Research Spotlight: Uncovering the Pathways and Causes of Suicidal Ideation
In an intriguing UK study of a large, non-clinical community group, researchers worked with public advisors with lived experience of suicidal behaviours to develop a study that explores suicidal thoughts and their predictors. Cecil Kullu, a Consultant Psychiatrist at GMMH, and one of the co-authors of this study, told us more about the findings.
Much of the research into suicide and self-harm ideation has previously occurred in small samples of people who have had clinical contact with mental health services. The NIHR’s Household Health Survey (HHS) surveyed over 6,700 people at one or two timepoints between 2015 and 2018 in their own homes in the North West of England. Using the data from 851 individuals who had responded to two surveys over a period of three years, the comprehensive longitudinal study identified three suicidal ideation trajectories: 'onset', 'remission', and 'persistence'.
‘Suicidal ideation onset’ meant that ideation only occurred in the later survey. ‘Suicidal ideation remission’ indicated that ideation only occurred in the first survey, but not in the second. And ‘suicidal ideation persistence’ was defined as a person who experienced ideation at both periods of time that the surveys took place.
Age, socioeconomic indicators, health and other factors were analysed against these trajectories to better understand risk factors and protective factors related to suicidal thoughts. Common patterns across the three trajectories were noted, such as persistent physical health problems or a feeling of entrapment such as having caring responsibilities or problems with housing.
While the study found similar trends in the onset and persistent stages, the remission stage was quite different. The remission trajectory indicated improvement over time, and the data analysis suggested characteristics such as fewer debilitating physical health factors, no entrapment-related risk factors, and an improvement in socioeconomic position.
It was also found that health conditions that cause chronic pain, medication side effects as well as hearing problems, raised chances of having suicidal thoughts. Lifestyle or personal coping behaviours, such as smoking and consuming alcohol, have been identified as additional risk factors for suicidal ideation too. The remission stage on the other hand, shows a state of improved health, marked by a reduction in debilitating factors and an increase in self-reliance, or the ability to take control of one's own activities.
Additionally, it was found that young people with depression are more likely to have suicidal thoughts than other people. Belonging to marginalised groups, such as people with Black, Asian, or other minority ethnicity (BAME), has also been recognised as a risk factor. Higher risk is also associated with lower socioeconomic positions, which is distinguished by elements like unemployment, stagnating finances, and substandard housing.
Furthermore, individuals with higher perceptions of hopelessness and a diminished ability to plan their life course are also at an increased risk. However, those with high empathy, self-esteem, and social connectedness, such as being involved in their community, have been shown to be protected from suicidal ideation. Strong social ties, social support, and a stable attachment style have been shown to prevent suicidal thoughts and behaviours.
The findings of this study can further inform mental health evaluations by providing new insights into dynamic suicide risk in real world settings and the changing nature of suicidal ideation, and action, over time. The researchers hope that a greater appreciation for the many different aspects of suicidal trajectories can lead to the development of more targeted interventions.
The published article is available to read on BMJ Open here. Mulholland H, Whittington R, Lane S, et al. Longitudinal investigation of the presence of different trajectories and associated health and socio-economic determinants, for participants who report suicidal ideation within a community-based public health survey.
BMJ Open 2023;13:e063699. Doi:10.1136/bmjopen-2022-063699
