Suicide Ideation: A pivotal precursor to understanding suicide in young adults

By Madhav Bhargav.

Natural selection will never produce in a being any structure more injurious than beneficial to that being, for natural selection acts solely by and for the good of each. No organ will be formed for the purpose of causing pain or for doing an injury to its possessor.

Charles Darwin

Recently, more humans have been dying by suicide yearly than by murder and warfare combined. Suicide is a leading cause of death among young people aged from 15 to 29 years [1]. The pathways to suicide can be complex, with suicide being the output of an interplay of clinical, psychological, biological, social and cultural risk, and protective, factors [2]. Suicidal phenomena can be categorised into three main types. A suicide plan refers to the consideration of a particular method through which one may intend to die. A suicide attempt refers to participating in potentially self-injurious behaviour in which there is an intent to die. Lastly, suicide ideation refers to having thoughts about killing oneself [3]. Suicide ideation is considered to be an early predictor to later attempted suicide. More than 60% of individuals who progress from thinking about suicide to attempting suicide will do so within the first year after the onset of suicidal ideation, suggesting that the year after the first onset of suicidal ideation is a high-risk time [4]. And this pattern can also be seen in the young adult cohort too [5].

Young adulthood – ages approximately 18 to 25 years – is a vital time in life. In recent years, rapid technological changes, unpredictable economic challenges, and a lengthy transition to adulthood appear to be contributing to the mental and physical health problems of young adults by increasing their stress [6]. These challenges and transitions make them less likely to engage with work and family roles that serve as strong social controls on risk-taking [6]. Indeed, stress has been cited as the top hindrance to academic performance in a survey of over 80,000 students in the United States in 2008 [7]. Research has indicated that 18% of undergraduate students have seriously considered attempting suicide during their lifetimes and 40% to 50% of these students reported multiple episodes of suicidal thoughts [8]. Rates may typically vary considering a wide range of variables such as age, gender, inpatient or outpatient groups etc. Moreover, in a survey of over 80,000 students at 106 schools, approximately 1 in 10 college students reported suicidal ideation within the past year [7]. Subsequently, a cross-national prevalence study found that just under 3% of people will attempt suicide during their lifetime, however, 9.2% will have suicide ideation which is more than three times that number [9].

A conversation about why should we study suicidal thinking in young adults is due and necessary, both from a theoretical and practical perspective. Theories such as the interpersonal theory of suicide [10] and the integrated motivational-volitional model of suicide provide [11] that foundation for the research to outline the crucial difference between suicide ideation and behaviours. Another framework such as the “Ideation-to-action” framework of suicide [12] proposes that suicide ideation is one of the first steps on the pathway to suicidal behaviours. It is pivotal to understand the differentiation between ideation and suicidal behaviour. There may be completely distinct mechanisms underpinning these phenomena. Predictors and explanations for suicide should be classified as to whether they address (a) risk of suicide ideation, (b) risk of suicide attempts among those with ideation, or (c) both.

It is crucial to outline the fact that individuals with suicidal thoughts who think about suicide don’t necessarily go on to make attempt – meaning suicide is not an inevitable outcome and that many help and supports are available [3,4]. Suicidal ideation might be a distressing and difficult experience for someone in and of itself and studying it can help us develop strategies to address this difficult experience. Mental health professionals and counsellors can use this for screening purposes to effectively support individuals with lived experiences. An in-depth comprehension of survivor experiences can assist and empower mental health professionals to provide effective psychoeducation and informed support to individuals. [13,14]. There is still no question that talking about suicide is stigmatized. But when people hear stories of each other struggling with mental illness or with suicide ideation, that helps people to know they are not alone and helps in reducing the stigma.

References

1. World Health Organization (WHO). (2021). Suicide worldwide in 2019: global health estimates.
2. O’Connor, R. C., & Nock, M. K. (2014). The psychology of suicidal behaviour. The Lancet Psychiatry, 1(1), 73-85. https://doi.org/10.1016/S2215-0366(14)70222-6
3. Nock, M. K. (2009). Why do people hurt themselves?: New insights into the nature and functions of self-injury. Current Directions in Psychological Science. https://doi.org/10.1111/j.1467-8721.2009.01613.x
4. Nock, M. K. (2016). Recent and Needed Advances in the Understanding, Prediction, and Prevention of Suicidal Behavior. Depression and Anxiety, 33(6), 460–463. https://doi.org/10.1002/da.22528
5. Karatekin, C. (2018). Adverse Childhood Experiences (ACEs), Stress and Mental Health in College Students. Stress and Health. https://doi.org/10.1002/smi.2761
6. Bonnie, R. J., Stroud, C., Breiner, H., Committee on Improving the Health, S., & National Research Council. (2015). Education and Employment. In Investing in the health and well-being of young adults. National Academies Press (US).
7. Hoban, M. (2009). American college health association-national college health assessment spring 2008 reference group data report (Abridged): The American college health association. Journal of American College Health. https://doi.org/10.3200/JACH.57.5.477-488
8. Drum, D. J., Brownson, C., Denmark, A. B., & Smith, S. E. (2009). New Data on the Nature of Suicidal Crises in College Students: Shifting the Paradigm. Professional Psychology: Research and Practice. https://doi.org/10.1037/a0014465
9. Nock M.K, Borges G, Bromet E.J, et al. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans, and attempts. Br J Psychiatry 2008;192:98–105. doi: 10.1192/bjp.bp.107.040113.
10. Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press. Harvard University Press.
11. O’Connor, R. C., & Kirtley, O. J. (2018). The integrated motivational-volitional model of suicidal behaviour. In Philosophical Transactions of the Royal Society B: Biological Sciences. https://doi.org/10.1098/rstb.2017.0268
12. Klonsky E.D, Saffer B.Y, Bryan C.J, (2018). Ideation-to-action theories of suicide : a conceptual and empirical update. Current Opinions Psychology 2018;22:38–43. doi: 10.1016/j.cop- syc.2017.07.020.
13. Kleiman, E. M. (2020). Suicidal thinking as a valuable clinical endpoint. EClinicalMedicine, 23, 100399. https://doi.org/10.1016/j.eclinm.2020.100399
14. Shamsaei, F., Yaghmaei, S., & Haghighi, M. (2020). Exploring the lived experiences of the suicide attempt survivors: a phenomenological approach. International journal of qualitative studies on health and well-being, 15(1), 1745478.

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