The forever decision: a qualitative study among survivors of a suicide attempt

Karlijn Heesen; Saskia Mérelle; Isa van den Brand; Diana van Bergen; David Baden; Karin Slotema; Renske Gilissen; Sisco van Veen

doi:10.1016/j.eclinm.2024.102449

The forever decision: a qualitative study among survivors of a suicide attempt

EClinicalMedicine. 2024 Feb 1:69:102449. doi: 10.1016/j.eclinm.2024.102449. eCollection 2024 Mar.

Authors

Karlijn Heesen^{1

2}, Saskia Mérelle¹, Isa van den Brand¹, Diana van Bergen^{1

3}, David Baden^{4

5}, Karin Slotema^{6

7}, Renske Gilissen¹, Sisco van Veen^{1

8}

Affiliations

¹ 113 Suicide Prevention, Paasheuvelweg 25, 1105 BP, Amsterdam, the Netherlands.
² Psychotraumacentrum Zuid Nederland, Reinier van Arkel Groep, 5211 LJ 's-Hertogenbosch, The Netherlands.
³ University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands.
⁴ Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, the Netherlands.
⁵ Nederlandse Vereniging van Spoedeisende Hulp Artsen, Mercatorlaan 1200, 3528 BL, Utrecht, the Netherlands.
⁶ Parnassia Psychiatric Institute, Lijnbaan 4, 2512 VA, The Haque, the Netherlands.
⁷ Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, the Netherlands.
⁸ Amsterdam University Medical Centre, Department of Psychiatry & Department of Ethics, Law and Humanities, De Boelelaan 1117, Amsterdam, the Netherlands.

Abstract

Background: Suicide attempts have a profound emotional impact on both individuals and society as a whole. This qualitative study delves into three key aspects: 1) the progression through the suicidal process, 2) the influential factors facilitating the transition from ideation to attempt using the volitional moderators within the integrated motivational-volitional (IMV) model, and 3) preventive strategies impeding this transition from ideation to attempt.

Methods: Between October 1, 2022 and March 7, 2023 we interviewed 27 adults (23 women, four men, mean age 33 years) who attempted suicide within the past 12 months. Participants were recruited through social media and in collaboration with several mental health institutions in the Netherlands. The participants were initially screened and interviewed based on the Pathway to Suicidal Actions Interview. Analysis was performed employing the constant comparative method.

Findings: Despite the heterogeneity of the suicidal process, suicidal thoughts predominately emerged during adolescence (Mdn = 15, M = 17.8). In most participants, planning and preparatory actions occurred long before the attempt, with a median of six years prior to the attempt for the selection of the method. All volitional moderators were observed, although pain sensitivity in particular varied among participants. Access to lethal means and planning emerged as important moderators in the suicidal process. Asking the survivors what could have helped to prevent their attempts, most participants mentioned that they felt their suicidality was not taken seriously enough.

Interpretation: We discussed the significance of planning in the suicidal process, challenges in conceptualizing planning and impulsivity, and individual differences in pain sensitivity. Based on the findings, we underscore the critical need for restricting access to means, giving greater consideration to preparatory actions within the suicidal process, and fostering open dialogues about suicidality.

Funding: This research was funded by ProRail, the Dutch rail infrastructure manager in line with their work on mental health.

Keywords: Protective factors; Risk factors; Suicidality; Suicide attempt; Suicide prevention.