the social roots of adolescent suicide€¦ · • social-contextual characteristics of communities...
TRANSCRIPT
TheSocialRootsof
AdolescentSuicideAnnaS.Mueller,PhDMA
© Anna S. Mueller. 2018. This presentation is made available under the CC-BY-NC-ND 4.0 licensehttps://creativecommons.org/licenses/by-nc-nd/4.0/
Department of Comparative Human Development
NationalSuicidePreventionLifeline:1-800-273-TALKanytimeIfyouorsomeoneyoucareaboutareinacrisis,callthelifeline
DepartmentofComparativeHumanDevelopment
Overview
1. Brieflysetthestage– Trendsinadolescentmentalhealth– Leadingtheoriesofsuicide
• Andtheirlimits…
2. Presentsomeofmyresearchonasuicide-pronecommunity• 2016.“AdolescentsunderPressure:ANewDurkheimianFrameworkforUnderstandingAdolescentSuicidein
aCohesiveCommunity.”AmericanSociologicalReview81(5):1-23.• 2017.“DoestheMediaMattertoSuicide?:ExaminingtheSocialDynamicssurroundingMediaReportingon
SuicideinaSuicide-ProneCommunity.”SocialScience&Medicine180:152-159.• 2018.“TowardsaCultural-StructuralTheoryofSuicide:ExaminingExcessiveRegulationanditsDiscontents.”
SociologicalTheory36(1):48-66.3.Linkmyresearchtoourunderstandingofsuicide&implicationsforsuicideprevention
DepartmentofComparativeHumanDevelopment
Overview
• Takehomepoint:
–Mentalhealthproblemshavesocialroots
– Effectiveinterventionsmustengagetherootcausesaswellasbeabletoidentifyyouthincrisis
DepartmentofComparativeHumanDevelopment
MentalHealthinAdolescence
• Mostyouthdoreasonablywell
• Butadolescenceisaperiodofdevelopmentalvulnerability– Somuchischanging!– Particularlyintermsofsuicide• Past10years,seenanincreaseinprevalenceofsuicide
DepartmentofComparativeHumanDevelopment
FEMALEADOLESCENT
SUICIDE
200%*
53%*
DepartmentofComparativeHumanDevelopment
In2015,suiciderateforfemalesages15-19reacheda40yearhigh
QuickStats:SuicideRatesforTeensAged15–19Years,bySex—UnitedStates,1975–2015.MMWRMorbMortalWklyRep2017;66:816.DOI:http://dx.doi.org/10.15585/mmwr.mm6630a6
DepartmentofComparativeHumanDevelopment
MALEADOLESCENT
SUICIDE
37%*
8%*
DepartmentofComparativeHumanDevelopment
LeadingTheoriesofSuicide
• Causesofsuicidearecomplex– interminglingofbiological,social,environmental,
andpsychologicalriskfactors
• InterpersonalTheoryofSuicide(Joiner2005)– Suicideoccurswhenthreefactorsco-occur• PerceivedBurdensomeness• ThwartedBelongingness• AcquiredCapacity
– Theoryisappliedtobothadultsandyouth
DepartmentofComparativeHumanDevelopment
UniqueVulnerabilityofYouth
• Braindevelopmentisinprogress– Consequences:
• Abilitytocopewithstress• Futureorientation
– (BlakemoreandMills2014)
• Peerinfluencesisalsoheightened– Duetocognitivegrowth
• Unstablesenseofself– Identitydevelopmentisinprogress
• Heightenedsensitivitytopeersalsocoincideswithlarger,lessintimateandmorecompetitiveschools– Highschool!
– (Eccles1993)
DepartmentofComparativeHumanDevelopment
HowContextMatters
• We(suicidology)oftenthinkaboutindividualriskandprotectivefactorsforsuicide– E.g.,thwartedbelongingness
• Social-contextualcharacteristicsofcommunitiescanamplifyoramelioratethwartedbelongingness– Thesearethe“socialroots”ofsuicide(andmentalhealth)
• Illustrateacasewhereignoringthesocialrootsofsuicidewilllimitefficacyofsuicideprevention
- AdolescentsunderPressurein“PoplarGrove,”*USA
*Allnamesofpeopleandplacesarepseudonyms
DepartmentofComparativeHumanDevelopment
In-DepthCaseStudy:PoplarGrove,*USA
• Affluent,educated,privilegedcommunity– Homogeneouspopulation– Enduringsuicideproblem
• 2+yearsoffieldwork– InPoplarGrove
– ~100interviews&focusgroups– Participantobservation– Youth,Parents,MentalHealthWorkers,Religiousleaders,Teachers,
etc.» BROADcommunityapproachtotheresearch
– WithsuicidebereavedindividualsoutsideofPoplarGrove
– ~50interviews
*Allnamesofpeopleandplacesarepseudonyms
DepartmentofComparativeHumanDevelopment
In-DepthCaseStudy:PoplarGrove,*USA
• Communitywithasignificantadolescentsuicideproblem– Widelyrecognizedproblem– 18suicidedeathsfrom2000-2015
• Focuson2005-2015– 15formerorcurrentPGHShavediedbysuicidesince2000
• Allundertheageof25• Significantlyhigherthanwhatonewouldexpectofahighschoolofthissize
givennationalandstatesuiciderateforages15-24(11.0per100,000)• 3youthdiedduringourfieldwork
– 4confirmedand1additionalprobablesuicidecluster• Wheredecedentshadtiestoeachanddiedwithinashortperiod
– Manyofthedeathsfitdefinitionsof“echo-clusters”
DepartmentofComparativeHumanDevelopment
SuicidehasSocialRoots
1. Illustratethesocialroots
2. Discusstheirconsequences
3.Conclude:Talkaboutimplications&solutions
DepartmentofComparativeHumanDevelopment
FirstSocialRoot:SocialConnectedness
• Everyoneknowseveryone– Socialsupport!
• Jim,afather:“PoplarGroveisaverytight-knitcommunity…wehaveacommunitypoolwhereweallhangout.Everybodyknowseverybody,soyoufeellikethere'snetwork,asafetynetaroundyouallthetime.”
DepartmentofComparativeHumanDevelopment
FirstSocialRoot:SocialConnectedness
• Everyoneknowseveryone’sbusiness– Amplifiesconcernaboutkeepingupappearancesandwhatothersthink/know
DepartmentofComparativeHumanDevelopment
FirstSocialRoot:SocialConnectedness
• Thedownside:
• Margaret,amother:
“So….Idonotknowthisfamilyverywell,IonlyknowwhatI’veheardthroughthegrapevine.Emmettwhohadcommittedsuicide….hewasinandoutofamentalinstitutionacoupletimesiswhatIunderstand.Hewasonmedication.Hehadhadcounseling,supposedlyhehadthreatenedmanytimes….Hisparentsknewaboutit.Thelastfightthattheyhadwas‘Emmett-you’regettingreallybadagain,Ithinkit’stimeforyoutogobacktothehospital’andshortlyafterthathekilledhimself.That’stherumorIheard.It’squalified,butit’sstillarumor.”
DepartmentofComparativeHumanDevelopment
SecondSocialRoot:NarrowIdeals
• Culturallyhomogeneous– Homogeneous(andnarrow)viewsof“ideal”kidsorfamilies
– Cultureofachievement
DepartmentofComparativeHumanDevelopment
SecondSocialRoot:NarrowIdeals
• Elizabeth:Achievementiseverything.So,whenwethinkofPoplarGrove,wethinkofachievement[inschoolandathletics]…
• Tina[chimesin]:Ithinkthat'sprettyaccurate.Ithinkit'sawonderfulcommunitytoraiseafamilyin,andit's...greatpeople,butitisverydriven.It'sexhausting.It'schallenging…It'shardtocomplainaboutitbecausewehavealotofopportunityhere…So,it'skindofablessingandacurseallatthesametime.
DepartmentofComparativeHumanDevelopment
ThirdSocialRoot:MentalHealthStigma
• Havingamentalhealthproblemisseenascontrarytotheidealofa“perfect”kidorfamily
• Peoplehidementalhealthproblemsordon’twanttodiscussthem–Whentheyarediscusseditsmoretodeflectorplaceblameonothers
DepartmentofComparativeHumanDevelopment
ThirdSocialRoot:MentalHealthStigma
• Hannah(teen):– “Allthebadstuffgetscoveredup.Sonobodywantstobelike‘Ihaveanissue.’Andnobodywantstocomeoutandbehonestaboutit.SokidscoveritupandtrytoactliketheyaredoingwellinschoolandtheyarebeingthePoplarGrovekidthattheyaresupposedtobe.”
DepartmentofComparativeHumanDevelopment
ThirdSocialRoot:MentalHealthStigma
• Hannah(teen):– “Allthebadstuffgetscoveredup.Sonobodywantstobelike‘Ihaveanissue.’Andnobodywantstocomeoutandbehonestaboutit.SokidscoveritupandtrytoactliketheyaredoingwellinschoolandtheyarebeingthePoplarGrovekidthattheyaresupposedtobe.”
• Natalie(teen):– “everyoneisstressedout…butifyouadmitthatyouneedhelp,itskindoflookeddownupon”
DepartmentofComparativeHumanDevelopment
SERIOUSCONSEQUENCESFORYOUTHMENTALHEALTH
DepartmentofComparativeHumanDevelopment
Consequence#1:
Suppressedhelp-seeking
• Kidswereunwillingtoseekhelporbehonestwithparentsoradultsabouttheirsuffering– Only32%ofyouthwerewillingtoseekhelp– Comparedto67%inourcomparisongroup– Scaredpeoplewillfindout
• Mentalhealthworkersreportedparentswerehardtopartnerwith– 60%ofmentalhealthworkersreportedthis• (11outof17)
DepartmentofComparativeHumanDevelopment
Consequence#2:Stress,Anxiety,&NegativeEmotions
• Centeredaroundtheideaof“failure”– Kidsreported:
• “Failurewasnotanoptionforanyofus”(young-adult,woman)
• “Ifyoudon’tsucceed,youjustfailandyoufeelterribleaboutit.”(teenager,woman)
• Cryingregularlybecauseofhomework
• Hairfallingoutfromstress
DepartmentofComparativeHumanDevelopment
Consequence#3:DisconnectionbetweenYouth&Adults
• Youthhaveknownmanyclassmateswhohavediedbysuicideorattemptedsuicide
• Schoolsseemsunpreparedtocopewithsuicideloss– Schooldoesn’twanttotalkaboutsuicide• Fearofcausinga“rippleeffect”
DepartmentofComparativeHumanDevelopment
Consequence#3:DisconnectionbetweenYouth&Adults
• Kidscan’tforgetor“sweepitundertherug”– Eveniftheyweren’tthatclosetothedecedent
• Shara(teen):– Ifeltlikealotofadultsdidn'tunderstandor…believeuswhenwesaidwe’restressedout,whenwesaid,‘Thisisreallyhard,’and‘we’rereallyscared.’Theywerelike,‘Oh,you’refine.It’sjusthighschool.’Butit'ssomuchmoreandpeoplearedying[bysuicide].
DepartmentofComparativeHumanDevelopment
Consequence#4:PassiveViewsofSuicide
• Schooldoesnotwanttotalkaboutsuicidewithyouth– NoQPR;NoSOS;NoYAMS
• BUT– Youtharetalkingaboutsuicide
• amongstthemselvesatschool,overtext,onlineafterasuicide
• Youthwerelargelymakingsenseofsuicideontheirown
DepartmentofComparativeHumanDevelopment
Consequence#4:PassiveViewsofSuicide
• Suicideassomethingthatcanjust“happen”toyou
DepartmentofComparativeHumanDevelopment
Consequence#4:PassiveViewsofSuicide
• Suicideassomethingthatcanjust“happen”toyou– Grace:Ithinkalotofthekidswerejustlike“Ohmygosh,that’sgonnabeus[meaningsomeonewhodiesbysuicide].We’reallgonnastressoutandloseit,evenifyourlifeisgreatyoucanstillsnaponeday.”
DepartmentofComparativeHumanDevelopment
Consequence#5:ExpansionofSuicideasanOption
• Becca,whohasahistoryofsuicideideationandself-harm:
– “I’vewantedtogetawayfromhavingalltheseproblems.Seeingalltheseotherpeoplegothroughalltheseproblems,theiranswerissuicidesowhycan’tmyanswerbesuicide.”
– I’lltalkmoreaboutthistomorrowat1:30pm• “PreventionSuicide"Contagion"inHighSchools”
DepartmentofComparativeHumanDevelopment
Summary
• ThesocialconnectednessandhomogeneousandnarrowcultureinPoplarGrovegeneratedadditionalstress&pressureforyouth
• Resultedin– Increasedemotionaldistress– Suppressionofhelpseeking
• Combinedwithexposuretosuicide,amplifiedvulnerabilitytosuicide
DepartmentofComparativeHumanDevelopment
ImprovingourUnderstandingofSuicide
ThwartedBelonging-
ness
PerceivedBurdensome-
ness
AcquiredCapacity
InterpersonalTheoryofSuicide
Social-contextualfactors
DepartmentofComparativeHumanDevelopment
ImprovingourUnderstandingofSuicide
ThwartedBelonging-
ness
PerceivedBurdensome-
ness
AcquiredCapacity
InterpersonalTheoryofSuicide
Social-contextualfactors
THESOCIALROOTS
DepartmentofComparativeHumanDevelopment
SpecialNoteonConnectedness
• Thepotentialdownsidesofsocialconnectednessareactuallywellknown– Thoughrarelyreferencedinsuicideprevention
• InPoplarGrove,theyundermineprevention
DepartmentofComparativeHumanDevelopment
INPURSUITOFSOLUTIONS
DepartmentofComparativeHumanDevelopment
EmpowerYouth
• Engageyouthinfindingsolutions
• LISTENTOYOUTH
DepartmentofComparativeHumanDevelopment
EmpowerYouth
• Whatmakesyouthmiserable?– PoplarGrove
• Academicandsocialpressuretobeperfect• Gossipandrumors
– LGBTQIAYouth• Socialrejection(especiallyfromfamilies)• Homophobiaortransphobia• Especiallywheninstitutionalized
– E.g.,rulesaboutbathroomsorlockerrooms
– 13ReasonsWhy• Sexualassault,bullying,rumors• Mytakeon13ReasonsWhy:https://contexts.org/blog/13-reasons-why/
DepartmentofComparativeHumanDevelopment
ChallengeNarrowIdeals
• Notfittinginisextremelypainful– SomeofthegreatestriskfactorsforLGBTQIAyouthisrejectionfromfamily,peers,andschools
– LGBTQIAyouthwhoattendschoolswithmorehomophobicorhostileclimates,haveworsementalhealthandacademicoutcomes• (Wilkinson&Pearson2009;2013)
DepartmentofComparativeHumanDevelopment
BePreparedwithExtraSupportforMarginalizedYouth
Trainingspecificallyforpreventing
suicideamongLGBTQIAyouth
www.theTrevorProject.org
DepartmentofComparativeHumanDevelopment
ChallengeMentalHealthStigma
• Mentalhealthproblemsarenodifferentthanotherformsofmedicalproblems– Theydonotdiminishotheraspectsofpeople– Theydeserverespectandtreatment
DepartmentofComparativeHumanDevelopment
ShiftingCultureisPossible(ThoughaChallenge!)
• Evidencebasedprogramsforshiftingcultureexist– ChallengeSuccess(forproblemswithacademicpressure)
• www.challengesuccess.org
• Upstreamevidence-basedsuicidepreventionprograms– SourcesofStrength
• (Wymanetal.2010)– YouthAwareofMentalHealthIntervention
• http://www.y-a-m.org/
DepartmentofComparativeHumanDevelopment
AvoidPassiveLanguageforTalkingAboutSuicide
DepartmentofComparativeHumanDevelopment
AvoidPassiveLanguageforTalkingAboutSuicide
• Suicideisnot“contagious”likeavirus
• Suicidecannothappentoyouviaa“rippleeffect”
• Metaphorsmatter– Neuroscienceshowstheyshapeourunderstandingandemotions!
DepartmentofComparativeHumanDevelopment
Exposuretosuicidedoes,onaverage,increaseriskofsuicidality
• Itisaveryhardexperienceforyouth– Youthgrieveforyears,justlikeanadultwould
• Ifyouthdon’tunderstandsuicideandwhattodoiftheyfeelsuicidal,thatisrisky
• Ifyouthareleftalonetomakesenseoftheirfriendorclassmate’smotivesforsuicide– Suicidecanseemlikeanoption
DepartmentofComparativeHumanDevelopment
Talkingaboutsuicidedoesnotincreaserisk
• Experimentalevidenceshowsthis–MattNock’steamatHarvard,MadelynGould’steamatColumbia…etc
DepartmentofComparativeHumanDevelopment
Talkingaboutsuicidedoesnotincreaserisk
• Experimentalevidenceshowsthis–MattNock’steamatHarvard,MadelynGould’steamatColumbia…etc
• Adultshaveoneoption– Dotheyshareintheconversation?– Ordotheyleaveyouthtofigureitoutontheirown?
DepartmentofComparativeHumanDevelopment
Remember: YouthSeeThingsDifferently
• Remembertheyarefiguringthingsout,especiallybigthings,forthefirsttime
• Thingslike:– whydidmyclassmate/friend/siblingdiebysuicide?
–WhathappensifIdon’tliveuptoexpectations,ifIdon’tmakeit,ifIfail?
DepartmentofComparativeHumanDevelopment
Remember: YouthSeeThingsDifferently
• Tim:– Ithinkwe’resopressuredtoachievethatwe’veforgottenthatthisislikeonesmallsegmentofourentirelives.Yaknow?Notthatitisn’timportant.IknowthathighschoolisimportantandIdogetthosefeelings,likeohifIdon’tpassthistestthenI’mgoingtowinduphomeless.IthinkIdon’tlikethatthat’sthemindsetthatIgoto.Idon’tlikethatIhavetogotothatmindset.IwishIcouldchangeit.Ican’t.Idon’tknowwhatit’slikeinanyotherplaces.
DepartmentofComparativeHumanDevelopment
AcknowledgeCommunityProblems
• NecessaryfirststepSonia:BecauseIfeellikehere,it’snotlikenormal,butwearecomparingittootherplacesand[suicideslikeours]wouldbelikesuchashockforthem.Andwe’realwayslike,“itwastragic,”butwewe’renotshockedanymore,byit.
Danielle:Whichisreallysad.
[SeveralTeens]:Yeah.Yeah.Danielle:Wereallyshouldbe,andIfeellike.Idon’tknow,doesthecommunitynotfeellikeperceiveitislike,thatshouldn’tbehappening?Like,likeitmessesupthewholecommunity.Thewholecommunitygrievesoverit,andit’sjustlike…Louisa&Danielle(inunison):Andthenithappensagain.
DepartmentofComparativeHumanDevelopment
TOMORROW(FRIDAY):“PreventionSuicide‘Contagion’inHighSchools”
1:30pm-2:30pm Room307
ThwartedBelonging-
ness
PerceivedBurdensome-
ness
AcquiredCapacity
Social-contextualfactors
DepartmentofComparativeHumanDevelopment
Thankyou!AnnaS.Mueller,PhD
Visitwww.annasmueller.comforfreecopiesofthepublicationsthispresentationisbasedon
NationalSuicidePreventionLifeline:1-800-273-TALKanytimeIfyouorsomeoneyoucareaboutareinacrisis,callthelifeline