Personal Stigma in Suicide Attempters

Suicide-related stigma and its relationship with help-seeking, mental health, suicidality and grief: scoping review

BACKGROUND

Suicide-related stigma (i.e. negative attitudes towards people with suicidal thoughts and/or behaviours as well as those bereaved by suicide) is a potential risk factor for suicide and mental health problems. To date, there has been no scoping review investigating the association between suicide-related stigma and mental health, help-seeking, suicide and grief across several groups affected by suicide.

AIMS

To determine the nature of the relationship between suicide-related stigma and mental health, help-seeking, grief (as a result of suicide bereavement) and suicide risk.

METHOD

This review was registered with PROSPERO (CRD42022327093). Five databases (Web of Science, APA PsycInfo, Embase, ASSIA and PubMed) were searched, with the final update in May 2024. Studies were included if they were published in English between 2000 and 2024 and assessed both suicide-related stigma AND one of the following: suicide, suicidal thoughts or suicidal behaviours, help-seeking, grief or other mental health variables. Following screening of 14 994 studies, 100 eligible studies were identified. Following data charting, cross-checking was conducted to ensure no relevant findings were missed.

RESULTS

Findings across the studies were mixed. However, most commonly, suicide-related stigma was associated with higher levels of suicide risk, poor mental health, lowered help-seeking and grief-related difficulties. A model of suicide-related stigma has been developed to display the directionality of these associations.

CONCLUSIONS

This review emphasises the importance of reducing the stigma associated with suicide and suicidal behaviour to improve outcomes for individuals affected by suicide. It also identifies gaps in our knowledge as well as providing suggestions for future research.

Association Between Suicidal Ideation and Cancer Screening Uptake: Results from Middle-Aged and Older Adults in Korea

BACKGROUND

Compliance with cancer screening guidelines is crucial for the early diagnosis and prevention of cancer. We explored the association of suicidal ideation with participation in cancer screening programs.

METHODS

This cross-sectional analysis included a nationwide sample consisting of 22,554 Korean adults (9667 men and 12,887 women). Suicidal ideation in the past year was self-reported (yes or no). Participation in gastric, colorectal, cervical, and breast cancer screening within the past 2 years was assessed. Logistic regression models were employed to determine the association of suicidal ideation with participation in each cancer screening test. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.

RESULTS

Among men, the participation rates in gastric and colorectal cancer screening were 47.6% and 39.7%, respectively. Among women, the participation rates in gastric, colorectal, cervical, and breast cancer screening were 47.1%, 34.8%, 44.3%, and 50.8%, respectively. In the male sample, suicidal ideation was associated with reduced participation in gastric cancer screening (OR: 0.83, 95% CI: 0.69-0.99) and colorectal cancer screening (OR: 0.82, 95% CI: 0.67-1.00). Similarly, in the female sample, suicidal ideation was inversely associated with participation in gastric (OR: 0.74, 95% CI: 0.67-0.82), colorectal (OR: 0.71, 95% CI: 0.62-0.81), cervical (OR: 0.75, 95% CI: 0.68-0.84), and breast cancer screening (OR: 0.76, 95% CI: 0.68-0.84).

CONCLUSIONS

This study suggests that individuals with suicidal ideation demonstrated reduced participation in cancer screening tests. This study highlights the need for targeted support to improve access to cancer screening programs for individuals with mental health problems.

Change in incidents of suicidal acts after intervention on a bridge in South Korea

PURPOSE

To investigate whether two novel interventions on a bridge - a Video Incident Detection System (VIDS) and spinning bar barriers - have an impact on suicidal behaviour on the bridge.

METHODS

A total of 146 suicidal acts were retrieved for analyses; 108 interventions before suicidal acts, 35 suicide deaths and 3 suicide attempts. Incident rate ratios (IRR) were calculated to estimate the change in incident rate associated with implementation of the two interventions: VIDS and the spinning bar 2-metre high barrier.

RESULTS

The results of the Poisson regression showed that the rate of suicide deaths, after installation the VIDS, did not change significantly (IRR: 1.23, 95% Confidence Interval [95% CI]: 0.59-2.56), although the rate of intervened suicidal acts increased (IRR: 2.40, 95% CI: 1.65-3.47). The results showed that subsequent spinning bar installation resulted in a decrease in the incident rate of intervened suicidal acts (IRR: 0.37, 95% CI: 0.25-0.57) as well as suicide deaths (IRR: 0.23, 95% CI: 0.07-0.71). Comparison of the period when both interventions were in place with the period with no interventions indicated a reduction in suicide deaths (IRR: 0.28, 95% CI: 0.10-0.82), but no change in intervened suicidal acts (IRR: 0.90, 95% CI: 0.59-1.38).

CONCLUSION

The rate of suicide death decreased after the installation of the spinning bar barrier but not after the implementation of VIDS alone. Our findings reinforce that restricting access to means is a highly effective way of preventing suicide on bridges and that spinning bars may be a helpful way to design barriers.

Validation of the personal suicide stigma questionnaire among adolescents with suicide attempts in mainland China

Objectives

The study aimed to translate and culturally adapt the personal suicide stigma questionnaire (PSSQ) into simplified Chinese and evaluate its psychometric properties among adolescents who have attempted suicide in mainland China.

Methods

Following Brislin's translation model and using purposive sampling, we surveyed 440 adolescents who had attempted suicide at Hangzhou Seventh People's Hospital in Zhejiang Province, China. Content validity was determined by a panel of experts, and the construct validity of the scale was assessed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity, and discriminant validity. Reliability analysis was evaluated using Cronbach's α coefficient, test-retest reliability, and half-split reliability.

Results

The Chinese version of the PSSQ consists of three dimensions and 14 items. After two rounds of expert consultation, the item-content validity index for all items exceeded 0.70, and the scale-content validity index exceeded 0.90. EFA extracted three factors and retained all 14 items. The CFA indicators demonstrated a good fit. The Cronbach's α coefficient of the scale was 0.880, the half-split reliability was 0.681, and the test-retest reliability was 0.862. It is evident that the PSSQ and its subscales demonstrate stable structural validity and good internal consistency in measuring self-stigma among individuals with suicidal tendencies, indicating that the PSSQ is a reliable tool for assessing the degree of personal stigma in Chinese adolescents who have attempted suicide.

Conclusion

This study ensured the linguistic and cultural appropriateness of the Chinese version of the PSSQ through cross-cultural adaptation and validation of its reliability and validity, thereby enhancing the accuracy and reliability of assessing personal stigma among Chinese adolescents who have attempted suicide. The validation of the Chinese version of the scale not only enriches the research tools available for studying personal stigma related to suicide in mainland China, but also provides a reliable quantitative tool for future research on the psychological states of individuals who have attempted suicide, the impact of stigma, and the effectiveness of interventions.

'I live it all together…sadness, desperation': A qualitative exploration of psychosocial challenges and needs of young people after suicide attempt

This study aimed to explore the psychosocial challenges and support needs of young people after suicide attempt. In the research, the phenomenological approach was used. Semi-structured interviews were held with 16 young people shortly after suicide attempt. Data were analysed via content analysis. The data were categorized into five themes: effort to return to the old normal, living with remains, need for support, barriers to seeking help, and awareness. Understanding the psychological challenges and support needs of young people who have attempted suicide will facilitate future research and practice. To support young people in the acute period following the intervention, supportive interventions at the individual, social and political levels need to be established. These findings shed light into the structuring of supportive interventions to be applied to young people following a suicide attempt.

Remaining Between the Cracks - The Long-Term Effect of Different Suicide Risk Exclusion Criterion on Outcomes of an Online Intervention for Depression

Background: Previous studies have demonstrated that excluding individuals at risk of suicide from online depression interventions can impact recruited sample characteristics. Aim: To determine if a small change in suicide risk exclusion criterion led to differences in the usage and effectiveness of an Internet depression intervention at 6 months of follow-up. Method: A partial sample of a recently completed online depression intervention trial was divided into two groups: those with no risk of suicide versus those with some risk. The two groups were compared for baseline demographic and clinical measures, as well as intervention uptake and treatment success across 6 months. Results: Overall, individuals with less risk of suicide at baseline reported significantly less severe clinical symptoms. Both groups interacted with the intervention at the same rate, but specific use of modules was different. Finally, the impact of intervention usage on outcomes over time did not vary by group. Limitations: While different suicide risk exclusion criteria can change recruited sample characteristics, it remains unclear how these differences impact intervention uptake and success. Conclusion: Overall, the findings suggest that researchers should exercise caution when excluding individuals at risk of suicide, as they greatly benefit from web-based interventions.

Suicide literacy mediates the path from religiosity to suicide stigma among Muslim community adults: Cross-sectional data from four Arab countries

BACKGROUND

The majority of research attention has been devoted to the link between religiosity and suicide risk, and a considerable amount of studies has been carried out on how stigma impacts individuals with mental health problems of different kinds. However, the interplay between religiosity, suicide literacy and suicide stigma has seldom been empirically researched, especially quantitatively. We sought through this study to redress the imbalance of research attention by examining the relationship between religiosity and suicide stigma; and the indirect and moderating effects of suicide literacy on this relationship.

METHOD

A cross-sectional web-based survey was conducted among Arab-Muslim adults originating from four Arab countries (Egypt: N = 1029, Kuwait: N = 2182, Lebanon N = 781, Tunisia N = 2343; Total sample: N = 6335). The outcome measures included the Arabic Religiosity Scale which taps into variation in the degree of religiosity, the Stigma of Suicide Scale-short form to the solicit degree of stigma related to suicide, and the Literacy of Suicide Scale explores knowledge and understanding of suicide.

RESULTS

Our Mediation analyses findings showed that literacy of suicide partially mediated the association between religiosity and stigmatizing attitude toward suicide. Higher religiosity was significantly associated with less literacy of suicide; higher literacy of suicide was significantly associated with less stigma of suicide. Finally, higher religiosity was directly and significantly associated with more stigmatization attitude toward suicide.

CONCLUSION

We contribute the literature by showing, for the first time, that suicide literacy plays a mediating role in the association between religiosity and suicide stigma in a sample of Arab-Muslim community adults. This preliminarily suggests that the effects of religiosity on suicide stigma can be modifiable through improving suicide literacy. This implies that interventions targeting highly religious individuals should pay dual attention to increasing suicide literacy and lowering suicide stigma.

Measuring Gatekeeper Instructor Comfort to Inform Suicide Prevention Train-The-Trainer Recruitment & Training in Agricultural Communities

Farmers experience psychological distress and suicide at consistently higher rates than workers in other industries. A gatekeeper is an individual who has been trained to recognize warning symptoms of possible suicidal ideations in others. Gatekeeper programs are recognized by the federal Substance Abuse and Mental Health Services Administration as a best practice for suicide prevention. While gatekeeper programs offer promise to addressing the increasing worldwide suicide rate, how to develop these networks in communities with largely ingrained stigma and taboo related to mental health and suicide remains unanswered. Three of this study's researchers were part of the development and pilot of an agricultural community gatekeeper program and questioned how gatekeeper instructor psychological comfort could be conceptualized and operationalized for the purpose of informing gatekeeper instructor recruitment and training. After a thorough review of the literature, the researchers constructed a conceptual developmental model of gatekeeper instructor comfort and created a Gatekeeper Instructor Comfort Measure instrument which was then piloted with Kentucky K-12 and university agricultural educators. The researchers of this study employed the Rasch model to determine whether the developmental model of gatekeeper instructor comfort held together empirically. Infit and outfit mean squares (0.73 to 1.33) indicate that the items measure one construct, or are unidimensional, while person reliability and separation statistics indicate that the Gatekeeper Instructor Comfort Measure is composed of enough items to differentiate respondents into almost four strata of gatekeeper comfort. The Gatekeeper Instructor Comfort Measure's fit to the Rasch model indicates that the instrument meets the requirements of invariant measurement and should serve as a useful measure for other researchers. The instrument's item difficulty hierarchy also serves as a guide for those training gatekeepers on how to target different gatekeeper outcomes sequentially or developmentally. Researchers recommend restructuring item responses to enable greater discrimination between categories and then piloting the instrument again with a more diverse sample. The revised measure could be used pre- and post-gatekeeper instructor training to determine the impact of training on gatekeeper comfort.

The Personal Suicide Stigma Questionnaire (PSSQ): Relation to Self-Esteem, Well-Being, and Help-Seeking

Two studies are reported that extend the evidence base for use of the Personal Stigma of Suicide Questionnaire (PSSQ). In the first study (N = 117), the Rosenberg Self-Esteem Scale, the WHO-5 measure of well-being, as well as measures of suicidality were examined in relation to the PSSQ. A self-selected sub-sample (N = 30) completed the PSSQ after an interval of two months. In line with the stigma internalization model, when demographic variables and suicidality were accounted for, the PSSQ self-blame subscale was the most significant predictor of self-esteem. As for well-being, the rejection subscale was involved as well as self-blame. The retest stability of the PSSQ for the sub-sample was 0.85 and coefficient alpha for the total sample was 0.95, indicating both good stability and internal consistency for the scale. In the second study (N = 140), PSSQ was studied in relation to intention to seek help from four sources in the case of suicidal ideation. The strongest relationship with PSSQ was with intention not to seek help from anyone (r = 0.35). When other variables were included in the prediction of help-seeking from a general medical practitioner, family or friends, or from nobody, the only significant PSSQ correlate was minimization. For help-seeking from a psychologist or psychiatrist, the most significant predictor was judged helpfulness of prior contact with them. The results from these studies strengthen previous findings of the construct validity of the PSSQ and point to its utility in understanding barriers to help-seeking among those experiencing suicidality.

Peer Intervention following Suicide-Related Emergency Department Presentation: Evaluation of the PAUSE Pilot Program

The risk for future suicidal behaviours is elevated following suicide attempts, particularly for those with complex needs or those who are disconnected from healthcare systems. The PAUSE program was designed to address this gap using peer workers to provide continuity and coordination of care following suicide-related emergency presentations. This study aimed to evaluate the pilot program's effect on suicidal ideation and hope, and to explore the acceptability and participants' experiences. A mixed-methods design was employed with pre- and post-evaluation questionnaires, including the GHQ-28-SS (general health questionnaire suicide scale), AHS (adult hope scale), and K10 (Kessler psychological distress scale). Participant engagement rates and semi-structured interviews were used to explore program acceptability. In total, 142 people were engaged with the PAUSE pilot between 24 August 2017 and 11 January 2020. There were no significant gender differences in engagement. The suicidal ideation scores decreased, and the hope scores increased after participation in PAUSE. A thematic analysis revealed that participants identified that the key program mechanisms were holistic and responsive support, ongoing social connectedness, and having peer workers who understood their experiences and treated them like people rather than clients. The small number of participants and lack of a control group limited the result generalizability. The findings suggest that PAUSE was an effective and acceptable model for supporting people following suicide-related hospitalisations in this pilot sample.

Suicide stigma measures: A scoping review

BACKGROUND

Worldwide, approximately 800,000 people die by suicide every year, and non-fatal suicidal thoughts and behaviours are common. Stigma is likely a major barrier to preventing suicide. The purpose of our review is to scope the development, psychometric properties and use of measures that explicitly seek to measure the construct of suicide stigma.

METHODS

We conducted a scoping review. We searched PubMed, PsycINFO, Embase and CINAHL using search terms related to suicide, stigma and measures/scales with no date limits. We included any measure the authors defined as measuring suicide-related stigma. Only peer-reviewed articles published in English were included.

RESULTS

We included 106 papers discussing 23 measures of suicide stigma; 82 provided data on psychometric properties. Measures assessed personal or public stigma; and stigma toward a range of suicidal phenomena (e.g., suicidal thoughts, those bereaved by suicide). 'Stigma' definitions varied and were not always provided. The Grief Experience Questionnaire, Suicide Opinion Questionnaire and Stigma of Suicide Scale were the most commonly cited. Measures varied in the strength of their psychometric properties.

LIMITATIONS

We only included papers in English. Because we included any measures authors defined as measuring suicide stigma, we may have included measures not commonly considered as measures of suicide stigma, and conversely we might have excluded relevant measures because they did not use the term 'stigma'.

DISCUSSION

This review aimed to assist in better understanding available suicide stigma measures, their strengths and weaknesses and current uses, and will inform the development of future suicide stigma measures.

Suicide in Switzerland: why gun ownership can be deadly

There is a great deal of empirical evidence that owning a firearm increases the risk of dying from suicide. Most suicides are impulsive. Nearly 50% of survivors of suicide attempts report that they took less than 10 minutes between the decision to die and their suicide attempt. The great majority of these suicide survivors never make another attempt and die of natural causes. Because nearly 90% of firearm suicide attempts have a deadly outcome, gun owners are unlikely to have such a second chance. These impulsive suicide attempts are typically carried out with the means at hand. Swiss men have much higher firearm suicide rates than men in other European countries and this excess is likely to be due to their easy access to guns, because army conscripts have to keep their guns at home. When the number of conscripts was nearly halved in 2003/4 as a result of the Swiss Army Reform XXI, the number of army-issued firearms was reduced by an estimated 20%. An analysis of suicide rates before and after the reform indicated that male (but not female) suicide rates decreased by 8%, with no evidence of substitution with other means of suicide. If the army would require that the remaining half of conscripts had to keep their weapons at their barracks rather than at home, a further decrease in male suicide rates could be expected.

Two sides of the same coin? The association between suicide stigma and suicide normalisation

AIMS

Evidence suggests that suicide stigma (i.e. negative attitudes towards persons affected by suicide/suicidality) and suicide normalisation (i.e. liberal attitudes towards suicide) are both associated with increased suicide risk. Despite conceptual similarities and potential interaction, suicide stigma and suicide normalisation have usually been investigated separately. We used cross-sectional data from a community sample to test the association between suicide stigma and suicide normalisation as well as to identify their respective determinants and consequences.

METHODS

Participants were N = 3.269 adults recruited from an established online-panel using quotas to reflect the composition of the German general population with regard to age, gender, education and region. We collected information about suicide stigma, suicide normalisation, intentions to seek help for suicidality, current suicidality, suicide literacy, negative mood and socio-demographic variables. We used regression modelling to determine the association between suicide stigma and suicide normalisation as well as to identify their determinants and consequences.

RESULTS

Suicide stigma and suicide normalisation were inversely associated so that higher suicide stigma scores were linked to lower suicide normalisation. More suicide stigma was associated with reduced intentions to seeking professional help, increased willingness to seek help from family and friends and lower odds to experience current suicidality, however the association between suicide stigma and intentions to seek professional help diminished after controlling for confounding variables. Increased suicide normalisation was linked to reduced intentions to seek help from professionals or family and friends, as well as higher odds to experience current suicidality, even after controlling for confounding variables.

CONCLUSIONS

Our findings suggest that interventions to reduce public suicide stigma are at risk to unintentionally increase suicide normalisation, which appears to be a key barrier to seeking help for suicidality. Future research should therefore identify strategies to improve attitudes towards persons affected by suicidality that avoid normalisation, i.e. do not convey the message of suicide as an acceptable solution for difficult life situations. One strategy with great potential to safely reduce public suicide sigma could be interventions that stimulate interpersonal contact with affected persons sharing their recovery story.

Psychological well-being in US veterans with non-fatal suicide attempts: A multi-cohort population-based study

BACKGROUND

Most people who survive suicide attempts neither re-attempt suicide nor die by suicide. Research on suicide attempt survivors has primarily focused on negative endpoints (e.g., increased suicide risk) rather than positive outcomes. One important outcome is psychological well-being (PWB), defined as positive functioning across emotional, intrapersonal, and interpersonal domains. We compared PWB among US military veterans with (i.e., attempt survivors) and without (i.e., non-attempters) a history of suicide attempt(s) using data from three nationally representative cohorts.

METHODS

Each US veteran cohort (Cohort1: N = 3148; Cohort2: N = 1474; Cohort3: N = 4042) completed measures of suicidality (e.g., attempt history), character strengths (e.g., curiosity, optimism), psychological symptoms (e.g., depression), and indicators of PWB (e.g., happiness). t-Tests were conducted to examine group differences in PWB; hierarchical regressions were conducted to examine suicide attempt status as a predictor of PWB controlling for symptoms and demographics. Multivariable regressions were conducted to identify predictors of PWB among attempt survivors.

RESULTS

In each cohort, reported PWB was markedly lower among suicide attempt survivors than non-attempters (ds = 0.9-1.2), even after adjusting for mental health symptoms. Individual differences in PWB were observed, with a subset of suicide attempt survivors reporting higher PWB levels than non-attempters (1.4-7.4 %). Curiosity and optimism were positively associated with PWB among suicide attempt survivors (rs = 0.60-0.78).

LIMITATIONS

Data were cross-sectional, limiting inferences about causation and directionality of associations.

CONCLUSIONS

Findings highlight diminished PWB as an important and understudied concern among veteran attempt survivors. Collectively, our findings underscore the importance of considering PWB in the research, assessment, and treatment of suicidality.

Preliminary Evaluation of Lived Experience of Suicide Training: Short-, Medium- and Longer-Term Impacts of Our Voices in Action Training

Despite increased participation and multiple workforce roles of those with lived experience in suicide prevention, there are no evaluated training programs to support this population. This study evaluated a training program aimed to prepare people for these important roles. Survey data at pre-, post- and at three- and 12-month follow-up were used measuring knowledge, attitudes, and self-efficacy, as well as psychological distress as a safety measure. Participants experienced significant gains in knowledge after training, although not all aspects of knowledge were maintained at follow-up. Self-efficacy was examined through confidence and empowerment. Confidence gains were significant at immediate and longer-term follow-up but gains in empowerment were not maintained over time. Participants' positive attitudes improved but this was not significant. There was no indication of increases in psychological distress in participants throughout the training and follow-up periods. Implications of these outcomes are discussed.

Dismantling Structural Stigma Related to Mental Health and Substance Use: An Educational Framework

Stigma related to mental health and substance use (MHSU) is a well-established construct that describes how inequitable health outcomes can result from prejudice, discrimination, and marginalization. Although there is a body of literature on educational approaches to reduce stigma, antistigma education for MHSU has primarily focused on stigma at the social, interpersonal/public, and personal (self-stigma) levels, with little attention to the problem of structural stigma. Structural stigma refers to how inequity is manifested through rules, policies, and procedures embedded within organizations and society at large. Structural stigma is also prominent within clinical learning environments and can be transmitted through role modeling, resulting in inequitable treatment of vulnerable patient populations. Addressing structural stigma through education, therefore, has the potential to improve equity and enhance care. A promising educational approach for addressing structural stigma is structural competency, which aims to enhance health professionals' ability to recognize and respond to social and structural determinants that produce or maintain health disparities. In this article, the authors propose a framework for addressing structural MHSU stigma in health professions education that has 4 key components and is rooted in structural humility: recognizing structural forms of stigma; reflecting critically on one's own assumptions, values, and biases; reframing language away from stereotyping toward empathic terms; and responding with actions that actively dismantle structural MHSU stigma. The authors propose evidence-informed and practical suggestions on how structural competency may be applied within clinical learning environments to dismantle structural MHSU stigma in organizations and society at large.

Validity of the Personal Suicide Stigma Questionnaire in a Community Sample

Abstract. The Personal Suicide Stigma Questionnaire (PSSQ) is a new scale assessing the experience of stigma in those who have been suicidal. This study examined the construct validity of the scale using a sample of participants from the general community who reported being suicidal at some point in their lives ( N = 3,947). The Distress Questionnaire – 5 and the Suicidal Ideation Attributes Scale were used to assess the severity of distress and suicidality. Confirmatory factor analysis (CFA) showed a three-factor model (Rejection, Minimization, Self-Blame) with one general Personal Stigma factor influencing the three first-order factors, which best fit the data. Scalar invariance was reached for both age and gender. The same factor structure was maintained when the format of the scale was altered for a subsample to provide a “not applicable” option for each item. PSSQ total score remained a significant predictor of distress after suicidality and demographic variables were accounted for. The PSSQ and its subscales can be used for the assessment of personal suicide stigma.

Professional Care Experiences of Persons With Suicidal Ideation and Behavior: Model Development Based on a Qualitative Meta-Synthesis

BACKGROUND

Health care professionals (HCPs) are challenged in caring for persons with suicidal ideation or behavior. For affected persons, professional care is essential, and being interviewed about their experiences can be stressful. The experiences of persons ideating or attempting suicide are essential to designing eHealth products to support them in crises and provide continuous care.

OBJECTIVE

This study aimed to synthesize published qualitative research about how persons with suicidal thoughts or behavior experience inpatient or outpatient care. A model will be derived from the meta-synthesis to guide HCPs in their work with affected persons and provide a thorough needs assessment for eHealth development.

METHODS

A qualitative meta-synthesis was conducted using an inductive approach, as proposed by Sandelowski and Barroso. The inclusion criteria were studies in English and German that dealt with persons who ideated or attempted suicide. Relevant articles were identified by searching the PubMed and Cinahl databases and by hand searching relevant journals and reference lists. The findings of each study were analyzed using initial and axial coding, followed by selective coding. Finally, a conceptual model was derived.

RESULTS

In total, 3170 articles were identified in the systematic literature search. Articles were screened independently by 2 researchers based on the eligibility criteria. Finally, 12 studies were included. The central phenomenon observed among persons ideating or attempting suicide is their process from feeling unanchored to feeling anchored in life again. During inpatient and outpatient care, they experience being dependent on the skills and attitudes of HCPs. While helpful skills and attitudes support persons ideating or attempting suicide to reach their feeling of being anchored in life again, adverse interactions are experienced negatively and might lead to prolonging or maintaining the feeling of being unanchored in life.

CONCLUSIONS

The study promotes a differentiated view of the experiences of persons ideating or attempting suicide. The derived conceptual model can guide HCPs in their work with affected persons to support affected persons during their recovery. Moreover, the conceptual model is useable as a springboard to develop eHealth solutions for crisis situations and long-term care.

Consumer and Carer Perspectives of a Zero Suicide Prevention Program: A Qualitative Study

This study explored the experiences of healthcare consumers who had recently attempted suicide, and their carers, following placement on a Suicide Prevention Pathway based on the Zero Suicide framework. Qualitative interviews were conducted with 10 consumers and 5 carers using a semi-structured interview schedule. Interviews were transcribed and thematic analysis was applied to identify prominent themes and sub-themes. Three interrelated themes were identified. The first theme was 'Feeling safe and valued' with the associated sub-theme pertaining to perceived stigmatizing treatment and self-stigma. The second was 'Intersection of consumer and staff/organizational needs' with a related sub-theme of time pressure and reduced self-disclosure. The final theme was 'Importance of the 'whole picture', highlighting the relevance of assessing and addressing psychosocial factors when planning for consumer recovery. Overall, consumers and their carers reported a favorable experience of the Suicide Prevention Pathway; however, there were several areas identified for improvement. These included reconciling the time-pressures of a busy health service system, ensuring consumers and carers feel their psychosocial concerns are addressed, and ensuring that adequate rapport is developed. Key to this is ensuring consumers feel cared for and reducing perceptions of stigma.

Family group conferences for suicidal adolescents: Promising results from naturalistic case study research

Can thwarted belongingness and perceived burdensomeness, risk factors for suicidal adolescents, be turned around by family group conferences? In this case study on Nick, a 17-year-old who undertook six suicide attempts, we (including Nick) share insights and learning opportunities on how family group conferences can be used. The thematic analysis suggests that family group conferences might be a promising intervention for suicidal adolescents. For Nick, the conference was a turning point in his life, correcting perceptions of being a burden, pushing back passiveness, and boosting connection with and support from the broad social network.

Self-Stigma and Its Relationship With Rates of Depression Diagnosis

Background: Self-stigma about suicide might impede people seeking help from mental health professionals. There is little research about self-stigma expressed by suicide decedents. Aims: We aimed to explore (a) self-stigma about suicide through examination of suicide notes; and (b) whether the expression of self-stigma was associated with the formal diagnoses of depression. Method: Data were extracted from notes left by people who died by suicide in two major Chinese cities (Shanghai, 2004-2017; Wuhan, 2005-2019). Note content was examined and self-stigma items were coded. Demographics associated with self-stigma were reported. Rates of depression were compared between note-leavers who expressed self-stigma, and those who did not. Results: Notes were left by 567 suicide decedents (representing about 19% all suicides). Approximately 25% notes contained at least one self-stigma item. Older people made fewer self-stigma references, as did people from Wuhan. Depression was not associated with self-stigma. Limitations: Not all people dying from suicide leave notes, and suicide notes variably report self-stigma, thus self-stigma about suicide may be underestimated. Conclusion: Self-stigma items varied across regions and age groups, but not with depression. Therefore, self-stigma expressed by suicide decedents may not reflect help-seeking behaviours from professional mental health services.

Study protocol for a mixed methods prospective cohort study to explore experiences of care following a suicidal crisis in the Australian healthcare system

INTRODUCTION

For individuals presenting to the emergency department (ED) for a suicide attempt, the period after discharge from hospital is marked by heightened vulnerability for further suicide attempts. Effective care following a suicidal crisis has the potential to significantly decrease this risk. The current study aims to examine the impact of the LifeSpan multilevel suicide prevention model on experiences of care following a suicidal crisis. Perspectives from healthcare consumers (individuals who have presented to the ED following a suicidal crisis), carers, and health professionals will be explored. The LifeSpan model is currently being evaluated as a high-fidelity trial in four geographically defined regions in New South Wales, Australia.

METHODS AND ANALYSIS

This study will use a mixed methods prospective cohort design. Quantitative data collection includes a structured survey, administered to healthcare consumers from LifeSpan sites and control sites. Two cohorts of healthcare consumers will be recruited 12 months apart with baseline assessment occurring within 18 months of the ED presentation, and follow-up 12 months after the initial assessment. Survey participants will be recruited online and through participating EDs, mental health organisations and aftercare services. Qualitative interview data from healthcare consumers, carers who have accompanied a loved one to the ED following a suicidal crisis and health professionals who provide care to people at risk of suicide will be collected concurrently with the recruitment of the first cohort of survey participants. Purposive and convenience sampling techniques will be used for recruitment of interview participants. The primary outcome for this study will be healthcare consumers' experiences of service provided at the ED. Analysis will be undertaken of the change over time within LifeSpan sites, as well as between LifeSpan sites and control sites, using mixed effects repeated measures models as principal means of data analysis.

ETHICS AND DISSEMINATION

This research has been approved by the Hunter New England Human Research Ethics Committee (HREC/17/HNE/144). Results will be disseminated via conferences and peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ACTRN12617000457347.

[Suicide stigma and suicide prevention]

In many societies suicide was and is an extremely controversial topic. This review article outlines the historical background of social condemnation of suicidal thoughts and actions in the western world. It summarizes current research results about the consequences of suicide stigma for affected persons and its relevance for suicide prevention. Finally, the next steps in research and prevention are discussed. Over time and in different cultures, the societal judgement of suicide has greatly varied. During antiquity, some philosophers viewed suicide negatively and by the fifth century AD suicide was widely condemned by societies across the western world. Until today suicide remains a taboo topic in Germany and other countries. Current research showed that the social condemnation of suicidal thoughts and behavior (i.e. suicide stigma) is an additional stressor among persons who experience or have experienced suicidality and their relatives. Furthermore, suicide stigma is considered to be a central barrier to seeking help for and disclosure of suicidality. Despite its relevance for suicide prevention, only a few interventions to reduce suicide stigma among members of the general public and to support affected persons in dealing with suicide stigma exist.

The model of dynamic balance in therapists' experiences and views on working with suicidal clients: A qualitative study

Working with suicidal clients is frequently referred to as one of the most demanding and anxiety-provoking aspects of therapeutic work. The aim of this study was to obtain an in-depth understanding of therapists' experience in treating suicidal individuals and to develop a theoretical model of it. Eleven psychotherapists (four men and seven women) participated in individual semistructured interviews. The interviews were audiotaped, transcribed and analysed by the principles of grounded theory. We developed a model of dynamic balance in therapists' experiences and views on working with suicidal clients. The model includes six core themes, which represent aspects of therapists' experience and views where a dynamic balance is needed between two different poles. The core themes are as follows: (i) understanding of suicidality: the general versus specific; (ii) the role of alliance: protective factor versus no guarantees; (iii) attitudes: acceptant versus life-oriented; (iv) emotional response: worry versus trust; (v) responsibility: therapist's professionality versus client's autonomy; and (vi) focus: suicidality versus individual as a person. The model takes into account other variables that are relevant to the process and outcomes of the therapy: factors, related to the therapist and the client, as well as system regulations and therapeutic setting. The presented model may be helpful for mental health professionals in reflecting on their experiences of working with suicidal clients, describing the relevant topics and the way they relate to each other.

Anticipated Suicide Stigma, Secrecy, and Suicidality among Suicide Attempt Survivors

OBJECTIVE

Suicidal behavior is stigmatized, and suicide attempt survivors often keep their experiences secret. Although secrecy can protect from discrimination, research from related fields suggests that both the experience of stigma and secrecy can contribute to suicidality. Although suicide attempt survivors are at high risk for reattempt, research investigating the link between suicide stigma and suicidality among this group is rare.

METHOD

A community sample of 159 suicide attempt survivors participated in an online survey in the US. We used multiple linear regression models to test the association between anticipated suicide stigma and current suicidality, as well as a path model to test the mediating effect of secrecy.

RESULTS

After controlling for age, sex, number of lifetime suicide attempts, and time since the most recent suicide attempt, anticipated suicide stigma was significantly associated with increased suicidality. In a controlled path model, this link was partially mediated by increased secrecy.

CONCLUSION

These results provide initial support that anticipated suicide stigma, and secrecy can contribute to suicidality among suicide attempt survivors. Therefore, programs to support suicide attempt survivors in coping with suicide stigma and secrecy, as well as interventions to reduce harmful aspects of public suicide stigma, could contribute to suicide prevention.

Internalized stigma, sense of belonging, and suicidal ideation among veterans with serious mental illness

OBJECTIVE

There is emerging evidence that internalized stigma increases risk for suicide among individuals with serious mental illness. The purpose of the current study was to evaluate whether sense of belonging moderates the relationship between internalized stigma and suicidal ideation.

METHOD

Two hundred forty-two veterans with serious mental illness completed measures of internalized stigma, belongingness, and depression. Moderation analysis was used to determine whether sense of belonging interacts with internalized stigma to predict suicidal ideation when accounting for individual differences in depression and relevant demographic variables.

RESULTS

Consistent with our hypothesis, sense of belonging significantly moderated the relationship between internalized stigma and suicidal ideation. Specifically, the relationship between internalized stigma and suicidal ideation was strongest when sense of belonging was low.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Internalized stigma and belongingness interact to increase risk for suicide. Both constructs should be assessed and included in interventions to reduce suicide risk among veterans with serious mental illness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Why social justice matters: a context for suicide prevention efforts

Suicide is among the 10 leading causes of death in the US and has the potential to suddenly change many lives. It often occurs when people are disproportionately affected by societal conditions, including inequities, discrimination, oppression, and historical trauma. We posit that a social justice framework can improve suicide prevention efforts when incorporated into existing strategies because it mandates that inequities be addressed. It does so through education, engagement, advocacy, and action, and can be especially effective in states and nations with high suicide rates and entrenched societal inequities.

Men's Reflections on Postsuicide Attempt Episode in Bangladesh

This is the first ever research in Bangladesh that provides understanding about men's postsuicide attempt reflections from a district called Jhenaidah which is assumed to be a high suicide-prone area in the country. Employing qualitative semistructured interviews with 17 men who have attempted suicide, aged 18 years and older, this research finds the survivors encountered several immediate reactions from others specifically targeting toward demeaning their masculinity. Nonetheless, they adopted several means to cope with the postsuicide episode that are thematically arranged as self-deprecation, rebuilding oneself, revenge vis-à-vis forgiveness, and impulses to escape vis-à-vis nonreactive. The postattempt episodes of the survivors are likely to be moved toward further risk factors. Therefore, it is important to take protective measures for the survivors. Specific to this district, developing a context-specific suicide prevention model, targeting the risk population could be a possible solution to the problems associated with the postattempt episodes.

The Attempt Was My Own! Suicide Attempt Survivors Respond to an Australian Community-Based Suicide Exposure Survey

Those who attempt suicide have often been overlooked in the suicide prevention literature. Where stories of lived experience have been included, it is often from the perspectives of healthcare professionals who treat the physical and/or psychological impacts following an attempt, rather than firsthand accounts. Yet, the most intimate insights of suicide are lost by not including the voices of those with lived experience of suicide attempt. Through an online, community-based, non-representative survey exploring the impact of exposure to suicide, a sub-sample of 88 participants responded who reported their exposure to suicide as being their own attempt. The survey covered demographic information, questions assessing exposure to suicide attempts and death, current global psychological distress via the Kessler Psychological Distress (K10) Scale, and short qualitative responses provided by 46 participants. The qualitative data was thematically analysed resulting in three themes; the way in which individuals experienced being suicidal; who they were able, or not, to disclose these intentions to—before and after their suicide attempt; and, how these people experienced the formal and informal health care supports available to them to assist with their suicidal crisis. This paper presents important findings from a sample of participants who are highly distressed, and have previously attempted to take their own lives. This adds depth to our understanding of lived experience of suicide attempt, issues associated with seeking appropriate support after suicide attempt, and also demonstrates a willingness of participants to share their stories, even in a study that did not explicitly target those with lived experience of suicide attempt. The need for consistent and compassionate mental health care after a suicide attempt is identified as a vital component of living well after a suicide attempt.

Is suicidality a mental disorder? Applying DSM-5 guidelines for new diagnoses

Suicidality-specific diagnoses have been proposed recently, but suicidologists are only just beginning to evaluate their merits. To advance this discussion, I introduce the term suicidal syndrome to describe the underlying entity, present a rationale for why a formal diagnosis is necessary, define the major features of the syndrome, and show how the syndrome could meet the requirements for new diagnostic candidates used in the development of the DSM-5. Against this backdrop, I examine common objections to a suicidality-specific diagnosis. Finally, I discuss several challenges with the creation of new diagnostic entities as they apply to suicidal syndrome.

Suicide-related disclosure: implications for inclusion and recovery

Purpose

People who have lived experiences with suicide often struggle with concealable stigmatized identities that threaten their inclusion and recovery. While disclosure of a stigmatized identity can promote support and recovery and therefore prevent suicide, it may also present distinct risks. The purpose of this paper is to summarize key issues in suicide-related disclosure, suggest theoretical models for describing suicide-related disclosure and identify research needs.

Design/methodology/approach

This conceptual paper discusses the existing literature on disclosure of concealable stigmatized identities, then explores research on disclosure of suicidal ideation, suicide attempt and suicide loss. Theoretical models (disclosure processes model and interpersonal theory of suicide) that can be employed in understanding suicide-related disclosure are explored. Finally, the paper suggests areas for future research, including longitudinal research to identify strategic disclosure practices that can lead to greater inclusion and recovery.

Findings

Research on suicide-related disclosure should differentiate between disclosure of past and current suicidality, incorporate theoretical frameworks and examine approaches for preparing potential confidants and disclosers for the disclosure process.

Originality/value

This paper highlights issues unique to the disclosure of suicidal thoughts and behaviors, and to suicide loss.

Factors related to suicide's unpredictability: a qualitative study of adults with lived experience of suicide attempts

Purpose: In recent decades, suicide prevention initiatives have increased substantially, yet the suicide rate has continued to rise, and suicide deaths are still generally perceived as unexpected. This study sought to identify factors that might account for this discrepancy by focusing on the exhibition of suicide warning signs.

Methods: Qualitative interviews were conducted with 15 adults [mean age = 36 (SD = 14), 93% female] who had attempted suicide at least once in their lifetime.

Results: A disconnect between participants and their environment emerged as a central theme. Many expressed ambivalence about whether they wanted others to intervene before their attempts, resulting in either expression or inhibition of warning signs. Regardless of whether they wanted their attempt to be predictable, most participants expressed disappointment if they perceived a lack of intervention before their attempt. In some cases, this disappointment exacerbated distress and may have contributed to the attempt itself. Participants also expressed difficulty disclosing their suicidal ideation to others. Thus, even if they wanted help, participants were unsure how to effectively attain it.

Conclusions: Findings underscore the complexity of predicting and preventing suicide; however, engaging individuals with lived experience in these efforts facilitates greater understanding toward outreach and intervention approaches.

The construction of people in suicide prevention documents

Suicide is a significant issue worldwide and despite comprehensive prevention activities, suicide stigma remains. To explore this issue, we used critical discourse analysis to examine how Australian suicide prevention documents (n = 8) constructed people living with thoughts of suicide. We found that risk and biomedical discourses dominated, with people experiencing suicide ideation constructed as dangerous, different, lacking coping skills, and burdensome. We propose that future suicide prevention activities address potentially stigmatizing language, broaden support and advocacy options, and meaningfully include people with lived experience of suicidal ideation or behavior in the development of policy and interventions.

Information needs of people after a suicide attempt: A thematic analysis

OBJECTIVE

This study aimed to identify the information that people who have attempted suicide and those who support them believed to be helpful to receive after an attempt.

METHODS

Thirty-seven people with lived experience of suicide attempt(s) (suicide attempt survivors and family members/friends of survivors) were recruited through two national lived experience community groups in Australia. Participants completed a semi-structured telephone interview that included questions about the types of information they believed important to receive after an attempt.

RESULTS

Using thematic analysis, the key information participants identified was helpful to receive following a suicide attempt was that which could challenge stigma and address negative community attitudes towards suicide. Participants spoke of a need for practical information and information that provided hope. Personal stories of recovery were identified as an important way of communicating this sort of health information.

CONCLUSIONS

People who have attempted suicide and their family members and friends want information that challenges stigma and supports recovery expectations.

PRACTICE IMPLICATIONS

Providing people with accurate information about recovery and using personal stories to communicate health information is one way people affected by suicide attempt identify can challenge stigma, and address information needs after a suicide attempt.

Development and Validity of the Personal Suicide Stigma Questionnaire (PSSQ)

Background: The detrimental consequences of stigma have been recognized in extensive research on mental illness stigma, but experiences of suicide-related stigmatization have not received sufficient research attention. The lack of a simple self-report assessment of personal suicide-related stigma led to the work reported here. Aim: To develop and assess the validity of the Personal Suicide Stigma Questionnaire (PSSQ). Method: The item pool for PSSQ was based on qualitative data and was tested in a community sample of 224 adults (mean age = 32.68 years, 83% female, 92.9% Caucasian) who reported lifetime suicidality. Factor analysis was used for item selection. The Self-Stigma of Mental Illness Scale - Short form (SSMIS-SF) and Suicide Behaviors Questionnaire - Revised (SBQ-R) were used to assess validity of the scale. Results: Following analysis, 16 items, forming three highly interrelated factors (Rejection, Minimization, and Self-blame), were selected for the PSSQ. The PSSQ scores showed predicted relationships with mental illness stigma and suicidality, suggesting its validity. Limitations: The validity of the scale still requires further research in clinical populations. Conclusion: The newly developed PSSQ can be used to assess the levels of suicide-related stigma experiences of suicidal individuals.

Health-Care Workers’ Perception of Patients’ Suicide Intention and Factors Leading to It: A Qualitative Study

This study explored health-care workers’ perception of patients’ suicide intention and their understanding of factors leading to particular interpretations. Semistructured face-to-face in-depth interviews were conducted with 32 health-care workers from a general hospital in Klang Valley, Malaysia. Interview data were transcribed verbatim and analyzed using the interpretative phenomenological analysis. The health-care workers were found to have four types of perceptions: to end life, not to end life, ambivalence about intention, and an evolving understanding of intention. Factors leading to their perceptions of patients’ suicide intention were patient demographics, health status, severity of ideation/attempt, suicide method, history of treatment, moral character, communication of suicide intention, affective/cognitive status, availability of social support, and health-care workers’ limited knowledge of patients’ condition/situation. Insufficient knowledge and negative attitudes toward suicidal patients led to risk minimization and empathic failure, although most health-care workers used the correct parameters in determining suicide intention.

Examining the Relationship Between Attitudes Toward Suicide and Suicide Attempt History

Background: Relatively little is known regarding the relationship between attitudes toward suicide, suicide attempt (SA) history, and future suicidal behaviors. Aims: Utilizing a sample of firefighters, this study compared attitudes toward suicide between individuals with/without a career SA history and evaluated whether certain attitudes toward suicide are associated with a greater self-reported likelihood of making a future SA. Method: US firefighters (N = 818) completed self-report measures. One-way ANOVAs and linear regression analyses were utilized to address study aims. Results: Firefighters with a career SA reported significantly greater normalization/glorification of suicide - yet lower attributions of suicide to isolation/depression - than those without this history. More stigmatizing attitudes toward suicide and greater normalization/glorification of suicide were each significantly associated with greater self-reported future SA likelihood. Limitations: Data were cross-sectional and findings may not be generalizable. Conclusion: Firefighters who have made an SA during their firefighting careers may normalize and glorify suicide more than those who have not. These attitudes may be associated with greater self-perceived risk for future SAs. Research is needed to replicate findings and evaluate strategies for targeting potentially harmful beliefs about suicide among SA survivors.

Relations Between Thwarted Belongingness, Perceived Burdensomeness, and History of Suicide Attempts and Readiness for Mental Health Treatment in High-Risk Veterans, Reserves, and Active Duty Service Members

Suicide rates for service members and veterans are growing rapidly in the United States. Despite availability of evidence-based approaches, a large number of high-risk individuals are reluctant to seek out treatment. The present study used the interpersonal theory of suicide, involving 3 primary predictors of death by suicide to investigate treatment readiness in high-risk U. S. veterans, reserves, and active duty service members. Four hundred and two service members were recruited. Inclusion criteria involved (a) reporting active suicidal ideation and (b) denying active behavioral health treatment. All participants completed a self-report battery that assessed burdensomeness, thwarted belongingness, lifetime suicide attempts, and perceptions about treatment. Regression analyses revealed that thwarted belongingness was significantly predictive of treatment perceptions and readiness, in that higher or more severe scores on the thwarted belongingness scale were significantly related to lower or less likely treatment perceptions and readiness scores. The findings suggested that, in high-risk service members, thwarted belongingness is predictive of lower treatment readiness, and contributes to the growing literature on perceived stigmas, treatment barriers and readiness, and suicidal behaviors and risk factors.

Stigma and suicidality among suicide attempt survivors: A qualitative study

Among people with mental illness, stigma experiences can increase suicidality, and suicidality itself is associated with negative stereotypes. Suicide attempt survivors experience both mental illness stigma and suicide stigma, which could contribute to their increased risk for completed suicide. We interviewed 13 suicide attempt survivors regarding experiences and consequences of stigma and identified five stigma-related themes. Stigma led to substantial emotional strain, including loneliness and hopelessness, which are important precursors of suicidality. Our findings suggest that both mental illness stigma and suicide stigma can contribute to suicidality among people with mental illness in general, and in suicide attempt survivors specifically.

Intervention related reductions in perceived burdensomeness mediates incidence of suicidal thoughts

BACKGROUND

Interventions aimed at preventing suicidal thoughts target people at risk for suicide based on risk factor elevations. Based on the interpersonal psychological theory of suicide, elevated perceived burdensomeness (PB) and thwarted belongingness (TB) are potential targets for prevention of the occurrence of suicidal thoughts. PB is the belief that one is a burden to others. TB is the perceived lack of social connectedness.

METHODS

This study was designed to examine the effects of a preventative intervention targeting PB and TB on the 6-month incidence of suicide ideation in a sample of 138 people (M = 38.01 years, SD = 16.40; 50.7% female) with elevated levels of these variables but no current suicidal thoughts at baseline. The three-session intervention included psychoeducation and cognitive bias modification.

RESULTS

PB was reduced in the intervention condition, compared to the repeated contact control condition (B = 2.50, p < .05) and TB was not (B = 1.42, p = .43). The likelihood of a reported incident of suicidal thoughts was reduced for those in the active intervention compared to those in the repeated contact control condition, through reductions in PB (B = .12, 95% confidence interval [.01, .32]).

LIMITATIONS

There were two components of the intervention, cognitive bias modification and psychoeducation; thus, it is unclear whether one or both components contributed to these findings.

CONCLUSIONS

This intervention can be used as a preventative intervention for suicidal thoughts by targeting PB. These results further confirm PB as a causal risk factor for suicidal thoughts.

Advocacy and luck: Australian healthcare experiences following a suicide attempt

High quality mental healthcare after a suicide attempt is a key strategy for preventing subsequent suicide attempts and deaths, yet little is known about how people navigate the healthcare system following a suicide attempt. This paper focuses on the stories told by 20 people who had attempted suicide. Five themes emerged: fitting into the healthcare system; need for advocacy; consistent care; lucky to find help; and, small kindnesses. Positive and empathetic healthcare experiences, as well as connected services, assisted the recovery of people who have attempted suicide.

Under Reporting of Suicide Ideation in US Army Population Screening: An Ongoing Challenge

Previous research in US Army Soldiers shows rates of mental health concerns as two to four times higher on anonymous surveys than on postdeployment health assessments. In this study, Soldiers presenting for health reassessment completed two questionnaires on suicide risk factors: one linked to the health assessment and one anonymous. About 5.1% of respondents reported suicide ideation on the anonymous questionnaire, 3.0% on the linked questionnaire, and 0.9% on the health reassessment. About 56.4% who reported suicide ideation anonymously told nobody of their thoughts. Current screening procedures identify only one in seven Soldiers experiencing suicide ideation and highlight the need for alternative risk-detection strategies.

The specificity of public stigma: A comparison of suicide and depression-related stigma

Each year, approximately 1.3 million Americans survive a suicide attempt. While stigma has been reported by suicide attempt survivors, limited research has examined how suicide stigma may differ from the stigma of mental illness. U.S. adults (n = 440) completed an online survey in which they were randomly assigned to one of four vignettes. Vignettes depicted a target individual with either past depression, past suicide attempt, death by suicide, or no information on suicide or mental illness (control). Participants completed a general measure of stigma, a suicide-specific stigma measure, and were surveyed on the recovery potential of individuals with mental illness and suicide attempt. While the general stigma measure failed to distinguish between groups, significant differences on the suicide stigma scale (SSAS-44) emerged between participants assigned in the depression and suicide conditions, especially for stereotype and prejudice subscales. Across conditions, participants believed that recovery was more realistic for someone described as having a mental illness than it was for someone described as having attempted suicide. These findings suggest that individuals who have attempted suicide are subject to differential stigma content from those with depression. Implications are discussed for combating stigma for suicide attempt survivors.

Stakeholder Perspectives on the Stigma of Suicide Attempt Survivors

Abstract. Background: Past scholarly efforts to describe and measure the stigma surrounding suicide have largely viewed suicide stigma from the perspective of the general public. Aims: In the spirit of community-based participatory research (CBPR), the current study brought together a diverse stakeholder team to qualitatively investigate the suicide stigma as experienced by those most intimately affected by suicide. Method: Seven focus groups (n = 62) were conducted with suicide attempt survivors, family members of those who died by suicide, and suicide loss therapists. Results: Themes were derived for stereotypes (n = 30), prejudice (n = 3), and discrimination (n = 4). People who attempted suicide were seen as attention-seeking, selfish, incompetent, emotionally weak, and immoral. Participants described personal experiences of prejudice and discrimination, including those with health professionals. Conclusion: Participants experienced public stigma, self-stigma, and label avoidance. Analyses reveal that the stigma of suicide shares similarities with stereotypes of mental illness, but also includes some important differences. Attempt survivors may be subject to double stigma, which impedes recovery and access to care.

The Web-Based Assessment of Suicidal and Suicide-Related Symptoms: Factors Associated With Disclosing Identifying Information to Receive Study Compensation

With the increasing utilization of Web-based surveys for suicide and suicide-related research, it is critical to understand factors that affect participants' decision to request study compensation (and thus potentially reveal their identity) or remain anonymous. This study evaluated differences in demographics, suicidal symptoms, and suicide-related constructs between participants electing and declining to provide identifying information to receive study compensation. A sample of 931 firefighters (91.5% male) participated in a Web-based mental health survey; on survey completion, individuals had the option to provide contact information to receive a $10 gift card. Logistic regression analyses were employed to investigate differences between those who did and did not provide this information. Overall, 82.8% provided identifying information, with younger individuals significantly more likely to do so. Participants reporting more severe suicidal symptoms and greater levels of suicide-related constructs appeared equally, and in some cases, significantly more, willing to provide identifying information. Findings indicate that individuals reporting more sensitive or stigmatizing experiences might not systematically opt out of receiving study compensation to remain anonymous on Web-based surveys. Additional research is warranted to replicate these findings in more representative samples and further delineate personality and other factors influencing the disclosure of contact information to receive study compensation.