Yasdiman, Meryem Betul
(2023)
Examining the protective role of posttraumatic growth against the development of suicidal ideation.
PhD thesis, University of Nottingham.
Abstract
Background: Suicide prevention efforts traditionally focused on identifying risk factors and reducing their mental health impacts. But increasing research attention seeks to explore suicide protective factors, which focuses on how individual differences, such as hope or resilience, can inform prevention strategies by reducing the salience of suicide risk factors.
Aims and objectives: This thesis aims to explore the potential protective influence of perceptions of posttraumatic growth (PTG) pertaining to positive changes in worldviews, relationships, and identity after highly challenging life events. Previous research has consistently found negative associations between PTG and suicidal thoughts, but has not explained mechanisms underlining this relationship. This thesis examines the protective function of PTG through a theoretical framework that explains the formation of suicidal thoughts and behaviours: The Integrated Motivational-Volitional Model of Suicidal Behaviour (IMV).
Method and results: Five empirical studies using both qualitative and quantitative methodologies were conducted. The first explored the personal experiences of veterans deployed on operational tours during their military service through semi-structured interviews, finding that they identified PTG from their adverse experiences, reporting some risk factors specified by the IMV. The second examined associations between key suicide risk factors in the IMV (i.e., defeat and entrapment appraisals), suicidal ideation, and PTG within a sample of veterans, finding that PTG was negatively correlated with defeat and entrapment with large effect sizes, but was unrelated with suicidal thoughts. The third study examined a sample of community participants to determine whether PTG moderated relationships between (1) defeat and entrapment and (2) entrapment and suicidal ideation, derived from the pathways specified in the IMV. Perceiving PTG did not moderate either of these two relationships, but it has a direct effect on suicidal ideation, whereby higher PTG predicted lower levels of suicidal ideation (consistent with existing literature). The fourth study examined whether PTG attenuated the strength of the longitudinal relationships between (1) T1 burdensomeness and T2 burdensomeness and (2) T1 thwarted belongingness and T2 thwarted belongingness across six weeks in an at-risk community sample. It found that perceiving PTG from recent stressors reduced the strength of the relationship between T1 and T2 burdensomeness levels. In study five, an experimental design with control and experimental groups was used to induce PTG utilising positive reappraisals about past adversity to investigate whether this manipulation results in reductions in burdensomeness levels from pre to post-test measure. There was not a significant impact of positive reappraisal manipulation on the reports of perceived burdensomeness across groups.
Thesis findings: Overall, findings indicated that perceiving PTG from past adverse experiences did not function in the way that the IMV predicted, but it was negatively associated with suicidal ideation directly. The findings across five studies suggested that the protective influence of PTG against the development of suicidal thoughts might be through negative self-appraisals, such as burdensomeness.
Implications: Given that PTG could be modified through training and interventions, the findings of this thesis may inform suicide prevention strategies after these results are confirmed with further research. For example, PTG training could reduce perceptions of burdensomeness, which is a robust and known risk factor for suicide.
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