Elucidating the chronic, complex nature of suicidal ideation: A national qualitative study of veterans with a recent suicide attempt

Abstract

• The lived experience of suicidal ideation was examined in qualitative interviews. • Suicidal ideation was chronic, non-linear, with periodic increases in severity. • For some, severity increases are perceived as a result of negative self-evaluation. • For some, severity increases are perceived as random and uncontrollable. • Treatment and assessment should emphasize functioning and symptom management. Understanding the nature of suicidal ideation, or how suicidal ideation is experienced by the individual in its course and development, is important for informing suicidal ideation assessment and treatment. In this study, we conducted qualitative interviews with a national sample of fifty United States (U.S.) military veterans with recent suicide attempts to elucidate the nature of suicidal ideation from the perspective of those with lived experience. We interviewed 25 women and 25 men veterans from Veterans Health Administration healthcare facilities across the U.S. who made a recent (prior 6 months) suicide attempt. Data were analyzed using a thematic analysis approach. Suicidal ideation was characterized as chronic, varying in severity and duration. Two typologies characterized increases in suicidal ideation severity: those whose ideation increases due to negative self-evaluations and those whose ideation increases without clear warning. Additionally, participants described needing help recovering from severe episodes of suicidal ideation, which often disrupted their lives and everyday functioning. This was a study of U.S. military Veterans with a recent suicide attempt; our findings may differ from studies of nonveterans or those with suicidal ideation but have never attempted suicide. Our findings align with prior research that suicidal ideation is often experienced as chronic, fluctuating, and nonlinear. Suicide risk assessment may benefit from use of a combination of ideation severity and functional measures. Future work should investigate treatment of suicidal ideation that targets active symptom management and ameliorates the negative impacts that suicidal ideation has on patients’ functioning.