Background: Suicide is a major public health concern with around 727,000 people dying by suicide globally each year. Research in the field of suicide aims to understand the risk factors associated with suicide and how best to prevent suicide. However, despite growing research in the area, suicide-related stigma remains under researched as a potential risk factor for suicide. Although there has been an increase in research and a growth in the conversations around suicide, it is still seen as taboo within society and remains illegal in some countries. Progress has been made to better understand suicide, with theories investigating biological, psychological and sociological factors associated with suicide risk. Recent reviews also highlight that suicide-related stigma is associated with several negative outcomes for those bereaved by suicide. Therefore, it is important for further research to understand whether similar outcomes exist among those who have attempted or thought about suicide. It is also important to understand how suicide-related stigma differs across demographic characteristics and how best to mitigate this stigma. Therefore, this thesis aims firstly to examine group differences in suicide-related stigma and experiences, and secondly to understand its impact on those with lived experience. Methods: This PhD thesis comprises five research chapters. It begins with a scoping review which aimed to understand the associations between suicide-related stigma and help-seeking, grief, mental health and suicide risk (n = 100 studies). Chapters 3 and 4 present the findings from a quantitative study. Chapter 3 investigated associations between suicide-related stigma, help-seeking, mental health and suicide risk, and whether stigma levels differed by age, gender, education and suicidal history. Chapter 4 examined mechanisms behind stigma within the Integrated Motivational-Volitional (IMV) Model using mediation analyses. Chapters 5 and 6 relate to qualitative interviews (n = 30) which were conducted as part of this thesis. Chapter 5 used the Framework analysis method to understand whether the experiences of those who had attempted suicide differed from those who had thought about suicide with regards to suicide-related stigma. Finally, Chapter 6 aimed to provide recommendations for the reduction of suicide-related stigma based upon suggestions of those with lived experiences using Reflexive Thematic Analysis. Results: The scoping review (Chapter 2) highlighted the negative effects of suicide-related stigma, such as a higher risk of suicidality, poor mental health, lowered help-seeking intentions/behaviours and grief-related difficulties among those bereaved by suicide. Suicide-related stigma was found to be related to feelings of isolation, shame and secrecy. A small number of studies discussed the protective nature of suicide-related stigma in that it can encourage help-seeking. The scoping review allowed for the development of a novel model of suicide-related stigma which displays the directionality of these associations. In the first quantitative study (Chapter 3, n = 470 participants), males were found to stigmatise those who die by suicide more than females. The analyses in Chapter 3 also found that individuals with a history of suicide (thoughts or attempts) held fewer stigmatising attitudes towards those who die by suicide but more stigmatising attitudes towards those bereaved by suicide and suicide attempts compared to those without a suicidal history. Chapter 3 found significant associations between suicide-related stigma and higher levels of depression, anxiety and suicidal ideation as well as lower help-seeking intentions. In Chapter 4 (additional analyses from the survey reported in Chapter 3), serial mediation analyses revealed that defeat and entrapment fully mediated the relationship between the glorification of suicide, suicide-related stigma measures and suicidal ideation. Chapter 5 explores the findings from the qualitative study. A key finding was that those with a history of suicide attempts had similar experiences regarding suicide-related stigma to those with a history of suicidal thoughts. Five themes were developed from the interviews: 1) “suicide is stigmatised;” 2) “it’s like the elephant in the room, nobody wants to talk about it;” 3) “I was so ashamed;” 4) “I think generally people think suicide is selfish, cowardly, inexplicable, mad;” and 5) “So I guess it’s about being taken seriously and being believed almost.”. These themes captured the silence and secrecy around suicide, the negative labels attached to those who experience suicidality and the shame associated with these experiences as well as the experience of their reasons for their suicidality being questioned. Finally, Chapter 6 (further analyses from the interviews described in Chapter 5) explored the consequences of suicide-related stigma and yielded suggestions from those with lived experience regarding how to reduce the stigma related to suicide. These analyses identified three themes related to the impact of suicide-related stigma: negative consequences, positive and supportive reactions, and no impact. Most of the participants described the negative consequences of suicide-related stigma such as lowered help-seeking and poor mental health outcomes. Regarding how suicide-related stigma could be reduced, two themes emerged from the transcripts: education and open conversations. Most of the participants described the importance of education in schools and workplaces to mitigate suicide-related stigma as well as the importance of having open and non-judgmental conversations around suicide. Conclusion: To my knowledge this thesis includes the first literature review of its kind, a scoping review investigating the associations between suicide-related stigma and help-seeking, mental health, grief, and suicide risk among different groups of individuals. This review led to the development of a model explaining the directionality of the associations between suicide-related stigma and the outcomes explored within the review. The quantitative and qualitative studies provided novel findings, such as defeat and entrapment mediating the stigma–ideation relationship and lived-experience accounts of the impacts of suicide-related stigma and potential interventions to reduce stigma. The findings reveal possible groups for intervention, such as men (Chapter 3) while also highlighting the similarities in the way those affected by suicide experience stigma. The evidence presented in this thesis has important implications for policy and clinical practice.
Jessica Wyllie (Thu,) studied this question.