We’re going to do one more baby hit of worthlessness research, just to drive the point home. I’ve been claiming worthlessness is the driver of everything we know as unresponsive PTSD or typical CPTSD – all the way down to the worst outcomes commonly linked with high ACE scores like institutionalization and early death.
Today let’s make sure I’m not exaggerating on the detrimentality of comparative worth.
Feelings of worthlessness, traumatic experience, and their comorbidity in relation to lifetime suicide attempt in community adults with major depressive disorder
Hong Jin Jeon a,b,c , Jong-Ik Park d , Maurizio Fava c , David Mischoulon c , Jee Hoon Sohn e , Sujeong Seong e , Jee Eun Park e , Ikki Yoo a , Maeng Je Cho
Journal of affective disorders
2014
Suicide is not a simple “A leads to B” event. It condensates from the convergence of several factors which generally have relationship to each other. For instance, depression and substance misuse support each other and act as suicide attempt risk factors. One could also step back a few feet and suspect that trauma might be related to both, potentially through destructive perspectives that might connect the bunch. So it’s not too surprising that sense of worthlessness is considered a proximal trigger of suicide attempt, while issues like PTSD are assessed as distal – or more distant, background - factors.
Roughly 0.014% of people commit suicide worldwide. However, about 11 people attempt suicide for every 1 that is documented. Meaning about .14% of people are documented as suicidal or suicide attempting. And how many are undocumented? What we do know is major depression drives the behavior.
Major Depressive Disorder is implicated, especially due to its connections with other mental disorders, environmental conditions, and traumatic stress. And interestingly, while the experience of depression is unique between sufferers, worthlessness is one of the defining diagnostic criteria, suggesting it’s a stable characteristic. In fact, CBT for MDD focuses on negative beliefs, such as worthlessness, partially due to its correlation with suicide attempt.
But major depression doesn’t wander alone; it’s often hand in hand with PTSD. Trauma is also correlated with suicide attempt, with poor social experiences as one of the potential predisposing factors. With depression and low social support piggybacking on feelings of worthlessness, and bolstering the post-traumatic stress symptomology experience, we might have a perfect storm for suicidal ideation and attempt.
Methods:
In this study, researchers aimed to investigate the co-occurrence and correlation of major depression, trauma history, sense of worthlessness, and lifetime suicide attempts. The study was performed with a large pool of participants who underwent diagnostic interviews.
And they found!
Discussion
There are two massive findings from this study.
First: sense of worthlessness predicts lifetime suicide attempt more intensely than any other depression symptoms. Actually, from a list of 20 options, worthlessness was the only symptom correlated with lifetime suicide attempt in this research. In another study, in a majorly depressed population, worthlessness has been shown to correspond with a 4-5 time increase of suicide attempt.
On top of that rather definite finding, sense of worthlessness, trauma, and MDD promote lifetime suicide attempt in the following fashion: worthlessness predicts suicide attempt in individuals with significant trauma histories, and trauma history predicts suicide attempt for those with major depression who also had sense of worthlessness. They’re all related risk factors that predict each other!
The authors suggest this could be due to below-threshold post-traumatic stress. When an individual doesn’t meet the diagnostic qualifications for full-blown PTSD, feelings of worthlessness may still be present and linger. They might tip into major depression or strengthen already-active depression. Together, feelings of worthlessness, trauma history, and depression might result in suicide attempt.
What kind of trauma is most likely to lead to suicide attempt? Military experience and significant beatings were both shown to predict lifetime suicide attempt. However, multiple traumas of any variety, when combined, have a similar effect.
And as they say:
Those findings tell us that there should be an interaction between interpersonal trauma and one of the few explicitly interpersonal symptoms of depression assessed in predicting SA. (worth-less-ness)
In conclusion, the findings of this study suggest a web of depression (ego forfeit), feelings of worthlessness compared to the rest of the population, trauma history of large unpersonal varieties or multiple interpersonal events, and eventual suicide attempt.
Worthlessness and trauma history with a side of MDD seem to be the strongest predictors, but so do worthlessness and major depression, with a trauma history that may or may not be enough to qualify for a PTSD diagnosis.
Meaning worthlessness may be the central promoting factor for suicidality; acting as the glue stringing together PTSD and depression, and worsening their cognitive and emotional effects, so they precipitate into one highly risky situation that may end lives.
And that is the major threat of estimating oneself worth-less.
TO BRING IT HOME
It’s worthlessness assessment and unlearning, all the way down, to prevent suicidal attempt. The good news being, this is one central factor and point for healing, in an otherwise multinodal and highly individual series of interrelated risks. Maybe we don’t need to deeply understand every person’s trauma history or depressive cognitions to save lives. We simply need to help people feel worth-equal.
And with that… thanks for being here.
There’s value in it, for everyone you know and don’t. You can’t know the depth of the impact you make, or to whom. You’re worth more than you believe.
And I’ll talk to you soon.