suicide. For each specific suicide case, mental illness is possible with or without the "solution" to suicide.
Brian also often encountered situations where a person committed suicide without warning. His family looked back in extreme shock for clues of mental or psychiatric illness, sometimes finding some, but sometimes finding nothing. Bereaved family members sit in front of psychologists crying, not knowing what they missed and what they should have done. Many people believe that the suicide of a loved one is so unexpected that there is little obvious warning.
Why are suicide warnings so hard to detect?
Can suicide be stopped by "identifying suicide warning signs"?
Existing suicide risk screening methods are far from accurate.
Let's start with a list of typical suicide warning signs -
Suicide warnings
- 1. Talk about suicide or wanting to die
- 2. Find ways to end your life
- 3. Alcohol or drug abuse
- 4. Social withdrawal, isolating oneself and staying away from others
- 5. Despair
- 6 Sleep changes, sleeping particularly much or too little
- 7 anxiety, restlessness
- 8 Feeling trapped and with no way out
- 9. Irritability
These warning signs do exist, but the problem is,
- 1 These warning signs also appear in people who do not commit suicide, and most people who do not commit suicide eventually do not commit suicide,
- 2 These warning signs do not necessarily appear in people who commit suicide, and even if they do, they do not necessarily attract the attention of those around them.
Since suicide is inherently a low-probability event, this means that "most people detected in suicide screening do not commit suicide."
Make a very ideal assumption - assume that according to suicide alarm screening, 99% of people who are actually going to commit suicide can be found, and there is only a 1% chance of misjudging people who do not actually commit suicide.
Sleep changes are suicide warning signs, but people who do not commit suicide also have these warning signs
According to the "China Health Statistics Yearbook 2021", the suicide mortality rate of urban and rural residents is about 3.8~8.65/100,000 - overestimated, even if it is 10/100,000, this means that for every 1 million people, 100 people will commit suicide, and 999,900 people will not commit suicide.
So the screening would find 99 of those 100 people and 999,999 of the 999,900 people. Of the 10,098 people, only 99 actually committed suicide, an accuracy rate of less than 1%. In other words, although people who commit suicide are likely to have warning signs in advance, very few of those who do do do actually commit suicide.
For "low-probability events," the result of mass screening is that the number of people with warning signs is too large to intervene effectively, and a subset of suicides are always missed. Screening for suicide signs is certainly better than doing nothing, but it's not much better.
A 2017 study in the Journal of the American Medical Association: Psychiatry found that screening patients who were sent to the emergency room for suicide risk did not reduce the rate of attempted suicide in the coming year.
In 2013, a paper in the journal Psychiatric Services analyzed 200,000 psychological questionnaires from 84,418 individuals, with 709 suicide attempts and 46 suicide deaths during the study's follow-up period. The researchers asked these people if they had suicidal thoughts in the previous two weeks, and those who answered "almost every day" had a 0.3% risk of suicide in the next year; Those who answered "never thought of it" had a 0.03 percent risk of suicide in the next year.
It's easy to understand that people who want to commit suicide every day have a tenfold higher risk. But if you look at the data from another perspective, it means that 99.7% of people who "almost want to kill themselves every day" are still alive a year later. And for every 3,000 "people who have never thought about suicide," 1 in 3,000 people will not survive the second year.
The study also found that of the 46 people who died by suicide, 13 said they had "thought about suicide almost every day" in the past two weeks, 12 said they had "thought about suicide for more than half of the day," 12 said they "thought about it for a few days," and 9 (20 percent) consistently answered that they had "never thought about suicide" when surveyed.
Is it true that there are no suicidal thoughts, or is it unwilling to reveal what is true? There may be both. People who impulsively commit suicide may have really had no suicidal thoughts at all before. And a large proportion of people with suicidal thoughts are reluctant to tell others.
A 2017 paper in the journal Suicide and Life-Threatening Behavior compared several surveys in the military, and 5.1 percent of the same population reported suicidal thoughts when they were completely anonymous, while only 0.9 percent reported suicidal thoughts during real-name health assessments.
Never thought about suicide" Is it true that there are no suicidal thoughts, or is there an unwillingness to reveal what is true? Both may have figureworm ideas
A 2018 paper in the International Journal of Environmental Research and Public Health surveyed 14,322 people, of whom 719 had suicidal thoughts in the past year, and half of those (348) had never told anyone they had suicidal thoughts.
There are many reasons why people are reluctant to disclose their suicidal thoughts: for people who are bent on death, disclosure can invite additional humiliation or harm to themselves, and may also thwart their plans. For people who still want to live, disclosure may hurt their interpersonal image, is not conducive to their future career development, and they may not want to die in a few days, why tell others about their momentary mood swings.
How to spot a person's "high suicide risk" moment?
Suicidal thoughts fluctuate greatly.
A 2017 study in the Journal of Abnormality Psychology attempted to track changes in suicidal thoughts over a short period of time, and the participants were all at high risk of suicide. These people were asked an average of 2.5 times a day about "thoughts of that moment" and found that suicidal desire fluctuated dramatically on most days. Feelings of hopelessness, loneliness, thinking that they are a burden to others... These feelings vary equally greatly.
These people were questioned 2.5 times a day for 28 consecutive days. Different colored lines represent different people, and everyone's suicidal thoughts change a lot
A person may have been fine yesterday, but today at noon there are suddenly extremely strong suicidal thoughts, and in the evening, the suicidal thoughts disappear again.
In 2018, Brian published a paper in the journal Suicide and Life-Threatening Behavior analyzing the social media content of 315 military members in the year before their deaths. Of those soldiers, 157 died by suicide and 158 from other causes. The results showed that the "pattern of change in social media content" was different for suicide and non-suicide people -
1. Simply comparing "social media content", there is no difference between suicide and non-suicide. Both express negative thoughts and describe stressful events.
2. Suicides have a typical time pattern: publish negative thoughts while describing stressful events. The two topics appear consecutively, and may be published on the same day or only a day apart.
In contrast, non-suicidal people also post their own negative thoughts and stressful events, but the two themes do not appear consecutively. Non-suicidal people have "negative thoughts" more often in succession with "physical discomfort."
In other words, "stressful events" and "negative thoughts/negative perceptions" were strongly correlated in suicidal people. Non-suicidal people are not.
3. The closer to the suicide date, the more obvious this time pattern of suicide is reflected.
The most important "suicide marker" is not a distinction between people, but a specific change in the individual over time—more and more frequently referring to both "stressful events" and "negative thoughts."
For example, the balance beam athlete will move more frequently and amplitly to restore balance before the athlete falls off the balance beam. But every athlete's movement habits are different, and if we only focus on the frequency and amplitude of the movements, we can't necessarily predict who in a group of athletes is about to fall off the balance beam. But if the frequency and amplitude of an athlete's movements suddenly increase significantly compared to his own, this is a "warning sign", and it can be predicted with a relatively safe sense that the person is in a "high-risk period of falling off the balance beam".
Mention "stressful events" and "negative thoughts" more and more frequently, possibly in a high-risk period
Traditional questionnaire screening has a hard time capturing these naturally occurring fluctuations or identifying a person's most dangerous moments. If a person's suicide risk rises dramatically within hours, is there a way to detect and stop him at that moment?
But how can a person suddenly become "at high risk of suicide" in a matter of days or even hours?
Not a continuous change, but a sharp point mutation
The traditional imaginary suicide risk is a "continuum in a single dimension" -
- 1 Many people basically do not want to die, which is the "low suicide risk group".
- 2 Some people have a little desire to die, which is the "medium suicide risk group".
- 3 A small group of people desperately want to die, which is the "high suicide risk group".
Starting from a continuous model, suicide risk is considered a "gradual" rather than "mutational" process. A person has to slowly accumulate a lot of stress before changing from low risk to medium risk, and then slowly accumulate a lot of stress and change from medium risk to high risk.
But when Brian spoke to some suicide survivors, he noticed another pattern of similar "butterfly effect": a relatively small change that produced a small push that pushed a person past a certain "tipping point" and eventually led to a dramatic change — people deciding they had "had enough."
More suitable for describing suicide is the CUSP catastrophe model.
There is already some research evidence to support a "sharp point mutation model" of suicide risk.
First, several studies have found that suicide risk is not distributed continuously, but is closer to being divided into different categories. A 2017 paper in Psychological Assessment surveyed 1,773 people, and a 2018 paper in the same journal surveyed 2,385 people, both found that suicide risk was made up of two subgroups — the "low-risk group" and the "high-risk group." The two groups did not differ much in symptoms of mental illness such as depression and hopelessness, but there was a big difference in factors associated with suicide risk, such as "how strong the suicidal thoughts were." That is, two people with similar levels of depression may have a low risk of suicide and a high risk of suicide.
Second, interviews with suicide survivors often reflect extremely rapid state changes, an emotional impulse, an emotional fluctuation, may jump directly from "low suicide risk" to "high suicide risk" in a short period of time.
A 2007 paper in the Journal of Affective Disorders found 112 people who had attempted suicide, a quarter of whom were impulsive—they attempted suicide on impulse without planning their suicide in advance. In addition, the majority of suicide attempts (63%) believe that the entire suicide process is ups and downs and fluctuating; Only a minority (22%) believe that the suicide process is linear and progressively severe.
A 2017 paper in the journal Suicide and Life-Threatening Behavior interviewed 30 people hospitalized for suicide attempts, and based on their review, laid out a typical "suicide journey timeline" —
The researchers found that the transition from "low suicide risk" to "high suicide risk" was not linear, but exponential. The vast majority of people suddenly made up their minds to commit suicide in a short period of time and then immediately began to execute them – all 30 people took action within 3 days of making up their minds, of which 18 (60%) committed suicide within 5 minutes of making up their minds.
The tipping point for the transition in the state of suicide risk is "a fierce debate about 'life versus death' in the heart." If the conclusion of "survival" is reached, it will quickly return to the "low suicide risk" state, but if the conclusion of "death" is reached, then the person is likely to form a suicide plan and commit suicide within the next few hours.
And at this critical tipping point, it is likely to be extremely small factors.
In normal times, a little pressure change may not matter. But at tipping points, a hug or a scolding can push a person down a completely different path.
This is also in line with the fourth characteristic of the sharp point mutation model – small changes in conditions can lead to very different results.
Schematic diagram of the "sharp point mutation model" of suicide risk
Suicide is likely to be a complex dynamic system in which sudden, discontinuous catastrophic changes sometimes occur. The change was so dramatic, so irrational, so unpredictable, so drastically changing the way the whole system operated. There is little indication of when catastrophic change will occur. This unpredictability is the source of its destructive power.
If we can't predict when someone will commit suicide, can we still prevent suicide?
At this time, the fifth feature of the sharp point mutation model is used - adding a factor can promote a person to change from low suicide risk to high suicide risk, but reducing this factor does not necessarily promote a person to change from high suicide risk to low suicide risk.
Just like pressing the accelerator can quickly accelerate the car, but to slow down the car in a few seconds, it is not enough to release the accelerator, we also have to press the brakes hard.
To stop suicide, you need to find the "brakes on suicide".
Brian began asking suicide survivors, "What are your brakes?" When you are in intense pain, what methods work for you and which help? How did you face a new crisis and make yourself not want to commit suicide? Did you do anything different?
Direct focus on reducing suicide, not reducing suicide by reducing mental illness
Existing suicide intervention methods are only marginal in reducing suicidal thoughts and behaviors.
This conclusion comes from a 2020 meta-analysis published in Psychological Bulletins, which included 1,125 controlled studies over nearly 50 years and concluded that "short-term, inexpensive interventions and long-term, expensive interventions are as effective as those that are similar, or as poor" and that "suicide interventions require fundamental change."
Many of the current interventions and treatments for suicide are not as effective as they should be, possibly because they are designed to "reduce suicide by reducing mental illness."
But if you want to reduce suicide, the design idea is best to directly add "suicide brakes" to people. That is, therapies that directly focus on suicide reduction are more effective.
The first brake is to increase the willingness to live, that is, to make people "want to live more".
"How much you want to live" and "how much you want to die" are related, but they can also change independently. There are people who "don't want to live too much, and they don't want to die too much", and there are people who "want to live very much, and at the same time want to die very much".
Suicide is because of "wanting to die", but also because of "lack of reason to live".
A 2005 paper in the American Journal of Psychiatry asked 5814 patients to assess their "willingness to live" and "willingness to die" and found that as long as there was at least some willingness to live, it could offset many wishes to die and significantly reduce the risk of suicide.
A 2016 paper published by Brian in the Journal of Affective Disorders similarly found that suicidal behavior is primarily driven by "not wanting to live very much" rather than "wanting to die very much." A decrease in the "willingness to live" greatly increases the risk of suicide. In contrast, a change in "will to die" has a less significant impact.
As Nietzsche famously said, "A man who knows what he lives for can endure any kind of life." To prevent suicide, it is necessary not only to reduce the "willingness to die", but also to increase the "willingness to live". Expecting a "meaningful life worth living" can resist the impermanence and pain that inevitably occur in life.
Not being able to rest assured that a puppy is also a willingness to survive|Tuworm Creative
The second brake is to teach people to stick to new strategies that work even when frustrated.
A 2010 study in the American Journal of Psychiatry found that people who had attempted suicide had a characteristic compared to others — the ability to reverse learning was poorer, that is, cognitively rigid and inflexible, more difficult to forget outdated old experiences, and more difficult to learn new experiences adapted to the current environment.
Successful reversal learners can: quickly adapt to unexpected changes in the environment, and quickly identify current success strategies in an uncertain environment; Even with occasional setbacks, stick to newly learned strategies for success.
When the rules quietly change, can you find new ways to overcome setbacks and stick to them?
People who have attempted suicide are significantly weaker in this regard. One of their characteristics is that "even if they know that it is an effective strategy, as long as it does not work once, it is enough to make them give up" - they know that exercise will significantly improve their mood, but the last time they went to the gym, they were said by the coach and never wanted to go to the gym again. Obviously, most of the time friends will patiently accompany themselves, but the last time I looked for a friend, the other party happened to have no time, so I never contacted my friend again.
Only by being able to tolerate occasional setbacks can you stick to and benefit from a long-term strategy. Only by realizing the rewards of patience in the present can we not impulsively make desperate behaviors.
This is the third brake.
The third brake is to teach people how to slow down their decision-making in times of extreme pain.
A 2016 paper in the American Journal of Geriatric Psychiatry found that people who have committed suicide have a decision-making style that favors high-risk, high-reward rather than low-risk, low-reward. Ordinary people are more inclined to choose the strategy of "small wins, small losses, long-term earnings", but people with a history of suicide are more willing to choose the strategy of "big wins, big losses, long-term losses". In particular, people who have committed suicide by highly lethal violence are more inclined to choose "gambling big" and "stud".
Suicide survivors need to learn to change their decision-making style, learn not to "end the pain immediately" when the future is full of uncertainty and extreme pain, but to slow themselves down, do something else, divert attention, relieve negative emotions, endure uncertainty, and wait for things to turn around.
Therapies that can do this relatively well include dialectical behavior therapy, cognitive behavioral therapy for suicide prevention, and crisis response plans. What these "suicide-centered" therapies have in common is that they all aim to directly reduce suicidal thoughts and behaviors.
For example, Dialectical Behavior Therapy (DBT) focuses on teaching four core skills:
- 1 Mindfulness: Being aware of what is happening to you without judgment or self-blame,
- 2 tolerance of pain: the ability to withstand pain, stress and other negative emotions,
- 3 Emotion management: identify, influence, change one's own emotions,
- 4 Effective interpersonal relationships: Interact effectively with others
All four skills point to calming down and making better decisions when a person is most emotionally distressed.
Mindfulness calms people down when they are most emotionally troubled|Tuworm Creative
Cognitive behavioral therapy for suicide prevention (CBT-SP) is very similar to DBT, while reinforcing the skill of "transforming the thoughts":
There are many thoughts: "things will never get better" (despair, no way out), "I dragged others down, everyone would be better off without me" (consider themselves a burden), "I don't deserve to live" (self-hatred), and so on.
This therapy teaches people to replace these negative thoughts with more balanced, objective ideas (such as "I made a mistake, but it doesn't mean I'm a loser, and it doesn't mean I deserve to die"). It also teaches them to establish new beliefs that "the future may be difficult, but not completely desperate, that sometimes things may be better than expected, and that sometimes we do get what we want"—that people are more willing to slow down, gather more information, and wait for a turnaround.
A 2014 paper in the American Journal of Preventive Medicine showed that patients who received cognitive therapy for suicide prevention were 50 percent less likely to attempt suicide again than those who received routine follow-up and referral.
A crisis response plan (CRP) is a simple approach. Users should remember and practice "what to do when overwhelmed and overwhelmed":
- 1 Identify the "warning signs" of an individual's emotional crisis,
- 2 Use some simple strategies to reduce stress, or divert attention,
- 3 Think of reasons worth living,
- 4 Ask friends, family, or others who will support you for help,
- 5. Go for professional support or crisis services.
The details of these five steps can be written on a small card and put in your wallet to carry with you. In an emotional moment, taking out this card is equivalent to stepping on the brakes hard.
One of Brian's studies, published in the 2017 journal of Affective Disorders, found that 97 people who had committed suicide were randomly assigned to either a "non-suicide protocol group" or a "crisis response planning group." The "non-suicide protocol group" uses a commonly used strategy to guide patients to commit not to suicide and sign a "safety protocol". Over a six-month period, 19% of the Non-Suicide Protocol Group attempted suicide again, while only 5% of the Crisis Response Planning Group attempted suicide again.
During suicide intervention, Brian spends an entire class discussing "reasons to live" with the patient. While many suicide people say, "I don't have any reason to live," with support and help, most people can find at least one reason — the most common reasons include family, friends, pets, and hope for the future.
Family and friends are also "reasons to live" |
Next, each patient should write down their reasons on a small card, take it with them, whether they are calm or depressed, and read them from time to time.
This is to remind them of the meaningful, happy, positive parts of life. As these parts continue to be consolidated and expanded, the pillars of life will become more and more diverse, thick and indestructible.
They still experience the ups and downs of life... But at their lowest point, they learn to believe that "hope" and "reason to live" must exist somewhere, that they can still "build a meaningful life."
The "brakes" that directly target suicide are effective, but there is also a way to prevent suicide.
Prevent suicide in the same way as traffic fatalities
Maybe it's not necessary to be obsessed with "identifying people who are going to commit suicide first, and then intervening in this group."
Even if you don't know who is most likely to commit suicide, you can still prevent it. Just like even if you don't know who will be in a traffic accident, you can still reduce the number of traffic fatalities.
The focus of suicide prevention now is overwhelmingly on "reducing human wrong thoughts and behaviors." We do risk screening, encourage people to be alert to suicide signs, and if there are signs, go to psychotherapy, take medication, and call suicide prevention hotlines.
If the same line of thinking is applied to traffic accident prevention, then we will endlessly train people to pay attention to the various warning signs in the environment, often screening drivers for "Have you been speeding lately?" Drunk driving? Did you look at your phone while driving? ", arrange for the driver of the accident to take a safe driving course.
These work, but these are not enough.
A complex system needs to "improve security based on the knowledge that humans will make mistakes."
Not only to change the thinking and behavior of individuals, but also to change other parts of the system to ensure that if something goes wrong in one part, the people in the system are still protected by the others.
From the design idea, reducing danger and improving safety can be divided into five levels -
Many studies have proven that "restraint" can be said to have an immediate effect in reducing suicide.
A 2005 review in the Journal of the American Medical Association (JAMA) reviewed suicide prevention strategies and found that one of the most effective strategies was to "reduce suicide pathways and limit suicide methods." To put it simply, add various obstacles to the road to death: gun control, restrictions on the prescription of lethal drugs, replacing highly toxic pesticides with low-toxicity pesticides, replacing gas with natural gas that is not easily poisoned, building high guardrails on bridges to prevent jumps...
In the UK, as the proportion of carbon monoxide in the gas supply fell from 12% to 0%, the suicide rate fell by almost 30%, and women who would have committed suicide with gas did not commit suicide otherwise.
After Sri Lanka banned its most toxic insecticide, suicide rates fell by nearly 50 percent. Following the ban on paraquat in Samoa, suicide rates dropped by nearly two-thirds. Rural people who would have committed suicide with highly toxic pesticides have not committed suicide in other ways.
Since 2006, the Israeli army banned soldiers from returning home on weekends with military-issued guns, and the suicide rate among military personnel has fallen by 57 percent. Much of this decline is due to the fact that soldiers who would have committed suicide with guns at home did not commit suicide in other ways.
New Zealand's Grafton Bridge removed an old fence to prevent suicides by jumping off the bridge in 1996, and the number of suicides by jumping off the bridge changed from 1 per year to 3 per year. In 2003, an improved fence was installed, and the number of suicides jumping off the bridge immediately dropped to zero. The data also showed that the addition of a fence to the Ellington Bridge in Washington, D.C., reduced the number of suicides by jumping from 4 to 0.2 per year, and that the number of suicides committed by jumping off the nearby Taft Bridge did not rise.
Grafton Bridge | Wikimedia Commons
People who would have jumped off this bridge will not go to another bridge.
……
Psychotherapy that directly focuses on suicide can reduce the suicide rate by about 15%~22%.
The "restriction of suicide means" can reduce the suicide rate by about 30%~60%.
In addition to psychotherapy, there are many means to prevent suicide, which have great potential.
For example, make the world more "worth living".
A 2006 paper in the Journal of Clinical Psychiatry showed that the higher the percentage of residents with health insurance in each U.S. state, the lower the suicide rate. For every 1% increase in the medical insurance population, the suicide rate decreases by 1~2%. The reduced risk of suicide may be due to easier access to health care and reduced healthcare-related anxiety.
A 2019 paper in American Preventive Medicine showed that in various U.S. states, the higher the minimum wage, the lower the suicide rate. For every $1 increase in the minimum wage, the suicide rate drops by 1.9 percent. The decline in suicide risk may be due to reduced financial stress.
Psychotherapy is of course very important, but psychotherapy can't pay your bills, can't give you a job, can't give you a home, can't give you health insurance, can't protect you from online violence or violence from people around you... To address suicide, it is necessary to go beyond the "personal responsibility lens". It is important to realize that suicide is not just a problem of "suicides". Suicides are not so much the problem as "fire alarms". They told others with their lives that there is still a painful fire burning everywhere in the world.
Every initiative to make the world a better place reduces the risk of suicide for everyone in the world.
Save every stranded fish because that little fish cares. It is also because most small fish will survive in the deep blue sea after surviving the disaster of "stranding".
A 2002 review in the British Journal of Psychiatry analysed 90 follow-up studies of suicide survivors and found that about 7% of those who had attempted suicide would try and die again, 23% would attempt suicide again and survive, whereas 70% would not try again.
They decided to cherish this "second life", face an uncertain future, face pain and confusion, and live.
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Author: You Zhiyou
Editors: odette, Emeria, Little Towel
Cover image source: Figureworm Creative