PSYCHOLOGICAL RESILIENCE TO SUICIDAL THOUGHTS AND BEHAVIOURS IN PEOPLE WITH A DIAGNOSIS OF SCHIZOPHRENIA OR NON-AFFECTIVE PSYCHOSIS

Abstract

Suicide fatalities are a major health care concern globally. People with severe mental health problems, such as schizophrenia, are at a substantially greater risk of death by suicide. Between 4% and 13% of people with a diagnosis of schizophrenia die by suicide. Suicidal ideation and behaviours are even more frequent. Studies have reported suicidal ideation rates of around 28% and a lifetime prevalence of suicide attempts between 20% and 40%. However, not everyone at risk of suicide death thinks about, attempts, or dies by suicide. Some people appear resilient to the impact of suicide-precipitating experiences on their wellbeing. Therefore, it is important to identify how people are resilient to the impact of these experiences, in order to inform effective suicide prevention interventions. The overarching aim of this thesis was to investigate the roles of psychological resilience and psychosis on suicidal thoughts and behaviours. A mixed-methods approach was used to address this aim, incorporating four empirical studies. First, a systematic literature review identified psychological factors that confer resilience to suicidal thoughts and behaviours in people experiencing non-affective psychosis, including i. perceived social support, ii. holding religious and spiritual beliefs, iii. identifying reasons for living, and iv. perceived positive personal skills and attributes (Chapter 3). Second, a qualitative study examined individual perspectives of factors that contribute to resilience to suicidal thoughts and behaviours. Resilience was described as a dynamic, effortful process that developed over time, through the experiences of mental health problems, the interrelated suicidal experiences, and their deleterious impact on individual wellbeing. A multi-componential resilience model was developed based on the data (Chapter 4). Third, another qualitative study examined the perceived impact of psychosis on suicidal thoughts and behaviours from the perspectives of individuals with these experiences. Hallucinations and delusions were reported to have a central role in the development of suicidal experiences. A practical heuristic was proposed that described a vicious cycle between immense psychological distress due to psychosis and changes in behaviours and self-appraisals, whereby suicidality was perceived as the only way to escape distress. Certain types of delusions were sometimes perceived to reduce the intensity of suicidal experiences and psychological distress (Chapter 5). Fourth, a longitudinal study incorporating a three-month follow-up period investigated the moderating roles of psychosis, distress associated with psychosis and resilience in the relationships between key suicide precursors (i.e., defeat/entrapment, and hopelessness) and suicidal thoughts and behaviours. Baseline defeat/entrapment predicted suicidal thoughts and behaviours over time. The strength of this relationship was amplified by the severity of delusions, hallucinations and the associated distress at baseline, when psychological resilience was at its lowest (Chapter 6). The results of this thesis highlight the importance of nurturing resilience and managing psychosis and the associated psychological distress as a means of improving wellbeing and reducing suicidal experiences in people with schizophrenia diagnoses or non-affective psychosis. The theoretical and clinical implications of these findings are discussed throughout this thesis and suggestions are made for clinicians conducting assessments and formulations. A key step in research is to identify resilience mechanisms and incorporate them into interventions aiming to nurture resilience to suicidal thoughts and behaviours and reduce suicide-related experiences

Date of Award	1 Aug 2021
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Gillian Haddock (Supervisor), Patricia Gooding (Supervisor) & Sarah Peters (Supervisor)