Society for Social Work and Research

Sixteenth Annual Conference Research That Makes A Difference: Advancing Practice and Shaping Public Policy
11-15 January 2012 I Grand Hyatt Washington I Washington, DC

116P Death As An Escape From Discrepancy: Examining the Value of Life Satisfaction and Self-Esteem In Predicting Suicidality In Schizophrenia

Saturday, January 14, 2012
Independence F - I (Grand Hyatt Washington)
* noted as presenting author
Anthony Fulginiti, MSW, Ph.D. Student, University of Southern California, Los Angeles, CA
John S. Brekke, PhD, Frances Larson Professor of Social Work Research, Associate Dean of Research, University of Southern California, Los Angeles, CA
Background: Suicide in schizophrenia occurs at an alarming rate and continues to be poorly understood. Suicide is often framed as an escape but an escape from what? The Escape Theory of Suicide posits that suicide is an escape from discrepancies in perceptions of self and life, which are characterized by the distance between where one is and where one wants to be. Discrepancy factors have not been well-studied in the suicide literature and the explanatory framework carries tremendous promise for an improved understanding of why people kill themselves, and more critically, how we should intervene.

Informed by the Escape Theory of Suicide, the present study aims to examine the relationship between incongruence in self and life conditions and current suicidality.

Methods: An analysis was performed using baseline data from an NIMH-funded, longitudinal study investigating the psychosocial rehabilitation of individuals with serious mental illness. All individuals with a schizophrenia-spectrum diagnosis (N=166) were selected for analysis. The Satisfaction with Life Scale (SLS) and Index for Self-Esteem (ISE) were employed to operationalize life- and self- discrepancy. The Brief Psychiatric Rating Scale-Extended (BPRS-E) was used to measure psychiatric symptom severity. History of suicide attempt and demographic factors were measured using self-report. Current suicidality was measured by a single-item from the BPRS-E.

Hierarchical regression was employed to examine the relative contribution of three sets of predictors in explaining current suicidality: (i) demographic/historical factors, (ii) current clinical factors and (iii) discrepancy factors. Model 1 included demographic/historical variables. Model 2 added a variable for psychiatric symptom severity. Model 3 added the set of discrepancy factors.

Results: Model 1 was significant (F=4.252, p<01). Model 2 represented a significant improvement in fit relative to Model 1 (change in F-statistic= 12.592, p<.001), and Model 3 represented a significant improvement in fit relative to Model 2 (change in F-statistic= 3.291, p<.01). Model 3 accounted for an additional 9.9% of the variance in current suicidality. Based on these findings, Model 3 was identified as the best fitting model, accounting for 26.8% of the variability in current suicidality. Controlling for all other variables (such as age, race, gender), lower life satisfaction (p<.01, one-tailed), suicide history (p<.01, one-tailed) and greater psychiatric symptom severity (p<.01, one-tailed) were significant individual predictors of current suicidality.

Conclusions and Implications: Although suicide is a primary source of premature mortality in the Schizophrenia population, it has surprisingly garnered little attention. To prevent suicide, we need to know why individuals kill themselves, which can only be furthered by more vigorous research efforts. The current research answers this call to action. Consistent with the Escape Theory of Suicide, discrepancy factors, particularly life satisfaction, were important factors in explaining suicidality. These findings suggest that discrepancy factors may be ideal targets and new entry points for suicide intervention and assessment. Future research should attempt measuring life discrepancy directly, as it is largely implied from our current measures; nonetheless, the current findings speak to the viability of Escape Theory in predicting suicidality among individuals with Schizophrenia.