Nock, M. K., Jaroszewski, A. C., Deming, C. A., Glenn, C. R., Millner, A. J., Knepley, M., Naifeh, J. A., Stein, M. B., Kessler, R. C., & Ursano, R. J. (2025). Antecedents, reasons for, and consequences of suicide attempts: Results from a qualitative study of 89 suicide attempts among army soldiers. Journal of Psychopathology and Clinical Science, 134(1), 6–17. https://doi.org/10.1037/abn0000935

Key Takeaways

The study investigates the antecedents, reasons for, and consequences of suicide attempts among 89 U.S. Army soldiers.
The primary reason for suicide attempts was to escape psychologically aversive conditions.
Most soldiers did not disclose their suicidal thoughts before the attempt.
The study highlights the need for improved identification and intervention methods for suicide prevention.
The authors suggest educating families and the broader society about indirect warning signs for suicide.
The study emphasizes the importance of early intervention and support to prevent suicide attempts.

A sad soldier in a therapy session sat opposite each other.

Rationale

Suicide is a complex issue, and despite extensive research, there are still many unanswered questions.

Traditional quantitative research, which often focus on comparing individuals who have attempted suicide to those who have not, have not been able to fully explain why people try to kill themselves.

Therefore, the next step is to explore this issue by directly asking individuals who have survived suicide attempts about their experiences, motivations, and potential preventative factors.

Method

This mixed-methods study involved 89 active-duty U.S. Army soldiers hospitalized following a suicide attempt.

Participants were recruited from five Army hospitals across the United States and were required to be medically stable and fluent in English.

Within 72 hours of hospital admission, potential participants were identified and, following informed consent, completed a telephone-based qualitative interview with a study team member located off-site at Harvard University.

The interview focused on understanding the antecedents, reasons for, and consequences of suicide attempts from the soldiers’ perspectives.

Sample

The study included 89 active-duty U.S. Army soldiers who had recently attempted suicide.

The majority of participants were male, white, under 30 years old, and had less than a college degree.

Results

The study revealed several key themes:

Immediacy of suicidal thoughts: The majority of participants reported that their suicidal thoughts began shortly before their attempt, with 80% reporting the onset within the month prior. This underscores the importance of timely intervention.
Lack of disclosure: Despite experiencing distress, less than half of the participants disclosed their suicidal thoughts to anyone before the attempt. This highlights the hidden nature of suicidal ideation and the need for proactive identification strategies.
Escape as a primary motivator: The most common reason for attempting suicide was to escape unbearable psychological states. This supports the escape theory of suicide and suggests that interventions should focus on helping individuals manage and cope with such states.
Perceived lack of options: Participants often felt trapped and believed they had no other options besides suicide. This emphasizes the importance of instilling hope and promoting problem-solving skills in individuals at risk.
Potential for prevention: Most participants believed that something could have changed their minds about attempting suicide, such as receiving support or relief from their psychological distress. This underscores the importance of providing timely support and resources to individuals at risk.

Insight

This study provides valuable insights into the motivations and experiences of individuals who attempt suicide.

By using a qualitative approach, the researchers were able to capture the nuances of suicidal ideation and decision-making, going beyond the limitations of traditional quantitative studies.

The findings challenge common misconceptions about suicide and offer concrete directions for prevention and intervention efforts.

Myth: Suicide is a long-considered decision. This study found that many suicide attempts follow shortly after the onset of suicidal thoughts, challenging the notion that they are always the result of prolonged consideration.
Myth: People who want to die by suicide cannot be stopped. The study found that most participants believed something could have prevented their suicide attempt, indicating that intervention is possible.
Myth: Suicide attempters are determined to die. While some participants desired to die, the primary motivation was often escaping psychological distress, suggesting that interventions should focus on alleviating this distress.

Clincial Implications

This study challenges the misconception that individuals who attempt suicide are determined to die and cannot be stopped.

The research found that most participants believed something could have changed their minds about attempting suicide, highlighting the potential for prevention.

Early identification and intervention: The study’s findings emphasize the need for early identification and intervention strategies, especially given that suicidal thoughts often emerge shortly before an attempt. This suggests a need for proactive approaches that do not solely rely on self-disclosure.
Addressing psychological distress: Understanding that suicide attempts are often motivated by a desire to escape unbearable psychological states underscores the importance of addressing this underlying distress. Interventions should focus on helping individuals manage and cope with such states.
Promoting problem-solving skills: The finding that participants often felt trapped and believed they had no options other than suicide highlights the need to promote problem-solving skills. Interventions should focus on helping individuals explore alternative solutions and develop coping mechanisms.
Fostering hope and support: Recognizing that most participants believed something could have prevented their attempt underscores the importance of fostering hope and providing support. This can involve strengthening social connections, increasing access to mental health resources, and creating a supportive environment that encourages help-seeking behavior.

Strengths

Qualitative approach: The study used in-depth interviews to gain a rich understanding of the participants’ experiences and motivations.
Focus on a high-risk group: The study focused on active-duty U.S. Army soldiers, a population with an elevated risk of suicide.
Large sample size: The study included 89 participants, which is relatively large for a qualitative study.

Limitations

Generalizability: The findings may not be generalizable to other populations, such as civilians or individuals from other military branches.
Telephone interviews: The use of telephone interviews may have limited the interviewers’ ability to observe nonverbal cues.
Focus on suicide attempters: The study focused on individuals who survived their suicide attempts, and the findings may not fully apply to those who die by suicide.

References