Autonomy and relatedness - suicidal ideation ESM study
Research type
Research Study
Full title
Is there a relationship between an individual’s sense of autonomy and social relatedness and their experience of suicidal ideation? An ESM (experience sampling methodology) Investigation
IRAS ID
319515
Contact name
Daniel Pratt
Contact email
Sponsor organisation
University of Manchester
Duration of Study in the UK
1 years, 8 months, 22 days
Research summary
We know that lots of people will at some point, have thoughts of taking their own life. For some this will lead to acting on these thoughts, but this does not happen to everyone. We would like to find out more about what makes people more likely to have these thoughts and what may help people to cope with these thoughts.
How in control someone feels of what they are doing can affect their mood. As can how connected to other people they feel. This may also have a bearing on thoughts they may have of taking their own life. At times, people who are unwell with their mental health will stay in hospital to receive support. We know that sometimes this can make people feel like they have less control in their life and impact relationships. In this study, we would like to find out more about how in control people feel, how connected, and thoughts they have of taking their own life.
We are going recruit adults (18+) who have experienced thoughts about suicide within the past month and are currently an inpatient on a mental health ward. We are going to ask people to fill in some forms which look at how they feel and their mood. We will then ask people to complete a diary on their phone containing questions about their feelings in the moment. People will complete this diary up to 7 times a day, for 6 days. The diary will take around 2-3 minutes each time to complete. We will then analyse this whole set of diaries to see how much thoughts about suicide are linked with feelings of control and connection.
We hope that this can help us to develop new ways to support people who have thoughts of taking their own life.
Lay summary of study results: This research was undertaken as a joint project by two doctoral students (Keeley Watson & Melissa Drake) at the University of Manchester, as part of their Doctorate in Clinical Psychology (DClinPsy). The research team would like to express their gratitude to all of the individuals who participated in the study.
- Seventeen individuals agreed to take part in the research and were recruited from inpatient mental health settings, including rehabilitation settings. Of these seventeen participants, fifteen participants completed at least one of the diary entries.
- Participants completed questionnaires at the beginning of the study which provided a baseline measure of factors including suicidal ideation, autonomy and relatedness. Factors that have previously been associated with suicidal ideation were also measured (including hopelessness and depression).
- Across a six-day period, participants completed an online diary up to seven-times a day. This diary asked about how individuals were feeling in the moment and participants scored their responses on a scale from 0 (indicating ‘not at all’) up to 7 (indicating ‘a lot’). Questions in the diary measured the same factors that were measured initially in the baseline questionnaires, including suicidal ideation, depression, autonomy and relatedness.
- This is a type of methodology called ESM (experience sampling methodology) which aims to measure thoughts, feelings and behaviour in the moment. Two experts by experience provided initial feedback after taking part in a pilot study of the first draft of the ESM diary measures. This feedback was drawn upon when the final draft of the ESM diary was developed.
- On average, participants completed sixteen diary entries out of a possible forty-two (38.8% completion rate). All data from participants was included in the statistical analysis, regardless of how many diary entries were completed.
- At the end of the study period, individuals who participated were offered a de-brief phone-call or meeting to discuss their experience of taking part and to ask any questions about the research.
- The data collected in the study was statistically analysed to explore whether there was any association between variables that were measured. The results indicated a negative association between autonomy and suicidal ideation, which describes that as one’s sense of autonomy reduced, their experience of suicidal ideation increased.
- This association was found when measuring autonomy and suicidal ideation at the same time point, and when the outcome of suicidal ideation was measured at a delayed time point. This suggests that there may potentially be a temporal relationship between autonomy and suicidal ideation, with reduced autonomy at one time point impacting upon suicidal ideation at a later time point.
- A negative association was also found between social relatedness and suicidal ideation, describing that as one’s sense of social relatedness reduces, their level of suicidal ideation increases. As noted with the measure of autonomy, this association was also found when the outcome of suicidal ideation was measured at a delayed time point.
- The statistical analysis controlled for the factors that have previously been established as associated with suicidal ideation (including depression, hopelessness, defeat and entrapment). The association with autonomy, and social relatedness, with suicidal ideation remained significant.Future research directions:
- This research highlights the importance of further research being undertaken to explore the relationship between how in control one feels, and how close one feels to those around them, and their experience of suicidal ideation.
- Exploring qualitatively how individuals make sense of concepts including autonomy and relatedness.
- Further research focused upon the role of autonomy and social relatedness within the development of suicidal ideation, and progression to suicidal behaviour.How could this research be applied clinically?
- It may be beneficial to support individuals to develop their sense of autonomy. This may include utilising recovery based frameworks and values-based approaches.
- Placing specific focus upon an individual’s sense of social relatedness, and the relationships they have with those around them.
- Thinking more broadly in mental health settings about the wider context and how systemic factors such as housing and benefits may directly impact upon one’s sense of autonomy.
- In relation to inpatient settings, explorations of how the environment could be adapted to support an individual to feel empowered, including positive risk taking and ‘least restrictive practice’. Focus could also be placed upon supporting individuals in relation to the sense of connection they perceive themselves to have to those around them.REC name
West Midlands - Coventry & Warwickshire Research Ethics Committee
REC reference
23/WM/0014
Date of REC Opinion
1 Feb 2023
REC opinion
Favourable Opinion