Skip to main content
Research Trends

Reports on the Perceived Advantages and Disadvantages of Suicidal Behavior by Patients With Depression

Content Analysis of the Decisional Balance Worksheet

Published Online:https://doi.org/10.1027/0227-5910/a000711

Abstract.Background: Studies suggest there may be perceived secondary advantages to engaging in suicidal behavior that impact the help-seeking behavior of at-risk individuals. Aims: The aim of this study was to assess the views of patients with depression regarding the advantages and disadvantages of engaging in suicidal behavior using a decisional balance worksheet (DBW) to inform prevention and intervention efforts. Method: Participants were adults with depression between the ages of 18 and 75 presenting to the emergency department with suicidal ideation (N = 42) who participated in a larger pilot study of a brief intervention aimed focused on treatment engagement. Using a content analysis approach, common themes were extracted. Results: Escaping from problems and negative thoughts, ending pain and suffering, and eliciting support and help were the most commonly cited advantages of engaging in suicidal behavior. Negatively impacting family, violating one's values, and missing out on the future were the most commonly reported disadvantages of suicidal behavior. Limitations: Results may not be generalizable to patients without depression who are experiencing suicidality. Conclusion: Results suggest intervention efforts focused on addressing decision-making and problem-solving skills and reinforcing the important role patients play in the lives of their significant others may help patients to resist the urge to act on suicidal thoughts.

References

  • Abbas, M. J., Mohanna, M. A., Diab, T. A., Chikoore, M., & Wang, M. (2018). Why Suicide? The Analysis of Motives for Self-Harm. Behavioural and Cognitive Psychotherapy, 46(2), 209–225. First citation in articleCrossref MedlineGoogle Scholar

  • Alonzo, D. (2016). Suicidal individuals and mental health treatment: A novel approach to engagement. Community Mental Health Journal, 52(5), 527–533. 10.1007/s10597-015-9980-3 First citation in articleCrossref MedlineGoogle Scholar

  • Alonzo, D., & Gearing, R. E. (2017). Suicide assessment and treatment: Empirical and evidence-based practices. New York, NY: Springer Publishing. First citation in articleCrossrefGoogle Scholar

  • Andriessen, K. (2006). On "intention" in the definition of suicide. Suicide and Life-Threatening Behavior, 36(5), 533–538. First citation in articleCrossref MedlineGoogle Scholar

  • Baechler, J. (1979). Suicides. (B. Cooper, Trans.). New York, NY: Basic Books. First citation in articleGoogle Scholar

  • Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47(2), 343. First citation in articleCrossref MedlineGoogle Scholar

  • Blakely, T. A., Collings, S. C., & Atkinson, J. (2003). Unemployment and suicide. Evidence for a causal association? Journal of Epidemiology & Community Health, 57(8), 594–600. 10.1136/jech.57.8.594 First citation in articleCrossref MedlineGoogle Scholar

  • Boergers, J., Spirito, A., & Donaldson, D. (1998). Reasons for adolescent suicide attempts: Associations with psychological functioning. Journal of the American Academy of Child & Adolescent Psychiatry, 37(12), 1287–1293. 10.1097/00004583-199812000-00012 First citation in articleCrossref MedlineGoogle Scholar

  • Bridge, J. A., McBee-Strayer, S. M., Cannon, E. A., Sheftall, A. H., Reynolds, B., Campo, J. V., … Brent, D. A. (2012). Impaired decision making in adolescent suicide attempters. Journal of the American Academy of Child & Adolescent Psychiatry, 51(4), 394–403. 10.1016/j.jaac.2012.01.002 First citation in articleCrossref MedlineGoogle Scholar

  • Brodsky, B. S., Spruch-Feiner, A., & Stanley, B. (2018). The zero suicide model: Applying evidence-based suicide prevention practices to clinical care. Frontiers in Psychiatry, 9, 33. 10.3389/fpsyt.2018.00033 First citation in articleCrossref MedlineGoogle Scholar

  • Brown, G. K., Henriques, G. R., Sosdjan, D., & Beck, A. T. (2004). Suicide intent and accurate expectations of lethality: Predictors of medical lethality of suicide attempts. Journal of Consulting and Clinical Psychology, 72(6), 1170–1174. 10.1037/0022-006X.72.6.1170 First citation in articleCrossref MedlineGoogle Scholar

  • Collins, D. (2014). Cognitive interviewing practice. Los Angeles, CA: Sage. First citation in articleGoogle Scholar

  • Collins, S. E., Carey, K. B., & Otto, J. M. (2009). A new decisional balance measure of motivation to change among at-risk college drinkers. Psychology of Addictive Behaviors, 23(3), 464. 10.1037/a0015841 First citation in articleCrossref MedlineGoogle Scholar

  • Conner, K. R., Wyman, P., Goldston, D. B., Bossarte, R. M., Lu, N., Kaukeinen, K., … Hesselbrock, V. M. (2016). Two studies of connectedness to parents and suicidal thoughts and behavior in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 45(2), 129–140. 10.1080/15374416.2014.952009 First citation in articleCrossref MedlineGoogle Scholar

  • Donald, M., Dower, J., Correa-Velez, I., & Jones, M. (2006). Risk and protective factors for medically serious suicide attempts: A comparison of hospital-based with population-based samples of young adults. The Australian and New Zealand Journal of Psychiatry, 40(1), 87–96. 10.1080/j.1440-1614.​2006.01747.x First citation in articleCrossref MedlineGoogle Scholar

  • Duberstein, P. R., Conwell, Y., Conner, K. R., Eberly, S., & Caine, E. D. (2004). Suicide at 50 years of age and older: Perceived physical illness, family discord and financial strain. Psychological Medicine, 34(1), 137–146. 10.1017/S0033​291703008584 First citation in articleCrossref MedlineGoogle Scholar

  • Duberstein, P. R., Conwell, Y., Conner, K. R., Eberly, S., Evinger, J. S., & Caine, E. D. (2004). Poor social integration and suicide: fact or artifact? A case-control study. Psychological Medicine, 34(7), 1331–1337. 10.1017/s0033291704002600 First citation in articleCrossref MedlineGoogle Scholar

  • Elliott, J. C., Carey, K. B., & Scott-Sheldon, L. A. (2011). Development of a decisional balance scale for young adult marijuana use. Psychology of Addictive Behaviors, 25(1), 90. 10.1037/a0021743 First citation in articleCrossref MedlineGoogle Scholar

  • Freedenthal, S. (2007). Challenges in assessing intent to die: Can suicide attempters be trusted? OMEGA-Journal of Death and Dying, 55(1), 57–70. 10.2190/5867-6510-3388-3517 First citation in articleCrossref MedlineGoogle Scholar

  • Gunn, J. F., III. (2014). Suicide as escape: Baechler, Shneidman, and Baumeister. In J. F. GunnD. Lester (Eds.), Theories of suicide: Past, present, and future (pp. 9–22). Springfield, IL: Charles C. Thomas. First citation in articleGoogle Scholar

  • Gutheil, T. G., & Schetky, D. (1998). A date with death: management of time-based and contingent suicidal intent. American Journal of Psychiatry, 155(11), 1502–1507. 10.1176/ajp.155.11.1502 First citation in articleCrossref MedlineGoogle Scholar

  • Harriss, L., Hawton, K., & Zahl, D. (2005). Value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self-injury. The British Journal of Psychiatry, 186(1), 60-66. 10.1192/bjp.186.1.60 First citation in articleCrossref MedlineGoogle Scholar

  • Henson, J. M., Pearson, M. R., & Carey, K. B. (2015). Defining and characterizing differences in college alcohol intervention efficacy: A growth mixture modeling application. Journal of Consulting and Clinical Psychology, 83(2), 370–381. 10.1037/a0038897 First citation in articleCrossref MedlineGoogle Scholar

  • Hom, M. A., Stanley, I. H., & Joiner, T. E., Jr. (2015). Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: A review of the literature. Clinical Psychology Review, 40, 28–39. 10.1016/j.cpr.2015.05.006 First citation in articleCrossref MedlineGoogle Scholar

  • Horiuchi, S., Tsuda, A., Kobayashi, H., & Prochaska, J. M. (2012). Reliability and validity of the Japanese language version of Pro-Change's decisional balance measure for effective stress management 1. Japanese Psychological Research, 54(2), 128-136. 10.1111/j.1468-5884.2011.00490.x First citation in articleCrossrefGoogle Scholar

  • Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. 10.1177/1049732305276687 First citation in articleCrossref MedlineGoogle Scholar

  • Janis, I. L., & Mann, L. (1977). Decision making: A psychological analysis of conflict, choice, and commitment. New York, NY: Free Press. First citation in articleGoogle Scholar

  • Joiner, T. E., Jr., Van Orden, K. A., Witte, T. K., Selby, E. A., Ribeiro, J. D., Lewis, R., & Rudd, M. D. (2009). Main predictions of the interpersonal–psychological theory of suicidal behavior: Empirical tests in two samples of young adults. Journal of Abnormal Psychology, 118(3), 634. 10.1037/a0016500 First citation in articleCrossref MedlineGoogle Scholar

  • Jollant, F., Guillaume, S., Jaussent, I., Castelnau, D., Malafosse, A., & Courtet, P. (2007). Impaired decision-making in suicide attempters may increase the risk of problems in affective relationships. Journal of Affective disorders, 99(1–3), 59–62. 10.1176/appi.ajp.162.2.304 First citation in articleCrossref MedlineGoogle Scholar

  • Kells, M., Burke, P. J., Parker, S., Jonestrask, C., & Shrier, L. A. (2019). Engaging youth (adolescents and young adults) to change frequent marijuana use: Motivational Enhancement Therapy (MET) in primary care. Journal of Pediatric Nursing, 49, 24–30. 10.1016/j.pedn.2019.08.011 First citation in articleCrossref MedlineGoogle Scholar

  • Kleiman, E. M., & Liu, R. T. (2013). Social support as a protective factor in suicide: Findings from two nationally representative samples. Journal of Affective Disorders, 150(2), 540–545. 10.1016/j.jad.2013.01.033 First citation in articleCrossref MedlineGoogle Scholar

  • Krippendorff, K. (2004). Reliability in content analysis: Some common misconceptions and recommendations. Human Commu-nication Research, 30(3), 411–433. 10.1111/​j.1468-2958.2004.tb00738.x First citation in articleCrossrefGoogle Scholar

  • Lai, E. R. (2011). Motivation: A literature review research report. Retrieved from http://images.pearsonassessments.com/images/tmrs/motivation_review_final.pdf First citation in articleGoogle Scholar

  • Lee, S. H., Tsai, Y. F., Chen, C. Y., & Huang, L. B. (2014). Triggers of suicide ideation and protective factors of actually executing suicide among first onset cases in older psychiatric outpatients: A qualitative study. BMC Psychiatry, 14(1), 269. ​10.1186/s12888-014-0269-9 First citation in articleCrossref MedlineGoogle Scholar

  • Lester, D., Wood, P., Williams, C., & Haines, J. (2004). Motives for suicide – a study of Australian suicide notes. Crisis, 25(1), 33–34. 10.1027/0227-5910.25.1.33 First citation in articleLinkGoogle Scholar

  • Miller, W. (1999). Toward a theory of motivational interviewing. MINUET, 6(3), 2–4. First citation in articleGoogle Scholar

  • Miller, A. B., Esposito-Smythers, C., & Leichtweis, R. N. (2015). Role of social support in adolescent suicidal ideation and suicide attempts. Journal of Adolescent Health, 56(3), 286–292. 10.1016/j.jadohealth.2014.10.265 First citation in articleCrossref MedlineGoogle Scholar

  • Mirkovic, B., Labelle, R., Guilé, J. M., Belloncle, V., Bodeau, N., Knafo, A., … Gérardin, P. (2015). Coping skills among adolescent suicide attempters: Results of a multisite study. Canadian Journal of Psychiatry/Revue canadienne de psychiatrie, 60(2 Suppl 1), S37–S45. First citation in articleMedlineGoogle Scholar

  • O'Connor, R. C. (2011). The integrated motivational-volitional model of suicidal behavior. Crisis, 32, 295–298. 10.1027/0227-5910/a000120 First citation in articleLinkGoogle Scholar

  • Oquendo, M. A., Halberstam, B., & Mann, J. J. (2003). Risk factors for suicidal behavior. Standardized Evaluation in Clinical Practice, 22, 103–129. First citation in articleGoogle Scholar

  • Oquendo, M. A., Halberstam, B., & Mann, J. J. (2008). Columbia suicide history form. Handbook of Psychiatric Measures, 2, 241–242. First citation in articleGoogle Scholar

  • Owen, G., Belam, J., Lambert, H., Donovan, J., Rapport, F., & Owens, C. (2012). Suicide communication events: Lay interpretation of the communication of suicidal ideation and intent. Social Science & Medicine, 75(2), 419–428. 10.1016/j.socscimed.2012.02.058 First citation in articleCrossref MedlineGoogle Scholar

  • Park, S. M., Cho, S. I., & Moon, S. S. (2010). Factors associated with suicidal ideation: role of emotional and instrumental support. Journal of Psychosomatic Research, 69(4), 389–397. 10.1016/j.jpsychores.2010.03.002 First citation in articleCrossref MedlineGoogle Scholar

  • Pollock, L. R., & Williams, J. M. G. (2004). Problem-solving in suicide attempters. Psychological Medicine, 34(1), 163–167. 10.1017/S0033291703008092 First citation in articleCrossref MedlineGoogle Scholar

  • Reist, C., Mee, S., Fujimoto, K., Rajani, V., Bunney, W. E., & Bunney, B. G. (2017). Assessment of psychological pain in suicidal veterans. PloS one, 12(5), e0177974. 10.1371/journal.pone.0177974 First citation in articleCrossref MedlineGoogle Scholar

  • Reynolds, F. M., & Berman, A. L. (1995). An empirical typology of suicide. Archives of Suicide Research, 1(2), 97–109. 10.1080/13811119508258978 First citation in articleCrossrefGoogle Scholar

  • Rodham, K., Hawton, K., & Evans, E. (2004). Reasons for deliberate self-harm: Comparison of self-poisoners and self-cutters in a community sample of adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 43(1), 80–87. 10.1097/01.chi.0000096627.64367.74 First citation in articleCrossref MedlineGoogle Scholar

  • Schütz, A. (1984). The phenomenology of the social world. Evanston, IL: Northwestern University Press. First citation in articleGoogle Scholar

  • Shek, D. T., Tang, V. M., & Han, X. Y. (2005). Evaluation of evaluation studies using qualitative research methods in the social work literature (1990–2003): Evidence that constitutes a wake-up call. Research on Social Work Practice, 15(3), 180–194. 10.1177%2F1049731504271603 First citation in articleCrossrefGoogle Scholar

  • Stone, D. M., Holland, K. M., Bartholow, B. N., Crosby, A. E., Davis, S. P., & Wilkins, N. (2017). Preventing suicide: A technical package of policies, programs, and practice. Atlanta, GA: National Center for Injury Prevention and Control. 10.15620/cdc.​44275 First citation in articleCrossrefGoogle Scholar

  • Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E., Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. 10.1037/a0018697 First citation in articleCrossref MedlineGoogle Scholar

  • Van Orden, K. A., O'Riley, A. A., Simning, A., Podgorski, C., Richardson, T. M., & Conwell, Y. (2015). Passive suicide ideation: An indicator of risk among older adults seeking aging services? The Gerontologist, 55(6), 972–980. 10.1093/geront/gnu026 First citation in articleCrossref MedlineGoogle Scholar

  • Walker, K. L., Chang, E. C., & Hirsch, J. K. (2017). Neuroticism and suicidal behavior: Conditional indirect effects of social problem solving and hopelessness. International Journal of Mental Health and Addiction, 15(1), 80–89. 10.1007/s11469-016-9648-4 First citation in articleCrossrefGoogle Scholar

  • Westheide, J., Quednow, B. B., Kuhn, K. U., Hoppe, C., Cooper-Mahkorn, D., Hawellek, B., … Wagner, M. (2008). Executive performance of depressed suicide attempters: the role of suicidal ideation. European Archives of Psychiatry and Clinical Neuroscience, 258(7), 414–421. 10.1007/s00406-008-0811-1 First citation in articleCrossref MedlineGoogle Scholar

  • Yoshimasu, K., Kiyohara, C., & Miyashita, K., & Stress Research Group of the Japanese Society for Hygiene. (2008). Suicidal risk factors and completed suicide: Meta-analyses based on psychological autopsy studies. Environmental Health and Preventive Medicine, 13(5), 243–256. 10.1007/s12199-008-0037-x First citation in articleCrossref MedlineGoogle Scholar