A new study investigating the role of unmet interpersonal needs and attitudes toward help-seeking in young adults (ages 18-25 years old), offers additional evidence that individuals with high self-concealment—a tendency to hide distressing or negative information from others—are more likely to experience suicidality.
Guided by an interpersonal theory of suicide, Cleveland based researchers Ingrid Hogge and Paige Blankenship advise clinical practitioners and the general public to be mindful of the connection between personal relationships and suicide.
“Our results offer potential explanations for the role of self‐concealment in suicide and suggest a path for future theory‐driven research using the interpersonal theory of suicide as a framework,” Hogge and Blankenship write. “We hope that this study inspires future research, intervention, and prevention efforts to address the complex nature of suicide among young adults.”
Suicide is the second leading cause of death for adolescents and young adults in the United States. However, given research evidence linking antidepressant use and suicidality, researchers have called for new approaches for discussing and preventing suicidality without further medicalizing and stigmatizing it. Recently, the United Nations has made it clear that we need to change our collective understanding of suicide prevention.
In this latest study, Hogge and Blankenship utilize a promising alternative understanding of suicide; one that is consistent with critiques of biomedical and coercive approaches, while also providing space to address the complex nature of the suicidal acts and behaviors.
The interpersonal theory of suicide posits that suicide risk is predicted by unmet interpersonal needs and the acquired capability to enact a lethal injury. In their research, the investigators sought to explore the relationship between self-concealment and its ensuing poor psychological outcomes to an increased risk of suicidality in young adults.
Because self-concealment is associated with unmet interpersonal needs and damaged help-seeking behaviors, the authors used measures created to understand how perceived burdensomeness and feelings of thwarted belonging are related to suicidal behaviors in a group of 245 participants.
Using a survey questionnaire, the researchers gathered data on unmet personal needs, self-concealment behaviors, and suicidality. To do so, they used the following measures: the Self Concealment Scale, Attitudes Toward Seeking Professional Psychological Help—Short Form, he Interpersonal Needs Questionnaire (INQ‐15), and The Suicidal Behaviors Questionnaire-Revised (SBQ‐R).
The results of a parallel multiple mediation model analysis found a significant positive relationship between self-concealment and suicidality, suggesting that young people who engaged in self-concealing behaviors were more likely to experience suicidal thoughts. In addition, self-concealment was also associated with negative attitudes toward seeking therapy. However, it is important to note that negative attitudes toward professional psychological help did not in themselves predict increased suicidality.
The analysis also found that the relationship between self-concealment and suicidality is “partially explained by unmet personal needs in a non-clinical sample of young adults.” This means that a significant portion of the connection between self-concealing behaviors and suicide may be due to relationships where the individual is unable to communicate needs effectively or where others are unwilling or unable to meet those needs adequately.
This study is limited by its cross-sectional design, which prevents causal conclusions from being made. Also, the sample was limited to young people in the general population and may not be generalizable to other age groups or people with a history of mental health treatment. The researchers also point out that the reasons people have for self-concealment may vary based on culture and context and can also be adaptive, writing:
“Reasons for concealing suicidality varied and included avoiding outcomes such as hospitalization, fear of therapist judgments, lack of trust in the client-therapist relationship, beliefs about self and suicide, and emotional factors such as shame. Taken together, these findings serve as a reminder to clinicians that some amount of concealment is likely in therapy, and may be more frequent among high self‐concealing clients. “
“Although our study focused on the negative consequences of self‐concealment, we also recognize that patterns of self‐concealment might have developed in response to the client’s history and their specific cultural context. Thus, we encourage clinicians to holistically assess the role of self‐concealment in the client’s life and consider ways that self‐concealment might also be protective and/or culturally relevant.”
These results underscore the importance of exploring the interpersonal needs of young adults when assessing suicidality. The researchers suggest that therapists take into account their client’s potential self-concealment behaviors and how they not only impact their feelings of belongingness and perceived burdensomeness in relationships with friends and family, but also with the therapist themselves.
In addition, this research highlights how suicide prevention efforts can be better designed to account for interpersonal aspects of suicidality “by pursuing broader community prevention initiatives, workplace programs, and continued attention to suicide prevention in the school years.”
Hogge, I, Blankenship, P. Self‐concealment, and suicidality: Mediating roles of unmet interpersonal needs and attitudes toward help‐seeking. J Clin Psychol. 2020; 1– 11. (Link)
As long as psychiatry is the only choice for families or persons to seek that which they know not what they seek, and as long as clients make the unknown mistake of wandering into dangerous territory, we will have suicides.
As long as the only escape left to a person is not honesty and emotional security, but suicide, we will have suicides.
Psychiatry forbids the honest intimacy of “relationships”, rather considering honesty as a crime.
IF psychiatry cared, they would recognize that they are failing, they would ask for help to do better. But they have not. Their idiotic belief systems are more important to them than any humans honesty and search.
It is soul killing, after which some people cannot take anymore.
It would be ideal to have grass roots movements that deal with the lack of interpersonal needs. That provide enough to help the person find and meet those interpersonal needs.
Aren’t we socially needy such that we want to know about each other through exchanging thoughts and feelings? Isn’t that just our nature, the way we are? So, you would expect we would feel pain if we were excluded, since pain motivates us to change. Getting messages from others that we are not acceptable would create pain, enough that the mind would try to find a way out of the pain, and suggest suicide. It would be a natural reaction. The thing to find out, is why people feel like rejecting one of their own, why we look at the social part of life as competitive. Are there just too many of us? Not enough stuff to go around? Or are we missing something that should be transferred from one generation to the next, and we have forgotten what it is?
“That the relationship between self-concealment and suicidality is ‘partially explained by unmet personal needs in a non-clinical sample of young adults'” sounds reasonable to me, especially if you consider the links between bullying and youth suicidality and how that might effect capacity to reveal inner turmoil and seek support. But I’d guess there’s causal relationships in both directions.
Revealing suicidality is stigmatising and likely to result in disempowerment and unwanted (and potentially harmful) medical attention. You can make a lot of rights disappear with the magic words “danger to oneself”. School children are under increasing surveillance for ‘signs’ of suicidality and mental illness (Hogge and Blankenship may have some experience of this). By and large they aren’t stupid. It would be a bit surprising if a lot of them aren’t concealing needs and feelings that might be interpreted as symptoms of something.
Wow, who would have GUESSED that feeling like killing oneself could be related to unmet needs? Such radical thinking! Just when we were all convinced it was a brain disorder that had nothing whatsoever to do with the person’s place in the world and experiences!
It is sad that such research is even needed. Seems to me kind of like discovering that “based on interpersonal theories of infant communication, crying in babies is often caused by unmet needs for food and nurturance.”
How many are driven to that which is illegal to talk about.
The act is legal, the expression of thoughts is not.
The message is, “go do what you think about”