Reports on the Perceived Advantages and Disadvantages of Suicidal Behavior by Patients With Depression
Content Analysis of the Decisional Balance Worksheet
Abstract
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
2018). Why Suicide? The Analysis of Motives for Self-Harm. Behavioural and Cognitive Psychotherapy, 46(2), 209–225.
(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
(2017). Suicide assessment and treatment: Empirical and evidence-based practices. New York, NY: Springer Publishing.
(2006). On "intention" in the definition of suicide. Suicide and Life-Threatening Behavior, 36(5), 533–538.
(1979). Suicides. (B. Cooper, Trans.). New York, NY: Basic Books.
(1979). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47(2), 343.
(2003). Unemployment and suicide. Evidence for a causal association? Journal of Epidemiology & Community Health, 57(8), 594–600. 10.1136/jech.57.8.594
(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
(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
(2018). The zero suicide model: Applying evidence-based suicide prevention practices to clinical care. Frontiers in Psychiatry, 9, 33. 10.3389/fpsyt.2018.00033
(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
(2014). Cognitive interviewing practice. Los Angeles, CA: Sage.
(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
(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
(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
(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/S0033291703008584
(2004). Poor social integration and suicide: fact or artifact? A case-control study. Psychological Medicine, 34(7), 1331–1337. 10.1017/s0033291704002600
(2011). Development of a decisional balance scale for young adult marijuana use. Psychology of Addictive Behaviors, 25(1), 90. 10.1037/a0021743
(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
(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.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
(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
(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
(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
(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
(2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. 10.1177/1049732305276687
(1977). Decision making: A psychological analysis of conflict, choice, and commitment. New York, NY: Free Press.
(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
(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
(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
(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
(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
(2011). Motivation: A literature review research report. Retrieved from http://images.pearsonassessments.com/images/tmrs/motivation_review_final.pdf
(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
(2004). Motives for suicide – a study of Australian suicide notes. Crisis, 25(1), 33–34. 10.1027/0227-5910.25.1.33
(1999). Toward a theory of motivational interviewing. MINUET, 6(3), 2–4.
(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
(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.
(2011). The integrated motivational-volitional model of suicidal behavior. Crisis, 32, 295–298. 10.1027/0227-5910/a000120
(2003). Risk factors for suicidal behavior. Standardized Evaluation in Clinical Practice, 22, 103–129.
(2008). Columbia suicide history form. Handbook of Psychiatric Measures, 2, 241–242.
(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
(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
(2004). Problem-solving in suicide attempters. Psychological Medicine, 34(1), 163–167. 10.1017/S0033291703008092
(2017). Assessment of psychological pain in suicidal veterans. PloS one, 12(5),
(e0177974 . 10.1371/journal.pone.01779741995). An empirical typology of suicide. Archives of Suicide Research, 1(2), 97–109. 10.1080/13811119508258978
(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
(1984). The phenomenology of the social world. Evanston, IL: Northwestern University Press.
(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
(2017). Preventing suicide: A technical package of policies, programs, and practice. Atlanta, GA: National Center for Injury Prevention and Control. 10.15620/cdc.44275
(2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. 10.1037/a0018697
(2015). Passive suicide ideation: An indicator of risk among older adults seeking aging services? The Gerontologist, 55(6), 972–980. 10.1093/geront/gnu026
(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
(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
(
, &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