Health & wellbeing

The QUEST study: understanding suicidal thoughts

Lisa Marzano Middlesex UniversitySenior Lecturer in Psychology Dr Lisa Marzano is leading the QUEST study team, which includes Bob Fields from Middlesex University and Jo Borrill and Jay-Marie Mackenzie from the University of Westminster, in a bid to better understand suicide on behalf of Samaritans. Here, the research team explain why this research is necessary and what they hope to achieve. 

According to a recent report by the World Health Organisation every year as many as 800,000 people die by suicide. This is equivalent to one suicide every 40 seconds, with indications that for every adult who died by suicide there may have been more than 20 others attempting suicide.

In the UK, 6,233 suicides were registered in 2013 (Samaritans, 2015). This corresponds to a rate of 11.9 per 100,000 (19.0 per 100,000 for men and 5.1 per 100,000 for women).  Despite reductions in UK suicides over the past decades and mainly stable suicide rates for women, the male suicide rate has risen lately to become the highest since 2001. In particular the suicide rate among men aged 45-59 – 25.1 per 100,000 – has been recorded as the highest for this group since 1981.

Ryan Melaugh (Creative Commons 2.0)
Photo by Ryan Melaugh (Creative Commons 2.0)

We know that although many people, young and old, male and female, from all backgrounds, end their lives in this way, appropriate help and support can enable people to overcome their difficulties. However we still have a lot to learn about the thoughts and expectations that lead people on a pathway to suicide completion. On Suicide Prevention Day this is an opportunity to explain the QUEST (‘Qualitative Understanding of Experiencing Suicidal Thoughts’) study, which is being carried out by researchers from Middlesex University and the University of Westminster.

Preventing suicide

The QUEST study aims to explore and understand why some people have thoughts about ending their lives, what influences their thoughts, and especially why they choose to end their lives in particular locations rather than others. The research was commissioned by Samaritans with the ultimate aim of preventing future suicide attempts by identifying which aspects of locations might make suicide less – or more – likely to occur.

One of the first stages of the QUEST research is therefore to hear the stories and experiences of as many people as possible with experience of suicidal thoughts and attempts.

As is it not possible to know what thoughts people have had about suicide when they are no longer alive to tell us, one of the next best approaches  is to hear the stories of people who have thought about suicide, including those who did not act on their thoughts, and others who survived a suicide attempt. This approach is considered to be a valid method because serious suicide attempters are epidemiologically very similar to people who complete suicide (Hawton, 2002).

One of the first stages of the QUEST research is therefore to hear the stories and experiences of as many people as possible with experience of suicidal thoughts and attempts.  Previous suicide research has often been limited to studies of people with a mental health diagnosis, as there is a strong link between mental health problems and suicidal behavior. However the QUEST study is based on gathering a wider range of thoughts and experiences, by inviting people who have had suicidal thoughts and are interested in taking part to complete a short online survey.

Some of the people who complete the survey and indicate that they have made suicide attempts in the past are also being invited to take part in an in-depth interview, face-to-face, online or by telephone. These participants will have the opportunity to explain their own thoughts and choices, their perceptions of different locations and their ideas about future prevention strategies. Other potential participants who are already known to the team as having survived a suicide attempt will be invited to take part in interviews about the specific method and location of their attempt(s) and the help they have received subsequently. All participants will be provided with information regarding advice and support services for people with suicidal thoughts, including links to Samaritans, Calm, Maytree, university counselling services and GPs. They will also complete the Research Participation Questionnaire Revised (Newman et al 2001) to assess the impact of taking part in the study.

Social media

A second novel component of the research, which will start later in the year, is to explore widespread perceptions and beliefs about different locations through analysis of social media. Perceptions from social media may include comments on the impact of suicide attempts in different settings, the likelihood of a suicide attempt in a particular place, and views about physical and social barriers to suicide. Using analysis of Twitter feeds and other social media sites, the study aims to gain a picture of how certain locations are viewed in relation to suicide events. Reporting of suicide in the British press (both online and print media) will also be analysed, as previous studies suggest that extensive, sensationalist and overly detailed reporting of suicide can influence suicidal behaviour and lead to imitative acts.

Finally, the QUEST study will analyse previously filmed material of events in the vicinity of where suicides have been attempted. The aim of this part of the study is to identify and examine any behaviours prior to the attempt, such as moving to a particular area, or avoiding other people. This information could be very helpful in designing safer public spaces and developing better pathways to help and support.

The QUEST study is very new but growing quickly. It will be running over the next year and we hope to present findings that will make a new contribution to suicide prevention.

Health & wellbeing

Why do some people develop depression?

Dr Zola Mannie Middlesex UniversityMental health has become a prominent topic of discussion in this year’s general election campaign, with Liberal Democrat leader Nick Clegg pledging “equality for people with mental health issues” and £3.5 billion of additional funding for care.

But while this money would be used for new facilities, reducing waiting times and improving access to treatment – all cures – prevention is not addressed. Middlesex University’s Dr Zola Mannie, a Research Fellow in the Faculty of Science and Technology, is one of those seeking to answer the important question:’Why do some people develop depression?’

In my research I am investigating young people aged 18-21 years who have never been depressed. Within this age range I am interested in comparing those who have experienced childhood adversity and/or those with a depressed parent with those who have not experienced adversity or parental depression. By childhood adversity, I mean events such as parental/familial neglect, maltreatment and various forms of abuse before the age of 17 years.

Although it is known that childhood adversity or parental depression increase the risk of developing depression, they do not seem to be sufficient to cause its onset. That means, not everyone exposed to these events/situations will get depressed – some will, but a significant number will not. The question is why? It seems that there may be other important factors – both neurobiological and psychological – involved and that is the basis of my research.

Depression - Ryan Melaugh
Depression – Photo by Ryan Melaugh (Creative Commons 2.0)

Could BDNF hold the key?

I am particularly interested in a protein called brain derived neurotrophic factor (BDNF), which is involved in neuroplasticity – the ability for the brain to strengthen or weaken neural connections as a result of changes in the environment, behaviour, cognitive and emotional processes or injury. The brain responds to these events throughout life, but how it responds will be partly influenced by BDNF expression and levels.

BDNF is therefore important for processes such as learning and memory, among others. Extremely high or low levels of BDNF impair learning and memory processes. I am interested in whether there are differences in BDNF production, learning and memory between those who have childhood adversity and/or parental depression compared to those without parental depression or childhood adversity.

If my research reveals that those at increased risk may produce less BDNF than those at low risk, it could be a step forward to our understanding of depression risk. The next step would be to test whether low BDNF and associated learning and memory problems can predict who will get depressed through further research. Although animal models of vulnerability to depression show that it can predict depressive-like behaviours, this has not yet been shown in humans.

The good news is that BDNF can be modified through behaviours such as physical exercise, energy restriction or cognitive training. Ultimately, through this type of research, interventions aimed at reducing the incidence of depression can be designed, and BDNF, learning and memory are potential targets.

Zola is looking for volunteers to assist with her research. Click here for more information if you would like to take part.