Factors that contribute to psychological resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses: qualitative study

Abstract

Background Suicide is a leading cause of premature death in people with a diagnosis of schizophrenia. Although exposure to stressors can play a part in the pathways to death by suicide, there is evidence that some people with a diagnosis of schizophrenia can be resilient to the impact of suicide triggers. Aims To investigate factors that contribute to psychological resilience to suicidal thoughts and behaviours from the perspectives of people with a diagnosis of schizophrenia. Method A qualitative design was used, involving semi-structured, face-to-face interviews. Twenty individuals with non-affective psychosis or schizophrenia diagnoses who had experience of suicide thoughts and behaviours participated in the study. The interviews were audio-recorded, transcribed verbatim and examined using inductive thematic analysis. Results Participants reported that psychological resilience to suicidal thoughts and behaviours involved ongoing effort. This ongoing effort encompassed: (a) understanding experiences (including reconciliation to mental health experiences and seeking reasons to live), (b) active behaviours (including talking to people and keeping occupied), and (c) relationship dynamics (including feeling supported by significant others and mental health professionals). Conclusions Psychological resilience was described as a dynamic process that developed over time through the experiences of psychosis and the concomitant suicidal experiences. Psychological resilience can be understood using a multicomponential, dynamic approach that integrates buffering, recovery and maintenance resilience models. In order to nurture psychological resilience, interventions should focus on supporting the understanding and management of psychosis symptoms and concomitant suicidal experiences. Declaration of interest None.

The clinical characterization of the patient with primary psychosis aimed at personalization of management

“…Given that no protective factor or aspect of resilience emerges as a "primary" contributor to functioning in persons with psychosis, consideration of several factors is important for understanding their relative contribution 296,299 . Some factors can have a direct effect on functioning, while others act as mediators of the relationship between one illness factor and daily functioning.…”

Protective effects of reasons for living against suicidal ideation in daily life

“…People who think about suicide tend to engage in an internal debate about their reasons for dying and living (Harris et al, 2019;Shneidman and Farberow, 1957). The interplay of these conflicting motivations has been shown to shape the degree of suicide intent severity, with greater orientation towards death being associated with more serious suicidal intent and vice versa (Brown et al, 2005;Kovacs and Beck, 1977;O'Connor et al, 2012).…”

Experiences and perceptions of people living with schizophrenia in Japan: A qualitative study

“…To achieve the objectives of this study, we developed through discussion an interview guide that we used in the semi-structured interviews. We incorporated the major topics covered in the interview guide that Harris et al (2019) had developed to help solve the problem of the lack of research from the perspective of the many people with schizophrenia who experience suicidal ideation. We collected basic information (age, sex, hospitalization periods and times, working status, current clinical treatment, etc.)…”