← Raising Good Humans
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- [00:01]
Danielle Bean
The following podcast is a Dear Media production.
- [00:10]
Dr. Matt Nock
Welcome to Raising Good humans and happy 2025 everyone. You're still easing your way into the new year. I'm here for you. And this 2025 season of raising Good Humans podcast is here here to help and support you. And today is a really hard topic. I want to encourage you to listen whether or not this topic has been in any way on your mind. It's suicide and self harm. It's such a hard topic to think about and to talk about, but by having these conversations we can actually prevent more harm. And one of the things we know is that nobody wants to talk about it. And it's really scary to think about. And of course it is. It's the worst thing you could possibly imagine, or it's the worst thing that you absolutely don't want to imagine. But having this conversation and knowing a little bit more, leaving this conversation can save lives. And I have enlisted Matt Knock. Professor Matt Knock is a brilliant, and I, I mean brilliant psychologist. He is at Harvard University. He's also a MacArthur Scholar, as in the MacArthur Genius Awards where they just pick geniuses out in the world who are contributing to changing our world for the better and grant them this award. His research is aimed at understanding why people behave in ways that are harmful to themselves. His work is funded from the National Institute of Health and he's published over 250 scientific papers, book chapters. He's recognized and has been recognized as the world's leading researcher on this incredibly hard topic. Gratefully, he's also a scientific advisor to the National Institute of Health, the World Health Organization, the World Mental Health Survey Initiative, the American Psychological association, the American Psychiatric Association, DMV 5 Childhood and adolescent Disorder Work Group, and at Harvard, he is also running the NOC lab, the Department of Psychology in general, and just really changing the world for the better. But it's really rare that we get to hear from him speaking directly to parents with the information that we need. So I'm honored and thrilled that he took the time to be here. And I hope this information can help support you, answer your questions, give you some guidance and leave you feeling hopeful. I'm just all for translating this to the world in any way that I can. And your work, especially right now, I think parents are fairly concerned and I think there's just a lot of misinformation and a lot of just like we don't have a lot of information about suicide and self harm. So I think you're the, you're the one who can Help us kind of unpack all of this. And so I wanted to go through a few things, but I'm open to anything that you want to talk about, like whatever you think. I have access to all these parents, what do they need to know? But top of mind for me is I want to think about how do these things develop, how do we predict them, how do we prevent them? Just like as my, you know, like if, if you were like this is what I need parents to know about in your research, kind of how much of that can we talk about? And then my other area that I want to touch on with you is kind of what are the myths around talking about suicide and self harm. And I think we have a lot of situations where there are two messages. One is we have to talk about this. But another is it's contagious and we shouldn't talk about this because when it happens in communities and people talk about it, it seems to happen more. And that seems to be very confusing. I know that there was a recent book written by a journalist that was, did very well last year that was criticizing, talking about suicide and how doctors were just, I think she framed it that doctors were sort of flippantly asking the question about have you ever had thoughts of harming yourself or thoughts of wanting to die? And she was very upset about it and she thought that was putting ideas into kids minds and contributing to mental health issues. And I, I am like so freaked out that people who don't do this research and understand this are just making statements like that that could be kind of harmful. So I just want to be quiet now and let you go on which, on any of the 700 questions I had, I guess whatever sounds most like what, what is the most important to you in terms of getting across to parents? I guess we should start there.
- [05:20]
Danielle Bean
Yeah, I think, hmm, what a great question. Most important, I think each of the things you mentioned are really important. Trying to better understand, predict and prevent suicide. And that's the focus of a lot of the focus of what our research program does. But I think even before that it's becoming comfortable talking about suicide. I think it's such a difficult thing for people to talk about in part because it's a, it's a scary, not well understood thing. And it's such an important thing. It takes the lives of people around us and when it takes the lives of our, our own children. I can't think of anything more devastating than losing a child early and losing a child early at their own hand and thinking did I play some part in this. Was there something I could have done to, to prevent this that I didn't do? So there's a lot of guilt involved. And so it's a really, really scary outcome that I think just leads people to clam up and not talk about it for fear that if I do talk about it, it's going to speak it into existence and make it happen. So I think just having this forum, having this conversation, doing the work that you're doing to spread this, spread information about suicide and try and help parents understand it a little bit better is so important. So I can talk a little bit about what we know about suicide as a start. So suicide is a leading cause of death around the world. This is true in the US where it typically has hovered around the 10th leading cause of death and it's true globally and it's especially leading cause of death in young people. So it's the second leading cause of death for those ages 10 to 34 years behind only accidents, which is a striking fact. And it's surprising for a lot of people in part because we don't hear a lot about suicide. We hear a lot about violence, about murder, about homicide. It's in the news. We hear about wars, we hear about genocide, we hear about local crime, local deaths. And we should, these are important. But there are more than twice as many suicides as homicides each year in the us More than five times as many suicides as HIV AIDS related deaths, again especially among young people. But we don't hear a lot about it. So it's important just to know that it is a common taker of life. It's also fairly common in kids. When we do surveys, nationally representative surveys, so we survey kids in high school and go to high schools and ask everybody to report on whether they every, whether they have ever thought about suicide. Between 15 and 20% of kids say that they've thought about suicide in the past year. That's a lot of kids, that's a high proportion of kids. It's one in five. So you know, think about your kids, think about your kids friend group. It's fairly common for a child or for, for your child or for, you know, your child's friend to have thoughts of suicide. So parents are often, as a parent of three myself, alarmed when we hear about kids thinking about suicide. But it's, it's, we should know, we should all know as parents and as clinicians, as caregivers. It's, it's fairly common. And I'll come back to you know what to do about that. Another thing that I like to make sure is in this part of the conversation is we hear a lot about suicide as an epidemic. This is a problem. Rates have increased dramatically in the past year. These are often headlines that we see and read and Time magazine has articles on it from time to time. The suicide rate now is virtually identical to what it was literally 100 years ago. So this has been a problem forever or for. Since we've been recording data on suicide, it's been about the same size problem. Now, the fact that it continues to be a problem is alarming. And if we look at a hundred years ago, the mortality rate from other leading causes of death like heart disease, cancers, pneumonia, automobile accidents, all of these things have dropped precipitously. Tuberculosis, pneumonia, go on and on. All different kinds of behavioral problems and medical illnesses have dropped enormously in their likelihood of leading to death. This hasn't changed for suicide. And I think that's part of the problem. And why, again, it's important to talk about it. So there's not a current epidemic. It is a big problem, but it's been a problem for a really long time. I'm hopeful that we'll start to have more of a bending of that curve. And again, in part due to conversations like this, just getting the word out about suicide and getting people to understand it a little bit better is helpful. And knowing that it's okay to talk about it and it's okay to talk to your kids about it, or if you're a clinician might be listening, it's okay to ask your patients about it. So again, I think important to have that context.
- [09:48]
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Dr. Matt Nock
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- [12:53]
Dr. Matt Nock
That context that I think is worth hammering home a little bit is why is it like what is it about the news right now and the conversation right now? I don't know if it's like the need to have one silver bullet that's like this is the reason like social media is causing increases in suicide and self harm. But I know a lot of parents are hearing those headlines and panicked about those headlines and it's not the real story and I can't quite figure figure out like what why that's happening and I would love your input.
- [13:28]
Danielle Bean
Yeah, it's a great point and I think the tenant well let me just Say from the outset, I can't explain media, explain why people, why journalists and publications frame things the way they do. But one thing that has been the case for decades, or at least the decades that I've been in the field, is there's a tendency to try and oversimplify things. And the world is much more complex than that. And I get it. It's more interesting and click worthy to say we have discovered a gene for happiness than it is to say, well, we've identified a genetic modification that is correlated with an increase in feelings of you've already lost me. So a gene for happiness sounds a lot better and a lot cleaner and a lot more easily consumed in a three minute read than what the real case is. And so this is true in science communication in general. There is not a gene for happiness like there is not a gene for most things in the world. So I think there's just a natural tendency to simplify and I think that that then is true as well. For suicide work, for research on suicide, for findings on suicide, there's a tendency to try and oversimplify. And there are articles about aging for suicide, or a cure for suicide, or a blood test for suicide, or the cause of suicide. And science shows us over and over and over again life just isn't that simple. So it's not the public's fault that there's not a good public understanding of suicide. There's just not a lot of information out there and the, the findings that we're, we're seeing in science. And I have to say it's a really exciting time in suicide research because the science is really advancing in the past five or so years, much more rapidly than it has in the past, you know, 20 years before that and you know, decades before that. So I think it is a time to be hopeful and optimistic about progress in this area. But even though the science is advancing, it's hard to get accurate information out to people about how it's advancing and about what you should know and about how advances in computing and technology, for instance, are seem to be causing some harm in the world to our adolescents. They can also technology, new technologies cause good and allow us to find people more easily who are at risk for suicide and deploy interventions more easily to people when they're in a time of, of need. So there's a lot of nuance that's I think, important to acknowledge and understand and try and capitalize on.
- [15:50]
Dr. Matt Nock
So let's talk about that nuance. What is it that you know because you can give Accurate information.
- [15:57]
Danielle Bean
I mean, I can try.
- [15:58]
Dr. Matt Nock
You can try. And I think it's important to say probably that we don't have all the answers, right? Like if we have.
- [16:05]
Danielle Bean
Absolutely not. Psychology is a fairly young field in, you know, the history of humankind, about a hundred or so years old. Clinical psychology, psychiatry are fairly new sciences. And so we're still developing an understanding of what mental disorders are, what suicide. We know what suicide is, but how is it, how does it develop? How do we predict it? How do we prevent it? These are areas of research that really are a few decades old where we've had serious concerted effort with more than a small handful of people working on these problems. So it's a pretty young area of, of science. And so we certainly don't have all the answers. And suicide is not perfectly predictable with, with a high degree of accuracy and it's not completely preventable. Where there are preventions and we can talk about interventions, there are, there are evidence based, effective things that can be done to significantly decrease a person's risk of suicide. But these are not perfect treatments. We can't perfectly predict and cure people of the things that lead to suicide. So we've, we're making progress, but there's still a long way to go.
- [17:09]
Dr. Matt Nock
Okay, so in terms of predictors without terrifying parents, are there, are there ways? Because you hear about, we, we've had, there's, there's a school in our community here in California that's had a number of suicides over the last couple of years. Sort of like proportionally shocking compared to the numbers of kids at that school. And so of course parents are so looking for an explanation for this and each child. And I think it's very natural when you hear about a story like this, you just want so much to know that there was something that you could have predicted and that there wasn't something or there could be something you could do to prevent or that this had to have been, you know, a long journey for that child or family of struggles. So many different things that people talk about. So I would love to. I mean that school and that scenario is so specific. But in general, can you kind of help us think about what do we know?
- [18:14]
Danielle Bean
Yeah, yeah, I can. I, I can and I will talk about specific risk factors that are important to keep an eye on. But one thing I wanted to note from the outset is we're not currently good at predicting suicide. I have spent the past 25 plus years of my life trying to better understand, predict and prevent suicide and using our most Cutting edge technology. We're getting better, but we're still far from perfect at predicting suicide. And so any given parent, any given clinician is not on average going to be able to predict suicide, and in actuality is not going to be able to predict suicide. So the expectation shouldn't, for each of us shouldn't be, well, you should have been able to do this, because those of us who have dedicated our lives to doing this and try and get better every single day still can't do it. And it's a hard thing to predict. These are rare, statistically rare events in terms of which person, at which point in time, in which place is going to do it. Kind of the same way, I think a lot about tornado prediction. Tornadoes are really hard to predict. They've been happening forever. They are deadly, but they're pretty rare events when they happen. They take a person, they take life, they take human life. We still don't completely understand why they occur. We're getting better, and the science around them gets better. As we have more data, we have sensors on wind speed and temperature and precipitation and so on. And as we get more data dynamically over time from sensors, we can better predict them. I think about suicide it's the same way. There's no one risk factor that causes suicide. Suicides occur as a result of a combination of many different risk factors, each with small effects. So that's, I think, important context for all of us to understand what are some of the strongest predictors. We know that there are developmental differences. Children very rarely think about suicide when people hit adolescence. And this is true globally. In every country we've examined dozens of countries, every country we've examined, the rate of suicidal thinking skyrockets during adolescence and young adulthood from age about 12 on. Now. This isn't to say younger kids don't think about suicide. We see kids 6, 7, 8 years old on rare occasions reporting suicidal thoughts. But generally it's. It's adolescence, it's middle school, it's high school. We see rates of suicidal thinking really increase. Only about a third of people who think about suicide will ever make a suicide attempt. So most people who have suicidal thoughts won't make a suicide attempt. The highest risk time thinking of risk factors for suicid for making a suicide attempt for those who do is within the first year after onset of suicidal thinking. So adolescence is a higher risk period. And the first year after a person has those thoughts is the highest risk period for making an attempt. So timing seems to be important. And interestingly, the longer A person goes thinking about suicide without making an attempt, the less likely they are to make an attempt in years. So we have people who are in their 20s, 30s, who've been thinking about suicide for a really long time, haven't made an attempt. Seems to be there's some kind of protective factor, lack of impulsiveness or good behavioral control or good support. We don't really understand it. Age and, and timing of onset is important. Mental disorders are highest impact risk factor. About 90 to 95% of people who die by suicide have a diagnosable mental disorder. Depression, anxiety, alcohol or substance use. Now, of course, most people with a mental disorder don't think about suicide, don't die by suicide. At any given time, about 50% of us will meet criteria for a mental disorder. Sorry, in our lifetimes, 50% of us will meet criteria at any given time. It's 20, 25% of people. Most people with mental disorder don't become suicidal. But that is our strongest risk factor. Having one disorder doesn't seem to increase your risk. Having multiple disorders does increase your risk. So the piling up of risk factor of mental disorders, depression and anxiety, and in alcohol or substance use and the behavioral problem really seem to increase risk. The type of disorder seems important. Depression is our strongest psychiatric risk factor for thinking about suicide, which most people could probably guess. If someone's thinking about suicide, people often say, well, I didn't know they were depressed. So depression is the disorder we commonly think about. But among people who have suicidal thoughts, depression doesn't predict which people go on to make a suicide attempt. What does are disorders characterized by anxiety, agitation, poor behavioral control. So it seems to be the combination of feeling depressed and being agitated, aggressive, struggling with alcohol and substance use, which, you know, in hindsight sort of makes sense. If you're feeling really down and depressed and you're agitated, you tend to act out, tend to act impulsively. That might get you acting on your suicidal thoughts. So putting this together, it's for parents. Adolescence, presence of multiple psychiatric disorders. Mental disorders like depression, anxiety, combined with poor behavioral control, explosively acting out, explosively being aggressive, struggling with alcohol and substance use, are the things that are most commonly associated with suicidal thoughts and attempts in this age period. There are other factors. There seems to be genetic loading, there is genetic risk for depression. Even more specific than that, there seems to be a genetic risk for suicide. So among, among families where there's a history of depression, there seem to be specific families where there's a history of suicide. So there does seem to be A specific genetic impact for suicide. But of course, genes aren't destiny. So the fact that there's depression or suicide in your family doesn't mean your child's going to be suicidal, but it does mean there's an increased statistical risk. And when you see depression, poor behavioral control, alcohol, substance use risk increases further.
- [23:47]
Dr. Matt Nock
Okay, so should, so if you are at increased risk or if you're not, like, do you have these conversations in a different kind of way?
- [23:56]
Danielle Bean
I would have the same conversation, but I'd be more likely to have it if you see increased risk. So. And there tends to be more of an opening if there's increased risk. So if I'm a clinician, if I'm a parent and a child, I'm interacting with a child who's struggling with depression and, or substance use or anxiety or some related problem, it's a little bit more of a natural in to ask about suicide. Hey, you're feeling really down, you're feeling really depressed lately. Have things ever gotten so bad that you've had thoughts of death or thought about suicide or thought about not wanting to be here? There's a natural opening to have those conversations where if there's not depression or anxiety or substance use, maybe it's a little bit more jarring or might feel more jarring to ask about suicide. Why are you asking me about suicide? So what I tell parents, what I tell clinicians that are, you know, we're, we're working with or in training or I do myself, it's if you're asking about, or having a conversation about a mental disorder, especially a depressive disorder, an anxiety related disorder or substance use disorder, ask about suicide. It's an, it flows naturally and there's good reason to ask about it because there is an increase in the likelihood, just statistically speaking, that the person might be thinking about suicide. But even if there's not, there's all sorts of natural ways to have these conversations. And, and if there's a suicide in the local school, in the local community, a person reads about it in the media, there's an article about social media and suicide, or you're just curious and you want to have a conversation with the child in an assessment or for a parent in a conversation. I know well, being a human myself, it can be scary. It can feel awkward to bring these things up for all of us again. I'm a licensed clinical psychologist. I've been studying suicide for decades. I still, since I'm among friends, I can say this. I still get a little bit nervous When I ask people about about suicide, when I'm talking to a friend or a family member and they tell me that they've been struggling with depression. I'm really depressed, I've been really down, I feel really exhausted. I ask about suicide. Do you sometimes are think that things get so bad you feel like you don't want to be here? Do you think about dying? Do you think about wanting to take your own life? And sometimes people say no and sometimes people say yes. But if you don't ask the question, you don't create the space for someone to talk about it. And it does feel scary. I acknowledge that. And it can be really helpful to have that conversation with someone.
- [26:06]
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- [29:13]
Dr. Matt Nock
And so when you're thinking about something, let's say that's in the news or in a school community or a friend, a family friend or something, and you have younger kids, like you have a sixth grader or even younger, at what point do you start to have those conversations?
- [29:30]
Danielle Bean
I think it's appropriate to have those conversations. I think it's a decision for each parent to make. Just like with, with dating and, you know, drinking and vaping and those things. Some people want to be proactive and let their kid know before they encounter the thing and some don't. We want our kids to be kids and not burden them with, with some of these, you know, more concerning subjects. So it's each parent's decision for me, I think about what age these things tend to occur and wanting to have those conversations around that time so that a, my child's prepared for when these things start to creep up in themselves, if they do and in their friends. And I have them or I try to have them, at least in a developmentally appropriate way. So with my child, when she is 10, I might talk about thoughts of dying or thoughts of death or thoughts of not wanting to be here anymore. Whereas with my 17 year old, I'll talk more about suicide and suicidal thoughts versus suicide attempts and, you know, it's more developmentally appropriate. The same with, you know, sex ed. I talk differently with a 10 or 11 year old and in my experience these days, schools are having those conversations earlier because girls are menstruating earlier and, and schools want to have those conversations earlier. And the younger the child, the, you know, more awkward the conversation can be. And as they get older, it gets to flow more, the conversation flows more naturally. And the same is true with suicide. What we encourage in, in training, you know, young clinicians is that people ask about suicide, as my colleague Barry Walsh says, in a calm, dispassionate demeanor. You know, the same way when you go to see your physician and they go to do a checkup and they say, okay, now remove your pants, now remove your shirt. They say it in a very calm, dispassionate way. And so when I'm at the doctor, I take off my pants and I take off. If they were giggling or if they seemed nervous when they said that, I'd be kind of freaked out and I'd probably walk out of the office. And the same is true with asking someone about death or suicide or violence. Ask about it in a calm, dispassionate way. It's a legitimate question. We're asking about a mental health concern and a very real behavioral concern. And so I think treating it in that calm, dispassionate, matter of fact way is less likely to make it awkward. And it also signals to the person that this is an okay thing to ask about. It's okay to have this conversation. It's okay to talk about it. And as a parent and as a clinician, I think that is one of the most important things. It's signaling to young people that it's okay to talk about this and that I'm an okay person to talk with about this for, you know, for my own kids, for my, my nieces and nephews, kids in the neighborhood, friends of my kids from. It's okay to talk about this. And if you want to talk about it, I'm here to talk with you about it. It's okay for you to talk with each other about this. There are data, there have been experimental studies on the question of is it harmful to ask people about suicide? Does it make people more distressed? Does it make them more likely to think about suicide? Are we giving kids the idea to kill themselves if we're asking them about it and the answer is no, if we randomly assign to get some kids are asked about suicide and a random half of kids aren't, the kids who we ask about suicide are not more distressed. They're not more likely to think about suicide now or in the future. Meaning it's safe to ask people about suicide. You're not likely to give someone the idea. Just like if I'm talking, we're talking about suicide now. I would venture to say people listening to this aren't suddenly getting the idea, aha, there's a thing called suicide. Maybe now I will end my own life. It doesn't work that way. People have. Some people have thoughts about suicide. They're scary things for many people to experience, for kids to experience themselves. And it can be awkward for them to tell other people they could be, you know, If I'm a 13 year old and I'm thinking about suicide for the first time, I might not want to tell my friends, I might not want to tell my parents because I don't know fully what I'm experiencing and I don't know what the response is going to be if they're asking me, hey, did you ever have these thoughts again? It creates an opening and creates a. Gives a message that it's okay and safe and normal and natural to have thoughts like this and talk about them. And so I know where I can go if these thoughts come back or if I want to have a conversation with someone about what I should be doing, keep myself safe or to, to manage these thoughts.
- [33:33]
Dr. Matt Nock
And so what about when there are. There is that sense of contagion. Can you explain that? Because I think that's where people get tied up in knots about talking about it. But it's not contagious. But then when you're in a community and it keeps happening that it feels like that is contagious. And what's all of that about?
- [33:53]
Danielle Bean
Yeah, it's a good question. And I think the science isn't fully there yet. There, you know, anecdotally there does. There do seem to be. There are, there are pockets of times and places where suicides seem to occur at a high rate. They're not. There are, there are geographic regions where suicide rates are higher and lower. Take zooming out a second. Mid Atlantic states, New York, New Jersey pretty consistently have the lowest rates of suicide over the years. Consistently the lowest rates. And national statistics as you go out west, north and south from around Las Vegas is a region that people call the suicide belt. There's a really high rate of suicides in western states pretty consistently. So there is some consistent geographical spread of suicide. We're still trying to figure out why this is. A lot of the common thinking on this goes to population density. New Jersey, my home state, I would argue it's a glorious place to live. It stands to reason that people be so happy in New Jersey.
- [34:54]
Dr. Matt Nock
You don't hear that so often.
- [34:55]
Danielle Bean
You don't hear that so much. And that's why I'm here today to spread the word. I think a lot of it is. We think a lot of it is population density. If there's a lot of people around you, you're more likely to get social support. You're more likely to have a hospital nearby, you're more likely to have outpatient services nearby, you're more likely to be prescribed the newest antidepressants, you're more likely to be able to get to a treater within 30 minutes. Whereas as you move out west, there's lower population density, less easy access to care, less easy access to newer treatments, more access to firearms, which is the leading method of suicide in the US More than half, slightly more than half of all suicides in the US are due to firearms. So these are probably some of the factors explaining these, this geographical spread. Now within areas, within places in New Jersey, within places in Massachusetts, within places in Wyoming, we do seem to see, we occasionally see clusters where there might be a half dozen suicides in a high school in a two year period. There's not yet agreement on how tightly clustered suicides have to be in time and place to constitute a contagion or a cluster. So the science isn't, isn't quite there yet. There do seem to be these clumps where suicides occur at high rates in the area. And it may be that risk factors vary. You know, think about tornadoes, there's some spread of risk factors across some area or it may be there's an impact of the suicide of one suicide on other people. For those who are at risk, a local death by suicide might have an impact on other people for suicide deaths. But we don't have the same evidence for thinking about suicide and talking about suicide there. In fact, there is pretty clear evidence that asking people about suicide doesn't again increase their distress, does not increase the risk of thinking about suicide.
- [36:36]
Dr. Matt Nock
So two things that I think we hear about a lot. I'm curious what your thoughts are and also. Well, I'll ask that one question, then I'll ask my next question. But I would say high achieving schools and social media are two areas that people and I know high achieving schools is a very niche, but the, and, and maybe to expand high achieving schools, maybe just thinking about achievement pressures, I, I think achievement pressures in social media get mixed up a lot in this conversation. And I'm so curious because I think you could probably have a high achieving kid who's experiencing those achievement pressures within themselves. And it doesn't feel like pressure, it's just sort of enjoyment. They're just conscientious. And you can have a high achieving kid where there are outside factors and internal factors that might in combination be quite lethal. And I'm so I guess instead what you hear is just high achieving equals high risk of suicide. Yeah, same with social media. So I kind of feel like I want to choose those two and get your, your more nuanced understanding.
- [37:48]
Danielle Bean
Yes, happy to dive in a little bit. I have a little bit of hesitation. It's in part because I think both of those. There's, there's a lot of data coming out now, a lot of focus on the latter on social media, and there's a lot of debate about what is the strength of the evidence on the association between social media use and suicide. And there, I think there's less debate that there does seem to be a strong correlation between problematic social media use, heavy social media use, and increased symptoms of depression and anxiety. And some, I think fairly compelling data showing that with really high rates of use, there are some people who do show increases in depression and anxiety and eating pathology and suicide risk and so on. The reason I have apprehension or had a little pause is I would encourage parents, clinicians, instead of looking for these factors or looking at these factors that are more ubiquitous or in the case of high achieving schools, might be a very broad brush to paint with, to say, well then don't put your child in a high achieving school. What I would look out for is if you're trying to predict suicide in your child or trying to know if your child's at risk or your loved one is at risk, your spouse is at risk. The thing that I look for as a clinician is psychological pain. So when we do studies where we ask people who have just made a suicide attempt, why did you try and kill yourself? Trying to understand suicide risk, the main thing that people say is I wanted to escape. Suicide is done to escape a seemingly intolerable painful state. What that pain is, where that pain comes from, I think that's where there's more variability. And maybe some of that pain is, is caused by being in a high achieving environment for this person or caused by bullying or results of sexting on social media or the things that I'm seeing on social media. So those are important. I mean, the environment that a person is in, are they, you know, abuse, physical abuse, sexual abuse, neglect, are all really important aspects of a person's context, of their environment that do seem to really significantly increase risk. Head traumas, social media use, certain aspect of social media use do seem to increase risk. The more local factor that I think is important for us to keep an eye on is psychological pain. So when I try and understand suicide, or through years of trying to understand suicide time and again, the thing that people who themselves have tried to kill themselves come back to is I wanted to escape a seemingly intolerable experience. Either it was my depression or humiliation or fear that I had let people down, or I had a loss that I find unbearable. I'm in intense pain, I can't tolerate anymore. So I want to end that pain through suicide. So suicide is not for most people an attempt to be reunited with a loved one or the completely unreasonable result of something that happened because I was in a high achieving school. No, it's the more local motivator is again, intense psychological pain. And it rationally, for me at least begins to make sense that if you're in intense pain, you want to relieve that pain. If I have a migraine, a toothache, if I'm in a burning room, I want to get out of that room. And I might engage in increasingly risky behaviors to try and get out of that room. And I think suicide operates similarly, that people try alcohol or substances or conversations or various things to try and get out of the pain they're experiencing. And when those things don't work, they escalate to suicide. So that's what I look for, is, is this person in psychological pain? If someone is having suicidal thoughts, I want to know as a clinician, as a parent, why, why are you having those thoughts? Is it about escape? What are you trying to escape from? And as a clinician, that's what we're going to focus on, is can we turn down the temperature on that pain in some way or teach you to tolerate that pain in some way until we can get, get to the point where we can turn down the temperature? And effective interventions for suicide, like cognitive behavior therapy or a more specific form called dialectical behavior therapy or dbt, which seems to be the most effective psychological treatment for people at risk for suicide. That's what it does. It tries to arm people with tools for tolerating distress and for ultimately decreasing the cause of distress so that they can live a more enjoyable life. But that's the motivator again, for most cases, is pain. So that's what I look for. And thinking of it that way, at least for me as a parent, gives me a little bit of more understanding and it gives me something to look for. So if my kid's in a high achieving school, I don't just have to sit back and be terrified that I hope my kid isn't the one that will end up thinking about suicide. Now I've got somewhere to start. When I have a conversation with my child and ask about how things are going, how are they feeling? I get a sense that they're in pain. I can ask them, how are you doing psychologically? How are you doing mentally? You're in a high achieving environment. Is it tough? Is it difficult? Do you struggle? Do you sometimes feel like you need to escape from it in some way? What is that about? Do you ever feel like you want to escape so much and you can't, that you have thoughts of suicide? So again, that's an end to talking about suicide for assessing our kids thinking about suicide. And also it's a modifiable thing that we can focus on to try and again strengthen the muscle or whatever the mechanism is for tolerating pain and gives us a target for trying to turn down that pain.
- [43:09]
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- [44:44]
Dr. Matt Nock
This leads me to kind of what you're talking about, which is some of the prevention work that we can do. If you could speak to what parents and what peers might do to just think about making the waters a little bit easier. Is there anything in your research that comes up?
- [45:06]
Danielle Bean
Yes, I think for parent, there's a few things that come up. One, one is, you know, things that a parent can do themselves or clinician can do themselves that go back to what we were talking about earlier, which is asking the question and having the conversations about suicide and about self injury, non suicidal self injury, which I wanted to make sure to mention. Cutting oneself, burning oneself, which often happens in young people without suicidal intent. And that too, the primary motivator is escape. Cutting yourself, burning yourself, hurting yourself in some way seems to significantly decrease negative thoughts and feelings. How does it work? Is it through distraction? Is it through some natural biological self soothing? We're trying to better understand. So it is okay to ask about these things. I would encourage parents to ask about these things. That's something a parent can do. Ask about suicidal thoughts, ask about suicidal urges, ask about engagement, self injury. If you think your child might be, might be doing so, it's okay to have that conversation and ask about why it's okay for parents to ask about what, what is leading a person, their child to have, or their spouse or their, their, their sibling or their friend to have these thoughts, these feelings, these urges to understand what the motivator is and to think with them about what they can do instead to try and, to try and feel better. And I wouldn't encourage anyone to try and manage all of those things on their own either. The person experiencing them, and I want to acknowledge that people listening might be experiencing these things. Thoughts of suicide, self injury, suicidal urges themselves. None of us should have to need to or should have to manage these things on our own, nor should our children, nor should our friends and family. There are treatments designed to help people manage their suicidal thoughts. And I mentioned two of them. Cognitive behavior therapy, dialectical behavior therapy. If those aren't available, there's often waiting lists for those specific kinds of therapies. Depending on where you are, other forms of therapy can be very helpful as well. And there are psychiatric treatments. Antidepressants for those struggling with depression, mood stabilizers for those with bipolar disorder. Antipsychotic medications for those with psychosis and psychotic illness. Bipolar disorder, in addition to depression are associated with significantly increased risk of suicide. Bipolar disorder especially so about 20% of people with bipolar disorder die by suicide, so bipolar disorder is fairly rare in the general population. About 1:1 or so percent of people meet criteria for bipolar disorder. If you or your child or someone you know has bipolar disorder, there's a Dramatically increased risk of suicide. And it usually occurs during a transition from a depressive to a, to a manic episode, a mixed state, so to speak, where someone, again, going back to something we talked about earlier, is feeling depressed, but is also a little agitated, overly energetic, a little disinhibited. That seems to be a really high risk time. There's evidence from experimental studies that mood stabilizers significantly decrease the risk of, of, of suicide. So there are things that can be done to try and decrease a person's impulsiveness, improve their mood, and in terms of the psychological interventions, understand why a person is suicidal and try and help them tolerate the thoughts or feelings or experiences that, that increase their risk and figure out ways to again turn down the temperature on the psychological pain they're experiencing. It's also, I think, important to know that for the vast majority of people, suicidal thoughts and suicide risk is transient. It changes over time. Just because a person has thoughts about suicide, it doesn't mean they're going to have them the rest of their lives. And in fact, in studies that we've done where we follow people over time with surveys, with smart, with smartphones, with wearable biosensors, we see that not only do these things tend to not last more than a few months, for about, about half of people who have suicidal thoughts, they never have them beyond the first year they experience them. They have them and they never come back again. For some people, they're a little more persistent. For those for whom they're persistent, they're really episodic. They go up and down pretty dramatically across hours, and so they're not always there. And that's. I found that helpful as a clinician to remind people who are in the throes of having suicidal thoughts. You know, did you have these months ago, years ago, weeks ago, hours ago? No, I didn't. Great. So they're probably not going to be there forever. Looking forward, they are malleable, they're changeable. And so can we get you to hang on for a little bit? And I know they're tough to experience. They can be tough to experience. Can we get you to hang on so we can try and bring them down so that you can experience and enjoy a life worth living? And again, we're not fully there yet. We don't have the ability to perfectly predict when these things are going to occur and to prevent them and treat them perfectly. But with each passing month and year, we're getting better at, at being able to arm parents and clinicians and people in our Society with the tools to know how to better understand these problems, how to better predict them, and how to better prevent them. So there, there is hope.
- [49:53]
Dr. Matt Nock
So after all of this, what is there to be hopeful about?
- [49:59]
Danielle Bean
That's a great question. I, I'm, I'm really hopeful.
- [50:01]
Dr. Matt Nock
Give us that.
- [50:03]
Danielle Bean
I'm hopeful about the advances we've made in the past few years that have resulted from technological, technological advances, advances in our, in the digital breadcrumbs that we're all generating and in improvements in computing power. So I mentioned earlier that, you know, predicting suicide is sort of like tornado prediction, and that work has been improved with sensors, putting sensors all over the place. And our weather. Think about the weather app on your phone. These have gotten pretty good. It used to be we, you know, turn on the television. I know we, they're not, they're not perfect. But it used to be you turn on the TV and the weather person says, you know, rain on Thursday. And that was terrible. Now, you know, my app tells me what the likelihood of rain is exactly where I am with pretty, pretty good, not perfect, pretty good accuracy and geographical and temporal granularity. So it reports, you know, to the hour, likelihood of rain and snow. And it's gotten a lot better. Now apply that to mental health understanding or suicidal behavior. The more data we have, the more we can train our models to learn over time, with increasing data, the better we're getting at understanding not just who's at risk, but when are they at risk. And so research is being done, and some of this is being done by our team here at Harvard, where we're using information that's sitting in your electronic health record. So you go see your doctor once a year, or you see your clinician once a week or once a month, and they're putting codes in your record. And they've been doing it for me here at Harvard for 21 years. We can write machine learning algorithms that go across your electronic health record and tell your clinician at your next visit what your risk of suicide is or domestic violence is, or, you know, fill in the blank. Here is with, with, you know, ethical approval and so on. We're getting pretty accurate at the ability to identify who is at risk. We're doing other research where we put an app on your smartphone and put a wearable device on your wrist like an Apple watch or a Fitbit type device, and we collect data with your consent over time. And we see how you're sleeping, how much you're moving around, where you're visiting, are you spending Time in parks or liquor stores. And we have you do surveys a couple times a day. Really quick surveys. How you feeling? We're building models that can tell us not just who's at risk, but what's their likelihood, what's this person's likelihood of making a suicide attempt in the next seven days? So figure between now and next time you go see your, your psychologist, your clinician. We're not perfect, but as we include more data, we're getting more and more accurate. So. And we're developing interventions that can be sent to you, to your phone to remind you to use that skill you learned in therapy. Hey, it looks like you're at. Looks like you're having thoughts of suicide in this moment. Remember that skill from your session. Here it is shown to you in brief graphical form. Let's practice it right now while we have you. Or here's a list of your friends names that you've put into this app of people you should call to help talk you through this. Sort of like, break the glass in case of emergency, rather than saying, go see your clinician next Wednesday and the Wednesday after that and the Wednesday after that. And good luck in between. With this improved digital breadcrumb tracking system, we can tell you, we can figure out when, when you're having thoughts of suicide or when you're likely to have those thoughts. And we can intervene proactively. Sort of like a weather app to tell it, to tell you, hey, it's going to rain, bring an umbrella. Hey, it looks like your mood's heading in a negative direction. Here are some things you can do. So again, I want to emphasize, we're not there yet. We're not perfect yet, but we're making big strides in our ability to do this and to make improvements in ways that we couldn't 10 years ago. So there are negative aspects of computer use and screen time and social media use, for sure. But they are also, you know, these tools also can be used for good and to monitor when dangerous things are going to happen to our kids and to try and promote more positive things in our kids. So these kinds of advances and these kinds of uses of new technology give me a lot of hope about where, where we might be, you know, a year from now, five years from now, ten years from now.
- [54:07]
Dr. Matt Nock
Okay, Well, I think the NOC lab gives me a lot of hope because I think you guys are doing the work that, that we need to put out in the world. So I very much appreciate it.
- [54:16]
Danielle Bean
Thank you for saying that. And the Raising Good Humans podcast gives me hope because you're. You're focusing on this issue and these issues and. And reaching so many people and getting the word out about, in this case, suicide, self injury and what parents can do and the directions that things can head if we all work together on this. So thank you for focusing. Thanks for having me on. Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.