Professor Rory O’Connor: Suicidal Behaviour Research Lab

DIMITAR KARADZHOV: Today, we’re talking to Professor Rory O’Connor, who directs the Suicidal Behaviour Research Laboratory at the University of Glasgow, one of the UK’s leading research centres for suicide prevention research. Professor O’Connor, suicidal behaviour is highly complex. Can you talk us through some of the interesting theoretical developments in this field?

RORY O’CONNOR: Sure. I think, it’s really important, as you highlighted, to recognise the complexity of suicide. And we understand that the factors that lead to suicide are a combination of biological, clinical, psychological, social, and cultural factors. But if you look at the new theoretical developments in the recent years, they’ve been really focused on the psychology of understanding suicide risk. And indeed, work that we’ve been doing has looked at that. In a very broad brush way, we often now talk about ideation to action frameworks.

And what ideation to action frameworks are recognising that the factors that lead to the emergence of suicidal thinking are often different from the factors that lead to someone to actually act on their thoughts to attempt suicide or die by suicide. And broadly speaking, there are three theoretical models within that ideation to action framework. But to focus in on the model I’ve been involved in, the IMV model of this integrated motivational volitional model, in essence, what it argues across three phases is that the key drivers to the emergence of suicidal thinking are feelings of defeat and/or humiliation from which an individual cannot escape, the sense of overwhelming entrapment.

And a lot of these other factors, clinical or social or negative life events, they can impact on individuals to make them feel more trapped. So the complexity is around trying to understand the emergence of this sense of entrapment. But the argument, according to my theory is that, yes, that will lead to the emergence of suicidal thinking. But the next key question is, well, what are the factors that govern the transition from thinking about suicide to attempting suicide? And so according to my model, there’s a group of factors which we call the volitional moderators or the volitional factors. And they are the key pillars that determine, we think, who is more likely to attempt suicide following thoughts of suicide.

And those key factors include things like knowing other people who’ve attempted suicide, so exposure. Impulsivity, the more impulsive you are, the more likely you are to act on your thoughts. Mental imagery about dying or death is another key one. Past behaviour, we know the best predictor of any future behaviour is whether you’ve tried that before. So there’s are some of the key factors which lead to the emergence not just of suicidal thinking, but crucially, this transition from thinking to attempting suicide. I think that’s been a big development in the field. And something we need to do more on, more research, and get it into clinical practise to help the most vulnerable.

DIMITAR KARADZHOV: And, professor, can you tell us about the important new clinic interventions in the field of suicide prevention?

RORY O’CONNOR: Yeah. What’s been great to see over the last 20 years has been this focus on trying to develop interventions for the most vulnerable. And indeed, there is growing evidence that psychological treatments, things like Cognitive Behaviour Therapy, Dialectical Behaviour Therapy, and Mindfulness-based Cognitive Therapy, they may be effective in reducing risk of suicidal behaviour. That’s been a great development. In addition, there has also been a focus in interventions, which we talk about as safety planning type interventions. And what we’re trying to do there is understand, can we work with people who are in crisis and reduce the likelihood that when they are in crisis, feeling suicidal, that they make that transition to acting on their thoughts, on attempting suicide?

And we hope in the next 5 to 10 years, we’ll have the evidence to demonstrate that safety planning prevents people attempting suicide in the future.

DIMITAR KARADZHOV: And what have been some of the most important policy developments?

RORY O’CONNOR: What’s been great in the last 10 years has been the recognition that, nationally, internationally, suicide prevention is now one of the number one public health priorities. And indeed, in 2014, the World Health Organisation published the first ever world suicide prevention report. That was sent out a really powerful message. But we need to do so much more, in particular in lower middle income countries where the vast majority of suicides occur. Because remember that 75% of the world’s suicides occur in low and middle income countries. So we need to ensure that the prioritisation, policy and otherwise, continues to grow, and not just at home, but abroad nationally and internationally.