Q&A with Prof. E. David Klonsky: Insights into Suicide

E. David Klonsky is clinical psychologist and an associate professor in the Department of Psychology. Director of the Personality, Emotion, and Behaviour Lab (PEBL), his research focuses on understanding and preventing suicide.
In advance of Suicide Awareness Day at UBC (January 27), we sit down with Dr. Klonsky to learn more about his research, to gain insights into suicide, and about how show support and get involved at UBC.
First of all, what has led you to research suicide?
While many variables in psychology are vague and hard to identify (e.g., what exactly is personality?), suicide attempts are real behaviours that are critical to understand and prevent. I am drawn to this topic both by intellectual curiosity (what motivates suicide, what leads some who feel suicidal to attempt suicide but not others), and by a strong desire to ensure that people in need can be understood and helped.

How is your research on suicide guided?
The scientific method is humanity’s most powerful tool for advancing knowledge. So we identify the questions we feel are most central to understanding suicide, and design scientific studies to answer them. In large part this involves recruiting people with histories of suicidal thoughts and behaviours so that we can ask them questions about their experiences; we are grateful to these individuals for their time and help.
You developed a measure of motivations for suicide. How can assessing the motivations for suicide attempts improve suicide prevention and intervention?
The truth is that mental health professionals don’t understand suicide very well. We have a partial understanding. This is reflected in the fact that there are various theories of suicide that emphasize different motivations (e.g., social isolation, hopelessness, overwhelming pain, cry for help), but there is no scientific consensus about which motivations are most common, in part because there has been no strong scientific effort to address this issue. Understanding why people attempt suicide is absolutely crucial for understanding how to best predict and prevent suicide.
Can you tell us more about the ‘Three-Step Theory’ of suicide that you developed?
In 2014 I proposed that an ‘ideation-to-action’ framework should guide suicide research, theory, and prevention. From this perspective, a) the development of suicide thoughts and b) the progression from thoughts to suicide attempts are distinct processes with distinct explanations. This framework is critical because most people with suicidal thoughts do not attempt. Moreover, research reveals that oft-cited suicide risk factors – including mental disorders, depression, hopelessness, and even impulsivity – strongly predict ideation but poorly distinguish attempters from ideators. In short, we do not understand when or why suicidal thoughts progresses to action. This knowledge gap severely limits how we understand and help people at risk for suicide.
The Three-Step Theory (3ST) is a new model of suicide that is evidence-based, easy to understand, and positioned within the ideation-to-action framework. The 3ST holds that: 1) suicidal thoughts result from the combination of emotional pain and hopelessness; 2) these thoughts becomes strong when pain exceeds connectedness; and 3) progression from thoughts to action requires one to overcome the fear of death, pain, and injury that serves as a barrier to making a suicide attempt. Clinically, the 3ST suggests 4 suicide prevention targets: a) reduce pain, b) increase hope, c) improve connection, d) reduce capacity to make an attempt. The theory is described in more detail here: http://www2.psych.ubc.ca/~klonsky/publications/3ST.pdf
How can we better understand why someone might be suicidal?
As suggested by the 3ST, we believe the first steps toward feeling suicidal are a) pain (usually psychological) and b) hopelessness that one’s situation will improve. Thus, the key for understanding any given person’s suicidal feelings is to understand the sources of their pain and the barriers that they feel prevent them from improving their circumstances. The answers to these questions will of course vary quite a bit from person to person, and manifest quite differently in, for example, a 73-year-old woman who recently lost a long-time spouse versus a 13-year-old adolescent boy struggling at school. But the 3ST provides useful guidance for understanding any given person’s experiencing of suicidal thoughts.
How do we help get society beyond stigma and fear around suicide?
This is a difficult but extremely important question. At one time breast cancer was so stigmatized that most people with breast cancer were secretive about their illness and most people at risk for breast cancer would not know to seek screening and potential early prevention. Breast cancer awareness and prevention campaigns have been extremely successful and substantially reduced mortality over the past few decades. I’m wondering if something similar could be possible for suicide.
Suicide is the 2nd leading cause of death among Canadians ages 15 to 34 – ahead of cancer, heart disease, auto accidents, and homicide. Yet it is not often discussed as a leading cause of death, and it is very difficult to get funding for suicide research. Why is this? I suspect stigma is a main reason. The topic makes people uncomfortable and many of us may hold (erroneous) negative beliefs about people who struggle with suicidal thoughts. As a result, suicide remains a leading cause of death that is rarely discussed seriously by policy-makers and community leaders. I wish I knew how to get society beyond the stigma and fear. I have a fantasy to one day work with experts in advertising and social media to figure out how to solve this. At the least, each person can remind themselves to be compassionate and non-judgmental when discussing suicide; people who struggle with suicidal feelings are suffering, and could use your help and compassion.
How can we help someone who is suicidal?
If you or someone you know is feeling suicidal and in crisis, you can call 1-800-SUICIDE (1-800-784-2433) to speak with a crisis line worker and get help.
January 27 is Suicide Awareness Day at UBC. There are a number of ways you can show your support and raise awareness to help prevent suicide. Learn more.

-Bonnie Vockeroth