The Impact of Relationship Separation on Suicidality and Mental Health
Date
2018
Authors
Kazan, Dominique
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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.
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Keywords
suicide, relationship separation, mental health, rct, interpersonal psychotherapy, ipt, podcast
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Thesis (PhD)
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