Understanding the concept of Suicidality
Review of Keefner, T. P., & Stenvig T. (2020). Suicidality: An Evolutionary Concept Analysis. Issues in Mental Health Nursing.
Suicide is a preventable public health problem, but mitigation efforts have fallen short. According to the recent South Dakota Suicide Surveillance Report (2022), suicide deaths have increased by 50% over the past ten years, and 2021 suicide deaths were the highest in SD history. There is no specific factor that explains the increase in suicide rates. However, some thoughts may explain in parts, such as better reporting and medications. In the past, due to the stigma of suicide, many deaths were reported as an accident when suicide could have been more likely. In the 1990s, suicide rates were going down. In early 1990’s Selective Serotonin Reuptake Inhibitors (SSRI) were developed and prescribed for depression and anxiety. The use of these medications did help and rates started to decline. After a while, research indicated that suicidal behaviors were a side effect of these medications and prescriptions went down, and suicide rates went up (Harkavy-Friedman, 2021).
In 2014, The National Action Alliance for Suicide Prevention: Research Prioritization Task Force (NAASP) set a goal to reduce suicide attempts and deaths by 20% in 5 years and at least 40% by 2025. This call to action inspired new ways of thinking about suicide prevention efforts and encouraged researchers to identify ways to improve the prediction and detection of suicidal risk. Suicide is a complex problem and requires thorough investigation for better understanding. The call to action from the NAASP (2014) has spurred innovative research and theoretical development. Once spars, suicide research is now burgeoning.
Understanding of the complex problems of suicide is essential to improving the identification and prediction of risk and preventing suicide. Various terms are found in the literature and used in practice to describe factors and phenomena leading up to suicide, including the broad categories of suicidal ideation and behavior. Inconsistent use of terminology confuses research and how providers communicate about suicide. Suicide researchers and clinicians have used suicidality to simplify suicide terminology. Instead, it has complicated the understanding of the phenomenon. Keefner and Stenvig’s (2020) analysis is congruent with other researchers who describe suicidality as a nonspecific concept that manifests along a spectrum of thoughts and behaviors with varying degrees of severity (Posner et al, 2007).
The figure illustrates the suicidality concept spectrum showing its attributes, antecedents, and consequences. The suicidality spectrum begins with suicide ideation, which can be active or passive. Suicidal thoughts can progress to passive or active suicidal behavior, then to non-fatal or serious suicide attempt(s), ending with suicide as the ultimate consequence. The top transecting horizontal arrow, starting with suicide ideation and traversing the path toward suicide, represents the antecedents affecting the level of intent to die. The center arrow represents intention. The stronger the intent to die, the greater the risk of suicide. The bottom transecting horizontal arrow indicates the consequences of suicidality. Each level or point on the spectrum may lead to various consequences. The curved arrows along the diagram perimeter indicate that the process of suicidality is not linear; there is no straight line or exact trajectory. Acknowledgment that suicide progresses along a spectrum provides the opportunity to intervene at any point of the suicidality spectrum promptly and appropriately to prevent the progression toward suicide.