Suicide is the intentional ending of one’s own life. It is a serious and growing problem. The highest suicide rate in the UK is for men aged 45-49. Whilst male suicide rates have decreased slightly in the past couple of years, female suicide rates have recently increased. According to the UK’s leading charity for suicide, the Samaritans, the recent rise in female suicide could be an indication of the picture of suicide risk changing. It now appears that male rates are decreasing and female rates are increasing. However, we must be mindful that these changes are based on year-on-year data, which could be natural fluctuations, rather than the beginning of a longer-term trend. This trend, clearly, needs careful monitoring. Men remain more than three times more likely to take their own lives than women across the UK and the Republic of Ireland, but we must pay attention to the risks in both genders. Research suggests that social and economic factors influence the risk of suicide in women as well as men, reinforcing the need to address inequalities to reduce suicide.
In the US, suicide ranks as the tenth most common cause of death, and the first most common cause of death in active military personnel. Despite these shockingly high statistics, there are surprisingly few evidence-based therapies addressing suicidality. The development of new treatments is also pitifully limited.
Beginning in 2005 (in no small part due to US military combat deployments in Iraq and Afghanistan), the incidence of suicide deaths in the US military began to increase sharply. Unique stressors, including combat deployments, have been assumed to underlie the increasing incidence. This long-held assumption by researchers in this area, that specific deployment-related characteristics such as length of deployment, number of deployments, or combat experiences are directly associated with increased suicide risk, has been contested by some of the more recent research. More recently, risk factors for suicide in military personnel are consistent with civilian populations, including a higher prevalence in males and the presence of mental disorders. Multiple studies have shown a marked increase in the number of diagnosed mental disorders in active service-duty members since 2005, paralleling the incidence of suicide. This would suggest that the increased rate of suicide in the military may be largely a product of an increased incidence of mental disorders in this population, possibly resulting from cumulative stresses both in terms of deployment and home-station environments over years of war. In this way, the stresses of living in and being active in war would appear to lead to mental disorders which in turn make members of this population more likely to commit suicide. This is a very tragic state of affairs indeed.
In this linked paper, a clinical trial testing a novel therapy for reducing suicide risk in military veterans, namely Mindfulness-Based Cognitive Therapy for Preventing Suicide Behaviour (MBCT-S), is planned. The ten-week intervention was adapted from an existing treatment for depression, MBCT, which has been gaining massively in popularity for a range of presentations in recent years. MBCT is rooted in Eastern culture and is characterised by a non-judgemental, purposeful, present-moment awareness as originally described by John Kabat-Zinn in 1990. MBCT is a groups skills training program, usually consisting of eight weekly sessions, which integrates elements of cognitive behavioural therapy (CBT) for depression into the mindfulness-based stress reduction (MBSR) training program developed by Kabat-Zinn with others. In MBCT, however, there is little emphasis on changing the content of thoughts; rather, people are taught to recognise that thoughts and feelings are events in the mind and not truths per-se nor aspects of the Self. Such an approach typically de-centres views, leading to new beliefs such as ‘thoughts are not facts’ and ‘I am not my thoughts’. People gradually learn to look ‘at’ thoughts rather than ‘from’ thoughts, thus identifying with the deeper Self beyond these thoughts as opposed to tangling up the thoughts with the sense of who they intrinsically are.
In this study, 164 high suicide risk veterans have been randomised to either treatment as usual or treatment as usual plus MBCT-S. Researchers were looking at whether MBCT-S would impact upon suicide-related events, suicide preparatory behaviours, self-harm behaviours with suicidal or unclear intent, suicide-related hospitalisations and emergency department visits. Measurements of each of these facets have been taken at baseline and will also be taken 12 months after baseline. Whilst the results are not yet in, we harbour a strong hope that MBCT-S could potentially be an efficacious intervention for reducing suicide risk. We will post the results here as soon as they are released. We believe that MBCT may achieve this reduction through increased awareness of internal experience (thoughts, feelings, bodily sensations (interoceptive awareness)), an awareness that has been shown in other populations to facilitate a move from automatic to conscious processing and thus allow for increased space to make choices. MBCT has been regularly found to help participants develop a different relationship with the thoughts, feelings, and bodily sensations that would normally ignite a downward, depressive spiral which deepens hopelessness and the sense of entrapment. This change may be particularly relevant for people whose suicidal thinking rapidly evaporates once a crisis is over.
Suicide is a growing problem yet is infrequently talked about in Western society. Perhaps it is time to take our heads out of the sand and commit to research and openness in this vital area. We invite you to share your comments and be willing to engage in this most difficult, yet most important, of discussions.