the social roots of adolescent suicide€¦ · • social-contextual characteristics of communities...

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


Overview

• Takehomepoint:

–Mentalhealthproblemshavesocialroots

– Effectiveinterventionsmustengagetherootcausesaswellasbeabletoidentifyyouthincrisis


MentalHealthinAdolescence

• Mostyouthdoreasonablywell

• Butadolescenceisaperiodofdevelopmentalvulnerability– Somuchischanging!– Particularlyintermsofsuicide• Past10years,seenanincreaseinprevalenceofsuicide


FEMALEADOLESCENT

SUICIDE

200%*

53%*


In2015,suiciderateforfemalesages15-19reacheda40yearhigh

QuickStats:SuicideRatesforTeensAged15–19Years,bySex—UnitedStates,1975–2015.MMWRMorbMortalWklyRep2017;66:816.DOI:http://dx.doi.org/10.15585/mmwr.mm6630a6


MALEADOLESCENT

SUICIDE

37%*

8%*


LeadingTheoriesofSuicide

• Causesofsuicidearecomplex– interminglingofbiological,social,environmental,

andpsychologicalriskfactors

• InterpersonalTheoryofSuicide(Joiner2005)– Suicideoccurswhenthreefactorsco-occur• PerceivedBurdensomeness• ThwartedBelongingness• AcquiredCapacity

– Theoryisappliedtobothadultsandyouth


UniqueVulnerabilityofYouth

• Braindevelopmentisinprogress– Consequences:

• Abilitytocopewithstress• Futureorientation

– (BlakemoreandMills2014)

• Peerinfluencesisalsoheightened– Duetocognitivegrowth

• Unstablesenseofself– Identitydevelopmentisinprogress

• Heightenedsensitivitytopeersalsocoincideswithlarger,lessintimateandmorecompetitiveschools– Highschool!

– (Eccles1993)


HowContextMatters

• We(suicidology)oftenthinkaboutindividualriskandprotectivefactorsforsuicide– E.g.,thwartedbelongingness

• Social-contextualcharacteristicsofcommunitiescanamplifyoramelioratethwartedbelongingness– Thesearethe“socialroots”ofsuicide(andmentalhealth)

• Illustrateacasewhereignoringthesocialrootsofsuicidewilllimitefficacyofsuicideprevention

- AdolescentsunderPressurein“PoplarGrove,”*USA

*Allnamesofpeopleandplacesarepseudonyms


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


In-DepthCaseStudy:PoplarGrove,*USA

• Communitywithasignificantadolescentsuicideproblem– Widelyrecognizedproblem– 18suicidedeathsfrom2000-2015

• Focuson2005-2015– 15formerorcurrentPGHShavediedbysuicidesince2000

• Allundertheageof25• Significantlyhigherthanwhatonewouldexpectofahighschoolofthissize

givennationalandstatesuiciderateforages15-24(11.0per100,000)• 3youthdiedduringourfieldwork

– 4confirmedand1additionalprobablesuicidecluster• Wheredecedentshadtiestoeachanddiedwithinashortperiod

– Manyofthedeathsfitdefinitionsof“echo-clusters”


SuicidehasSocialRoots

1. Illustratethesocialroots

2. Discusstheirconsequences

3.Conclude:Talkaboutimplications&solutions


FirstSocialRoot:SocialConnectedness

• Everyoneknowseveryone– Socialsupport!

• Jim,afather:“PoplarGroveisaverytight-knitcommunity…wehaveacommunitypoolwhereweallhangout.Everybodyknowseverybody,soyoufeellikethere'snetwork,asafetynetaroundyouallthetime.”



• Everyoneknowseveryone’sbusiness– Amplifiesconcernaboutkeepingupappearancesandwhatothersthink/know



• 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.”


SecondSocialRoot:NarrowIdeals

• Culturallyhomogeneous– Homogeneous(andnarrow)viewsof“ideal”kidsorfamilies

– Cultureofachievement


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.


ThirdSocialRoot:MentalHealthStigma

• Havingamentalhealthproblemisseenascontrarytotheidealofa“perfect”kidorfamily

• Peoplehidementalhealthproblemsordon’twanttodiscussthem–Whentheyarediscusseditsmoretodeflectorplaceblameonothers



• Hannah(teen):– “Allthebadstuffgetscoveredup.Sonobodywantstobelike‘Ihaveanissue.’Andnobodywantstocomeoutandbehonestaboutit.SokidscoveritupandtrytoactliketheyaredoingwellinschoolandtheyarebeingthePoplarGrovekidthattheyaresupposedtobe.”



• Hannah(teen):– “Allthebadstuffgetscoveredup.Sonobodywantstobelike‘Ihaveanissue.’Andnobodywantstocomeoutandbehonestaboutit.SokidscoveritupandtrytoactliketheyaredoingwellinschoolandtheyarebeingthePoplarGrovekidthattheyaresupposedtobe.”

• Natalie(teen):– “everyoneisstressedout…butifyouadmitthatyouneedhelp,itskindoflookeddownupon”


SERIOUSCONSEQUENCESFORYOUTHMENTALHEALTH


Consequence#1:

Suppressedhelp-seeking

• Kidswereunwillingtoseekhelporbehonestwithparentsoradultsabouttheirsuffering– Only32%ofyouthwerewillingtoseekhelp– Comparedto67%inourcomparisongroup– Scaredpeoplewillfindout

• Mentalhealthworkersreportedparentswerehardtopartnerwith– 60%ofmentalhealthworkersreportedthis• (11outof17)


Consequence#2:Stress,Anxiety,&NegativeEmotions

• Centeredaroundtheideaof“failure”– Kidsreported:

• “Failurewasnotanoptionforanyofus”(young-adult,woman)

• “Ifyoudon’tsucceed,youjustfailandyoufeelterribleaboutit.”(teenager,woman)

• Cryingregularlybecauseofhomework

• Hairfallingoutfromstress


Consequence#3:DisconnectionbetweenYouth&Adults

• Youthhaveknownmanyclassmateswhohavediedbysuicideorattemptedsuicide

• Schoolsseemsunpreparedtocopewithsuicideloss– Schooldoesn’twanttotalkaboutsuicide• Fearofcausinga“rippleeffect”


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].


Consequence#4:PassiveViewsofSuicide

• Schooldoesnotwanttotalkaboutsuicidewithyouth– NoQPR;NoSOS;NoYAMS

• BUT– Youtharetalkingaboutsuicide

• amongstthemselvesatschool,overtext,onlineafterasuicide

• Youthwerelargelymakingsenseofsuicideontheirown



• Suicideassomethingthatcanjust“happen”toyou



• Suicideassomethingthatcanjust“happen”toyou– Grace:Ithinkalotofthekidswerejustlike“Ohmygosh,that’sgonnabeus[meaningsomeonewhodiesbysuicide].We’reallgonnastressoutandloseit,evenifyourlifeisgreatyoucanstillsnaponeday.”


Consequence#5:ExpansionofSuicideasanOption

• Becca,whohasahistoryofsuicideideationandself-harm:

– “I’vewantedtogetawayfromhavingalltheseproblems.Seeingalltheseotherpeoplegothroughalltheseproblems,theiranswerissuicidesowhycan’tmyanswerbesuicide.”

– I’lltalkmoreaboutthistomorrowat1:30pm• “PreventionSuicide"Contagion"inHighSchools”


Summary

• ThesocialconnectednessandhomogeneousandnarrowcultureinPoplarGrovegeneratedadditionalstress&pressureforyouth

• Resultedin– Increasedemotionaldistress– Suppressionofhelpseeking

• Combinedwithexposuretosuicide,amplifiedvulnerabilitytosuicide


ImprovingourUnderstandingofSuicide

ThwartedBelonging-

ness

PerceivedBurdensome-

ness

AcquiredCapacity

InterpersonalTheoryofSuicide

Social-contextualfactors


ImprovingourUnderstandingofSuicide

ThwartedBelonging-

ness


ness

AcquiredCapacity

InterpersonalTheoryofSuicide


THESOCIALROOTS


SpecialNoteonConnectedness

• Thepotentialdownsidesofsocialconnectednessareactuallywellknown– Thoughrarelyreferencedinsuicideprevention

• InPoplarGrove,theyundermineprevention


INPURSUITOFSOLUTIONS


EmpowerYouth

• Engageyouthinfindingsolutions

• LISTENTOYOUTH


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/


ChallengeNarrowIdeals

• Notfittinginisextremelypainful– SomeofthegreatestriskfactorsforLGBTQIAyouthisrejectionfromfamily,peers,andschools

– LGBTQIAyouthwhoattendschoolswithmorehomophobicorhostileclimates,haveworsementalhealthandacademicoutcomes• (Wilkinson&Pearson2009;2013)


BePreparedwithExtraSupportforMarginalizedYouth

Trainingspecificallyforpreventing

suicideamongLGBTQIAyouth

www.theTrevorProject.org


ChallengeMentalHealthStigma

• Mentalhealthproblemsarenodifferentthanotherformsofmedicalproblems– Theydonotdiminishotheraspectsofpeople– Theydeserverespectandtreatment


ShiftingCultureisPossible(ThoughaChallenge!)

• Evidencebasedprogramsforshiftingcultureexist– ChallengeSuccess(forproblemswithacademicpressure)

• www.challengesuccess.org

• Upstreamevidence-basedsuicidepreventionprograms– SourcesofStrength

• (Wymanetal.2010)– YouthAwareofMentalHealthIntervention

• http://www.y-a-m.org/

http://www.challengesuccess.org

http://www.y-a-m.org/


AvoidPassiveLanguageforTalkingAboutSuicide


AvoidPassiveLanguageforTalkingAboutSuicide

• Suicideisnot“contagious”likeavirus

• Suicidecannothappentoyouviaa“rippleeffect”

• Metaphorsmatter– Neuroscienceshowstheyshapeourunderstandingandemotions!


Exposuretosuicidedoes,onaverage,increaseriskofsuicidality

• Itisaveryhardexperienceforyouth– Youthgrieveforyears,justlikeanadultwould

• Ifyouthdon’tunderstandsuicideandwhattodoiftheyfeelsuicidal,thatisrisky

• Ifyouthareleftalonetomakesenseoftheirfriendorclassmate’smotivesforsuicide– Suicidecanseemlikeanoption


Talkingaboutsuicidedoesnotincreaserisk

• Experimentalevidenceshowsthis–MattNock’steamatHarvard,MadelynGould’steamatColumbia…etc


Talkingaboutsuicidedoesnotincreaserisk

• Experimentalevidenceshowsthis–MattNock’steamatHarvard,MadelynGould’steamatColumbia…etc

• Adultshaveoneoption– Dotheyshareintheconversation?– Ordotheyleaveyouthtofigureitoutontheirown?


Remember: YouthSeeThingsDifferently

• Remembertheyarefiguringthingsout,especiallybigthings,forthefirsttime

• Thingslike:– whydidmyclassmate/friend/siblingdiebysuicide?

–WhathappensifIdon’tliveuptoexpectations,ifIdon’tmakeit,ifIfail?


Remember: YouthSeeThingsDifferently

• Tim:– Ithinkwe’resopressuredtoachievethatwe’veforgottenthatthisislikeonesmallsegmentofourentirelives.Yaknow?Notthatitisn’timportant.IknowthathighschoolisimportantandIdogetthosefeelings,likeohifIdon’tpassthistestthenI’mgoingtowinduphomeless.IthinkIdon’tlikethatthat’sthemindsetthatIgoto.Idon’tlikethatIhavetogotothatmindset.IwishIcouldchangeit.Ican’t.Idon’tknowwhatit’slikeinanyotherplaces.


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.


TOMORROW(FRIDAY):“PreventionSuicide‘Contagion’inHighSchools”

1:30pm-2:30pm Room307

ThwartedBelonging-

ness


ness

AcquiredCapacity



Thankyou!AnnaS.Mueller,PhD

[email protected]

Visitwww.annasmueller.comforfreecopiesofthepublicationsthispresentationisbasedon

NationalSuicidePreventionLifeline:1-800-273-TALKanytimeIfyouorsomeoneyoucareaboutareinacrisis,callthelifeline

http://www.annasmueller.com

the social roots of adolescent suicide€¦ · • social-contextual characteristics of communities...

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