Self-Attacking Thoughts, Critical Voices and Suicide in People who Hear Voices

Sammon, Myles and Kelly, James and Klein, Maike (2024) Self-Attacking Thoughts, Critical Voices and Suicide in People who Hear Voices. PhD thesis, Health Research.

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Abstract

Negative voice content is a key predictor of distress for voice hearers. Understanding how voice hearers experience and cope with negative voice content is key to furthering clinical research and practice. Hearing voices is associated with increased risk of suicidal ideation (SI) and suicidal behaviour (SB). Further work is needed to understand the relationship between negative self-talk, negative voice content, SI and SB in people who hear voices. Section one of this thesis reports a systematic literature review exploring how voice hearers experience and cope with negative voice content. A meta-ethnography synthesised 24 qualtative studies to produce four over-arching themes. The results show that negative voice content often relates to traumatic experiences, negative evaluations from self and others and current fears. This appears to mobilise social rank mentalities and voice hearers often cope through fight or flight mechanisms. Clinical and research implications are discussed. Section two reports an empirical study that explored the relationships between self-attacking thoughts and SI, and critical voices and SI, in people who hear voices. Additionally, the moderating role of self-compassion in these two relationships and the relationship between predictor variables and SB is explored. Self-attacking thoughts significantly predicted SI severity. Critical voices also significantly predicted SI severity. No significant moderating role of self-compassion was found and self-attacking thoughts or critical voices did not predict SB. Minoritsed gender and entrapment predicted SB. Findings suggest critical voices may be a key factor alongside entrapment in SI for people who hear voices. Clinical and research implications are discussed. Section three reports a critical appraisal including reflections on key challenges and the rationale for decisions made throughout the research process.