What factors influence the decision to disclose suicidal ideation?
Article in Review: Fulginiti, A, Pahwa, R, Frey, L, Rice, E & Brekke, J (2015) What factors influence the decision to share suicidal thoughts? A multilevel social network analysis of disclosure among individuals with serious mental illness. Suicide and Life Threatening Behaviour.DOI:10.1111/sltb.1224
Summary: Examining the critical factors that influence a person’s likelihood to disclose their suicidality. We also offer clinical considerations for how to integrate these findings into practice.
What supports a person who is at risk of suicide to disclose suicidal ideation to others? Does it have to do with personal characteristics of the individual or the characteristics of the relationships they have that allows such a disclosure? The factors influencing an individuals’ decision to share suicidal thoughts is an important consideration for practitioners working to prevent suicide. If the risk is not disclosed, our capacity for detection and intervention is restricted.
“Conservative estimates suggests that at least one third of those with suicidal thoughts do not reveal them”
Research by Fulginiti et al (2015) examined patterns of suicidal disclosure and the connections that exist within the social networks of individuals who have Serious Mental Illness (SMI). Not surprisingly, it was determined that favoured confidants of suicidal individuals were found to be family members and mental health providers as they provide greater acceptance and understanding of the individual, resulting in “comfort with disclosure”. Additionally, an individual may feel more secure about disclosing future thoughts of suicide to prior confidants if they experienced stability in their support. However, they also found that approximately one third of past confidants were not identified as targets for future disclosure. For individuals at greater risk for suicide (such as SMI) the majority of people within an individual’s network are usually advised by the client of their SMI, yet only one or two people are actually advised of their suicidal ideation. This research also indicated that individual factors, such as gender, marital status and symptom severity played only a moderate role in disclosure behaviours while relational factors such as number of contacts, availability, closeness and relationship type (family, friend, practitioner) were greater determinants to who, when and what is disclosed.
What does this mean for our practice?
In recognition of this pattern of disclosure, high probability confidants could be taught how to recognise risk and where to refer loved ones for help in times of need. Since it can be confronting for confidants to hear about suicidality, preparing them for challenges experienced for someone with a SMI prior to a potential crisis may serve to stabilise the confidant as an important support over time. More so, the strength and intimacy level of the relationships that exist within the social networks are important factors that influence a person’s willingness to share suicidal thoughts. Strengthening these connections or building a person’s social network is therefore likely to assist in broadening the potential points for disclosure. This research indicated that due to the perceived burdensomeness and stigma tied to suicidal disclosure, some individuals may be more secure in revealing suicidal thoughts to members of the mental health community in favour of family members. Ensuring this community has the capacity to utilise and endorse mental health programs and services is therefore beneficial.
What does this mean for safety planning?
- Ask the client to identify people they are most likely to confide in about feeling suicidal – past confidants are likely future confidants – is this the case for your client or does their social network fluctuate?
- Ask whether there are any barriers that might stop them from confiding in someone in the future – problem solve these barriers
- Collaborate with and encourage the client to invite potential confidants into the safety planning process
- Review safety plans regularly!
To overcome some of the challenges to disclosure and enhance support for suicide disclosure, greater research into an individuals’ perceived burdensomeness on the people in their lives is required as this is identified as an inhibiting factor. Furthermore, research into the connection between how the information is disclosed to others, and the reaction of the confident, can enhance this research by providing greater knowledge into how we increase support for suicidal disclosure. Ultimately, this research provides the basis for understanding conditions for disclosure and important relational factors which practitioners have an opportunity work with.
Fulginiti, A, Pahwa, R, Frey, L, Rice, E & Brekke, J (2015) What factors influence the decision to share suicidal thoughts? A multilevel social network analysis of disclosure among individuals with serious mental illness. Suicide and Life Threatening Behaviour.DOI:10.1111/sltb.1224
First published 29 January 2016