Objections to suicide among depressed patients with alcohol use disorders

Abstract

Background-Understanding how alcohol misuse interacts with beliefs that protect individuals against suicide can help to enhance suicide prevention strategies. One measure of suicide nonacceptability is the Moral Objections to Suicide (MOS) subscale of the Reasons for Living Inventory (RFLI).Method-521 mood disordered patients with and without alcohol use disorders (AUD) were administered a battery of clinical measures including the Scale for Suicidal Ideation and the Reasons for Living Inventory. A multivariate analysis of covariance (MANCOVA) was conducted, examining the effects of alcohol use history on the five RFLI subscales and suicidal ideation, while controlling for differences in age, education, marital status and sex.Results-RFL scores were no different between groups, except in one respect: patients with AUD had fewer moral objections to suicide. Higher suicidal ideation was associated with lower MOS scores. Prior suicidal behavior was associated with lower MOS, and higher current suicidal ideation. However, AUD history was not associated with suicidal ideation. Conclusion-Patientswith AUDs had fewer objections to suicide, even though their level of current suicidal ideation was similar to those without AUD, suggesting that attitudes about the acceptability of suicide may be conceptually distinguished from suicidal ideation, and may be differentially associated with risk for suicidal behavior. These findings suggest that alcohol use and suicidal behavior predict current attitudes toward suicide, however causal mechanisms are not clearly understood.

Moral or Religious Objections to Suicide May Protect Against Suicidal Behavior in Bipolar Disorder

“…Furthermore, in patients with alcohol use disorder, lower score on the moral objections to suicide subscale of the RFLI was reported to be associated with their higher level of suicidal ideation. 46 However, the literature on this topic is scarce. Further studies are needed to investigate the protective role of religious beliefs against suicide in different psychiatric conditions.…”

Protective effects of reasons for living against suicidal ideation in daily life

“…We used six items to assess daily RFL, derived from the survival and coping beliefs as well as responsibility to family subscales of the RFLI (Linehan et al, 1983). There is empirical evidence of a negative link between suicidal ideation and both survival and coping beliefs (e.g., Chang et al, 2014;Lee and Oh, 2012;Oquendo et al, 2005;Pinto et al, 1998;Richardson-Vejlgaard et al, 2009) and responsibility to family (e.g., Lee and Oh, 2012;Pinto et al, 1998;Richardson-Vejlgaard et al, 2009) subscales. Importantly for our ecological momentary assessment study design, we chose items expected to vary the most across days, while also capturing concrete positive deterrents, as opposed to items from other RFLI (Linehan et al, 1983) subscales (i.e., child-related concerns, fear of suicide, fear of social disapproval, or moral objections), which were not used in this study.…”

Crystal Methamphetamine, Body Dysmorphia, and Shame: A Psychodynamic Case Report from the Trainee Perspective

“…A link between drug abuse and suicidal ideation has been well established in the literature (Borges & Loera, 2010;Richardson-Vejlgaard et al, 2009;Mino et al, 1999;Ganz & Sher, 2009). Some have suggested that all self-defeating practices (e.g., cigarette smoking, poor dietary habits) represent subtle suicidal acts, and this may represent an identifiable unconscious process from an analytic perspective, but direct correlations have only been revealed between depression and substance abuse (Ellis & Trumpower, 2008).…”