Strategies to Stay Alive: Adaptive Toolboxes for Living Well with Suicidal Behavior.

Bonnie Scarth,Ian Marsh,Vilma Santiago-Irizarry,Jesse M Bering,Karl Andriessen

doi:10.3390/ijerph18158013

Abstract

Suicidal behavior constitutes a major global problem. Qualitative research utilizing the first-hand experiences of those who have survived attempts to take their own lives can offer much in the way of understanding how to live well despite ongoing suicidal behavior. Given that suicidal intentions and behaviors occur within the person’s subjective construal, the solutions to living—and preferably living well—despite such inclinations must also be subjective and adaptive. The aim of this study was therefore to understand how individuals live with different aspects of their suicidal behavior and their use of effective strategies to protect themselves from future attempts. Thematic analysis of semi-structured, qualitative interviews with 17 participants with lived experience of suicidal behavior from the USA yielded two main themes: (i) the ‘dynamic relationship with suicidal behavior: living with, and through’, and (ii) ‘the toolbox’. Each of these themes had four subthemes. Participants in this study offered important insights into what helped them not just survive ongoing suicidal behavior, but how they created unique toolboxes to continue living, and to live well. These toolboxes contained personalized solutions to dealing with recurring threats to their subjective wellbeing and included diverse solutions from spirituality, pets, peer-support, participating in the arts, through to traditional therapeutic supports. Some participants also discussed the importance of broader social policy and societal changes that help them live. The findings highlight crucial implications for suicide prevention efforts, especially in terms of encouraging collaborations with the lived experience community and furthering a strengths-based approach to mitigating suicidal behaviors. We encourage the clinical community to work in partnership with service-users to enable them to generate effective solutions to living—and living well—through suicidal behavior.

Highlights

Given the shortage of research regarding what it is like to live with suicidal behavior over a long period of time, the present study aimed to explore the personal experiences of those living with suicidal behavior, and the strategies that people with suicidal ideation or attempts adopt to cope with these significant challenges
While it is often stressed that the lifetime risk of suicide for people who have engaged in suicidal behavior heightens as they age due to practice [6,20], participants in this study demonstrated that they became very skilled and competent at managing but growing through ongoing suicidal behavior
This study provided first-hand insights into how people experienced their suicidal behavior and found ways to live with and through their desire to die by suicide

Summary

Introduction

According to the World Health Organization (WHO), every year over 700,000 people die by suicide around the world, making it the 17PthP leading cause of death. Community surveys undertaken in 21 countries by the WHO established the 12-month prevalence of suicidal ideation at approximately two percent [1] and the lifetime prevalence at nine percent [2]. Many people live with suicidal behavior (‘a spectrum of activities related to thoughts and behaviors that include suicidal thinking, suicide attempts, and suicide’) [3]). The WHO surveys estimated that for those with a lifetime history of suicidal ideation, the probability of ever making a suicide plan was around 33 percent, and of ever attempting suicide approximately 30 percent [2]

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Conclusion