Yearning to be heard: what veterans teach us about suicide risk and effective interventions.
BACKGROUND
Patients with serious mental illness can be at higher risk for suicide. Most research has focused on determining the risk factors for suicide-related events using quantitative methodologies and psychological autopsies. However, fewer studies have examined patients' perspectives regarding the experience of suicidal events.


OBJECTIVE
To better understand suicide experiences from the perspective of patients diagnosed with serious mental illness.


METHODS
This study purposively sampled and qualitatively interviewed 23 patients within the Veterans Affairs Hospital who were diagnosed with serious mental illness and who had attempted suicide. Using a phenomenological design, hermeneutic interviews included questions about the precursors, characteristics, and treatment of the suicide events, as well as patients' recommendations for care.


RESULTS
Loneliness, isolation, depression, and hopelessness were commonly described as emotional precursors to the suicide events for all patients, while command hallucinations were reported among patients with schizophrenia-spectrum disorders. When evaluating whether treatments were effective, patients focused primarily on the level of empathy and compassion shown by their providers.


CONCLUSIONS
The most common recommendation for the improvement of care was to increase clinicians' empathy, compassion, and listening skills. Additionally, efforts to bolster social supports were highlighted as a means to diminish suicide events.
<location>Department of Family and Preventive Medicine, Department of Psychiatry, University of California, San Diego, CA, USA</location>
Lori P
LP
Montross Thomas
<location>School of Social Work, University of Southern California, Los Angeles, CA, USA</location>
Lawrence A
LA
Palinkas
<location>Department of Psychiatry, University of California, San Diego, CA, USA</location>
Emily A
EA
Meier
<location>Department of Psychiatry, University of California, San Diego, CA, USA</location>
Alana
A
Iglewicz
<location>Department of Psychiatry, University of California, San Diego, CA, USA</location>
Tabitha
T
Kirkland
<location>Department of Psychiatry, University of California, San Diego, CA, USA</location>
Sidney
S
Zisook
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications / Q000523:psychology; D004645:Empathy; D005260:Female; D065026:Hope; D006801:Humans; D008132:Loneliness / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012307:Risk Factors; D012934:Social Isolation / Q000523:psychology; D013405:Suicide / Q000523:psychology; D013406:Suicide, Attempted; D014481:United States; D014728:Veterans / Q000523:psychology*; D000092864:Suicide Prevention
compassion; mental illness; patient-centered care; schizophrenia; suicide