The ANZJP: maintaining 2020 vision in the face of an ever-changing climate

Penning this in the dying days of 2019, as titanic plumes of smoke rise along Australia’s Eastern Seaboard and Sydney lies shrouded, the topic of suicide seems a timely one. As if the self-induced existential threat of anthropogenic climate change were not sufficiently anxiety-provoking, it is joined by anxieties about immediate global political developments: the impeachment of the US president and an election in the UK that will likely determine the fate of Brexit.

In the face of these challenging times, the content of the ANZJP conveys a range of sentiments, but chiefly those of discovery, advancement and hope, as we publish world-class research alongside opinions, observations and comments. Nonetheless, amongst this optimism lurks a sobering truth: suicide continues unabated – refusing to change course despite our best efforts. It is therefore a key theme in this issue, and one explanation for its uncompromising trend is provided by a Debate by Bastiampillai and colleagues (this issue). Bastiampillai et al draw on the perspectives of Durkheim, who framed the problem in sociological terms and presciently allowed for war and economic depression, respectively, to curb and exacerbate the rates of societal suicide. At the core of Durkheim’s argument is the extent to which an individual is integrated into their society through social groups. This brief article is well worth reading, and the figure of Australian suicide rates per 100,000 individuals extending over nearly a century should be committed to memory and serve as a clarion call for action.

At the other extreme, amongst a triad of debates on suicide, the question is posed as to whether ‘suicide’ can leave a biological signature by way of a failed suicide attempt and whether this serves as a catalyst for future suicidal ideation. Malhi and colleagues (this issue) outline a model of thinking that potentially underpins the process of suicide and suggest that perhaps this pathway is irreversibly altered by having enacted a suicide attempt.

The third suicide debate in this group briefly outlines the service provided by Lifeline and identifies its potential shortcomings - advocating a rethink of suicide prevention and the role a helpline can play in this regard. Again, this paper by Watson and Spiteri (this issue) is essential reading.

Sticking with the means to assist the delivery of mental health aid, Marshall and colleagues (this issue) examine critically the effectiveness of mobile mental health apps for treating anxiety and depression, concluding that, in addition to the well-rehearsed plea for further research, it also important to heed a warning that the efficacy of such technological alternatives should not be presumed in the absence of evidence. This review is followed by another led by Witt and colleagues (this issue) that addresses the molecule of the moment, namely ketamine, and its use for suicidal ideation in those with psychiatric disorders. The systematic review and meta-analysis suggest that a single infusion of ketamine may have a short-term beneficial impact on suicidal thoughts, meaning that it may well be able to target acute suicidality. The authors appropriately caution against premature enthusiasm, noting that whether the anti-suicidal effect is sustained needs to be determined, but the possibility that this approach could curb suicidal thinking and suicidal attempts is both intriguing and hopeful and will no doubt further the heightened interest in the actions of this ‘new medication’.

Suicide is discussed further in terms of its impact on family members bereaved by suicide in a study by Kõlves and colleagues (this issue), which identifies an effect on stigmatisation, shame, rejection and responsibility, an impact that appears to be sustained, at least for the first two years following loss. The impact of loss is developed further, but more specifically, by Pirkis and colleagues (this issue) who examine suicides in Australia following reports of the death of Robin Williams in the media. They examine the complex issue of how suicide should or should not be portrayed, reported or relayed and what potential impact this might have. These many discussions on suicide are picked up in Commentaries and Letters to the Editor that examine resilience and its relation to suicidal behaviour and consider more broadly our approach to framing suicide and its prevention (Rosenman, this issue; Sher, this issue; Pridmore, this issue).

Alongside the strong theme of suicide-related research and opinion, many other important topics are touched upon by papers in this first issue of 2020. Reflecting on the quality of research and erudition of discussion and debate, psychiatry in the pages of ANZJP, and Antipodean psychiatry as a whole, evidently has a lot to offer globally and draws clearly on solid foundations laid down by outstanding predecessors. If there were any question of whether this is mere hyperbole, then even a cursory glance at Gordon Parker’s Viewpoint (Parker, this issue) ‘Australian psychiatrists on the world stage’ will promptly clarify the matter and dispel any enkindled misgivings.

Thus, as we start the New Year, I am pleased to say, and I am sure you will agree, that the ANZJP continues to flourish and to achieve greater impact whilst maintaining its independence and diversity of opinion. If only we could be equally sanguine that we, and our leaders, will ‘choose life’ when it comes to global warming and the changing political climate. Let us hope that 2020 – the year of good vision – is one in which we will all be able to see a clearer future.