Suicidologists should stop studying non-lethal suicidal behavior

 

Suicidologists Should Stop Studying Non-Lethal Suicidal Behavior

 

David Lester

 

            An alternative title could be: The Method of Substitute Subjects Has No Value for Understanding Suicide. The method of substitute subjects as a term was coined for suicidologists by Neuringer (1962). Because suicides are deceased and, so cannot be given the standardized tests and interviews developed by psychologists, Neuringer suggested turning to the study of those who have suicidal ideation or who have attempted suicide – substitute subjects The majority of studies on suicide, therefore, use suicide ideators and attempters as the subjects for research.

 

            I would argue that this is great for getting publications, academic success and grants, but almost totally useless for understanding suicide.

 

            You might argue that we are interested in suicide ideators and attempters themselves, and this is, of course, true, but they are not as interesting as suicides and will not help us to understand suicides. Let me give an example.

 

            Joiner’s (2005) Interpersonal Theory of Suicide proposes that thwarted belongingness and perceived burdensomeness are behind every suicide. Almost all of the research of this theory uses living subjects and, indeed, often scores on scales to measure these two constructs are associated positively with a measure of suicidality. This has been found in samples of psychiatric patients (Teismann, et al., 2016) and undergraduate students (Lockman & Servaty-Seib, 2016).

 

            But studies of suicide notes and suicides find that there is little evidence that perceived burdensomeness plays a role in more than15% of the suicides (Gunn, et al., 2012; Lester & Gunn, 2021). How is this possible?

 

            Giving undergraduate students Joiner’s test of perceived burdensomeness (which provides scores in the range of x-x) does not mean that their scores will be high. Almost all of the students may obtain low scores. Thus, the researcher is basically comparing students with very low scores to students with somewhat low scores. If a Likert-type scale is used (with scores ranging from -3 to +3), nearly all the students might have negative scores. The correlation, therefore, between perceived burdensomeness and suicidal ideation is difficult to interpret. If you strongly disagree that you are a burden to others, you are less suicidal than if you somewhat disagree that you are a burden. This does not help us understand those who die by suicide.

 

            This is not relevant only to Joiner’s IPTS theory of suicide. It applies to the defeat-entrapment theory of suicide, the cognitive distortion theory, and all theories. I used Joiner’s theory only because myself and John Gunn have studied suicides from the point of view of Joiner’s theory and found that perceived burdensomeness is rare in suicides.

 

            These is perhaps a way out of this problem. In two paper (Lester, et al., 1975, 1979), I argued that researchers could use attempted suicides to learn about if suicide, if and only if they categorized the attempters into groups by their level of lethality or their level of suicide intent. They could then extrapolate to those who died by suicide, and I illustrated this technique with demographic variables (e.g., sex) and hopelessness scores. It is rare that this procedure is used.

 

            Grants are awarded and academics are tenured and promoted on the basis of their research on living suicidal and non-suicidal individuals, but suicide remains a puzzle, difficult to predict and difficult to understand.

 

References

 

Gunn, J. F., Lester, D., Haines, J., & Williams, C. L. (2012). Thwarted belongingness and perceived burdensomeness in suicide notes. Crisis, 33, 178-181.

Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.

Lester, D., Beck, A. T. & Mitchell, B. (1979). Extrapolation from attempted suicides to completed suicides: a test. Journal of Abnormal Psychology, 88, 78-80

Lester, D., Beck, A. T. & Trexler, L. (1975). Extrapolation from attempted suicides to completed suicides. Journal of Abnormal Psychology, 84, 563-566.

Lester, D., & Gunn, J. F. (2021). Is perceived burdensomeness present in the lives of famous suicides? Death Studies, in press.

Lockman, J. D., & Servaty-Seib, H. (2016). College student suicidal ideation. Death Studies, 40, 154-164.

Neuringer, C. (1962). Methodological problems in suicide research. Journal of Consulting Psychology, 26, 273-278

Teismann, T., Forkmann, T., Rath, D., Glaesmer, H., & Margraf, J. (2016). Perceived burdensomeness and suicide ideation in adult outpatients receiving exposure therapy for anxiety disorders. Behaviour Research & Therapy, 85, 1-5.