Detecting Suicide Risk: A New Approach

July 1, 2013 by Marjorie Antus In a May, 2013, press release, the Centers for Disease Control and Prevention announced that in recent years, the number of annual suicide deaths in the United States has surpassed the number of people dying yearly in automobile accidents. In 2010, for example, 33,687 people died by automobile and 38,364 by suicide. “Suicide is a tragedy that is far too common,” says CDC Director Tom Frieden, M.D. “[We] . . . need to expand our knowledge of risk factors so we can build on prevention programs. . .” (www.cdc.gov/media/releases/2013/p0502-suicide-rates.html) Fortunately, Harvard psychologist Matthew Nock is attempting to do just that. In 2003, Nock and a colleague began developing a series of tests they consider potentially capable of detecting suicide risk. The tests are modeled on the Implicit Association Test originated in the late 1990s which uses word associations to reveal biases about race, sexuality, gender and age that people either don’t wish to acknowledge or cannot even recognize in themselves. In short, Nock and his Harvard colleague have devised a series of tests to measure a person’s bias for and against being alive or dead. On a computer screen, “life” and “me” appear on one side and “death” and “not me” on the other. A person is asked to rapidly categorize a series of words such as “thrive,” “breathing,” and “funeral,” under one of those headings. Though complex in the execution, the tests basically detect how quickly a person identifies with either “life” or “death.” Hesitation in responding to the “life” heading, for example, might signal an association with dying that reveals a risk factor for suicide. “Doctors of all kinds, including psychologists, do no better than pure chance at predicting who will attempt suicide and who won’t” writes Kim Tingley in a recent article in The New York Times. “Their patients often lie about their feelings to avoid hospitalization. Many also appear to mislead by accident, not realizing they are a risk to themselves or realizing but not knowing how so say so.” (www.nytimes.com/2013/06/30/magazine/the-suicide-detective.html) Along with the hope Nock’s system brings to the worrisome field of suicide prevention, it brings deeper appreciation of my daughter Mary who died by suicide in 1995 at the age of 17. Several months before her death, Mary’s psychiatrist asked her whether she was thinking about suicide and heard, “No, I would never do that.” But maybe Mary wasn’t simply lying; maybe she didn’t recognize her risk or know how to talk about it.