WHY ARE WE FAILING TO PREVENT SUICIDE?
David Lester
There has been a tremendous growth in scholarly
articles on suicide over the last 21 years. Looking at publications in English
included in PsycInfo, the number has risen from 608 items in 2001 to 2,656 in
2021, 337% increase. How has the suicide rate changed over this period?
According to the National Center for
Health Statistics (2023), the suicide rate rose from 10.7 per 100,000 per year
in 2001 to 14.1 in 2021, a 32% increase. The correlations between the number of
publications on suicide and the suicide rate over this 22-year period is 0.87.
The more publications on suicide, the higher the suicide rate. This does not
look good. What is happening?
Clearly, lots of academics have
obtained tenure and promotion, several grants have been awarded from government
and private sources, and many graduate students have produced dissertations on
suicide. However, it does appear that we have not learned anything useful about
suicide, useful in the sense of helping us prevent suicide.
Of course, it could be argued that,
without this growth of “knowledge” about suicide, the suicide rate would have
risen even higher. That would be nice to believe, but there is no evidence for
this.
Hjelmeland and Knizek (2020) noted
that Joiner (2005) proposed a theory of suicide in which three factors
explained all suicides: thwarted belongingness, perceived burdensomeness
and the acquired capability for self-harm. This became the dominant theory of
suicide, aided by the factor that Joiner was the editor of Suicide &
Life-Threatening Behavior (SLTB). At their peaks, 45% of the articles in SLTB
were on Joiner’s theory, 31% of the articles in the Archives of Suicide
Research and 23% in Crisis according to Hjelmeland and Knizek. Not
only does Joiner’s theory fail to explain all suicidal behavior,
it has rarely been applied to suicides. Almost all of the research testing the
theory examines the theory’s relevance for suicidal ideation and attempted
suicide. Some of the old stalwarts like Louis
Dublin, Ronald Maris and Maurice Farber argued that suicidal ideators and
suicide attempters are a different population from suicides, although there may
be some overlap. The dominance of Joiner’s theory may, therefore, have impeded
progress on understanding and preventing suicide.
Lester, et al. (1975, 1979) proposed a
methodology in which we might learn about suicides from studies of attempted
suicides, specifically by dividing samples of attempted suicides into groups by
the lethality of their attempt (or the seriousness of their suicidal intent)
and then extrapolating to suicides, the most lethal of them all. This proposal
has been ignored.
In other fields, progress is made.
There is a great deal of research on medical diseases and, typically, this
research leads to better treatments and longer survival rates, sometimes even
cures. Apparently, that is not happening in suicidology.
References
Lester, D.,
Beck, A. T. & Trexler, L. (1975). Extrapolation from attempted suicides to
completed suicides. Journal of Abnormal Psychology, 84, 563-566.
Lester, D.,
Beck, A. T. & Mitchell, B. (1979). Extrapolation from attempted suicides to
completed suicides: a test. Journal of Abnormal Psychology, 88, 78-80.
