I'm June Gruber an Associate Professor of Psychology at the University of Colorado Boulder and director of this Mental Health experts Series. We're here today with Dr. Matt Nock, the Editor, Peers Professor of Psychology, Harvard College professor and Department Chair in the Department of Psychology at Harvard University to talk with him about his pioneering work on the suicide and other forms of self-harm. Thanks for being here today, Matt. Thanks so much for having me. Can you tell me a little bit about the kind of mental health work you're doing? Yes. So I'm fortunate to work in a research lab at Harvard University where we study primarily why people do things to intentionally harm themselves, so we study suicide and non-suicidal self-injury. Our work is aimed at trying to better understand, predict, and prevent these behaviors. How did you go about first getting started at this really important line of work? I got interested when I was a junior in undergraduate at Boston EU, I did a semester abroad in London. Sorry for the so much detail, but you asked. We did classes and they had us go on these sort of practicum placements. I was placed in a psychiatric hospital unit for patients who were violent and self-injurious. At the time, I wanted to be a practicing clinician and I was really taken aback, perplexed by the extreme self-harm violence suicidal behavior that I saw on the unit. I thought, if I'm going to work clinically, this is stuff that I really need to understand. It seems like deep end of the pool kind of stuff. When I finished my undergraduate training, my thought was let me learn more about suicide and self-injury. That will help me as a clinician to be able to treat everything else, if I can treat the harder stuff. I started doing volunteering, doing research on suicide and related behaviors and just really got hooked on the research process. The problem of trying to understand suicide. It's a huge, huge, it's second leading cause of death for those ages 15-35 in the US, so top ten leading cause of death overall. It just really, really poorly understood. So I have been really focused on trying to advance the science and use science to better understand suicide and take what we learn and translate it for clinical purposes. From that first practicum experience and thinking about your career trajectory until now, what stands out as some notable frustrations and challenges as well as successes you've savored along the way. There's lot of challenges to studying suicide in general. The stigma involved, makes it difficult and the stigma involved leads to decreased funding. So there's not a lot of funding available for suicide. It's a tenth leading cause of death. But if you'll get numbers nine and 11 and keep looking, they have three times as much funding as suicide does, which we think is largely driven by state, but people don't like talking about it. They don't like focusing on it. As a result, don't like allocating resources to better understand it, so it continues to have a negative impact. There's not as much funding for suicide as there is for other leading causes of death. Their work is challenging. IRBUI, we've done work in schools. Schools don't mostly ask their students about suicide. A lot of parents don't want us asking kids about suicide. So just layers of stigma that make it difficult to get traction and understand this problem, which I think is not dissimilar to what we saw decades ago. People wouldn't say the word cancer. They would say the C word, but they'd whisper it. Now that stigma has gone away, we've learned a lot about cancer, how to treat it. Same with HIV/AIDS. Unfortunately, this hasn't yet happened with suicide. Some of the biggest challenges have just been structural, societal and studying it. Successes. We haven't had enough. We haven't had a lot. It's still a big problem. Some that come to mind are, the past few years, other groups have gotten some traction in building more accurate predictive models, largely by trying new things that are now possible with advances in technology and digital data capture. We're doing things like using electronic health records. It used to be all of our health records that our doctors had on us were paper and pencil, now they're all electronic. So now we're using machine learning methods, statistical learning methods to comb across medical records to try and build more accurate predictive algorithms and having some successes. Rather than just relying on self-report; asking someone, are you thinking about killing yourself? Which a lot of people who are thinking about killing themselves will say no, because they don't want to be stopped. We now have digital tools, behavioral tasks, and other things where we can get a more objective read on how somebody might be thinking about suicide. Using new smartphone apps, wearable biosensors, Apple Watches, smartwatches, we can get a better sense of how suicidal thoughts ebb and flow. We know that they are very episodic, they're not there and then they appear. If we wait once a week, once a month to check in on someone that's too infrequent. We're learning a lot about how suicidal thoughts ebb and flow and better at using those data to predict when someone's going to try and kill themselves. There are a lot of barriers, we're starting to have more and more successes as we incorporate some newly available technology. I think there's reason for optimism. You're mentioning these really pioneering technologies that are helping advanced the field and move it forward. When you look forward and think of the future of the field, what do you see as the most important next steps? Identifying gaps and bridging them. We're trying to bridge them with these new technologies. Not just buying technology and use it because it's cool. But suicide, although a leading cause of death, is a low base rate behavior so we need really large samples to be able to predict accurately suicide attempts. Digital data allow us to get these larger and larger samples where we don't have good temporal granularity in our predictive models. Again, digital means are filling that gap and we're able to collect lots of data continuously over time on people. We're taking advantage of social media platforms where people are posting their thoughts, their feelings, their intentions. Building models that can identify people who are at-risk there and then across all of these, using these as an infrastructure for intervention. Sending signals to a person's clinician based on medical record, suggesting that they intervene, sending interventions to a person's smartphone, to a social media platform. I think there's a lot we can take advantage of, not just in suicide research, but at mental health research. There's been huge advances on how we live our lives based on technology. A lot of what we do in mental health, in terms of assessment and treatment, looks the same as it did 1000 years ago in terms of talk therapy and so on. Come in once a week for 50 minutes and see me, we'll talk about things, and then come back a week later and not do much in between. It's a little bit of a caricature, but I think there's a lot more that we could take advantage of digitally and getting ideas from younger people. I think that the digital natives, the people who have grown up with these technologies and know how they're used, how they're misused. I think younger people are going to be key for changing the way we do business and mental health research and practice. The last question I have for you is, what advice might you have for those who might be watching this interview today? Maybe students, the general public who are interested in the field and maybe want to get engaged. Get engaged, jump right in, work with people who are in your university, in your setting, and be creative. There's a great book by a scientist named E. O. Wilson, who's a Harvard researcher, no bias there. Actually, it's a really good book called Letters to a Young Scientist. He talks about how to succeed as a scientist if you want to go into science. He's got a TED Talk, if you don't want read the book, it's 15 minutes. I'll steal one of his key piece of that advice. He said there's an old military dictum that says, "To be a good soldier, march toward the sound of the guns." If you're in the fog of war, this is my interpretation of his statement. You're in a battle and you're soldier, go toward where the firepower is, go towards where the guns are, go to the battle. He says, "To be a good scientist, do the exact opposite." March away from the sound of the guns. Don't just do what everyone else is doing. Don't just do small incremental next steps, derivative of something that someone's doing. Identify a problem and think about a number of solutions to that problem. Learn another way to measure that problem or study that problem and push that forward. Learn about what's happening but don't be shy about being creative and trying something new. These are huge mental health problems we're struggling with and what we've been doing has helped, but it hasn't helped enough and so we need new people, new ideas, new methods to push things forward. I'm hopeful that some smart, creative young folks watching this are going to help make huge advances in understanding prediction, prevention of mental health problems that you and I have been studying for years. Great. Thanks so much Matt for talking today. Thank you so much for the opportunity.
