David Gunnell is Professor of Epidemiology at the University of Bristol, and leads the Bristol Suicide and Self-harm Research Group, hosted within the Centre for Academic Mental Health at the university.
What are your main research interests?
That’s a big question isn’t it? I’m a public health physician, so my focus is on prevention at a population level. My research comes from a desire to understand influences on variations in suicide rates nationally and internationally as well as over time, and from such an understanding identify the best targets for prevention. Related to this I’ve done quite a lot of work over the years on suicide methods and the role of means restriction in prevention; in particular, pesticide self-poisoning in developing countries and factors influencing the emergence of a new method of suicide such as the rise in suicide that occurred in the Far East with the charcoal burning epidemic. But I’m fairly eclectic, suicide is a huge area and I guess the main thing driving my thinking – before starting a piece of research – is whether findings could potentially help us understand how to better prevent suicide at a population level.
Can you describe briefly your career path?
I started out training as a medical doctor and spent the first couple of years of my post-qualification life working in general medicine, general practice and psychiatry. I then discovered, almost by chance, the discipline of public health in the early 1990s. My clinical career left me frustrated at times that the things we were seeing in clinics and emergency departments were potentially preventable. I didn’t really realise there was a medical specialty that was all about epidemiology and prevention: public health, sometimes called population health. I found out about it almost by accident and changed career tack to public health medicine in the early 1990s more or less straight away. I started out on a public health training scheme, moved onto an academic post from a service post, did a PhD in aetiological epidemiology, it focussed on investigating childhood influences on coronary heart disease and cancer in adulthood, this gave me my grounding in epidemiology and statistical skills. I did a master’s in medical statistics in London which was incredibly helpful.
For a spell I pursued twin interests in early life influences on adult cancer and cardiovascular disease as well as suicide prevention. As I became more senior and had more admin responsibilities, I just had to focus on one or other of those areas. I was particularly drawn to suicide prevention because of the impact on me of the suicides of some of my patients when I was doing psychiatry. Then one of my earliest jobs as a public health registrar, was to investigate why the region I was working in had such a high suicide rate. I spent a couple of months going through the coroner’s inquest records of two Coroners in Somerset and read the stories of about 100 people that died by suicide. In reading those accounts I was struck by the missed opportunities and potential for preventing some of those deaths, particularly where people had been going through brief periods of crisis.
What would you say your career highlights are?
It depends whether you mean academic achievements or things I think were fun. The highlights looking back at my career include working with great colleagues, seeing colleagues develop and become senior independent researchers. That’s a great driver. I think as you become more senior it’s rewarding to see people you work with develop skills do PhDs, publish papers, become independent.
Visiting colleagues around the world, working with them on issues of joint interest with some fantastic people in Asia, Europe and the Americas has also been really rewarding. Meeting the faces and personalities behind the papers that I’d admired and been influenced by as a junior researcher, from going to conferences and from developing collaborations, I’ve got to better understand the people behind the research, developed friendships and collaboration through that, that’s been great. Also, more recently the kind of opportunities to use experience and knowledge I’ve built up over the years to inform, or contribute to, policy-making and prevention strategies, working with WHO, the Department of Health in England, the MHRA [Medicines and Healthcare products Regulatory Agency], and Bristol City Council. Particular highlights have been working with Madeleine Moon MP and the APPG for suicide prevention – meeting Government Ministers and the Chief Coroner to discuss policy-related issues. Related to this working with the Samaritans media team and local and national media to make the reporting and coverage of suicide safer. It’s just a real privilege to be able to use one’s knowledge of the wider literature and sometimes one’s own findings to make sure people are using the best available evidence in research to inform practice.
It’s rewarding seeing how different countries are dealing with the same issue in a different context: travelling to countries such as Sri Lanka, Taiwan, Denmark, Norway, Hong Kong, China, India, and hearing about how the problems of suicide impact on their populations, that’s a real privilege; and using some of that knowledge, bringing it back here, thinking how can we implement those approaches here. One of the things when you go into research – unlike clinical practice -where we can often see within days and weeks the impact of treatments or advice on a person’s health, in population health it may take years or may never occur. One of the most rewarding things recently is seeing the impact in a couple of countries that have introduced pesticide regulation of those regulations on suicide rates, so it’s quite nice to actually see in real time if you like, the impact of policy measures around research that I’ve been involved with.
Could you discuss any career low-lights you’ve had?
There are the regular disappointments of all too frequent rejections from journals and funding bodies. You have to develop a thick skin as the highlights occur pretty infrequently. It’s hard to think of specific disappointments as there have been so many… The last couple of years here in Bristol have been really tough as we’ve experienced two clusters of suicide deaths amongst our students and that’s been immensely upsetting. The reporting of the deaths in some of the national papers has also really upset me and reminds me of the need for ongoing dialogue with the media. A real disappointment in recent times has been the reluctance of the Clifton Suspension Bridge trustees to further enhance the safety measures on the Bridge. One of the highlights early on in my career was doing some work in the 1990s with Mike Nowers, a local old age psychiatrist; we worked together to look at suicide deaths from the Clifton Suspension Bridge as it’s our local high-risk location. We presented our work to the Bridge Trustees who shortly afterwards ran a competition to put up protective measures on the Bridge, we then evaluated the impact of the barriers; suicide rates from the bridge halved and there was evidence of a reduction in suicides by jumping throughout Bristol, but due to the numbers involved it was not possible to detect an impact on overall suicide numbers. But since then, deaths have continued from the Bridge and it’s been really upsetting and frustrating trying to engage with the trustees to make the Bridge safer still, because it is very often young people that jump, often in a short lived period of crisis in their lives. Making the Bridge safer would protect more local lives. It’s sad that the Bridge remains a feature of deaths in Bristol most recently our student deaths. Another frustration and sadness has been the suicide prevention community’s degree of engagement with the pesticide industry; my sense has been that this has distorted our community’s priorities and advice surrounding this globally important issue. Some colleagues and suicide prevention organisations have tended to support policies that often lack evidence and favour industry priorities. Pesticide poisoning accounts for up to a fifth of global suicides, so this is a great disappointment.
A sad thing about being known for doing research in this area is that friends and colleagues who have lost a family member, friend or someone they work with to suicide will often ask me for advice, it’s rewarding to be helpful, but always really sad when you hear those stories it makes you wonder what more one should be doing in research and campaigning to prevent such deaths. My career isn’t one long career highlights that’s for sure – it’s punctuated by lots of highs and lows and frustrations as well as really exciting things.
What advice would you give to early career researchers working in the field of suicide and self-harm?
First of all, I would say thank you, it’s exciting to see that young enthusiastic people are coming into this field. It’s really important to have new blood, fresh ideas and perspectives. In terms of advice, I think the first thing is, you know this is quite a tough area emotionally to be working in, so look after yourself make sure you have a strong network of support. Make sure that you are aware that working in this area can be tough, not only have you got the real challenges of starting up a research career and the challenges of learning about the subject, writing an 80,000 word dissertation everything that goes with that you’ve also got the emotional challenges of working in an area that can be very distressing and affects so many people, but many people find difficult to talk about or feel prevention is futile. So protect yourself.
More generally, my advice to all researchers is, work hard and take as many opportunities that come your way as you can and prioritise publishing and dissemination. An academic career is tough, there’s a pyramidal structure to career progression, quite a lot of people do postgraduate study, a PhD, a masters, fewer progress onto post-doctoral research associate posts, fewer still to tenured posts. It’s important to get that work life balance right, clearly you can work far too hard and that isn’t good for your well-being and mental health, so get the balance right between work and play.
What are the key things you look for when you are hiring an early career researcher?
Well first of all it depends on the post, so if it’s a quantitative post or a qualitative post, someone’s skills in those particular areas, interest in the topic, someone who’s done the homework about the post and the institution they are coming to so you’ve got a sense they are really interested in joining a team or location, rather than it just being another job. Look at the record of their publications set against where they are in their career. Academia is really tough, you can be easily judged by simply typing someone’s name into Medline and just seeing how many publications they are producing and the impact of those publications – how often they’ve been cited, so in 5 minutes you can get a fair assessment of where someone is. I think that makes it quite tough. Of course, this can sometimes be over-simplistic because some branches of research it’s easier to produce and keep the momentum of publications going particularly perhaps if you’re working on a big cohort study it’s quite easy to do several relatively quick outputs from that work. Doing qualitative research or working on large clinical trials by contrast can be very difficult getting the data particularly in our field. So I think that looking at publication numbers alone can be too crude an indicator, you have to consider that against the quality of the paper and the area the person is working in. So, I’d look at interest in the job, publication track record, and as early career researchers work their way up the greasy pole, capacity to generate income via grant funding.
What do you get up to in your spare time and what is essential to your well-being?
I try to prioritise time with my family. Exercise I find a really fantastic release when I’m feeling stressed. I used to do triathlons, but I can’t run or cycle much now because of overdoing it in my 50s and damaging my knee. Now it’s just outdoor swimming, walking and yoga. Also, reading, cooking, a little amateur palaeontology and spending time with friends.