Unravelling the complexity of suicidality: a network analysis of theory-driven and culturally relevant suicide risk factors in a country with high suicide rates.

Purpose: This study aimed to explore whether individual theory-based constructs are sufficient in explaining suicidality in a culture marked by high suicide rates and whether, if any, culturally relevant factors need to be considered additionally.

Methods: The study used a community sample of 1873 Lithuanian adults (age M = 43.61 SD = 16.96, 69.1% female). A survey using online and pen-and-paper formats was conducted, measuring suicidality, the main constructs from two predominant theories of suicide (thwarted belongingness, perceived burdensomeness, acquired capability for suicide, and defeat and entrapment), and culturally relevant factors (gender role expectations, attitudes towards help-seeking, perfectionism, negative social comparisons, alcohol use, child-parent relationships and childhood experiences). Network analysis method was used in the analysis.

Results: From the key factors identified in the two theories perceived burdensomeness had stronger links with self-perceived risk for suicide compared to thwarted belongingness and entrapment. Acquired capability to suicide had no direct links with other factors in the network apart from a weak link with history of suicidal behavior. In the network some of the culturally relevant variables (reasons for alcohol use, experience of sexual abuse, emotional neglect, and cultural norms representing restricted emotionality and attitudes towards psychological help) had direct relationships with suicidality, not only via key theory based factors.

Conclusions: The results suggest the need to consider cultural context when applying universal suicide theories.