Pulling Together - The Protective Role of Belongingness for Depression, Suicidal Ideation and Behavior Among Suicide-Bereaved Individuals

'We're all in this together': the protective role of belongingness in the contribution of moral injury to mental health among participants in Israel's civil protest movement

Background: Participating in long-term protests against government actions can affect protesters' mental health and expose protesters to potentially morally injurious events (PMIEs), such as the betrayal by leaders they once trusted. This study aimed to shed light on the potential psychological buffers against the deleterious effects of exposure to PMIEs of betrayal among protesters and to examine the moderating role of belongingness in the relationships between protesters' exposure to PMIEs and stress, PTSD and depression levels.Method: The study sample comprised 4036 Israeli protesters (Mage = 54.27, SD = 12.45; 75.6% females) who took part in the unfolding civil protest movement against the government-led judicial and constitutional overhaul between January 2023 and August 2023. Protesters completed validated self-report questionnaires that included measures of PMIEs, stress, depressive and PTSD symptoms (PTSS).Results: Beyond demographic and protest-related characteristics, exposure to PMIEs of betrayal was found to contribute to both PTSD and depression levels. The indirect effects of PMIE-betrayal on PTSS/depressive symptoms through stress levels were significant, particularly when belongingness levels were low. Thus, a greater sense of PMIE-betrayal contributes to stress symptoms, which, in turn, is linked to higher levels of PTSS and depressive symptoms for protesters having low levels of belongingness.Conclusions: The study's findings highlight the critical contribution of PMIE-betrayal to both PTSS and depression levels, which were mediated by levels of stress. Moreover, experiencing belongingness moderated these relationships. Clinicians treating protesters coping with PTSS and depressive symptoms should also adopt therapeutic aims of establishing belongingness and social support among the protesters.

Shame, depression, and complicated grief among suicide loss-survivors: the moderating role of self-disclosure

Background: Suicide-loss survivors (SLSs) are recognised as an at-risk population for several psychiatric complications, including complicated grief (CG) and depression (SI). However, whereas shame is known as one of the characteristics of this population, knowledge about possible psychological processes which may moderate the contribution of shame levels to CG and depression in the aftermath of suicide loss is sparse. This study examines the role of self-disclosure - the inclination to share personal information with others - as a possible moderator of the associations of shame with CG and shame with depression over time.Method: Participants were 152 suicide-loss survivors, aged 18-70, who completed questionnaires tapping CG and depression at three time points (T1- index measurement, T2-two years after T1. and T3-four years after T1) and questionnaires tapping shame and SD at T3.Results: Hierarchical regression analyses showed that shame significantly and positively contributed to CG at T3 and to depression at T3, beyond the CG/depression trajectories. Notably, two significant interactions were found: Self-disclosure moderated the contribution of shame to CG at T3 and to depression at T3. At lower self-disclosure levels, shame's contribution to CG and depression was higher.Conclusion: The study's findings highlight shame as a significant facilitator of CG and depression in the aftermath of suicide loss. Moreover, the role of interpersonal interaction on SLSs' distress levels and grieving process was underscored, as this interaction may serve as a buffer against the deleterious sequelae of the suicide of a loved one.

The effect of suicide severity and patient's age on mental health professionals' willingness to treat: The moderating effect of ageism

Understanding mental health professionals' (MHPs) willingness to treat suicidal older adults is critical in preventative psychotherapy. We examined the effect of a hypothetical patient's age and suicide severity on MHPs' willingness to treat or refer them to another therapist. Vignettes of hypothetical patients were presented to 368 MHPs aged 24-72 years. The vignettes had two age conditions (young/old) and three suicidality severity conditions. MHPs completed measures of their levels of willingness to treat/likeliness to refer and their levels of ageism. As suicide severity intensified, MHPs were less willing to treat and more likely to refer. Willingness to treat was the lowest for the old/suicide attempt condition. Ageism moderated the relationships between patient age and willingness to treat: MHPs with higher ageism were less willing to treat older than younger patients, regardless of suicidality severity. Findings indicate that MHPs with higher ageism levels are more reluctant to treat older suicidal patients and highlight the need for training MHPs to reduce ageism and enhance competence in suicide interventions.

Prevalence and factors associated with suicidal ideation, cannabis, and alcohol use during the COVID-19 pandemic in Saskatchewan: findings from a joint-effect modeling

BACKGROUND

Generally, pandemics such as COVID-19 take an enormous toll on people's lives. As the pandemic now turns to an endemic state, growing attention has been paid to the multiple adverse mental health and behavioral issues, such as suicidal ideation and substance use. However, the interplay of suicidality and substance misuse during the pandemic has been limited. We aimed to investigate the prevalence of co-occurrence of suicide ideation, alcohol and cannabis misuse, and the factors that are associated with these co-occurrences in the province of Saskatchewan during the COVID-19 pandemic.

METHODS

We performed a multivariable trivariate probit regression on a sample of 666 Saskatchewan adolescents and adults (16 years or older), drawn from the cycle 10 data collection (March 2022) of the Mental Health Commission of Canada, and Canadian Centre on Substance Use and Addiction (MHCC-CCSA) dataset.

RESULTS

The prevalence of suicidal ideation was higher among respondents who reported both problematic cannabis and alcohol use (25.8%) than single users of alcohol (23.2%) and cannabis (18.7%). Younger respondents (16-34 years) and those who reported recent changes in other substance use were independent factors that were associated with the common experience of suicide ideation, problematic cannabis, and alcohol use. Having a diagnosis of mental health disorders either before or during the pandemic, and the perceived inability to bounce back after the pandemic (low resilience) are strong correlates of suicidal ideation. Those who lived alone, between 35 and 55 years of age were more likely to report problematic alcohol use. Those who reported changes in alternative activities, who reported pandemic stress, and declared a LGBTQIA2S + identity had higher probability of problematic cannabis use.

CONCLUSIONS

As the pandemic persists, improving access to suicide and substance use interventions for the vulnerable groups identified in this study may be impactful.

What Do We Know about Suicide Bereavement, and What We Can Do to Help Suicide-Loss Survivors?

"Suicide is not only the end of life for the deceased but also the beginning of a highly challenging life for those left behind" [...].

Depression and Suicide Ideation among Suicide-Loss Survivors: A Six-Year Longitudinal Study

Suicide is not only a tragic end of life but also may be the beginning of a very challenging life for those left behind. Suicide-loss survivors (SLSs) are individuals who were exposed to the suicide of a close family member or a friend and endure highly emotional distress. The psychological stance and reactions of SLS are deeply colored by painful, intense emotions that are expressed through different psychiatric symptoms, including depression and suicide ideation (SI). The present study investigated the long-term effects of interpersonal factors such as social support, self-disclosure, thwarted belongingness, and perceived burdensomeness on depression and suicidal ideation among SLS. One hundred fifty-two Israeli SLS, aged 20-72, participated in this longitudinal study, during which their suicide ideation and depression levels were assessed at four points over six years (T1-baseline, and two (T2), four (T3), and six (T4) years after baseline). At the last time point, interpersonal factors were also assessed. SLSs' interpersonal variables significantly predicted depression and SI levels beyond their usual trajectories over the years. Significant correlations were found between both perceived burdensomeness and thwarted belongingness and depression levels at all measurement points. Moreover, thwarted belongingness was found to be a significant moderator of the relationship between former and current depression levels, as the contribution of depression-T3 to depression-T4 was lower among SLSs with low thwarted belongingness (b = 0.14, CI = 0.05-0.34) compared with SLSs with high thwarted belongingness (b = 0.25, CI = 0.22-0.45). These findings emphasize the vital healing role of interpersonal factors such as belongingness, as they may attenuate depression and SI symptoms over time. Hence, clinicians should focus on therapies that boost interpersonal interactions and belongingness, as they seem to be crucial stepping stones on the way to recovery. Moreover, national programs should be implemented to offer SLSs targeted interventions to reduce distress and depression in the aftermath of suicide loss.

Prolonged Grief Symptoms among Suicide-Loss Survivors: The Contribution of Intrapersonal and Interpersonal Characteristics

BACKGROUND

Suicide-loss survivors (SLSs) are a population with unique characteristics that place them at increased risk for developing grief complications and painful feelings of guilt that may impact their supportive social environment. However, no studies to date have examined the role of intrapersonal and interpersonal variables that may contribute to prolonged grief symptoms (PGS) as outlined by the new DSM-5 criteria. The present study aimed to extend knowledge regarding the role of interpersonal variables, such as perceived burdensomeness, thwarted belongingness, and self-disclosure, in determining the impact of guilt on the development of PGS among SLSs.

METHOD

This study is part of a longitudinal study, though, in this study, we used a cross-sectional examination of the recently completed fourth measurement. Study participants included 152 SLSs aged 22 to 76 who completed questionnaires measuring guilt, depression, perceived burdensomeness, thwarted belongingness, self-disclosure, and PGS using the Prolonged Grief-Revised Inventory. Participants' demographics and loss-related characteristics, such as time since suicide and participant's age at the time of suicide, were examined.

RESULTS

Confirming the hypotheses, intrapersonal variables (i.e., guilt and depression), as well as interpersonal variables (i.e., perceived burdensomeness, thwarted belongingness, and self-disclosure), contributed significantly to PGS beyond sociodemographic and loss-related factors. Perceived burdensomeness significantly moderated the contribution of guilt to PGS: for participants with high burdensomeness levels, guilt contributed to PGS more strongly than for participants with low burdensomeness.

CONCLUSION

Guilt is an important contributor to PGS among SLSs, and perceived burdensomeness plays a critical role in moderating this contribution. In light of these findings, it can be suggested that SLSs with high levels of guilt should receive special attention and may benefit from therapeutic interventions focusing on reducing maladaptive cognitions that elicit intense guilt or perceived burden.