Achieving complete mental health after suicidality

Article in Review: Baiden, P. & Fuller-Thomson, E. (2016). Factors associated with achieving complete mental health among individuals with lifetime suicidal ideation. Suicide and Life Threatening Behaviour DOI: 10.1111/sltb.12230

Summary: This article considers the factors that may support a person “transitioning from experiencing suicidal ideation to complete mental health”. Considerations noted include; what is complete mental health and what would it mean for suicide prevention to identify such factors?

Suicide is a major cause of death in many countries, including Australia with recent data highlighting alarming increases in deaths by suicide. In Australia, although the Australian Bureau of Statistics reports deaths by suicide from 15 years of age, it is well known that suicidal behaviour and ideation can begin much earlier. As noted in prior articles, stigma – around mental illness, self injury and suicidality can influence how people see others and how they see themselves. Stigma also impacts a person’s willingness to help seek (Reynders et al 2014). But of those people who have experienced suicidality and survived, from relatively brief episodes to enduring ideation and non-lethal suicidal behaviour – what factors have supported their recovery? What factors contribute to mental health? How can we promote recovery in a way that will facilitate a person’s likelihood to ask for help and believe that change is possible?

Prior suicidality is a predictor of future suicidality.

Whilst that is the evidence, we have not examined the impact of emphasising this risk factor against promoting the potential for recovery. We know that people are not suicidal forever – we know that suicidality can be a temporary process, however when themes appear to focus on risk factors such as a history of self injury or suicidality, we may lose focus  on the impact this has on a person’s perception of themselves or their recovery.

Research by Baiden and Fuller-Thomson (2016) sought to identify what factors supported a person transitioning from experiencing suicidal ideation to complete mental health. The question is, what is complete mental health? Is it the absence of negative psychological symptoms? Is it being “happy” and content in life? Baiden and Fuller-Thomson (2016) defined complete mental health as having “flourishing mental health and being free of suicidal ideation and of mental illness”. They also noted mental health included an absence of addictions and the presence of meaning and purpose. While “flourishing mental health” is still somewhat ambiguous, we could likely assume the presence of positive feelings which are consistent with our social, cultural and environmental/contextual norms contributing to a persons positive quality of life.

What factors are more closely associated with the presence or absence of complete mental health?

Not surprisingly, it was found that individuals who had no previous experiences of suicidal ideation had greater probabilities of having complete mental health compared to those individuals with lifetime suicidal ideation. A major factor contributing to this was social support and the presence of a confident. Support from family and friends are extremely important when considering an individual’s mental health, increasing the likeliness of complete mental health significantly. Religious coping strategies were also predictive of complete mental health, as associated with connectedness and social support. Indeed, this was one of the greatest strengths of the research – emphasising the importance of developing capacities and connections for meaningful social interactions and support.

Additionally, individuals who experienced functional difficulties caused by chronic pain, mobility restrictions and an inability to engage in activities of daily living, were less likely to achieve complete mental health. Furthermore, chronic sleep disturbance was predictive of poorer mental health outcomes as was experiencing in excess of three adverse childhood events (when compared with no adverse childhood events). These results correspond with significant volumes of research done indicating that the presence of a mental illness, such as major depression dramatically increased the risk of future death from suicide.

Interestingly, it was found that there is a gender and age difference when assessing for complete mental health where females and older individuals were more likely to achieve complete mental health.

What does this mean for suicide prevention?

Clearly there are some ideals that we strive for, such as

•  Enhancing social and cultural expectations that protect individuals and prevent traumatic and negative events from occurring
• Access to early intervention for mental disorder and functional impairments, including building, consolidating and supporting support systems and help seeking
• Provision of interventions assisting with pain management, activities of daily living and fundamental skills such as sleep hygiene are also imperative

Preventing deaths by suicide should be only part of the goal – ultimately we also want people to live meaningful and positive lives. As practitioners, we have a responsibility to promote the evidence that people can and do live quality lives and achieve complete mental health after suicidality. It is up to us to provide and enhance conditions that allow this to happen.

References

Baiden, P. & Fuller-Thomson, E. (2016). Factors associated with achieving complete mental health among individuals with lifetime suicidal ideation. Suicide and Life Threatening Behaviour DOI: 10.1111/sltb.12230

Reynders, A, Kerkhof, A, Molenberghs, G. & Van Audenhove, C. (2014). Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions. Social Psychiatry & Psychiatric Epidemiology, 49, 231-239.

By Carmen Betterridge