The Decision‐Making Process for Disclosing Suicidal Ideation and Behavior to Family and Friends

Abstract

Objective This study was designed to explore the decision‐making processes for disclosing suicidal ideation and behavior. Background Suicide attempt survivors are an invaluable resource that can provide essential information about suicidal behavior and related communication to family and friends. Because of the stigma associated with suicide and seeking help, many individuals choose to conceal their suicidal ideation or behavior or to disclose only to a few family and friends. Method Semistructured, audio‐only interviews were conducted with a convenience sample of 40 suicide‐attempt survivors to develop a grounded theory of factors that influence the decision to disclose current and past suicidal behavior to family members and other individuals within one's social network. Results Several motivations for disclosing (e.g., seeking help, sharing personal information, informing others) were identified, and a majority of the sample conducted an informal cost–benefit analysis before disclosing. The findings also elucidate the process of choosing a person with whom disclosure occurs, and the importance of having that family or friend with whom attempt survivors feel safe disclosing ideation as it occurs as well as subsequently processing the experience and seeking treatment. Conclusion Decision‐making processes for suicide‐related disclosure include identifying motivations to disclose, an informal cost–benefit analysis, and the selection of a recipient to whom one will disclose. Implications This emergent model identifies five tangible intervention strategies for increasing the likelihood of suicide disclosure. Future research should examine the internal resources that motivate individuals to engage in subsequent disclosure to individuals from whom they have previously experienced stigma.

Factors related to suicide’s unpredictability: a qualitative study of adults with lived experience of suicide attempts

“…If an attempter perceives their environment to be invalidating, our results suggest this may lead to an increased urge to conceal warning signs and even attempt suicide to avoid feeling worse. This is consistent with previous studies of suicide attempt survivors that have found fears about receiving unsupportive responses, being rejected, and being stigmatized as primary reasons preventing disclosure (e.g., Frey et al, 2018;Sheehan et al, 2019). Some individuals might also interpret their environment to be invalidating after the exhibition of warning signs is not taken seriously.…”

“…This exploratory qualitative study sought to gain a better understanding of the complexity of predicting suicide by speaking directly to individuals with lived experience. Consistent with previous literature highlighting the cost-benefit determination suicidal individuals consider before disclosing their ideation or intent (e.g., Frey, Fulginiti, Lezine, & Cerel, 2018;Sheehan et al, 2019), our results suggest there is a notable disconnect between attempters and their environment. The superordinate theme of a disconnect between attempters and their environment was first indicated through a sense of ambivalence regarding whether or not participants wanted help prior to their attempts, which is consistent with prior research (Bruffaerts et al, 2011;Czyz et al, 2013).…”

Social Support Mediates the Association between Disclosure of Suicide Attempt and Depression, Perceived Burdensomeness, and Thwarted Belongingness

“…Results indicated a majority (63%) of undergraduate students disclose their suicide attempt to at least one social network member. Additionally, the majority of those who disclose (81%) reported disclosure to two or fewer DSA targets, supporting previous research indicating survivors of suicide attempts are very selective in choosing DSA targets (Frey et al, ). Individuals chosen as DSA targets by the present sample were comparable to those reported by a sample of middle‐aged adults (Frey et al, ).…”

“…To our knowledge, prevalence of DSA, the DSA target’s (person selected for disclosure) relationship to the discloser (e.g., friend, significant other), and levels of suicide risk associated with disclosure have not previously been studied in a sample of undergraduate college students. Although Frey, Fulginiti, Lezene, and Cerel () reported common relationships with disclosure targets, these data have not been reported for a sample of undergraduate college students. Similarly, Fulginiti, Pahwa, Frey, Rice, and Brekke () reported the prevalence of disclosure and type of relationship to disclosure target for individuals who had disclosed suicide ideation, but no such work has been conducted for individuals who have disclosed suicide attempts.…”

“…Additionally, Frey et al () reported levels of suicide risk associated with positive and negative reactions to different amounts of DSA, but disclosure was only considered if it was conducted with a familial disclosure target. In a small sample ( n = 40), more than half of participants reported disclosure to a friend, so the present study assesses disclosure to any social network member (Frey et al, ). The present study describes the rates of disclosure, the DSA target’s relationship to the discloser, and the suicide risk factors associated with disclosure in a sample of undergraduate college students.…”