Moving suicide prevention upstream by understanding the effect of flourishing on suicidal ideation in midlife: an instrumental variable approach

Abstract

Prior research has examined the association between flourishing and suicidal ideation, but it is unknown whether this association is causal. Understanding the causality between flourishing and suicidal ideation is important for clinicians and policymakers to determine the value of innovative suicide prevention programs by improving flourishing in at-risk groups. Using a linked nationwide longitudinal sample of 1619 middle-aged adults (mean age 53, 53% female, 88% White) from the National Survey of Midlife Development in the United States (MIDUS), this retrospective cohort study aims to assess the causal relationship between flourishing and suicidal ideation among middle-aged adults in the US. Flourishing is a theory-informed 13-scale index covering three domains: emotional, psychological, and social well-being. Suicidal ideation was self-reported in a follow-up interview conducted after measuring flourishing. We estimated instrumental variable models to examine the potential causal relationship between flourishing and suicidal ideation. High-level flourishing (binary) was reported by 486 (30.0%) individuals, and was associated with an 18.6% reduction in any suicidal ideation (binary) (95% CI, − 29.3– − 8.0). Using alternative measures, a one standard deviation increase in flourishing (z-score) was associated with a 0.518 (95% CI, 0.069, 0.968) standard deviation decrease in suicidal ideation (z-score). Our results suggest that prevention programs that increase flourishing in midlife should result in meaningful reductions in suicide risk. Strengthening population-level collaboration between policymakers, clinical practitioners, and non-medical partners to promote flourishing can support our collective ability to reduce suicide risks across social, economic, and other structural circumstances.

Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis

“…Men’s suicide rate is 4 times higher than women’s, and men are poorer at help-seeking. Physical illnesses can cause physical pain and psychological distress, which can lead to feelings of helplessness and heighten suicide risk that may be overlooked in medical settings . Suicidal patients may prioritize physical over mental health care because they consulted non–mental health care professionals twice as often as mental health professionals in the 30 days before death by suicide.…”

“…Physical illnesses can cause physical pain and psychological distress, which can lead to feelings of helplessness and heighten suicide risk that may be overlooked in medical settings. Suicidal patients may prioritize physical over mental health care because they consulted non–mental health care professionals twice as often as mental health professionals in the 30 days before death by suicide. Therefore, nonpsychiatric health care settings, especially primary care and emergency departments, are crucial for suicide risk screening.…”