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)