225P
Disclosure of Suicidal Thoughts: Examining Individual and Relational Factors for Getting Help
Suicidal thoughts are a well-recognized target for interventions aimed at reducing suicidal behavior but it is often overlooked that an individual must disclose those thoughts before suicide risk can be optimally managed and treated. In short, the disclosure of suicidal thoughts represents a key first step in getting help and provides a window of opportunity for suicide prevention. Available evidence in the general population suggests that approximately half of those with a history of suicidal thoughts have talked to someone about those thoughts. However, little is known about the subject of disclosure among those with serious mental illness (SMI), which is alarming given the fact that the risk of suicide is disproportionately concentrated in this vulnerable group. Given that any given disclosure involves a discloser and a target confidant for disclosure, understanding the disclosure of suicidal thoughts requires consideration of individual and relationship factors. The aim of the current study was to examine the association between individual and relationship factors and the intent to disclose suicidal thoughts.
Methods:
Egocentric network and survey data were collected from individuals with SMI receiving community-based mental health treatment. The current study focuses on individuals with a reported history of suicidal ideation (n=40). Information was obtained for individuals’ social networks, disclosure of suicidal thoughts as well as several clinical (i.e. psychiatric symptoms, function) and psychosocial (i.e. social support, stigma) variables. Multilevel Modeling (MLM) was conducted to determine the influence of individual and relational factors on intent to disclose future suicidal thoughts. Due to power concerns, individual and relational variables were evaluated separately in bivariate followed by multivariable analyses. MLM was used to account for clustering within individual-specific networks. The level 2 sample size constitutes the study participants (n=40) while the level 1 sample size constitutes participant network members (n=598).
Results:
Bivariate analyses of individual-level factors indicate that females as well as those reporting more support and less stigma are more likely to indicate an intent to disclose suicidal thoughts in the future. Results of the MLM demonstrated that only perceived social support (OR=1.16, p<.01) was found to be significantly associated with intent to disclose suicidal thoughts. Bivariate analyses and results from the MLM of relational-level variables indicate that relationship closeness (OR=2.03; p<.001), frequency of contact (OR=1.46, p<.01), and in-person contact (OR=3.47, p<.05)were associated with intent to disclose.
Conclusions and Implications:
At the individual-level, finding that social support and stigma represent key factors for the disclosure of suicidal thoughts is consistent with studies of other concealable stigmatized conditions (i.e. HIV/AIDS). This calls for increased efforts at enhancing social support and targeted stigma of suicide among those with a history of suicidal ideation. Furthermore, finding that relationship closeness and frequency of contact/in-person contact increase the likelihood of suicidal disclosure suggest that relationship quality and opportunity are critical for disclosure. This work highlights the protective value of relationship enhancement and social network development.