The Fundamentally Social Nature of Suicide Thomas Joiner

The Fundamentally Social Nature of Suicide Thomas Joiner, Ph. D. The Robert O. Lawton Distinguished Professor of Psychology Florida State University joiner@psy. fsu. edu

Case Example from Robins’ (1981) The Final Months “He became very agitated…restlessly pacing from room to room. At other times he would sit almost motionless for prolonged periods. His speech diminished greatly…He began to lose weight and to say that he was a burden on his family and would never get well. He developed insomnia…”

Sketch of the Interpersonal Theory Those Who Desire Suicide Perceived Burdensomeness Fearlessness about Death Thwarted Belongingness Serious Attempt or Death by Suicide Joiner, 2005, Why People Die By Suicide

Van Orden et al. , 2010, Psychological Review

Caring Texts (Military Continuity Study) The Military Suicide Research Consortium (msrc. fsu. edu)

Fig. 2. Exposure-response relationship between electronic device use and having at least one suicide-related outcome, bivariate and with demographic controls for race, sex, and grade, 9– 12 th graders, Youth Risk Behavior Surveillance Survey (YRBSS), 2009– 2015. Twenge, Joiner, et al. , 2018, Clinical Psychological Science

Empirical Support for the Interpersonal Theory of Suicide Chu et al. (2017, Psychological Bulletin): “using 122 distinct published and unpublished samples, findings revealed support for the interpersonal theory…”

Sketch of the Theory Those Who Desire Suicide Perceived Burdensomeness Fearlessness about Death Thwarted Belongingness Serious Attempt or Death by Suicide

Empirical Support for the Interpersonal Theory of Suicide Chu et al. meta-analysis (2017, Psychological Bulletin, continued): “…However, effect sizes for these interactions were modest. ”

Thank you for your attention joiner@psy. fsu. edu

Social Media, Depression, & Suicide Paul Weigle, MD Digital Media and Developing Minds October 16 th, 2018

SM & Depression Panel Agenda • Paul Weigle MD • Thomas Joiner Ph. D • Ethan Kross Ph. D • Panel Discussion Games for Health? Video games & Smartphone Applications to Enhance Psychiatric Treatment ~ October 23 rd, 2018

Social Media & Depression: Introduction • Background • Depressed teens on SM • User characteristics • SM habits • SM experiences From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Adolescent Depression • 1 -year prevalence increased 8. 7% in 2005 to 11. 3% in 2014 (Mojtabai ‘ 16) • Suicide attempts LP 4% (National Comorbidity Survey, Nock, ‘ 13) • Teen suicide increasing since 2007 (CDC ’ 16) • 2 nd leading cause of teen death (CDC, ‘ 15) From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Teen Social Media Habits • 2010 -2015: time spent on SM increased 2. 5 X (Rideout ‘ 10 & ‘ 15) • 58% use SM for average 2 hours 4 minutes • Girls > boys • Blacks > whites • Instagram, Snapchat & Facebook Web Junkies: Understanding Internet Disorders ~ June 21 st, 2018

SM & Social Connection • Teens use SM to maintain contact with friends & make new ones (Lenhart ’ 14, Teppers ’ 14 & Wood ‘ 16) • Related to increased self esteem & social support (Ellison ’ 11 & Best ‘ 14) • Most believe SM benefits their well-being (Rideout ‘ 18) • Minority youth, those struggling w sexual identity or LD meet similar peers, feel less lonely & more confident (Korchmaros ‘ 15) From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Depressed Teens & Social Media • Depressed teens prefer socializing online (Bonetti ’ 09, Valkenburg, Fioravanti ’ 12, Prizant-Passal ’ 16 & Rideout ‘ 18) • 90% seek help online • 3 X likely to feel SM very important to feel less alone, be inspired & express themselves (Rideout ‘ 18) From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

SM Displaces Protective Habits • Social contact IRL • Academics • Exercise • Sleep From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Social Media vs. Sleep • Insufficient sleep strongly predicts depression & suicidality (Matamura ‘ 14) • >60 studies found screen media related to insomnia (Hale ‘ 18) • Heavy SM use & cell phone use in bed predict insomnia (Fossum ‘ 14 & Woods ‘ 16) From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Depressed Teens on Social Media • Depressed teens 3 X as likely to report negative SM interactions & using SM to avoid problems (Rideout ‘ 18) • Engagement in online discussions about suicide relates to increased SI over time (Dunlop ’ 11 & Masuda ‘ 13) From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Social Media & Depression • Metanalysis found complex relationship (Baker ‘ 16) • 5 studies found positive relationship, 2 negative, and 4 found none • Risk Factors: heavy use, impression management, & passive SM use (Sampasa-Kanyinga ’ 15, Baker ‘ 16, Verduyen ‘ 17, Escobar-Viera ’ 18, & Primack ‘ 18) • Protective Factors: more ‘friends’ & active use From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Individual Risk Factors SM associated w depression & SI over time, especially in: • girls • unpopular • lack self-purpose • emotionally invested (Kim ’ 16, Wardeiner ’ 16 & Booker ‘ 18) From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Mediating Factors • Social Comparison • FOMO • Internet Addiction • Cyberbullying • Sexting From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Social Comparison • Determine self-worth based on how we stack up against others • Increases association between SM use & worsening depression, especially in unpopular girls who follow strangers (Lup ‘ 15 & Nessi ‘ 15) • Teens given to social comparison spend more time on SM, have lower mood (Vogel ‘ 15) • Depressed teens feel inferior after viewing SM (Appel ‘ 15) From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Fear of Missing Out • Excluded from experiences peers are enjoying without you • 18% of depressed youth feel left out on SM vs 1 % of peers (Rideout ‘ 18) • Leads lonely teens to feel inferior (Chou ’ 12, Przybylski ’ 14, & Keracher ‘ 17) • Leads to addictive SM use (Gil ’ 15, Al-Menayes ’ 16, & Oberst ‘ 17) From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Internet Addiction • Uncontrollable, excessive habit causes dysfunction, correlates to depression (Kok ’ 13, Hanprathet ’ 15, & Andreassen ‘ 16) • Depression increases risk for newonset IA (Fioravanti ’ 12, Brand ’ 14, & Lee-Won ‘ 15) • IA increase risk to develop new-onset depression (Lam ’ 10 & Achab ’ 11) From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Sexting • Most YA admit to sexting as a teen (Demateo ’ 14) • Predicted by unsupervised & unrestricted internet access (Doornward ‘ 14) • Associated w depression & 2 -3 X risk to attempt suicide in most (Schneider ’ 10, Van Ouytsel ‘ 14, Temple ’ 14, Frankel ’ 18 & Medrano ‘ 18) • But not all (Morelli ‘ 16) From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

Cyberbullying • Victims & perps have more suicidal thoughts & behaviors in 43 studies (van Geel ‘ 13) • Predicts worsening depression & suicide attempts (Kessel ’ 12, Machmutow ‘ 12, Salmivalli ’ 13 & Landoll ‘ 15) From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018

From FOMO to i. CBT, Online Perils & Prospects for Youth with Internalizing Disorders ~ October 27 th, 2018