Shame, guilt, and suicidal thoughts: The interaction matters

Abstract

Objectives This study examined associations between generalized shame and guilt, and suicidal ideation. Methods Individuals attending outpatient mental health services (N = 100) completed study measures at a single time point. Correlation and regression analyses examined associations between recent suicidal ideation and generalized shame and guilt, both concurrently and interacting, controlling for depressive symptoms and history of previous suicide attempt. Results When examined concurrently, guilt – but not shame – remained significantly associated with suicidal ideation, after accounting for effects of depressive symptoms and past suicide attempt. A significant shame × guilt interaction revealed the association between guilt and suicidal ideation intensified with higher shame. Conclusions Findings emphasize consideration of generalized shame and guilt – and their interaction – when working with patients exhibiting suicidal thoughts. Practitioner points Shame and guilt are self‐conscious emotions that, when generalized and excessive, may confer risk for suicidal ideation Generalized guilt may be uniquely linked with suicidal ideation, yet this association may also amplified by shame Both shame and guilt – and their interaction – are important to consider when working with patients exhibiting suicidal thoughts

Prevalence of Suicidal Behavior and Associated Clinical Correlates in Patients with Behavioral Addictions

“…Following this first hypothesis, the fact that gambling disorder, sex addiction, and buying–shopping disorder are characterized by higher levels of feelings of shame, isolation, and guilt [ 51 , 52 , 53 , 74 ] may contribute to increase the risk of suicide. Even though suicide is a complex multi-factorial phenomenon [ 75 ], there is large literature pointing out that feelings of shame and guilt are relevant drives for committing a suicidal act [ 55 , 56 ]. In addition, stigma has been reported to be particularly predominant in these disorders [ 76 , 77 , 78 ] and the former has been described as a trigger for suicidality [ 79 ].…”

“…In this regard, it is relevant to mention that diagnosis can be a double-edged sword: on the one hand, it facilitates communication among professionals and enables the development of more specific treatments. On the other hand, being diagnosed with a mental disorder (such as gaming disorder) may carry a certain degree of social stigma and this can increase feelings of shame and guilt [ 80 ] which, in the end, can be triggers for suicidal behavior [ 55 ].…”

“…In the last three addictions, this symptomatology is accompanied with feelings of shame and guilt for the severe consequences of the behavior (financial difficulties, lies, and even criminal behavior), negative social perception of these addictive behaviors, and addictive behavior-related harm cause to relatives and friends [ 51 , 52 , 53 , 54 ]. These feelings have been identified as relevant predictors for suicidal behavior [ 55 , 56 ].…”

Associations between symptoms of prolonged grief disorder and depression and suicidal ideation

“…Item 9 of the PHQ‐9, “In the last two weeks, how often have you been bothered by: Thoughts that you would be better off dead or of hurting yourself in some way,” was used to measure the severity of recent suicidal ideation. This item is widely used for this purpose (e.g., Kealy et al, 2021; Prigerson et al, 2021; Sekowski et al, 2022). In the study by Simon et al (2013), item 9 of the PHQ‐9 was a strong predictor of suicide attempt and a moderate predictor of suicidal death in outpatients.…”

A Standard Protocol for the Clinical Management of Suicidal Thoughts and Behavior: Implications for the Suicide Prevention Narrative

“…Translating suicidality as a function of limited individual self and emotional managements skills, problem-solving, or ineffective coping has a number of advantages, including: (a) it can be shared with a suicidal individual in a manner that fits with each unique individual history allowing someone to understand how developmental experiences (e.g., including previous trauma, family history, and genetic predisposition) create individual vulnerability and limit the opportunity to develop and refine much needed self and emotional management skills, (b) the model is easy to understand, remember, and apply to daily life experiences, (c) it creates an opportunity to address apprehension about treatment as being a function of limited self and emotional management skills, (d) it has been demonstrated to fuel hope and wish to live ( 22 ), (e) it emphasizes the importance of individual responsibility in self-management, (f) recognizes the importance of and explains the destructive role of shame and guilt ( 23 ), and (g) translates to simple, skill-based interventions that can be practiced in session and utilized in the plan for management of future suicidal episodes. In short, effective interventions help patients develop a working model of their own suicidality and the nature of their own upset, so that targeted interventions be used to more effectively self-manage suicidal impulses.…”