Understanding suicidality: A systematic review of the psychological protective factors for older adults and an empirical study of mental images of suicide and experiential avoidance

Maynard, Hannah 2023. Understanding suicidality: A systematic review of the psychological protective factors for older adults and an empirical study of mental images of suicide and experiential avoidance. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

Suicide is a pressing global health issue, with a significant number of individuals dying by suicide each year. It remains one of the leading causes of death worldwide, with one in every 100 deaths being attributable to suicide. As such, it is crucial to understand the factors that increase and reduce suicide risk to identify those in greatest need of intervention and to inform the development of effective prevention programs. The research described in this thesis seeks to explore the impact of psychological factors on suicidality in younger and older adults. Firstly, a systematic literature review was completed to identify the psychological factors that could protect against suicide in older adults. Secondly, an empirical study explored the relationship between the psychological processes of suicide-related mental imagery and experiential avoidance in a university student sample. Suicide rates in older adults are amongst the highest of any age group in developed countries. However, an understanding of the psychological factors that could reduce suicidal thoughts and behaviours in this population is limited. The aim of the systematic review was to identify psychological factors that could protect against suicidal thoughts and behaviours in adults aged 65 years and over. Seventeen papers were identified, which explored the influence of a variety of psychological factors in mitigating suicidal thoughts and behaviours. The review found that older adults with greater meaning and purpose in life, higher psychological wellbeing and satisfaction with life, and adaptive coping skills were less likely to experience suicidal thoughts. However, the findings of the review were based on limited data sets, with the quality of the papers varying in strength. Further research is needed to explore the influence of these psychological factors on suicidal thoughts and behaviours over time, as well as making comparisons on the protective influence of these factors across more defined age groups and populations. The psychological factors identified in the review should be considered in both suicide risk assessment and for informing the development of clinical interventions. During risk assessment, practitioners should seek to explore an older person's sense of meaning in life, psychological wellbeing, satisfaction with life, and coping style, to identify those at greater and lesser risk. In addition, interventions or therapies aimed at reducing suicide in older adults should seek to enhance the psychological factors identified in this review. Robust evaluations should be conducted alongside the implementation of these factors to ensure future interventions are evidence based. The objective of the empirical research was to investigate the potential relationship between two psychological constructs previously associated with an elevated risk of suicide. The sample consisted of 197 university students in Wales who completed online questionnaires of suicide-related mental imagery, experiential avoidance, and suicidality. Suicidal mental imagery refers to the visual contemplation of suicide, as opposed to verbal contemplation, with prior research indicating that individuals who experience mental images of suicide are at a heightened risk. Experiential avoidance describes attempts to suppress, control, or eliminate internal experiences (i.e., thoughts, emotions, memories, sensations) that are distressing. The empirical research examined the predictive nature of suicidal mental imagery on experiential avoidance, as well as the role that experiential avoidance plays in the relationship between suicide-related mental images and suicidality. The research found that those with greater experiences of suicide-related mental imagery had a greater inclination towards engaging in experiential avoidance. Suicide-related mental imagery also predicted levels of experiential avoidance and suicidality. In contrast to previous research, experiential avoidance was not found to predict suicidality, and concerns regarding the validity of the experiential avoidance measure used in prior research are discussed. This research highlights the need for clinicians to assess the presence of mental images of suicide, and not verbal thoughts alone, when exploring a client’s suicide risk. Moreover, the research identifies the significance of exploring the specific nature of suicidal mental imagery experienced by clients, with exploratory analysis revealing that "suicidal daydreaming" may serve as a more pronounced indicator of suicide risk compared to intrusive suicide-related mental imagery. The research also raises an interesting idea for clinicians to consider, with this being that promoting the notion of 'thoughts are just thoughts' may unintentionally downplay the gravity of experiencing mental images of suicide on suicide risk. Overall, this thesis provides important insights into the role of psychological factors in suicide risk, highlighting the need for continued research in this area to inform more effective prevention and intervention strategies.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	11 September 2023
Last Modified:	11 Sep 2024 01:30
URI:	https://orca.cardiff.ac.uk/id/eprint/162374

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