CLEMSON, South Carolina — When a celebrity like Kate Spade or Anthony Bourdain dies from suicide there’s often a call for more research. But what does that research look like? Suicide, the 10th leading cause of death in the United States, is difficult to study. Unlike the first nine causes, it doesn’t fit neatly into a single disease category, like heart disease (No.1), cancer (No. 2) or diabetes (No. 7).

Banner logo for Tigers Together to Stop SuicideA recent report by the Centers for Disease Control and Prevention says the rate of suicide across the country rose nearly 30 percent between 1999 and 2016, and 54 percent of the victims did not have a known mental illness.

The key word in the CDC report is “known,” said Martie Thompson, a psychologist at Clemson University. “Many who die by suicide had not recently sought treatment. Research shows that approximately three-quarters of those who die by suicide did not visit a mental health professional in the preceding month and slightly over half did not do so in the past year.”

But even counting suicides is difficult, said psychologist Heidi Zinzow, also at Clemson University. “Unless there’s a note, it’s difficult to know” if some causes of death, like drug overdoses, are intentional or unintentional, she said. Suicide attempts are even harder to count.

Suicide research at Clemson

A photo of Dr. Zinzow and Dr. Thompson

Heidi Zinzow (left) and Martie Thompson have several ongoing research projects to better understand suicide.
Image Credit: University Relations

Thompson and Zinzow recently completed a grant to implement college suicide prevention research and programming funded by the Substance Abuse and Mental Health Services Administration.

Clemson’s Tigers Together to Stop Suicide, started in the fall of 2014, implemented a range of policy and programmatic initiatives. One of these includes a suicide prevention advocacy program that trains students, faculty and staff to recognize warning signs, talk to someone about suicide and connect students to resources.

So far, the research shows that students who go through training are more knowledgeable of suicide warning signs and they are more comfortable talking about it and offering help. That’s progress, Zinzow said, but to know if the program achieves its ultimate goal — preventing the rate of suicide — requires scaling up the study to include more students followed over a longer period of time.

Some warning signs and risk factors are well known: changes in behaviors that include talking about ending their lives, researching methods and depression. Screening for risk factors and warning signs has recently been implemented in Student Health Services’ Redfern primary care clinic. But it’s not known how multiple risk factors work together. Science knows that cancer doesn’t have one cause; neither does suicide. Like in cancer research, science needs to understand how multiple risk factors work together to lead someone to suicide.

Social media

When suicides are glamorized or portrayed in great detail, it can create a “suicide contagion” and a cluster of suicides, Zinzow said. Social media use has made this phenomenon easier to take hold and spread quickly. This includes viral social media challenges that encourage users to engage in dangerous self-harming behavior.

Zinzow is working with colleagues in psychology and civil engineering on a study of viral social media challenges in the United States and India and how they are connected to adolescents’ participation in self-harming and suicidal behavior.

The Netflix show “13 Reasons Why” revolves around a teen suicide. Zinzow and Thompson lead a team of students who are working on a Creative Inquiry undergraduate research project as part of Tigers Together to Stop Suicide. The team is looking at social media posts using data from Clemson’s Social Media Listening Center to examine the extent to which messages related to the show encourage people to engage in suicidal behaviors or promote help-seeking.

Drugs and guns

Drugs and guns are two areas in which Zinzow and Thompson are not currently working, but they see a desperate need for research to understand their roles in suicide.

Firearms are used in more than half of all suicides, providing a very deadly tool for someone who might be in a temporary state of crisis — problems with relationships, finances, careers or being alone.

“If you can just get someone beyond that impulse, an hour or even a minute later they might not be suicidal,” Thompson said.

Having access to a firearm increases the likelihood that someone will die by suicide, but researchers don’t know enough about access to firearms or if restricting access would be effective because federal funding hasn’t been available to study it.

Opioid overdose is an increasing problem. It’s easier to overdose on opioids than on other substances because they are more potent and they work very quickly, narrowing the window of opportunity to receive care. Zinzow suspects there’s a lot of overlap between opioid use and suicide, but that’s another area that needs more funding and more research.

If you or someone you know is in crisis and needs help, call the National Suicide Prevention Lifeline, 1-800-273-TALK (8255). Clemson students and others on campus can also text “tigers” to 741-741 for immediate, anonymous access to a trained crisis counselor.