Modern living impacts on mental health and suicide

Peter Gluckman, from the Office of the Prime Minister’s Chief Science Advisor, has released a discussion document on youth suicide.

It says that complex issues are involved but the pressures of modern living are a major stress factor.

An edited version of the report:


Youth Suicide in New Zealand: a Discussion Paper

Not all suicide is the same and youth suicide often has different drivers to suicide at later ages. Further while much is spoken and argued about its prevention, it remains a complex and contentious area with much advocacy for unproven interventions.

In particular this paper makes the point that youth suicide is more than simply a mental health issue and that, with what we know at present, the focus must also include an emphasis on primary prevention starting from very early in life. This means promoting resilience to the inevitable exposure to emotional stresses and building self-control skills in early childhood and primary school years, by using approaches that we already know about.

It means promoting mental health awareness and ensuring that there are competent and adequate adult and peer support systems in secondary schools. This must be backed up by a capacity to find and rapidly support those children and young adults who are in mental distress and ensuring that the needed interventions and therapy are early and effective.

The changing context of a young person

The way that young people live their lives has changed greatly over recent decades and this has created a range of poorly understood but probably critical pressures that affect their psyche and behaviour.

Family structure has changed; childrearing practices have changed; for many, the level of parental engagement has changed. Technology has changed the nature of their social networks and communication; media, celebrities and other social factors can create unrealistic expectations and pressures on young people.

Compared to previous generations, youth face many more choices at an earlier age, but at the same time may have less clarity as to their path ahead. The role of traditional community supports such as sports, church and other youth groups has declined. Youth now have more access to credit cards and money that gives them greater freedoms.

The pace of these sociological and technological changes is unprecedented and it is not surprising that for many young people, particularly those with less psychological resilience, it can leave them with a growing sense of dislocation.

The many factors that impinge on the risk of youth suicide

Youth suicide cannot be considered as just a mental disorder. A number of factors interplay. Studies in the US5 and elsewhere4,6 show that the likelihood of a suicide attempt is associated with a number of factors including:

  • socio-demographic factors and restricted educational achievement;
  • family discord and poor family relationships;
  • the tendency to being impulsive;
  • what is termed externalising behaviour (anti-social behaviours, and alcohol
    problems);
  • what is termed internalising behaviour (e.g., depression);
  • low self-esteem, hopelessness, loneliness;
  • drug and alcohol misuse;
  • a history of suicidal behaviour among family and friends; and
  • partner- or family-violence exposure in adolescence.

Impulsive-aggressive behaviours are commonly associated with suicide in young
people and decline as a factor with age. Youth who demonstrate antisocial or
delinquent behaviours are 10 times more likely to have attempted suicide.

The key conclusion from these studies is that youth suicide needs to be regarded as much more complex than simply outward evidence of mental disorder. Rather, it needs to be seen as the result of a state of stressed, impaired or underdeveloped self-control in which mental health, emotional and brain development, alcohol, sociological, economic, and other factors interact to put some young people at greater risk.

Adolescence as a vulnerable period – brain, biology, and behaviour

There is now compelling evidence that children who enter puberty at a younger age
are at far greater risk of behavioural, psychological, and emotional disorder. There
are probably multiple reasons for this but most relate to:

  • a longer period before those counterbalancing inhibitory brain pathways
    fully mature;
  • greater sociological and sexual pressures related to the mismatch between
    the earlier onset of physical signs of maturity and psychosexual ideation and
    chronological age: and
  • socialising with older peers who may be engaged in or express anti-social
    behaviours.

There is unequivocal evidence that children who enter puberty relatively early:

  • are more likely to indulge in alcohol and drug abuse;
  • often demonstrate more impulsive behaviours; and
  • boys show greater impairment in the quality of their relationships.

Variation in suicide rates across population groups

Many factors appear to contribute to explaining the different prevalence of youth
suicide across different population groups. They include:

  • living in environments where low self-esteem within the peer group is
    common;
  • poverty, inequality, and social fragmentation;
  • having a high rate of engagement with the justice sector and a greater
    presence of gangs;
  • higher use of drugs and alcohol2; and
  • suicidal behaviour becoming a means of demonstrating worth to the peer
    group

Deficits in self-control

Adolescence is a period of relatively poorly developed self-control and heightened impulsive behaviour. This is why some stressors that do not lead to troubled emotional responses in more mature individuals can do so in some in this age group.

So, rather than resilience, which might be expected – and needed – we see severe and harmful (including self-harm) responses. These stressors can include aspects of engagement with peers (e.g., bullying, including cyber-bullying) and emotional situations (e.g., break up of relationships).

A further possible factor is a substantial change in the way we raise children: they now tend to be under tight control in the pre-pubertal period but less control postpuberty (as reflected in: school subject choice; parental controls on time, place and behaviour; access to credit cards; access to internet, etc.).

In contrast, 50 years ago, western child rearing practice followed a loose–tight pattern in which pre-pubertal children had more freedoms, especially to undertake risky play, but adolescence was much more constrained. This reversal may have resulted in a reduction in the capacity to self-assess risk in adolescence.

Alcohol and drugs

Alcohol intoxication or a history of alcohol abuse are often associated with youth suicide30. Alcohol misuse is often associated with triggering events (conflicts in peer and intimate relationships) and, in relation to suicidal behaviours, is probably underestimated and under-reported. Furthermore, alcohol reduces self-control, can increase despair and depression and, among those with mental disorders, exacerbates symptoms.

New Zealand data show that considerably more than half of youth suicides involve alcohol or illicit drug exposure.

Peer influences, bullying and cyber-bullying

Adolescence is a stage of life when there is a “trading of dependency on parents for dependency on peers”: it is therefore not surprising that peer relationships affect mood and behaviour, including possible suicidal behaviour.

Peer influences may be particularly evident in the growing evidence for online bullying leading to self-harm. Bullying in schools occurs in many countries to varying degrees but the reported rates are high in New Zealand.

Implications for reducing the incidence of youth suicide

Suicide prevention is complicated because we do not understand the causes well enough at the individual level. Completed suicide is a rare event so it is difficult to study in the way we can study influenza or diabetes. It is really hard to predict at an individual level, with perhaps the best indicator being a previous suicide attempt/self-harm even though most who commit self-harm (which may or may not be an attempted suicide) do not go on to commit suicide.

Nevertheless, the 8–9% of all youth who are suicide attempters – with their high subsequent life-course costs (as they often have long-term psychological morbidity) to themselves, family, whānau, and society – are an important risk-group to target.

There is no definitive solution but there is a growing consensus on the following.

Primary prevention: This must start in the pre-pubertal period and is aimed at  developing resilience to the inevitable stressors of growing up, and promoting development of impulse control. The broader benefits of this approach49 include major spillover benefits to educational achievement and, later, in employment, family stability, and quality-of-life measures.

Such approaches must start early in life – and early childhood is an important opportunity for enhancing these skills and should be an evaluable focus of all early childhood education. There needs to be intense engagement with the most vulnerable families in the first years of their children’s life.

There is clear and strong evidence that a primary prevention strategy using welldefined
and structured activities (e.g., Good Behaviour Game) focused on behaviour in primary school children as young as 6 and 7 contributes to reducing later adolescent suicidality as well as other unwanted behaviours, and we would strongly suggest the introduction of this into all primary schools.

Secondary prevention: This refers to programmes that focus on the adolescent period and seek to identify those at risk and make referrals when necessary. Such programmes include activities that seek to increase understandings and change attitudes about youth suicide and to enhance the capacity to intervene and prevent.

The role of teachers, trained counselors and peer leaders is seen as key. There is some evidence to support the importance of adults actively engaging with distressed students, but outside those situations where close counseling relationships have been developed, these programmes tend to be distressingly ineffective. Better results are claimed when secondary prevention is combined with primary prevention and engaging peer leaders (that is well-trained youth leaders).

Tertiary prevention: This focuses on those who are identified as being at particular risk, for example having attempted suicide. It generally involves CBT or medication or both; as noted above, the effect on suicidality, as opposed to other aspects of mental health, is relatively small. Although investing in youth mental health is a critical priority for the reduction of adolescent and adult mental health disorders, it cannot be the only strategy for reducing youth suicide.

Summary and conclusions

Youth suicide remains a complex, multifaceted challenge. A focus on adolescent mental health, although important, is not sufficient. Rather, we conclude that the high-priority need is to introduce and reinforce programmes focused on primary prevention starting early in life and developing secondary prevention strategiesinvolving well-trained and engaged mentors including peer mentors. Understanding and co-design with our communities and particularly with Māori perspectives will be crucial at each stage as we develop, test and take to scale approaches shown to make a difference.

The primary prevention approach involves strategies to improve impulse control and executive function from early childhood and this has broad spillover benefits. It involves combining these critical interventions in early childhood and primary education with secondary prevention approaches in adolescents and it requires a social investment approach particularly focusing on those communities with low resilience and self-esteem.

http://www.pmcsa.org.nz/wp-content/uploads/17-07-26-Youth-suicide-in-New-Zealand-a-Discussion-Paper.pdf

36 Comments

  1. Tipene

     /  July 27, 2017

    One has to love the euphemisms:

    “Family structure has changed”: (should read “clearly, it appears that not all family structures are indeed equal after all, with some family structures being shown to be better than other family structures”)

    “Child rearing practices have changed (should read “The advent of both parents working themselves into the ground, and having other people other than the parents looking after the children has shown to be sociologically unwise”)

    And technology? It’s become the Siri-like babysitter for exhausted or other-focussed parents.

    We get about 4380 days (0-12 years of age) to significantly influence our children- not many, is it?

    Very interesting commentary in the report as well regarding the null outcomes for popular intervention programmes, and the increased risk of suicide by chucking medication at minors.

    Hopefully, the Social Investment Strategy will sort this one out.

  2. sorethumb

     /  July 27, 2017

    The elephant in the room is diversity (as an end in itself).

    Local Government New Zealand say
    Equality and social cohesion
    On some measures inequality has worsened over the last 40 years
    • The shift.
    Inequality is difficult to measure, but looking at income levels and the concentration of wealth, inequality has worsened over the past 40 years. Research suggests that inequality reduces social cohesion—and moving from an area of high social cohesion to an area of low social cohesion is as bad for personal health outcomes as taking up smoking

    New Zealand’s ethnic composition is changing
    • The shift.
    From a mix of natural population increase and net migration to New Zealand, the European population is expected to decrease by 12 per cent while all other ethnicities are expected to increase (the Māori population by 25 per cent, the Asian population by 71 per cent, and the Pasifika population by 40 per cent).
    • Enduring questions. How can we best embrace the changing face of New Zealand? How might we empower and enable communities to express and celebrate their diverse cultural heritages, and respect the particular cultural significance of Māori as tangata whenua of New Zealand?
    http://archive.boston.com/news/globe/ideas/articles/2007/08/05/the_downside_of_diversity/
    http://www.citylab.com/housing/2013/11/paradox-diverse-communities/7614/

    • sorethumb

       /  July 27, 2017

      Thumbs down because???

      • Gezza

         /  July 27, 2017

        Not from me. Might be because you could be perceived as suggesting at the end there is something wrong with respecting the particular cultural significance of Māori as tangata whenua of New Zealand?

        Are you?

        • sorethumb

           /  July 29, 2017

          No I wasn’t really thinking about that (leave that out for now – it’s another complication). I was pointing out that they are affirming that diversity will happening like winter and summer but seem to be suggesting that it can be sorted out.
          What they say is that long-term problems (lack of cohesion), will settle down. They use the US as an example but they are picking a time when economic growth made people wealthy, not just a larger pie but larger pieces and there was a long hiatus. In addition they talk about “initiatives” such as Diversities and Intercities where allsorts of things are happening but only European cities and syrupy manipulative measures.

  3. sorethumb

     /  July 27, 2017

    Two new books, The Vanishing Neighbor by Marc Dunkelman, and Susan Pinker’s forthcoming The Village Effect, mine the data and sound loud warnings. The health aspects are alarming enough for Pinker, a Montreal-based developmental psychologist, to have changed her own habits of a lifetime. She argues that humans need face-to-face contact, as they need air and water. We have evolved for it, to the extent that those surrounded by a tight-knit group of friends who regularly gather to eat—and, crucially, gossip—live an average of 15 years longer than loners. Quality face-to-face contact is essential for a social species, Pinker writes, citing research that shows it fortifies immune systems, calibrates hormones and increases chances of surviving heart attacks, strokes, AIDS and cancer. “People with the most integrated social lives—overlapping relationships among friends, family, sports and other recreational or religious pursuits—have the best prognoses,” with the most life-threatening diseases. It’s true even with dementia: A 2004 Swedish study found its lowest prevalence among those with the most extensive social networks.
    The end of neighbours
    http://www.macleans.ca/society/the-end-of-neighbours/?

    • Tipene

       /  July 27, 2017

      We are created for relationship – and not with a smartphone

      • Kitty Catkin

         /  July 27, 2017

        How do these people suggest that when one is widowed and almost everyone reacts as if this is an unacceptable disease, one forms tight-knit relationships ? With whom ? Dream on.

        What about those who don’t HAVE a family ? Where does one obtain one from ?

        I don’t believe that there ever was a time when people lived social lives as a rule-it doesn’t fit in with what I have read, and I have read a lot of history including many first-hand accounts.

        • Gezza

           /  July 27, 2017

          Counelling a recently bereaved young family member at the moment. She doesn’t understand that you have to go through it yourself to finally understand what it is like, and what happens to you, and for how long you ache for them, and need to talk about them, so people don’t know what you need. They don’t mean to hurt you. It just simply doesn’t occur to them until it happens to them. To them, your partner is dead. Buried. Sad. But life goes on. As it must. Musn’t talk about them. Too awkward. You need to move on, they think. But they aren’t just gone, for us. It takes a long time to get used to it.

          • Alan Wilkinson

             /  July 28, 2017

            Good on you, G. Sometimes one good friend is enough to share with. Young and bereaved is tough in a different way – the broken future hopes.

            • Gezza

               /  July 28, 2017

              You’re a good bloke Wilkinson. But I’ll never tell you that because you already think ya a bloody saint!

            • Gezza

               /  July 28, 2017

              I don’t think she’ll always be alone now, Alan. Only 35. He was much older. But she’s not ready to hear or believe that yet.

            • Kitty Catkin

               /  July 28, 2017

              My own experience is sadly like that of far too many people; former friends no longer want to have anything to do with one. Seeing two ‘friends’ of 20 years driving past and pretending not to see me shouldn’t have surprised me-they have made no attempt to keep in touch despite early promises-and I do not regret giving them the finger the second time they did this.*

              There is no excuse for the heartless behaviour of people whose selfishness means that they would let someone die before they’d lift a finger to help them. Yes, many people are so callous that they would do this.

              One only knocks on someone’s door once after it’s been almost slammed in one’s face when the person is obviously doing nothing but doesn’t invite one in.

              Social isolation leads to greatly increased risk of untimely death from suicide as well as heart attacks and low immunity to disease generally. But heaven forbid that people should go to any slight inconvenience to do anything about this.

              The worst offenders are those who call themselves Christians, what a surprise.

              * I wish that I’d done a brown-eye.

              These are pillars of their church, the kind of people who raise their hands high during services and cry ‘Amen !’ and so on, she dances around the aisles waving banners….and told a woman with cancer that she would not survive the cancer because ‘she didn’t have enough faith.’ They also support Benny Hinn and Joyce Meyer….enough said.

            • Alan Wilkinson

               /  July 29, 2017

              Sad people Kitty. Glad to be rid of them. Maybe find someone good you can help?

            • Alan Wilkinson

               /  July 29, 2017

              Hell’s teeth, G. I’ve never aspired to be a saint. How friggin boring that would be. I just aspire to ignoring the long list of my character flaws that my friends and family know and love and continue on making mahem.

        • sorethumb

           /  July 29, 2017

          I don’t believe that there ever was a time when people lived social lives as a rule-it doesn’t fit in with what I have read, and I have read a lot of history including many first-hand accounts
          ………
          Evolutionary psychology suggests the opposite. people lived in tribes and while parents were primary Uncles and Aunts were right on tap. Not also the genes were shared.

          Benjamin Franklin noted that when Indian children were adopted by whites and white children captured by Indians (excuse the language). When the indian child went to live with his relatives you couldn’t get him/her back. Likewise the white child prfered the Indian life.
          One famous case was Cynthia Ann Parker

          • Kitty Catkin

             /  July 29, 2017

            It has been some time since Western society was tribal.

            The idyllic view of tribal village life doesn’t take human nature into account.

      • sorethumb

         /  July 29, 2017

        Dead right and for older people a smartphone and internet are expensive as is contents insurance etc

    • sorethumb

       /  July 29, 2017

      Cover story, Time Australia, 11 September 1995
      20th Century Blues
      http://www.oocities.org/athens/stage/8922/

  4. sorethumb

     /  July 27, 2017

    Immigration, Ethnic Diversity and Cities:
    A Literature Review for Auckland Council
    There is a general consensus that countries, cities and communities are diversifying
    and that this is only going to increase with patterns of migration and globalisation.9
    This increasing ethnic diversity impacts on individuals, communities, organisations
    and government with the potential for negative (inter and intra-group tension, lack of
    social cohesion) and positive (social interaction, feeling safe, civic engagement,
    vibrancy) impacts at a personal, neighbourhood, city or national level. Places such as
    Canada have built a reputation for being proactive around ethnic diversity,10 while the
    New Zealand government has been less interventionist.11 However, it is recognised
    that this may not be a sustainable approach for Aotearoa New Zealand’s future of
    ‘superdiversity’.12
    Paul Spoonley, ‘Superdiversity, Social Cohesion, and Economic Benefits’, IZA World of Labor,
    2014, 46, doi: 10.15185/izawol.46.
    12 Mai Chen, The Superdiversity Stocktake: Implications for Law, Policy and Business, Auckland,
    ……….
    Mai Chen is an expert?
    http://www.tailrisk.co.nz/documents/TheSuperdiversityMyth.pdf

    “Superdiversity?”
    there is no heuristic that determines at what point diversity transforms into
    superdiversity. “The use of ‘superdiverse’ as a descriptive adjective,” argues Deumert (2014), “is a theoretical cul-de-sac, because the complexities brought about by diversity in the social world ultimately defy numerical measurement” (p. 116). Tagging on super- does not solve the problem but amplifies it, requiring us to accept that which cannot be defined as an article of faith. To facilitate the process an American journalist Walter Lippman once labelled “the manufacture of consent”, the authors appeal to affective rhetoric (radical, tremendous, complexity of a different kind) and syntactic structures that naturalize superdiversity, making it an agent and an astroturfing voice that “questions the foundations of our knowledge”
    http://www.academia.edu/21163221/Superdiversity_and_why_it_isnt_Reflections_on_terminological_innovation_and_academic_branding_2016_

  5. Alan Wilkinson

     /  July 27, 2017

    I blame fuckwitted environmentalists making it hard for people and kids to have pets to look after and love and be loved. We’ve got a bunch of feather-head fixated loonies up here trying to ban all pets on Russell peninsular in pursuit of their ecological fantasies.

    • Patzcuaro

       /  July 27, 2017

      You are obviously not to worried about the Kiwi’s physical or mental health. I don’t deny the therapeutic effects of pets but it would be a very dull world when it gets down to just humans and their pets.

      • Alan Wilkinson

         /  July 27, 2017

        Then what is obvious is far from true, Patz.
        http://time.com/4870796/dog-owners-benefits/

        • Patzcuaro

           /  July 27, 2017

          I agree pets are great, we a poodle/lowchen cross, are dog sitting a golden retriever and are trying to tame a wild teenage cat, hopefully prior to pregnancy.

          But modern living impacts on everything around us, both the flora and fauna, but it is a balancing act, it would be a dull world without the flora & fauna. Unfortunately not everyone is a responsible cat or dog owner.

        • Alan Wilkinson

           /  July 27, 2017

          Some people are bad drivers but we don’t ban cars, Patz. The irony is the dog walkers spend far more time enjoying the natural world than most other people. They live in nice places like Russell exactly because they love and respect nature.

          They live it every day unlike those who migrate between home, work and coffee shop while virtue signalling about being Greenies.

          • Patzcuaro

             /  July 27, 2017

            We do ban bad drivers though and probably should ban more bad dog owners.
            Ever since man arrive in NZ we having been moulding nature to our needs, it is time to give a little back to nature.

    • sorethumb

       /  July 29, 2017

      I blame industrial society. The trade of for high production is specialised production and a division of labour.

  6. Gezza

     /  July 27, 2017

    Piss poor parents.

    • Kitty Catkin

       /  July 27, 2017

      Who have been around since human beings have,

      • Gezza

         /  July 27, 2017

        Christ – they must be bloody ancient now.

  1. Modern living impacts on mental health and suicide — Your NZ – NZ Conservative Coalition