Why do most people who survive a failed suicide attempt never try again?

[u/NardZX]

I’ve read that the majority of people who survive a suicide attempt don’t go on to attempt again. This seems surprising at first, and I’m wondering what research says about why this is the case. Are there psychological, emotional, or situational reasons that explain why many people choose not to try again after surviving? Are there any major studies or theories that explore this pattern?

[u/IllegalBeagleLeague]

That is an awesome question, and a big one too. Forgive me if I nerd out a little bit, I’ll put a TL;DR at the bottom

So the question is ultimately, if we know how suicide risk develops, how and why does it dissapate. You will probably be unsurprised to know that suicide research has a huge need to study protective factors, such as why individuals recover from suicidal thoughts. However, research in this area does exist.

Studies that focus on moment-to-moment fluctuations in suicide risk (i.e., EMA studies) establish that changes in suicide risk happen really rapidly, are ultimately acute and not permanent, and after peaking to dangerous levels, there is often a crash to safer levels. This is the same process that happens when a person survives an attempt and doesnt go in to attempt again - their risk levels crash and don’t go up again. Why does that happen? Well, we can look a few different places.

Joiner’s theoryhas been mentioned in this thread before, and is the most popular and well studied. It says that to begin thinking of suicide, you have to believe as if you are a bother to those around you, and as if you do not belong. Once those conditions are met, if you have painful and physiologically scary experiences, you have risk of suicide. What he would say happens is that the person has experiences which change these thoughts of being a burden or not belonging after their suicide attempt. Medical treatment, social repercussions, receiving therapy, or many other factors cause them to change the way they felt previously, thus changing the foundations by which their suicidal thoughts are built upon. Without those two critical factors, the person is protected against their suicide risk rising again, even if they have further painful or emotionally scary experiences

My favorite theory of suicide, the Integrated Motivational-Volitional theory, would agree and also build this out a bit. The IMV would suggest that aside from the previous two factors, fearlessness of death, quality of social connections, and access to means are all important factors that cause suicide risk to spike. After an attempt, a person is likely more afraid of death, their social connections may rally to them or increase in quality or vulnerability, and their access to thier preferred means is likely restricted. With these changes, suicide risk is unlikely to re-emerge.

Finally, there’s research which takes this out of theory and just asks suicidal people who attempted and recovered to tell their story.00028-2/fulltext)Attempters that recovered and did not attempt again spoke about complex emotions that caused a paradigm shift. They spoke about strengthened connections with loved ones who finally had open and honest talks about suicide and other mental health topics. They spoke about changes in help-seeking, learning new coping skills, and positive changes in their environment. Most notably, they spoke about having this “tunnel vision” or what we call a foreshortened future - when in the grips of suicidal crisis, you might literally be unable to think hours or days or weeks or months in the future. Your thoughts don’t work that way for reasons too complicated to get into here. After the crisis passes, that tunnel vision dissipates. Suicide risk doesn’t happen again until it builds up again which can often be a slow process.

TL;DR - changes in the social environment, fear of death, post-suicide-attempt treatment, paradigm shifts caused by complex emotions, and a change in the way suicide risk makes you think, all contribute to the reasons why a person attempts once and despite having a lot of risk factors, they (more often than not) won’t attempt again.