Suicide is a critical public health concern, claiming over 800,000 lives annually worldwide. It's not just a statistic—it represents a devastating loss for families, friends, and communities. The 10th of September marks International Suicide Prevention Day, a day dedicated to raising awareness, reducing stigma, and encouraging crucial conversations about mental health and suicide. As we approach this date, we wanted to take a moment to reflect on the importance of asking a simple but powerful question: "Are you OK?" This question can facilitate life-saving conversations and help us better understand the complex factors that contribute to suicide.

What Does the Research Say?

Recent research emphasizes the importance of cognitive risk factors in suicidality. Among these, Early Maladaptive Schemas (EMS) have emerged as significant contributors. But what exactly are EMS, and how do they influence an individual's mental health?

What Are Early Maladaptive Schemas?

EMS are deeply ingrained patterns of thinking, feeling, and behaving that develop during childhood or adolescence, often in response to unmet emotional needs or traumatic experiences. These schemas, identified by psychologist Jeffrey Young, reflect negative beliefs about oneself and one's relationships. When activated, these schemas can trigger intense emotional reactions and maladaptive coping behaviours, such as suicidal ideation or self-harm.

The Link Between Schemas and Suicidality

Research has shown that certain schemas are more strongly linked to suicidal ideation than others. The meta-analysis published in the Journal of Affective Disorders Reports highlights several key EMS that are strongly correlated with suicidal thoughts and behaviours:

Defectiveness/Shame Schema: This schema involves a pervasive belief that one is inherently flawed, unlovable, or unworthy. Individuals often experience deep feelings of shame and self-loathing. When triggered, this schema can lead to intense emotional pain, increasing the likelihood of suicidal thoughts. For example, a person with this schema might interpret a minor rejection as evidence of their inherent defectiveness, concluding that their existence is a burden to others.
Social Isolation/Alienation Schema: Individuals with this schema believe they are fundamentally different from others and do not belong. The loneliness and disconnection experienced by individuals with this schema can trigger suicidal ideation, as they may feel that there is no one who understands or cares about their struggles.
Emotional Deprivation Schema: This schema involves the belief that one’s emotional needs will never be met by others. Individuals often feel unloved and emotionally unsupported, leading to a deep sense of loneliness. When triggered, it can intensify feelings of isolation and hopelessness, contributing to suicidal ideation. For example, a person might interpret a friend’s unavailability as proof that they are unworthy of love and care.
Failure Schema: The belief that one is destined to fail, or has already failed in life, is central to this schema. Individuals with a strong Failure schema may feel that their efforts are futile and that they will never achieve success or acceptance. This persistent sense of inadequacy can contribute to a downward spiral of hopelessness, leading to thoughts of suicide as a way to escape their perceived failures.
Dependence/Incompetence Schema: This schema reflects a belief that one is unable to handle life’s challenges without significant help from others. When activated, this schema can lead to overwhelming feelings of helplessness and vulnerability. Individuals may feel incapable of managing their distress or resolving their problems, making suicide appear as the only solution.

These schemas are not just abstract concepts; they are deeply felt, lived experiences that shape how individuals interpret their daily lives. Furthermore, these schemas often coexist and reinforce each other, creating a vicious cycle. The more entrenched these schemas become, the more likely the individual is to engage in suicidal ideation or self-harm as a means of coping with their overwhelming emotions.

For mental health practitioners, understanding the specific schemas that contribute to a client’s suicidal ideation can enhance risk assessment and support the development of individualized treatment plans. By addressing these schemas, it may be possible to reduce the risk of suicide and help clients build healthier, more adaptive ways of thinking and relating to themselves and others.

The Weight Behind the Question

When we ask someone, "Are you OK?" we might not fully grasp the significance of what we’re asking. This question is not just about checking in; it's about offering an invitation to share burdens, fears, and struggles. For someone who is dealing with overwhelming emotional pain, this might be the first step toward seeking help. It can also be a gentle reminder that they are not alone.

However, it’s important to understand that asking "Are you OK?" is just the beginning. The response to this question can vary greatly depending on the individual's state of mind, their support network, and the underlying factors that may be contributing to their distress.

While asking "Are you OK?" is a powerful first step, it's important to recognize that some struggles are deeply rooted in long-standing patterns of thought and emotion, such as EMS. These ingrained schemas can perpetuate feelings of worthlessness, isolation, or emotional deprivation that a simple conversation may not resolve. While your support is invaluable, these complex issues often require the expertise of a mental health professional who can help the individual identify and challenge these harmful patterns. Encouraging them to seek professional help is crucial for their long-term well-being.

How Can We Help?

Recognizing the signs of someone in distress and knowing how to respond is vital. Here are some steps you can take if you’re concerned about someone’s well-being:

Start the Conversation: Don’t be afraid to ask, "how have things been going for you?", “what has been on your mind recently?” or even more directly, "have you been thinking about hurting yourself?" Contrary to common fears, asking about suicide doesn’t plant the idea or increase someone’s suicidal ideation. Instead, asking directly about suicide can help reduce shame and it opens the door for honest communication.
Listen Without Judgment: If someone does open up, listen with empathy. Avoid offering quick fixes, problem solving, or dismissing their feelings. Sometimes, just being there, listening, and allowing them to express themselves is the best support you can provide.
Encourage Professional Help: Suggest they speak with a mental health professional. Psychological therapy and medication can be life-saving. If they’re hesitant, offer to help them find resources or accompany them to an appointment.
Stay Connected: Continue to check in, even after the initial conversation. Showing ongoing support and concern can make a significant difference.
Know the Emergency Contacts: In cases of immediate danger, don’t hesitate to contact emergency services or a suicide helpline (resources are at the end of this post). It’s better to be safe and take action than to regret not intervening.

Conclusion

Efforts to prevent suicide are ongoing, and understanding the cognitive factors that drive suicidal thoughts and behaviors is crucial. Early Maladaptive Schemas play an important role in this, highlighting areas for targeted mental health intervention and support. Through therapy and early intervention, we can work to heal these EMS, offering hope and healing to those who need it most. In this context, the question "Are you OK?" might seem simple, but its impact can be profound. By understanding the factors that contribute to suicide, we can be better equipped to support those who might be struggling. Every conversation counts, and sometimes, the smallest gesture can be the one that makes all the difference.

If you or someone you know is struggling, don’t hesitate to reach out for help. You are not alone.

Resources
Lifeline - 13 11 14 (24/7 crisis support)

Suicide Call Back Service - 1300 659 467 (24/7 phone and online counselling to people affected by suicide)

References
Pilkington, P., Younan, R., & Bishop, A. (2021). Early maladaptive schemas, suicidal ideation, and self-harm: A meta-analytic review. Journal of Affective Disorders Reports, 3, 100541. https://doi.org/10.1016/j.jadr.2020.100051

Are you o.k? Behind the Question: What Contributes to Suicide and How to Help