Contending With Complexity: Crisis Workers' Perspectives on Suicide, Stigma, And Existing Measures

Although there have been developments in the reduction of mental health stigma in recent decades, the stigma of suicide remains prevalent as suicide rates continue to climb (SAMSHA, 2024; Sudak et al., 2008). And while there are many existing measures of suicide stigma, none to date have been developed and evaluated in consultation with crisis workers who provide direct support and resources to individuals utilizing suicide prevention services. Our study aimed to explore ways in which existing psychometric tools do or do not align with contemporary experiences of suicide stigma, as observed by crisis counselors and specialists who have operated various crisis lines, including the 988 Suicide and Crisis Lifeline. During one-on-one interviews with 19 crisis workers, we asked participants about their conceptualizations of suicide stigma, their experiences as crisis workers, and perspectives on two measures of suicide stigma, the Suicide Opinion Questionnaire (Domino et al., 1982) and Scale of Suicide Stigma (Batterham et al., 2013).

Through these interviews we identified four primary themes: suicide stigma is complex, interpersonal, and preventable, suicide stigma measures miss the mark but not everyone agrees why, suicide stigma measures get it right at least some of the time, and how researchers could or should be measuring suicide stigma. For participants, their perspective was often not only professional but personal, with many participants having disclosed personal encounters with suicidality and suicide stigma. Participants were ultimately conflicted about their disapproval of specific measure items and were skeptical about the accuracy and effectiveness of the measures presented to them. Despite this, participants also identified accurate aspects of the measures, and most expressed preference for the Scale of Suicide Stigma (Batterham et al., 2013). Participants also shared their recommendations for suicide stigma researchers. This included recommendations to factor in the role of identities and positionality of those being assessed for suicide stigma, consider impacts of social desirability on the effectiveness of suicide stigma measures, develop more implicit or nuanced measures targeted toward capturing the complexities of stigma, and to consult and collaborate directly with individuals who have experienced suicide ideation when developing or revising measures in the future.