Self-Orientation and Relational-Orientation in Suicidal Risk: Possible Facilitative and Protective Aspects
Understanding the mindset of the suicidal patient is still one of the most critical and challenging tasks that a clinician can encounter. Various efforts have been made that help to explain the suicidal person's motivation via frameworks pertaining to the individual's self-orientation vs. a relational-orientation (Jobes, 1995). On one hand, various theoretical models and empirical investigations point to such things as a desire to escape negative self-image as a frequent motivator for suicide (e.g., Baumeister, 1990; Jobes & Mann, 1999). Conversely the literature shows that interpersonal relationships play a major role in the thinking of suicidal people. This interpersonal focus has even been shown to function as both a protective factor, in that the individual will refrain from suicide to avoid emotionally harming loved ones (e.g., Harris & McLean, 2007), as well as a facilitative factor in that suicidal acts are often preceded by feelings of thwarted belongingness and perceived burdensomeness to loved ones (Joiner, 2005). The present study attempted to better understand this complex relationship between an orientation towards oneself, an orientation towards others, and suicide risk potential by investigating these constructs in a sample of 108 psychiatric inpatients who had been admitted with suicidal ideation or behaviors at the Mayo Clinic in the Midwestern United States. Participants provided qualitative responses to prompts asking for such things as their reasons for living, reasons for dying, descriptions of psychological pain and self-hate. These self-generated responses were then reliably coded as either "self-focused" or "relationally-focused," and then analyzed in association with several key suicide risk factors. Results show that greater self-orientation was significantly, but inconsistently, related to suicide risk level. All self-generated qualitative responses were also coded as either "suicide-facilitating" or "suicide-preventative" to investigate any possible interaction with the self/relational-orientations. Significant interactions were detected, and the suicide-facilitating and suicide-preventative qualitative codes proved to be highly predictive of a patient's relative risk level in their own right. This factor was significantly related to each of the risk variables it was tested against, suggesting that a person's qualitative description of their own suicidality could be immensely valuable as a form of risk assessment.
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