Citation

Tham SG, Ibrahim S, Hunt IM, Kapur N, Gooding P. J. Affect. Disord. 2019; ePub(ePub): ePub.

Affiliation

Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, UK. Electronic address: Patricia.A.Gooding@manchester.ac.uk.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.jad.2019.11.037

PMID

31744741

Abstract

BACKGROUND: Psychological models of suicide emphasize perceptions of negative stressors, hopelessness and self-harm as key antecedents to suicidal thoughts/acts. Such models also emphasize the potential protective role of social support in these pathways. However, such pathways have not been tested using population level data. Hence, this study aimed to redress this gap.

METHODS: Questionnaire data regarding 24,444 patient suicide deaths were analysed. All individuals died between 1996 and 2015 and were seen by secondary mental health services in England within 12 months before their death. Mediation analyses, using fitted logistic regression models, investigated direct and indirect pathways between negative stressors, hopelessness and a proxy measure of suicide, namely, self-harm history. In addition, the buffering effects of social support were examined in these pathways.

RESULTS: There was a direct effect of negative life events on suicidal behaviors. Supporting contemporary psychological models of suicide, a mediated effect via hopelessness and a protective effect of social support were identified. Social support buffered the pathway between stressful life events and hopelessness, with hopelessness decreasing as social support increased. LIMITATIONS: Causal inferences are inappropriate as the design was cross-sectional. A proxy measure of suicidality was utilized (history of self-harm) as all individuals had died by suicide.

CONCLUSIONS: This is the first time that population data has been used to test psychological pathways to suicidal acts involving negative stressors, hopelessness and social support. Psychological interventions should focus on increasing social support following negative life events together with ameliorating perceptions of hopelessness.

Copyright © 2019. Published by Elsevier B.V.

Language: en

Keywords

Hopelessness; Life events; Mediation; Self-harm; Social support; Suicide