The Impact of Relationship Separation on Suicidality and Mental Health

Abstract

Introduction: Relationship separation is common and can be a significant risk factor for suicidal thoughts and behaviours. However, there exists a paucity of research that explores the relationship between suicidality and separation, and even less focusing on accessible interventions for separated individuals. Methods: A systematic review was conducted to establish the impact of intimate partner relationships on suicidality, specifically how relationship separation contributes to suicidal thoughts and behaviours. An online cross-sectional survey was developed to explore potential predictors of suicidality and to identify challenges, benefits and help-seeking strategies following a relationship separation. A final systematic review was conducted to assess the impact of existing separation interventions on mental health, specifically focusing on suicidal thoughts and behaviours. The results from these studies guided the development of MindCast, a six-session, online podcast program based on Brief Interpersonal Psychotherapy (IPT-B), designed for people who have separated from a relationship. The effectiveness of this intervention was evaluated through a randomised controlled trial of 124 Australian participants who had separated in the last six months. Results: The results of the systematic reviews highlighted that relationship separation and poor quality relationships are likely to be important risk factors for suicidal thoughts and behaviours and are a frequent trigger for a suicide attempt. However, there exists a paucity of trials that adequately assess the effects of non-marital relationship separation interventions on mental health outcomes and none that consider suicidal thoughts and/or behaviours. The cross-sectional study identified greater symptoms of antagonism and disinhibition and less active coping, decreased positive family support, less negative friends and lower self-esteem as being significantly associated with increased odds of suicidal ideation. Qualitative analyses revealed that males were significantly more likely to report “no benefit” to the separation, compared with females who were significantly more likely to report “leaving an abusive and/or negative relationship” and “moving on” as benefits to the relationship break-up. Although the MindCast intervention did not have a significant effect on depression or suicidal ideation, across time, between group effects sizes (post, d = 0.50 and follow-up, d = 0.10) indicated that the MindCast intervention may have the potential to decrease depressive symptoms in people who have separated from a relationship, compared to a control condition. Low post-intervention (n = 30) and follow-up (n = 20) response rates were a primary limitation. Conclusion: The MindCast podcast represents the first self-directed, online podcast developed for people who have separated from an intimate partner relationship. It was also the first study of its kind to adapt IPT, of any form, to a podcast format and to explore the influence of such an intervention on suicidal ideation and broader psychosocial targets. Although the results did not indicate that the intervention was effective in terms of targeting primary mental health outcomes, qualitative feedback suggests that participants were keen to engage in the content. Further, the small to moderate between group effect sizes were encouraging and suggest that significant effects may be observed in an adequately powered trial. Research focusing on suicide prevention and early intervention is needed to continue to identify risk factors and key intervention areas.