By Kamelia Harris
Suicide is a leading cause of premature death in people experiencing mental health problems such as schizophrenia . Around 10% of people experiencing this mental health problem die by suicide  and many more will experience suicidal thoughts and behaviours. My work focuses on understanding how by developing resilience in people, suicidal thoughts and behaviours can be prevented or reduced. Resilience to suicide has been explained as an ability to regulate suicidal thoughts , or an internal factor which defends against suicidality . In order to effectively reduce the rate of suicide deaths, particularly in high-risk populations, such as those experiencing mental health problems, we should look to understand what can prevent people from thinking about or attempting suicide .
To do this, I interviewed 20 people with schizophrenia-related mental health problems (e.g., schizophrenia, delusional disorder, schizoaffective disorder, non-affective psychosis) about their perspectives and experiences of resilience to suicidal thoughts and behaviours . Half of the participants in the study were female, most were white British, and their average age was 48 years. All participants reported suicidal experiences in their lifetime, such as suicidal thoughts, plans, attempts, and/or self-harm. During the interviews, I asked people how they were coping with thoughts about suicide, what prevented them from thinking about or attempting suicide, what they found was helpful in those situations, and how they managed to get through such difficult times.
People described resilience as a process which developed over time, through the experience of managing mental health problems and suicidal experiences, and their impact on wellbeing. Importantly, resilience involved substantial effort to develop and maintain in the long term: ‘Put the effort in and you’ll get there in the end…You keep going and you’ll get there at the end.’ This effort involved three aspects:
- Understanding experiences (including accepting mental health experiences and seeking reasons to live),
- Active behaviours (including talking to people and keeping occupied),
- Relationship dynamics (including feeling supported by significant others and mental health professionals).
Having an understanding of personal suicidal experiences was also described as important in developing resilience. Understanding was based on individuals’ perceptions of their own experiences and the different ways they made sense of these over time. The process of understanding led to reconciliation and acceptance. The longer people experienced such problems, the better they felt able to manage them effectively.
Participants also spoke about the importance of having reasons to carry on with their life. Seeking out purpose in life was key in building resilience to suicidal thoughts and behaviours. Purpose in life was unique to each individual and seemed to relate to their current circumstances and what they considered to be of main importance. For example, one participant described feeling responsible for her children: ‘That’s what kept me going, my children, and the thought of them being left without a mum.’
People also described a range of behaviours that helped them cope with suicidal experiences. These behaviours included talking to people and keeping occupied by doing things, such as reading, listening to music, cooking, cleaning, going for a walk/to the gym, watching television, and playing computer games. In addition, family, friends and mental health professionals had an important role in helping to build individual resilience. Actively seeking and maintaining supportive relationships was key in coping with suicidal experiences. Feeling loved and supported by others was essential in times of crisis when individuals’ suicidal experiences felt too severe and difficult to cope with. As one participant said, other people’s effort made him feel that he was cared for, which contributed to his resilience: ‘I’m cared for, it’s the fact that the effort has been made by me and the care community around me.’
These findings highlight the effort that individuals need to go to in order to develop and maintain their resilience, especially at times of crisis when resilience may be low, and they feel vulnerable. This underlines the need for planning additional mental health care support during such circumstances.
- Reininghaus, U., Dutta, R., Dazzan, P., Doody, G.A., Fearon, P., Lappin, J., . . . Jones, P.B. (2015). Mortality in schizophrenia and other psychoses: a 10-year follow-up of the ӔSOP first-episode cohort. Schizophrenia Bulletin, 41(3), 664-673.
- Hor, K., & Taylor, M. (2010). Suicide and schizophrenia: a systematic review of rates and risk factors. Journal of Psychopharmacology, 24, 81-90.
- Osman, A., Gutierrez, P.M., Muehlenkamp, J.J., Dix-Richardson, F., Barrios, F.X., & Kopper, B.A. (2004). Suicide Resilience Inventory–25: development and preliminary psychometric properties. Psychological Reports, 94(3), 1349-1360.
- Rutter, P.A., Freedenthal, S., & Osman, A. (2008). Assessing protection from suicidal risk: psychometric properties of the suicide resilience inventory. Death Studies, 32, 142-153.
- Rudd, M.D. (2012). The clinical risk assessment interview. In R. I. Simon & R. E. Hales (Eds.). The American Psychiatric Publishing Textbook of Suicide Assessment and Management (2nd ed., pp. 57-73). Washington, DC: American Psychiatric Publishing.
- Harris, K., Gooding, P., Haddock, G., & Peters, S. (2019). Factors that contribute to psychological resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses: Qualitative study. BJPsych Open. DOI: 10.1192/bjo.2019.63.