Revealing a Potentially Life-Saving Secret: An Exploratory Social Network Study Examining the Patterns and Correlates of Suicidal Disclosure Among People with Serious Mental Illness in India

Background and Purpose: Non-disclosure of suicidal thoughts can seriously limit suicide risk management. Despite functioning as a key step in getting “help”, there is a paucity of literature on the subject of “suicidal disclosure” (i.e. disclosure of suicidal thoughts). Although this research gap is apparent in the domestic literature on serious mental illness (SMI)—which is alarming given the disproportionately higher suicide risk in this group—it is even more pronounced in international work. With increasing rates of suicide in India during recent decades and no known work examining disclosure among people with SMI in India, an exploratory study is needed to begin shedding light on the issue of disclosure in this high-need population and cultural context. Consistent with the notion that any disclosure involves a sender (i.e. discloser) and receiver (i.e. confidant), a thorough examination of “suicidal disclosure” demands accounting for individual and relationship factors. The aims of this preliminary study were to (1) describe patterns of disclosure and (2) examine the association between individual and relationship factors and the intent to disclose suicidal thoughts in a small group of people with SMI in India.

Methods: Egocentric network and survey data were collected from individuals with SMI receiving community-based mental health treatment in India. Information was gathered about the individual participants, including clinical (e.g. psychiatric symptoms) and psychosocial (e.g. social support) variables, as well as their relationships with people in their social networks. Two-level hierarchical logistic models (HLM), which accounted for clustering within individual-specific networks, were employed to examine the associations between individual and relational factors and the intent to disclose. Due to the exploratory nature of the study and power constraints, individual and relational variables were evaluated in bivariate analyses. Level 2 sample size constitutes study participants (n=12) while level 1 sample size constitutes participant network members (n=170).

Results: Participants, on average, had disclosed their suicidal thoughts to nearly 4 people in their social network in the past and intended on disclosing to nearly 3 people in the future if suicidal thoughts were to reoccur. Bivariate analyses of individual-level factors indicated that people with greater social support (OR=1.51; 95% CI: 1.07, 2.13) are more likely to intend to disclose suicidal thoughts. Bivariate analyses of relational-level factors indicated that greater frequency of contact (OR=1.79; 95% CI: 1.12, 2.83) and greater relationship closeness (OR=2.43; 95% CI: 1.44, 4.11) with a social network member was associated with increased intent to disclose to that network member.

Conclusions and Implications: In line with work on other concealable stigmatized statuses (e.g. HIV/AIDS), social support was found to be influential in the disclosure of suicidal thoughts among people with SMI in India. This raises awareness about additional benefits of enhancing social support among people in the higher risk subpopulation of people with SMI and a history of suicidal ideation. Finding that greater frequency of contact and relationship closeness increased the likelihood of suicidal disclosure suggests that generating greater opportunities for social interaction and stronger bonds within social networks could pay untold dividends for greater disclosure.