Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-20T03:56:44.270Z Has data issue: false hasContentIssue false
  • English
  • Français

The link between mental health-related discrimination and suicidality: service user perspectives

Published online by Cambridge University Press:  13 February 2015

S. Farrelly ,
D. Jeffery ,
N. Rüsch ,
P. Williams ,
G. Thornicroft  and
S. Clement
S. Farrelly*
Affiliation:
Health Service and Population Research Department, Kings College London, Institute of Psychiatry, London, UK
D. Jeffery
Affiliation:
Health Service and Population Research Department, Kings College London, Institute of Psychiatry, London, UK
N. Rüsch
Affiliation:
Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
P. Williams
Affiliation:
Health Service and Population Research Department, Kings College London, Institute of Psychiatry, London, UK
G. Thornicroft
Affiliation:
Health Service and Population Research Department, Kings College London, Institute of Psychiatry, London, UK
S. Clement
Affiliation:
Health Service and Population Research Department, Kings College London, Institute of Psychiatry, London, UK
*
*Address for correspondence: S. Farrelly, PhD, Section of Community Mental Health, PO29, Health Service and Population Research Department, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email: simone.farrelly@kcl.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Suicide is a major global public health issue. Mental illness is a risk factor for suicide, but as many individuals with a diagnosed mental health problem do not experience suicidal ideation or attempt suicide, other individual and societal factors must be considered. Mental illness-related discrimination is one potential risk factor.

Method

Using mixed methods, the influence of discrimination on suicidality amongst 194 individuals diagnosed with depression, bipolar or schizophrenia spectrum disorders was investigated. Qualitative interviews with a sub-sample of 58 individuals who reported a link between experience of discrimination and suicidality were analysed using framework analysis. Quantitative methods were used to examine the model derived from qualitative analyses.

Results

Results indicate that the experience of discrimination led 38% of the overall sample of 194 participants, to suicidal feelings and 20% reported that it contributed to making a suicide attempt. The qualitative model derived from interviews with a sub-sample of 58 participants suggested that the experience of discrimination is experienced as a stressor that exceeds coping resources, leading to a negative self-image and a perception of decreased supportive networks/social structure. The anticipation of further negative events and treatment, and the perception of a lack of supportive networks led individuals in this study to feelings of hopelessness and suicidality. Quantitative analyses provided support for the model.

Conclusions

These data suggest that both psychological therapies aimed at improving coping skills and population-level anti-stigma interventions that reduce the occurrence of discrimination may provide some protection against suicide amongst individuals with mental health problems.

Keywords

Bipolar disorderdepressiondiscriminationEnglandmental illnessmixed methodspsychosissuicide
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 10 , July 2015 , pp. 2013 - 2022
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Acosta, FJ, Aguilar, EJ, Cejas, MR, Gracia, R (2013). Beliefs about illness and their relationship with hopelessness, depression, insight and suicide attempts in schizophrenia. Psychiatria Danubina 25, 49–54.Google ScholarPubMed
Beautrais, AL (2000). Risk factors for suicide and attempted suicide among young people. Australian and New Zealand Journal of Psychiatry 34, 420–436.CrossRefGoogle ScholarPubMed
Beautrais, AL (2002). A case control study of suicide and attempted suicide in older adults. Suicide and Life Threatening Behaviour 32, 1–9.Google Scholar
Beautrais, AL, Joyce, PR, Mulder, RT (1998). Psychiatric contacts among youths aged 13 through 24 years who have made serious suicide attempts. Journal of the American Academy of Child and Adolescent Psychiatry 37, 504–511.Google Scholar
Beck, AT, Steer, RA (1988). Manual for the Beck's Hopeless Scale. Psychological Corporation: San Antonio, Texas.Google Scholar
Benning, TB, O'Leary, M, Avevor, EA, Avevor, ED (2006). Biology and stigma. British Journal of Psychiatry 188, 89.Google Scholar
Brohan, E, Slade, M, Clement, S, Thornicroft, G (2013). Development and psychometric validation of the discrimination and stigma scale (DISC). Psychiatric Services 7, 297.Google Scholar
Brown, GK, Beck, AT, Steer, RA, Grisham, JR (2000). Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. Journal of Consulting and Clinical Psychology 68, 371–377.Google Scholar
Cavanagh, JTO, Carson, AJ, Sharpe, M, Lawrie, SM (2003). Psychological autopsy studies of suicide: a systematic review. Psychological Medicine 33, 395–405.CrossRefGoogle ScholarPubMed
Cleary, A (2012). Suicidal action, emotional expression, and the performance of masculinities. Social Science and Medicine 74, 498–505.Google Scholar
Clements-Nolle, K, Marx, R, Katz, M (2006). Attempted suicide among Transgender persons. Journal of Homosexuality 51, 53–69.Google Scholar
Durkheim, E (1951/1897). Le Suicide (English translation A. Spaulding and G. Simpson, 1951). The Free Glencoe: Illinois.Google Scholar
Eagles, JM, Carson, DP, Begg, A, Naji, SA (2003). Suicide prevention: a study of patients' views. British Journal of Psychiatry 182, 261–265.Google Scholar
Farrelly, S, Clement, S, Gabbidon, J, Jeffery, D, Dockery, L, Lassman, F, Brohan, E, Henderson, RC, Williams, P, Howard, LM, Thornicroft, G, MIRIAD study group (2014). Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: a cross sectional study. BMC Psychiatry 14, 157.Google Scholar
Gabbidon, J, Farrelly, S, Hatch, SL, Henderson, C, Williams, P, Bhugra, D, Dockery, L, Lassman, F, Thornicroft, G, Clement, S (2014). Discrimination attributed to mental illness or race-ethnicity by users of community psychiatric services. Psychiatric Services. Published online: 01 08 2014 . doi:10.1176/appi.ps.201300302.Google Scholar
Gomez, J, Miranda, R, Polanco, L (2011). Acculturative stress, perceived discrimination, and vulnerability to suicide attempts among emerging adults. Journal of Youth and Adolescence 40, 1465–1476.Google Scholar
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205–228.Google Scholar
Hauser, M, Galling, B, Correll, CU (2013). Suicidal ideation and suicide attempts in children and adolescents with bipolar disorder: a systematic review of prevalence and incidence rates, correlates, and targeted interventions. Bipolar Disorder 15, 507–553.Google Scholar
Joiner, TE (2005). Why People Die by Suicide. Harvard University Press: Cambridge, MA.Google Scholar
Lasalvia, A, Zoppei, S, Van Bortel, T, Bonetto, C, Cristofalo, D, Wahlbeck, K, Bacle, S, Van Audenhove, C, Van Weeghel, J, Reneses, B, Germanavicius, A, Economou, M, Lanfredi, M, Ando, S, Sartorius, N, Lopez-Ibor, JJ, Thornicroft, G (2013). Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet 381, 55.Google Scholar
Lester, D (1994). A comparison of 15 theories of suicide. Suicide and Life Threatening Behavior 24, 80–88.Google Scholar
Linehan, MM (1996). Suicide Behaviors Questionnaire (SBQ). Unpublished manuscript, Department of Psychology, University of Washington: Seattle, Washington.Google Scholar
Livingston, J, Boyd, J (2010). Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Social Science & Medicine 71, 2150–2161.Google Scholar
Novick, DM, Swartz, HA, Frank, E (2010). Suicide attempts in bipolar I and bipolar II disorder: a review and meta-analysis of the evidence. Bipolar Disorder 12, 1–9.CrossRefGoogle ScholarPubMed
Osman, A, Bagge, C, Gutierrez, PM, Konick, LC, Kopper, BA, Barrios, FX (2001). The suicidal behaviors questionnaire – revised (SBQ-R): validation with clinical and nonclinical samples. Assessment 8, 443–454.Google Scholar
Ritchie, JS, Spencer, L (1994). Qualitative data analysis for applied policy research. In: Analysing Qualitative Data (ed. Bryman, A. and Burgess, R. G.). Routledge: London.Google Scholar
Ritsher, JB, Otilingam, P, Grajales, M (2003). Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research 121, 31–49.Google Scholar
Robinson, J, Harris, MG, Harrigan, SM, Henry, LP, Farrelly, S, Prosser, A, Schwartz, O, Jackson, H, McGorry, PD (2010). Suicide attempt in first-episode psychosis: a 7.4 year follow-up study. Schizophrenia Research 116, 1–8.Google Scholar
Rüsch, N, Corrigan, PW, Wassel, A, Michaels, P, Olschewski, M, Wilkniss, S, Batia, K (2009 a). A stress-coping model of mental illness stigma: I. Predictors of cognitive stress appraisal. Schizophrenia Research 110, 59–64.Google Scholar
Rüsch, N, Corrigan, PW, Wassel, A, Michaels, P, Olschewski, M, Wilkniss, S, Batia, K (2009 b). A stress-coping model of mental illness stigma: II. Emotional stress responses, coping behavior and outcome. Schizophrenia Research 110, 65–71.CrossRefGoogle ScholarPubMed
Rüsch, N, Zlati, A, Black, G, Thornicroft, G (2014). Does the stigma of mental illness contribute to suicidality? British Journal of Psychiatry 205, 257–259.Google Scholar
Sharaf, AY, Ossman, LH, Lachine, OA (2012). A cross-sectional study of the relationships between illness insight, internalized stigma, and suicide risk in individuals with schizophrenia. International Journal of Nursing Studies 49, 1512–1520.Google Scholar
Thornicroft, G, Brohan, E, Rose, D, Sartorius, N, Leese, M (2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 373, 408–415.Google Scholar
Trout, DL (1980). The role of social isolation in suicide. Suicide and Life-Threatening Behavior 10, 10–23.Google Scholar
Wang, KT, Wong, YJ, Fu, CC (2013). Moderation effects of perfectionism and discrimination on interpersonal factors and suicide ideation. Journal of Counselling Psychology 60, 367–378.CrossRefGoogle ScholarPubMed
WHO (2014). Preventing suicide: a global imperative (http://www.who.int/mental_health/suicide-prevention/exe_summary_english.pdf).Google Scholar
Wray, M, Colen, C, Pescosolido, B (2011). The sociology of suicide. Annual Review of Sociology 37, 505–528.Google Scholar