Help-negation 1

Running Head: SUICIDAL IDEATION AND HELP NEGATION

Suicidal ideation and elp-negation: Not !u"t opele""ne"" o# p#io# elp$

%#an& P$ Deane' Co#alie ($ )il"on' * (o"ep Cia##oc i Uni+e#"it, o- )ollongong

%#an& Deane i" an A""ociate P#o-e""o# in t e Depa#t.ent o- P",c olog, and Di#ecto# o- t e Illa/a##a In"titute -o# 0ental Healt $ Co#alie )il"on i" a docto#al candidate and (o"ep Cia##oc i i" a Lectu#e# in t e Depa#t.ent o- P",c olog, at t e Uni+e#"it, o- )ollongong' Au"t#alia$ Co##e"pondence conce#ning t i" a#ticle " ould 1e add#e""ed to %#an& Deane' Depa#t.ent o- P",c olog,' Uni+e#"it, o- )ollongong' )ollongong' NS) 2322' Au"t#alia$ Telep one 4526 7221-7328' tele-a9 4526 722171:8; e-.ail %#an&<Deane=uo/$edu$au$

Deane, F., Wilson, C., & Ciarrochi, J. (2001). Suicidal ideation and helpnegation !t"s not #ust hopelessness or prior help. Journal o$ Clinical %s&cholog&, '(, )01-)1*.

Help-negation 2 A1"t#act %e/ di"t#e""ed ,oung people "ee& p#o-e""ional p",c ological elp and little i" &no/n a1out / at "ou#ce" o- elp ,oung people "ee& -o# di--e#ent p#o1le."$ In "uicidal ,out ' poo# elp-"ee&ing .a, 1e e9ace#1ated 1, t e p#oce"" o- elp-negation$ T #ee und#ed and t/o unde#g#aduate uni+e#"it, "tudent" co.pleted a >ue"tionnai#e .ea"u#ing "uicidal ideation' opele""ne""' p#io# elp-"ee&ing e9pe#ience' and elp"ee&ing intention"$ Pa#ticipant" indicated t e, /ould "ee& elp -#o. di--e#ent "ou#ce" o- elp -o# di--e#ent t,pe" o- p#o1le."' 1ut -#iend" /e#e con"i"tentl, #ated a" t e .o"t li&el, "ou#ce o- elp$ Help-negation /a" "ugge"ted 1, ig e# le+el" o- "uicidal ideation 1eing a""ociated /it lo/e# elp-"ee&ing intention"$ Ho/e+e#' t e negati+e "uicidal ideation? elp-"ee&ing intention" #elation" ip /a" not e9plained 1, opele""ne"" and p#io# elp-"ee&ing$ Help-"ee&ing appea#" to in+ol+e .o#e t an !u"t negati+e e9pectation" #ega#ding t e -utu#e$ T e di"cu""ion p#opo"e" "ocial p#o1le."ol+ing o#ientation a" one o- a nu.1e# o- potential e9planato#, +a#ia1le"$

Help-negation 8

Suicidal ideation and elp-negation: Not !u"t opele""ne"" o# p#io# elp$ See&ing and #ecei+ing elp -#o. .ental ealt p#o-e""ional" can a""i"t in t e #eduction o- di"t#e""ing p",c ological ",.pto." 4@e#gin * Ga#-ield' 1AA76' ,et -e/ / o e9pe#ience "igni-icant p",c ological di"t#e"" "ee& p#o-e""ional elp 4e$g$' Ca#lton * Deane' in p#e""; @olde#o * %allon' 1AA3; 0ee an' La.1' SaltB.an' * OCCa##oll' 1AA26$ A #ecent Au"t#alian National Su#+e, o- o+e# 15':55 pe#"on" -ound t at / ile .o#e t an one in -i+e adult" .eet t e c#ite#ia -o# a .ental ealt di"o#de#' D:2E ope#"on" /it a .ental di"o#de# did not "ee& an, p#o-e""ional elp -o# .ental ealt p#o1le."F 4And#e/"' Hall' Tee""on' * Hende#"on' 1AAA' p$ 8G6$ T i" "t#i&ing "tati"tic #ai"e" "e#iou" conce#n" -o# t e Au"t#alian population in gene#al' and pa#ticula#l, -o# ,out ' a" t e "a.e #epo#t -ound t at .ental ealt di"o#de#" /e#e .o"t p#e+alent a.ong ,oung people$ Alt oug it i" clea# t at p#o1le.-t,pe in-luence" t e c oice o- elp "ou#ce 4Oli+e#' Reed' HatB' * Haug ' 1AAA; @olde#o * %allon' 1AA36' t e a""ociation" 1et/een patte#n" o- ,out p#o1le." and acce""ing potential "ou#ce" o- elp' / et e# -o#.al o# in-o#.al' a#e cu##entl, unclea# 4Oli+e# et al$' 1AAA; Pe"cocolido' * @o,e#' 1AAA6$ Little i" &no/n a1out / en ,out "ee& elp' -o# / at t,pe" o- p#o1le."' and -#o. / ic elping "ou#ce"$

) ile -e/ adole"cent" "ee& p#o-e""ional p",c ological elp' .o"t /ill "ee& elp -#o. a +a#iet, o- ot e# "ou#ce" "uc a" -a.il, .e.1e#"' -#iend"' and teac e#" 4@olde#o * %allon' 1AA3; O--e#' Ho/a#d' Sc one#t' * O"t#o+' 1AA16$ Up to A5E oadole"cent" tell t ei# pee#" #at e# t an a p#o-e""ional o- t ei# di"t#e"" 4Hala-at' 1AAG; Hala-at * Elia"' 1AA36$ Adole"cent .ale" a#e .o#e li&el, to "ee& elp -#o. pa#ent" and le"" li&el, to "ee& elp -#o. pee#" t an -e.ale" 4@olde#o * %allon' 1AA36$

Help-negation 7 Gene#all, "pea&ing' it "ee." po"iti+e t at .o"t adole"cent" a#e /illing to tal& to "o.eone a1out t ei# di"t#e""$ It al"o "ee." po"iti+e t at .an, pe#cei+e t e elp "ou#ce a" elp-ul 4Du1o/' Lo+&o' * Hau" ' 1AA56$ Ho/e+e#' D-o# t e .o"t pa#t' di"tu#1ed adole"cent" do not o1tain t e elp t e, needF 4O--e# et al$' 1AA1; p$ :2I6$ ) en pee#" a#e "oug t -o# elp' t e, .a, 1e poo#l, e>uipped to p#o+ide elp-ul #e"pon"e" to di--icult >ue"tion"$ Suicidal adole"cent" -o#. Dpoo# >ualit, -#iend" ip"F 4Cole' P#otin"&,' * C#o""' 1AA2' p$ I1G6' di"tu#1ed adole"cent" -o#. -#iend" ip" t at in+ol+e con-lict' cogniti+e di"to#tion"' and poo# "ocial-cogniti+e p#o1le. "ol+ing 40a#cu"' 1AA:6' and di"tu#1ed adole"cent" " o/ a "t#ong li&ing -o# -ello/ di"tu#1ed pee#" 4Sa#1o#nie * Hau--.an' 1AI36$ T e"e -inding" #ai"e "e#iou" conce#n" a1out t e 1ene-it o- "ee&ing elp -#o. pee#" 4O--e# et al$' 1AA16$ E+idence "ugge"t" t e p#oce"" leading to "uicide i" not an i.pul"i+e act 1ut t e end point in a pat ological #eg#e""ion 4No+ic&' 1AA:6' Da continuu. 1eginning /it ideation' continuing to atte.pted "uicide' and ending /it co.pleted "uicideF 4Cole et al$' 1AA2' p$ I186$ T e#e-o#e' "ee&ing elp -#o. a poo# >ualit, pee# #elation" ip -o# a ig #i"& .ental ealt ",.pto.' "uc a" "uicidal ideation' a" t e potential to lead to t#agic con"e>uence"$ T e#e i" a ig #i"& -o# "uicide co.pletion i- t e ,out doe" not "ee& and #ecei+e app#op#iate t#eat.ent o# ad+ice 4Ro"en1e#g' Edd,' )olpe#t' * @#ou.a"' 1AIA6$ In cont#a"t' i- t e ,out #ecei+e" app#op#iate t#eat.ent and ad+ice' "uc a" t at -#o. a .ental ealt p#o-e""ional / en t e, a#e "uicidal' #i"& and di"t#e"" a#e li&el, to 1e #educed 4Rudd' Ra!a1' O#.an' Stul.an' (oine#' * Di9on' 1AA:6$ Ce#tainl, a .atc 1et/een app#op#iate elp "ou#ce and p#o1le.-t,pe i" i.po#tant -o# #eduction o- ,out di"t#e""$ Jout decide / o to tal& to on t e 1a"i" ot ei# "peci-ic p#o1le.$ Re"ea#c "ugge"t" t at adole"cent" -o#. pe#ception" a1out t e "uita1ilit, o- elping "ou#ce" and "ee& elp -#o. t o"e "ou#ce" t at a#e #eadil,

Help-negation 3 a+aila1le to t e. 4@olde#o * %allon' 1AA3; O--e# et al$' 1AA16$ Ho/e+e#' it i" unclea# i- t i" deci"ion i" 1a"ed on a pe#ception o- elp-"ou#ce e--ecti+ene"" o# a -unction ot e #elation" ip 1et/een t e ,oung pe#"on and potential elp-gi+e# 4@olde# * %allon' 1AA36$ Di"t#e""ed c ild#en a+e 1een -ound to c oo"e elp gi+e#" on t e 1a"i" ope#cei+ed >ualitie" #at e# t an t ei# o/n need" 4)e"tcott * Da+ie"' 1AA36$ Unde#"tanding t e patte#n" o- ,out elp-"ee&ing -o# di--e#ent p#o1le." .a, g#eatl,

en ance ou# a1ilit, to de+elop e--ecti+e "uicide p#e+ention and inte#+ention p#og#a."$ U"ing a "a.ple o- 8'G51 outpatient" "ee&ing p",c iat#ic t#eat.ent' @ec& and colleague" 41AAA6 -ound t at "uicidal ideation at it" /o#"t point p#edicted "uicide co.pletion at a #ate 17 ti.e" ig e# t an "uicidal ideation in a lo/e# #i"& catego#,$ T e"e "o1e#ing #e"ult" indicate t at "ee&ing app#op#iate elp 1e-o#e "uicidal ideation i" at it" /o#"t point .a, 1e c#ucial -o# inte##upting t e de+elop.ent o- "uicidal ideation to co.pletion$ Ho/e+e#' t #ee #epo#t" indicate t at "uicidal ideation i"' in and o- it"el-' a potential 1a##ie# to elp-"ee&ing$ U"ing a "a.ple o- 1G'1A8 non-clinical adole"cent"' Saunde#" and colleague" 41AA76 -ound t at ig e# "uicidal ideation /a" #elated to a lo/e# p#o1a1ilit, odi"t#e""ed teenage#" actuall, "ee&ing elp$ T e #e"ea#c e#" "ugge"ted t at "uicidal ideation i" a "igni-icant 1a##ie# to elp-"ee&ing$ In "uppo#t' Deane' S&og"tad' and )illia." 41AAA6 in t ei# "tud, o- 111 non-clinical p#i"on in.ate" -ound t at intention" to "ee& p#o-e""ional p",c ological elp /e#e lo/e# -o# "uicidal t oug t" t an pe#"onal-e.otional p#o1le."$ T e #e"ea#c e#" "peculated t at t i" -inding .a, #e-lect a"pect" o- t e elp-negation p#oce"" p#e+iou"l, identi-ied in acutel, "uicidal "a.ple" 4Rudd' (oine#' * Ra!a1' 1AA36$ T e te#. D elp-negationF /a" adopted to de"c#i1e t e p#oce"" o- #e-u"al to accept o# acce"" a+aila1le elp 4e$g$' Rudd et al$' 1AA3; Cla#& * %a/cett' 1AA26$

Help-negation : Ca#lton and Deane 4in p#e""6 al"o -ound t at "uicidal ideation /a" a "igni-icant and uni>ue negati+e p#edicto# o- elp-"ee&ing intention"$ U"ing a "a.ple o- 221 nonclinical 17-1I ,ea# old ig -"c ool "tudent"' t e #e"ea#c e#" -ound t at adole"cent" /it ig e# le+el" o- "uicidal ideation tended to a+e lo/e# elp-"ee&ing intention"$

T e, "ugge"ted t at t i" #elation" ip again " o/ed a"pect" o- elp-negation' and "peculated t at t e p#oce"" .a, in pa#t 1e a -unction o- adole"cent cogniti+ede+elop.ental ta"&" a""ociated /it t e de+elop.ent o- independence "uc a" identit, -o#.ation and t e di--e#entiation o- "el- -#o. -a.il,$ A" "uc ' t e #e"ea#c e#" "ugge"ted t at adole"cent" .a, "ee t e deci"ion to li+e o# die a" one a"pect o- t ei# li+e" / ic t e, can cont#ol$ To ou# &no/ledge' elp-negation in non-clinical "a.ple" a" 1een "ugge"ted in onl, t #ee "tudie" 4Deane et al$' 1AAA; Ca#lton * Deane' in p#e""; Saunde#" et al$' 1AA76$ Gi+en t e i.plication" o- "uc a -inding' t e#e i" a need to #eplicate and e9tend t e"e -inding" to ot e# non-clinical "a.ple" and' to 1egin to un#a+el t e potential e9planation" o- "uc a p#oce""$ T e elp-negation p#oce"" a" 1een i.plicated in ig "c ool and p#i"on in.ate "a.ple" and t e p#e"ent "tud, ai.ed to e9tend t e"e -inding" to a uni+e#"it, "a.ple$ T e p#e"ent "tud, con"ide#ed t/o e9planation" -o# elp-negation in nonclinical "a.ple"$ %i#"t' t at elp-negation .a, 1e a #e-lection o- opele""ne"" o# negati+e e9pectation" a1out t e -utu#e$ Second' t at elp-negation .a, #e-lect eit e# li.ited o# negati+e p#io# elp-"ee&ing e9pe#ience"$ Hopele""ne"" a" 1een -ound to 1e a "t#ong p#edicto# o- "uicidal ideation 4(oine# * Rudd' 1AA:; Le+,' (u#&o+ic' * Spi#ito' 1AA36$ Alte#nati+el,' ope a" 1een "t#ongl, #elated to #educed "uicidalit, 4Range' * Penton' 1AA76$ Since a opele"" pe""i.i"tic "t,le i" o-ten "een in t e cogniti+e?a--ecti+e "uicidal "tate o# in t e gene#al

Help-negation G c a#acte#i"tic" o- t e"e indi+idual" out"ide t e c#i"i" "tate 4Hala-at' 1AAG; Rudd et al$' 1AA3; Hug e" * Nei.e,e#' 1AA86' it a" 1een "ugge"ted t at elp-negation .a, 1e a de.on"t#ation o- an o+e#all .aladapti+e coping "t,le in acutel, "uicidal "a.ple" 4Cla#& * %a/cett' 1AA26$ Indi+idual" / o a#e acutel, "uicidal .a, #e!ect elp 1ecau"e t e, a+e pe""i.i"tic and negati+e e9pectation" a1out t e /o#t o- "uc In " o#t' t e, .a, +ie/ t ei# "ituation a" opele""$ Help-negation i" i.plied i"uicidal ideation inc#ea"e" and intention" to "ee& elp dec#ea"e$ To ou# &no/ledge' no "tud, a" e9a.ined a #elation" ip 1et/een "uicidal ideation' opele""ne"" and elp-"ee&ing$ I- opele""ne"" cont#i1ute" to t e #elation" ip 1et/een "uicidal ideation and elp-"ee&ing t en t e "t#engt o- t i" #elation" ip /ould 1e "u1"tantiall, #educed i- opele""ne"" /a" cont#olled$ T e deci"ion to "ee& elp a" 1een a""ociated /it p#io# elp-"ee&ing e9pe#ience 4@olde#o * %allon' 1AA3; Ca#lton * Deane' in p#e""; Deane et al$' 1AAA; Ste-l * P#o"pe#i' 1AI36$ Deane and Todd 41AA:6 -ound indication" t at non-clinical uni+e#"it, "tudent" D/ o ad p#e+iou"l, "oug t elp appea#ed .o#e li&el, to "ee& elp in t e -utu#eF 4p$ 386$ Alte#nati+el,' li.ited p#io# elp-"ee&ing e9pe#ience" .a, li.it -utu#e elp-"ee&ing$ Ric&/ood and @#ait /aite 41AA76 po"tulated t at Done a" to &no/ o/ to "ee& elp' not 1, 1eing told / at to do' 1ut 1, 1eing in+ol+ed in a net/o#& / e#e di"cu""ing pe#"onal p#o1le." i" accepted and encou#agedF 4p$ 3:A6$ T i" i.plie" t at e+en /it a &no/ledge o- a+aila1le elp "ou#ce"' /it out p#io# elp"ee&ing e9pe#ience' t e indi+idual .a, a+e di--icult, appl,ing t ei# &no/ledge$ Negati+e o# un elp-ul p#io# elp-"ee&ing e9pe#ience" .a, al"o 1e a""ociated /it #educed elp-"ee&ing$ Deane and colleague" 41AAA6 -ound t at pe#cei+ed >ualit, op#io# elp /a" i.po#tant in t e deci"ion to "ee& elp$ P#io# D elp-ulF contact /it a .ental ealt p#o-e""ional /a" a""ociated /it intention" to "ee& elp -o# a pe#"onalelp$

Help-negation I e.otional p#o1le. and "uicidal t oug t"$ T i" "ugge"t" t at negati+e o# un elp-ul p#io# elp-"ee&ing e9pe#ience" .a, in-luence negati+e e9pectation" and #educed intention" to "ee& elp in t e -utu#e$ In t i" /a,' t e p#oce"" o- elp-negation .a, in pa#t #e-lect un elp-ul p#io# e9pe#ience"' pa#ticula#l, /it .ental ealt p#o-e""ional"$ %o# t i" "tud,' /e anticipated t at p#io# elp-"ee&ing and t e >ualit, o- t e e9pe#ience /ould 1e a""ociated /it elp-"ee&ing intention"$

T e ai. o- t e p#e"ent "tud, /a" to in+e"tigate t e t,pe" o- p#o1le." -o# / ic ,oung adult" "ee& elp and t e "ou#ce" -#o. / ic t e, intend to "ee& elp$ )e anticipated t at elp-"ee&ing -#o. -#iend" /ould 1e "igni-icantl, ig e# t an ot e# "ou#ce" o- elp' pa#ticula#l, p#o-e""ional p",c ological "ou#ce"$ )e al"o e9pected t at t i" #elation" ip /ould 1e "igni-icant -o# an, t,pe o- .ental ealt p#o1le.$ )e e9pected to con-i#. t e elp-negation #elation" ip in a non-clinical uni+e#"it, "a.ple$ T i" /ould 1e #e-lected in an in+e#"e #elation" ip 1et/een "uicidal ideation and elp"ee&ing intention"$ )e al"o intended to te"t / et e# opele""ne"" and p#io# elp"ee&ing e9pe#ience" could e9plain t i" #elation" ip$ 0et od Pa#ticipant" * P#ocedu#e T e "tud, #ecei+ed et ical app#o+al -#o. t e Uni+e#"it, Hu.an Et ic" Co..ittee$ T e "tud, /a" de"c#i1ed in an ad+e#ti"e.ent on a Depa#t.ent oP",c olog, uni+e#"it, #e"ea#c p#o!ect "ign-up 1oa#d$ Pa#ticipant" +olunta#il, "igned up -o# inclu"ion in t e "tud, and eac pa#ticipant co.pleted t e anon,.ou" >ue"tionnai#e indi+iduall, unde# t e "upe#+i"ion o- a po"tg#aduate #e"ea#c a""i"tant$ A de1#ie- " eet outlining a+aila1le elp "e#+ice" /a" "upplied a-te# t e >ue"tionnai#e /a" co.pleted$

Help-negation A A total o- 852 p",c olog, unde#g#aduate" co.pleted t e #e"ea#c >ue"tionnai#e$ Pa#ticipant" /e#e not &no/n to 1e cu##entl, #ecei+ing t#eat.ent -#o. a .ental ealt "e#+ice$ T/o- und#ed and t i#t,-t/o pa#ticipant" 4GGE6 /e#e -e.ale and G5 428E6 /e#e .ale$ T e .ean age /a" 25$3I ,ea#" 4SD K 7$AI ,ea#"6 and I5E o- t e "a.ple /e#e 21-,ea#" o# ,ounge#$ 0ea"u#e" T e >ue"tionnai#e u"ed in t i" "tud, co.p#i"ed t #ee "el--#epo#t "cale": t e Suicidal Ideation Lue"tionnai#e 4SIL; Re,nold"' 1AIIa6; t e @ec& Hopele""ne"" Scale 4@HS; @ec&' )ei"".an' Le"te#' * T#e9le#' 1AG76; and t e Gene#al Help-See&ing Lue"tionnai#e 4GHSL6$ T e SIL 4Re,nold"' 1AIIa6 co.p#i"e" 85 "uicide t oug t" t at a#e #ated on a G-point "cale 45 K I ne+e# ad t i" t oug 1e-o#e' : K Al.o"t e+e#, da,6$ Ite." a""e"" "uicidal ideation and a#e "co#ed to indicate t e -#e>uenc, /it / ic eac "uicide t oug t a" occu##ed in t e p#eceding .ont $ T e SIL i" "uppo#ted 1, "ound #elia1ilit, and con"t#uct +alidit, data 4Re,nold"' 1AIG' 1AIIa' 1AII1; @eau.ont' 1AA76$ T e @HS 4@ec& et al$' 1AG76 co.p#i"e" 25 t#ue--al"e ite." / ic #e-lect opele""ne"" 4e$g$' D0, -utu#e "ee." da#& to .eF6 and acce"" t e gene#al opele""ne"" con"t#uct$ T e @HS i" "uppo#ted 1, "ound #elia1ilit, and con"t#uct +alidit, data 4e$g$' 0etal"&, * (oine#' 1AA26$ It a" good inte#nal con"i"tenc, 4HR-25 K $A86 and i" ig l, co##elated /it ot e# "el--#epo#t .ea"u#e" o- opele""ne"" 4@ec& et al$' 1AG76$ T e GHSL /a" de+eloped -o# t i" "tud, to -o#.all, a""e"" elp-"ee&ing intention" -o# non-"uicidal and "uicidal p#o1le."$ Re"pondent" /e#e a"&ed to #ate t e li&eli ood t e, /ould "ee& elp -#o. a +a#iet, o- people -o# t #ee p#o1le. t,pe":

Help-negation 15 pe#"onal-e.otional' an9iet,-dep#e""ion' and "uicidal t oug t"$ T e t #ee p#o1le. p#o.pt" ad t e -ollo/ing gene#al "t#uctu#e' DI- ,ou /e#e a+ing a pe#"onale.otional p#o1le.' o/ li&el, i" it t at ,ou /ould "ee& elp -#o. t e -ollo/ing peopleMF %o# eac p#o1le. #e"pondent" /e#e a"&ed to #ate t ei# intention" to "ee& elp on a G-point "cale 41Ke9t#e.el, unli&el,' GKe9t#e.el, li&el,6 -o# "i9 "ou#ce" oelp: -#iend' pa#ent' ot e# #elati+e' .ental ealt p#o-e""ional' p one elp line' docto#?GP 4"ee Ta1le 16$ Hig e# "co#e" indicated ig e# intention" to "ee&- elp$ Additional ite." a"&ed pa#ticipant" to indicate' i- t e, /ould not "ee& elp -#o. an,one' ot e# "ou#ce" o- elp t at t e, .ig t go to' i- t e, ad e+e# "een a .ental ealt p#o-e""ional 4e$g$' coun"ello#' p",c ologi"t' p",c iat#i"t6' and o/ elp-ul t i" /a"$ Re"ult" T e .ean "co#e" and "tanda#d de+iation" -o# t e "tanda#di"ed .ea"u#e" o"uicidal ideation 40 K 1A$A:' SD K 21$8:6 and dep#e""ion 40 K 12$25' SD K A$576 /e#e co.pa#ed to a+aila1le no#.ati+e data 4 opele""ne""' 0 K 28$A8' SD K 8$G:' 1ut co.pa#i"on" not .ade due to li.ited no#.ati+e data6$ )e -ound t at 1:E 4n K 316oou# "tudent" #epo#ted a le+el o- "uicidal ideation "i.ila# to t at o- "uicide atte.pte#" /it c #onic p",c iat#ic p#o1le." 4Re,nold"' 1AIG6$ T e .ean #ate o- dep#e""ion #epo#ted #ep#e"ent" a .ild le+el o- dep#e""ion and i" "i.ila# to t at -ound in di--e#ent college "a.ple" 4e$g$' @ec&' Stee# * @#o/n' 1AA:' 0 K 12$3:6$ Al"o' 1IE o- ou# "tudent" #epo#ted .ode#ate to "e+e#e dep#e""ion 4@ec& et al$' 1AA:6' "i.ila# in inten"it, to a g#oup t at /a" diagno"ed a" "u--e#ing -#o. "ingle epi"ode' .a!o# dep#e""ion 4@ec& et al$' 1AA:6$ Ho/e+e#' o+e#all t e de"c#ipti+e #e"ult" "ugge"t t at t e .a!o#it, o- t e "a.ple /a" in t e no#.al #ange on t e"e .ea"u#e"$

Help-negation 11 Ou# "a.ple /a" p#edo.inantl, -e.ale and -e.ale" a+e 1een -ound to a+e .o#e po"iti+e elp-"ee&ing attitude" and intention" in p#e+iou" #e"ea#c ' 4e$g$' And#e/" et al$' 1AAA; P#ice * 0cNeill' 1AA2; Dad-a# * %#iedlande#' 1AI2; Su#geno#' 1AI36$ T e#e-o#e /e conducted p#eli.ina#, anal,"e" to dete#.ine / et e# t e#e /e#e gende# di--e#ence" on t e .ea"u#e" p#io# to pe#-o#.ing t e .ain anal,"e"$ A" e9pected' 1eing -e.ale /a" a""ociated /it .o#e /illingne"" to "ee& elp -o# non"uicidal p#o1le." -#o. -a.il, .e.1e#"' # 48556 K $1:' p N $51' ealt p#o-e""ional"' # 48556 K $12' p N $53' and -#iend"' # 48556 K$1I' p N$51' and /it le"" /illingne"" to #e-u"e elp -#o. an,one' # 42AI6 K $13' p N $51$ T e#e /a" no e--ect o- "e9 on /illingne"" to "ee& elp -#o. a docto# o# elp line' p" O $1' and t e#e /e#e no e--ect" o- "e9 on an, o- t e "ou#ce" o- elp -o# "uicidal p#o1le."' all p" O $1$ Ou# .ain anal,"e" -i#"t e9a.ined / et e# t e#e /e#e an, di--e#ence" in peopleC" p#e-e##ed "ou#ce o- elp' and / et e# t e#e /e#e an, elp "ee&ing di--e#ence" ac#o"" p#o1le. t,pe" 4Ta1le 16$ A Gene#al Linea# 0odel #epeated .ea"u#e" 0ANCOPA /a" u"ed to e9a.ine t e i.pact o- elping "ou#ce 4-#iend"' pa#ent"' ot e# #elati+e"' .ental ealt p#o-e""ional' p one elp line' Docto#?GP6 and p#o1le. t,pe 4"ocial e.otional p#o1le.' an9iet,-dep#e""ion' and "uicidal ideation6 on intention" to "ee& elp $ T e#e /a" a "igni-icant .ain e--ect -o# elping "ou#ce' % 43 ' 2A556 K 173$G2' p N $551$ Ho/e+e#' t i" e--ect /a" >uali-ied 1, a "igni-icant inte#action /it p#o1le. t,pe' % 415' 2A556 K G2$5I' p N $551' indicating t at peopleC" p#e-e##ed "ou#ce o- elp depended upon t e t,pe o- p#o1le. t e, /e#e -acing$ To -u#t e# e+aluate t i" inte#action' pai#/i"e co.pa#i"on" /e#e conducted u"ing a @on-e##oni ad!u"t.ent to cont#ol -o# t,pe I e##o#$ T e #e"ult" a#e p#e"ented in Ta1le 1$ Pa#ticipant" indicated t at t e, /e#e .o"t li&el, to "ee& elp -#o. -#iend" -o# all t,pe" o- pe#"onal p#o1le."$ Ho/e+e#' t e, /e#e le"" li&el, to "ee& elp -#o.

Help-negation 12 -#iend" -o# "uicidal ideation t an t e, /e#e -o# t e ot e# p#o1le."$ Pa#ticipant" al"o indicated t at / en e9pe#iencing "uicidal ideation #at e# t an ot e# p#o1le."' t e, /e#e le"" li&el, to "ee& elp -#o. pa#ent" and ot e# #elati+e" 1ut .o#e li&el, to "ee& elp -#o. .ental ealt p#o-e""ional" and p one elp line"$ Gi+en t at elp "ee&ing -o# pe#"onal e.otional p#o1le." did not di--e# "igni-icantl, -#o. elp "ee&ing -o# an9iet,-dep#e""ion 4"ee Ta1le 16' /e e9a.ined / et e# /e could co.1ine t e"e "cale"$ )e "u1.itted t e G "ou#ce" o- elp -o# t e t/o t,pe" o- p#o1le." 417 ite."6 to e9plo#ato#, p#inciple co.ponent anal,"i"' and unco+e#ed -i+e -acto#" /it eigen+alue" g#eate# t an 1 / ic e9plained I1E o- t e +a#iance$ U"ing O1li.in #otation' /e -ound t at ite." Dpa#entF and Dot e# #elati+e?-a.il, .e.1e#F loaded on -acto# 1 42 p#o1le. t,pe"' 2 ite."6' D.ental ealt p#o-e""ionalF and Ddocto#?GPF loaded on -acto# 2 42 p#o1le. t,pe"' 2 ite."6' D-#iend 4not #elated to ,ou6F loaded on -acto# 8 42 p#o1le. t,pe"' 1 ite.6' DP one elp lineF loaded on -acto# 7 42 p#o1le. t,pe"' 1 ite.6' and DI /ould not "ee& elp -#o. an,oneF loaded on -acto# 3 42 p#o1le. t,pe"' 1 ite.6$ @a"ed on t i" -acto# anal,"i"' ne/ "u1-"cale" /e#e -o#.ed 1, collap"ing g#oup ite."$ Ho/e+e#' /e decided not to collap"e t e ite." -o# -acto# 2 1ecau"e cu##ent t eo#, "ugge"t" t at "ee&ing elp -#o. docto#" and .ental ealt p#o-e""ional" .a, di--e# in i.po#tant /a," 4e$g$' Pe"cocolido * @o,e#' 1AAA; Tudi+e# * Tal1ot' 1AAA; Ro"" * Ha#d,' 1AAA6 $ T e ne/ +a#ia1le" -o# 1ot non-"uicidal and "uicidal p#o1le." /e#e called D-a.il,F' D.ental ealt p#o-e""ional"F' Dp ,"ical ealt p#o-e""ional"F' D-#iendF' Dp one elp lineF' and D/ould not "ee& elpF$ %u#t e# anal,"i" #e+ealed t at ite." on t e GHSL could 1e co.1ined to -o#. a #elia1le elp "ee&ing intention" +a#ia1le 4 K $I26' o# could 1e #elia1l, 1#o&en do/n into t/o "u1-acto#"' elp "ee&ing -o# "uicidal p#o1le." 4K$G:6 and elp "ee&ing -o# non-"uicidal p#o1le." 4K$:G6$

Help-negation 18 )e ne9t in+e"tigated t e po""i1ilit, t at people ig in "uicidal ideation /ould " o/ e+idence o- elp negation' t at i"' t e, /ould indicate lo/e# intention" to "ee& elp 4Ca#lton * Deane' in p#e""6$ ) il"t t e co##elation coe--icient" /e#e not pa#ticula#l, ig ' .o"t /e#e "igni-icant and t e patte#n" tell a con"i"tent "to#,$ Suicidal ideation /a" co##elated /it eac o- t e elp "ee&ing +a#ia1le"$ A" e9pected' /e -ound clea# e+idence -o# elp negation 4Ta1le 26$ Co##elation" 1et/een elp"ee&ing intention" -o# "uicidal p#o1le." and "ou#ce" o- elp /e#e "igni-icant and negati+e$ Hig e# "uicidal ideation /a" a""ociated /it lo/e# intention" to "ee& elp -o# "uicidal p#o1le." -#o. all "ou#ce" o- elp$ Hig e# "uicidal ideation /a" al"o negati+el, a""ociated /it elp-"ee&ing -#o. -#iend" and -a.il, -o# non-"uicidal

p#o1le."$ %inall,' "uicidal ideation /a" po"iti+el, #elated to pa#ticipant"C indication" t at t e, /ould not "ee& elp -#o. an,one -o# eit e# "uicidal o# non-"uicidal p#o1le."$ It a" 1een t eo#iBed t at' people conte.plating "uicide .ig t negate elp 1ecau"e t e, -eel opele""' 1ecau"e t e, a+enCt ad elp-"ee&ing e9pe#ience"' o# 1ecau"e t e, a+e ad negati+e elp-"ee&ing e9pe#ience"$ To te"t t e"e po""i1ilitie"' /e conducted t/o Gene#al Linea# 0odel 0ANCOPA"$ One -o# "uicidal and one -o# non-"uicidal elp-"ee&ing$ GL0 /a" u"ed in t i" in"tance 1ecau"e it allo/ed u" to u"e t e continuou" +e#"ion" o- t e independent and dependent +a#ia1le" and did not #e>ui#e u" to di+ide people into g#oup"$ Suicidal ideation /a" u"ed to p#edict t e "i9 elp-"ee&ing intention +a#ia1le" / ile cont#olling -o# opele""ne"" and p#io# elp"ee&ing e9pe#ience$ 4)e al"o cont#olled -o# "e9 1ecau"e -e.ale" a+e con"i"tentl, 1een -ound to 1e .o#e li&el, to "ee& elp6$ Suicidal ideation "igni-icantl, p#edicted elp-"ee&ing intention" -o# "uicidal t oug t"' )il&C" La.da K $A77' p N $53' 1ut not -o# non-"uicidal p#o1le."' )il&C" La.da K $A:3' p K $18$ To -u#t e# e9a.ine t i"

Help-negation 17 e--ect' /e conducted uni+a#iate te"t" -o# eac +a#ia1le$ A" can 1e "een 1, t e #e"ult" p#e"ented in Ta1le 8 4@eta coe--icient"6' "uicidal ideation /a" negati+el, #elated to elp-"ee&ing intention"' -o# all "ou#ce"$ Suicidal ideation /a" a""ociated /it a #eduction in all intention" to "ee& elp$ Pa#ticula#l, note/o#t , i" t e ig l, "igni-icant negati+e #elation" ip 1et/een "uicidal ideation and intention" to "ee& elp -#o. .ental ealt p#o-e""ional" 4Ta1le 86$ Al"o note/o#t , a#e t e "igni-icant negati+e #elation" ip" 1et/een "uicidal ideation and intention" to "ee& elp -#o. a p one elp line' and t e "igni-icant po"iti+e #elation" ip 1et/een "uicidal ideation and intention" not to "ee& elp -#o. an,one$ In o#de# to e9a.ine t e"e #e"ult" -u#t e#' /e conducted t e "a.e 0ANCOPA a" a1o+e' e9cept t at in"tead o- u"ing "uicidal ideation 4SIL6 a" a continuou" +a#ia1le /e dic oto.i"ed it "o t at t e ig "co#e#" in t e top 1:E 4n K 316 4e>ui+alent to a "uicidal atte.pte# "a.ple' Re,nold"' 1AAG6 /e#e co.pa#ed /it t e #e.ainde# o- t e "a.ple$ T i" anal,"i" #eplicated t e patte#n o- -inding" -o# elp "ee&ing intention" -o# "uicidal t oug t" de"c#i1ed in Ta1le 8' and "ugge"t" t at t e"e #e"ult" appl, to people e9pe#iencing "igni-icant le+el" o- "uicidal ideation a" /ell a" t o"e e9pe#iencing lo/ le+el" o- "uicidal ideation$ Di"cu""ion A" e9pected' intention" to "ee& elp -#o. -#iend" /e#e "igni-icantl, ig e# t an -#o. an, ot e# elp "ou#ce$ Con"i"tent /it p#e+iou" -inding"' elp "ou#ce" /e#e di--e#ent -o# di--e#ent t,pe" o- p#o1le." 4e$g$' O--e# et al$' 1AA1; @olde#o * %allon' 1AA36 and elp-"ee&ing intention" /e#e di--e#ent -o# "uicide #elated and non-"uicide #elated p#o1le." 4e$g$' Sc /eitBe#' Hla,ic * 0cLean'1AA36$ Pa#ticipant" #epo#ted t at t e, /e#e .o"t li&el, to "ee& elp -#o. -#iend"' pa#ent"' and -a.il, -o# p#o1le." t at /e#e not "uicide #elated and .o"t li&el, to "ee&

Help-negation 13 elp -#o. a .ental ealt p#o-e""ional o# a telep one elpline -o# "uicidal t oug t" 4Ta1le 16$ Since ,out -o#. pe#ception" a1out t e "uita1ilit, o- elping "ou#ce" and decide / o to tal& to on t e 1a"i" o- "peci-ic p#o1le." 4@olde#o * %allon' 1AA3; O--e# et al$' 1AA16' it i" li&el, t at t e ,out in t i" "a.ple #ecogni"ed t e "e#iou"ne"" o"uicidal t oug t" and t e 1ene-it o- "ee&ing elp -#o. a t#ained p#o-e""ional / en "uicidal t oug t" a#e e9pe#ienced$ A "t#ong elp-negation e--ect' con"i"tent /it t at identi-ied 1, Ca#lton and Deane 4in p#e""6' /a" al"o de.on"t#ated$ A" e9pected' a "igni-icant negati+e #elation" ip /a" -ound 1et/een le+el" o- "uicidal ideation and elp-"ee&ing intention"$ Ho/e+e#' t e "t#engt o- t i" #elation" ip /a" une9pected and pa#ticula#l, di"tu#1ing 4Ta1le 86$ E+en t oug pa#ticipant" ad unde#g#aduate t#aining in p",c olog, and .ig t #ea"ona1l, 1e e9pected to &no/ t e 1ene-it" o- p",c ological elp' / en actuall, e9pe#iencing "uicidal t oug t" 4al1eit at "u1clinical le+el"6' t e, /e#e lea"t li&el, to "ee& elp -#o. a .ental ealt p#o-e""ional o# a telep one elpline$ A" "uicidal ideaton inc#ea"ed "o too did t e tendenc, to not "ee& elp -#o. an,one at all 4Ta1le 86$ T i" "ugge"t" t at "uicidal t oug t" o# t e e9pe#ience o- "uc t oug t" .a, "o.e o/ in i1it elp-"ee&ing$ It al"o p#e"ent" a pe#ple9ing incon"i"tenc,$ ) en e9pe#iencing non-"uicidal p#o1le."' t e ,out in ou# "a.ple indicated t at t e, intended to "ee& elp -#o. di--e#ent "ou#ce" -o# di--e#ent p#o1le.t,pe" 4Ta1le 16$ ) en t e "a.ple /e#e non-"uicidal t e, ad #ational plan" to "ee& elp$ %o# gene#ic Dpe#"onal-e.otionalF p#o1le." t e, tended to "ee& elp .o#e -#o. -#iend" and -a.il, t an p#o-e""ional "ou#ce"$ Ho/e+e#' / en actuall, e9pe#iencing "uicidal ideation' t e "a.ple did not -ollo/ t ei# indicated intention plan"$ In -act' t e, #epo#ted oppo"ite intention plan"$ To "u..a#iBe' t e #e"ult" -#o. Ta1le 1 -ocu" on o/ intention" to "ee& elp -#o. di--e#ent "ou#ce" +a#, ac#o"" di--e#ent p#o1le.

Help-negation 1: t,pe"' and -ind" t at people a#e .o"t /illing to "ee& elp -#o. a .ental ealt p#o-e""ional -o# "uicidal t oug t"$ Ta1le 8 -ocu"e" on o/ intention" to "ee& elp #elate to people e9pe#iencing di--e#ent le+el" o- "uicidal ideation$ People e9pe#iencing .o#e "uicidal t oug t" a#e le"" /illing t an ot e#" to "ee& elp -#o. a .ental ealt p#o-e""ional$ )e "ugge"t "e+e#al po""i1le #ea"on" -o# t i" intention " i-t$ %i#"t' "uicidal t oug t" .a, in i1it t e #et#ie+al o- #ational elp-"ee&ing intention" t #oug p#oce""e" o- cogniti+e di"to#tion 4)ei" aa#' 1AA:6$ Second' t e i##ational cogniti+e?a--ecti+e "tate a""ociated /it "uicidal t oug t" .a, inte#-e#e /it t e #et#ie+al o- #ational elp-"ee&ing intention"$ T i#d' "uicidal t oug t" .a, inte#-e#e /it #ational p#o1le. app#ai"al p#oce""e" and t e indi+idualC" pe#cei+ed need to act on t ei# p#e+iou"l, eld elp-"ee&ing intention"$ %inall,' t e #e"ult .a, in+ol+e an e9plicit #ational #e"pon"e to 1elie-" a1out "uicide$ T at i"' DI- I /a" "uicidal' I /ould not /ant to get elpF$ @a"ed on p#e+iou" -inding" 4e$g$' Rudd et al$' 1AA3; Cla#& * %a/cett' 1AA2; Huge" * Nei.e,e#' 1AA86' /e in+e"tigated t e po""i1ilit, t at opele""ne"" .ig t cont#i1ute to t e in+e#"e #elation" ip 1et/een "uicidal ideation and elp-"ee&ing intention"$ Ho/e+e#' t e #e"ult" "ugge"t t at opele""ne"" did not a+e a #ole in dec#ea"ing elp-"ee&ing intention" o+e# and a1o+e "uicidal iedation$ Hopele"" alone could not account -o# t e elp-negation e--ect$ Neit e# could "e9 o# p#io# elp"ee&ing e9pe#ience$ Toget e#' t e"e #e"ult" lend "t#ong "uppo#t to t e "ugge"tion t at "uicidal ideation dec#ea"e" intention" to "ee& elp -#o. an, "ou#ce' e"peciall, .ental ealt p#o-e""ional"$ T e, al"o "uppo#t t e "ugge"tion t at "uicidal ideation act" a" a 1a##ie# to elp-"ee&ing 4Saunde#" et al$' 1AA76$ Since /e #uled out opele""ne"" and p#io# elp-"ee&ing e9pe#ience" a" potential e9planation" o- elp-negation' it i" po""i1le t at "o.et ing a1out t e natu#e

Help-negation 1G o- "uicidal ideation act" a" a 1a##ie# to elp-"ee&ing' pa#ticula#l, -#o. .ental ealt p#o-e""ional"$ T e#e i" e+idence to "ugge"t t at D opele""ne"" and pe""i.i". .a, 1e .o#e gene#all, c a#acte#i"tic o- 4"uicidal6 indi+idual" out"ide t e c#i"i" "tateF 4Hala-at' 1AAG' p$ 1I26$ T i" i.plie" t at t e con"t#icted?a--ecti+e p",c ological "tate c a#acte#i"tic o- t e "uicidal indi+idual .a, al"o 1e c a#acte#i"tic o- t o"e indi+idual" p#io# to de+elop.ent o- "uicidal ideation$ T at i"' "uicidal ideation .a, not al/a," 1e a -unction o- opele""ne"" 1ut ot e# p",c ological p#oce""e" "uc a" cogniti+e di"to#tion and?o# de-icit 4)ei" aa#' 1AA:; @ec& * )ei" aa#' 1AA36$ Lending "uppo#t to t i" +ie/' cogniti+e di"to#tion #at e# t an opele""ne"" a" 1een -ound to 1e a p#i.a#, p#edicto# o- "uicidal intent 40endonca * Holden' 1AA:6' and cogniti+e #igidit, a" 1een -ound to .ode#ate t e #elation" ip 1et/een pe#"onalit, and a--ecti+e +a#ia1le"' and "uicidal ideation$ Hopele""ne"" a" 1een -ound to 1e a co##elate o"uicidal ideation onl, -o# cogniti+el, #igid pa#ticipant" 4Up.an,u' Na#ula' * 0oein' 1AA36$ So.e #e"ea#c e#" +ie/ "uicidal 1e a+iou# p#i.a#il, a" a -unction o- poo# "ocial p#o1le.-"ol+ing a" /ell a" cogniti+e di"to#tion$ )e "peculate t at poo# p#o1le.-"ol+ing' pa#ticula#l, p#o1le. o#ientation de-icit"' .a, al"o pla, a pa#t in elp-negation in non-clinical "a.ple"$ Le+en"on and Neu#inge# 41AG16 e9a.ined co.ponent" o- t e "ocial p#o1le.-"ol+ing p#oce"" in "uicidal adole"cent" and -ound t e, pe#"i"ted /it ine--ecti+e "olution" e+en / en a .o#e e--ecti+e "t#ateg, /a" o--e#ed$ T e #e"ea#c e# "ugge"ted t i" e--ect could 1e a -unction o- cogniti+e #igidit, o# t e dic oto.ou" t in&ing c a#acte#i"tic o- "uicidal pe#"on"$ 0a#9 and colleague" 41AA26 e9a.ined co.ponent" o- t e "ocial p#o1le.-"ol+ing p#oce"" and -ound de-icit" in t e cogniti+e "tage / e#e gene#ating an e--ecti+e detailed "olution /a" t e goal$ T ei# non-clinical pa#ticipant" /it p#o1le.-"ol+ing de-icit" de.on"t#ated t e "a.e

Help-negation 1I di--icultie" a" dep#e""ed pa#ticipant" in de+eloping alte#nati+e" and p#oducing potential o1"tacle"$ Si.ila#l,' p#o1le. o#ientation in t e p#o1le. "ol+ing p#oce"" a" 1een a""ociated /it "uicidal ideation 4e$g$ Di9on' Heppne# * Rudd' 1AA76$ T e"e -inding" #ai"e t e po""i1ilit, t at elp-negation i" a -unction o- "uicidal t oug t" t at cont#i1ute to ine--ecti+e p#o1le.-"ol+ing "olution" 4i$e$' "ee&ing elp -#o. no-one6 and in i1it t e #ecall o- app#op#iate "ocial p#o1le.-"ol+ing "t#ategie" o# t e gene#ation o- ot e# "olution"$ Pe#"i"tent and #epetiti+e "uicidal t oug t" .a, p#o.ote "uicide a" a de"i#a1le "olution$ T at i"' D"uicide .a, appea# a" a "olution / en a pe#"on i" una1le to " i-t to a ne/ "t#ateg,' i" incapa1le o- tole#ating t e an9iet, o- p#o1le.-"ol+ing' o# a" -ault, a""u.ption" a1out "uicideC" e--ecti+ene"" to "ol+e p#o1le."F 4)ei" aa#' 1AA:' p$ 28G6$ T u"' it i" po""i1le t at elp-negation i" a .ani-e"tation o- an in i1ited a1ilit, to +ie/ t e "uicidal "tate a" a p#o1le. to 1e "ol+ed' di--icultie" in identi-,ing t e con"e>uence" a""ociated /it p#o1le.-"ol+ing alte#nati+e"' and de-icit" in "electing p#o-e""ional elp-"ee&ing a" a +ia1le "olution -o# t e "uicidal "tate$ ) ile t e"e ,pot e"e" p#o+ide "ugge"tion" a1out / , elp-negation in gene#al occu#"' t e, do not "peci-icall, add#e"" t e >ue"tion o- / , t e elp negation e--ect /a" pa#ticula#l, "t#ong -o# .ental ealt p#o-e""ional" and telep one elp line"$ Again' /e can onl, "peculate' 1ut it "ee." #ea"ona1le to "ugge"t t at gene#al attitude" o# 1elie-" a1out t e e--ecti+ene"" o# elp-ulne"" o- t e"e "e#+ice" .ig t 1e a -acto#$ Si.ila#l,' "tig.a o# -ea#" .a, pla, a #ole$ It i" po""i1le t at "tudent" /e#e conce#ned t at i- t e, contacted .ental ealt p#o-e""ional" t e, .ig t #i"& -u#t e# lo"" ocont#ol and o"pitaliBation$ T e#e i" a need to -u#t e# e9plo#e t e #ea"on" -o# elp negation in nonclinical "a.ple" "o t at /e can inte#+ene to inc#ea"e app#op#iate elp "ee&ing in population" at ig #i"& o- "uicide$

Help-negation 1A T e#e a#e "e+e#al li.itation" o- t e p#e"ent "tud,$ ) il"t t e "tud, a" #eplicated t e elp negation -inding in nonclinical "a.ple" 4Ca#lton * Deane' in p#e""6' t e#e i" a continued need to "ee / et e# t e -inding can 1e gene#aliBed -#o. ,out 4age" 17 to 22 ,ea#"6 to olde# adult "a.ple" and to non"tudent "a.ple"$ %ollo/ing t e gene#al .et odolog, o- p#io# "tudie" and .ea"u#e" 4e$g$ Intention oSee&ing Coun"eling In+ento#,' Ca" ' @egle,' 0cCo/n * )ei"e' 1AG3; Cepeda@enito * S o#t' 1AAI6 atte.pt" /e#e .ade u"e a .ea"u#e o- elp "ee&ing intention" / ic al"o "peci-ied di--e#ent p#o1le. t,pe"$ Ho/e+e#' t e .ea"u#e a"&ed #e"pondent" a1out a ,pot etical p#o1le.$ It i" unclea# to / at e9tent pa#ticipant" /e#e a1le to identi-, /it t e p#o1le. / en .a&ing t ei# #ating"$ Su1"e>uent "tudie" .ig t add#e"" t i" i""ue 1, "upple.enting t i" .et od /it a"pect" o- Hin"on and S/an"onC" 41AA86 .et odolog, -o# a""e""ing /illingne"" to "ee& elp$ T e, .anipulated p#o1le. "e+e#it, 1, p#o+iding t/o elp "ee&ing "cena#io" and t en pa#ticipant" /e#e a"&ed a "e#ie" o- >ue"tion" a1out t e +i+idne"" /it / ic t e, could i.agine t e p#o1le.' "e#iou"ne""' app#op#iatene"" o- p#o1le. -o# elp "ee&ing' and e9tent #e"pondent" ad e9pe#ienced t e p#o1le. in t ei# o/n li-e$ De"pite t e"e li.itation"' t e p#e"ent "tud, a" no/ e"ta1li" ed t e elpnegation p#oce"" in #elation to "uicidal ideation in "e+e#al independent non-clinical "a.ple" utili"ing +a#,ing .et od"$ T i" "tud, -ound t at elp-negation i" not .e#el, a #e"ult o- opele""ne"" o# p#io# elp-"ee&ing e9pe#ience"$ Gi+en t e potentiall, t#agic con"e>uence" o- elp-negation in "uicidal indi+idual" t e#e i" a need -o# -utu#e #e"ea#c to continue to e9plain / at account" -o# t i" p#oce""$ T e#e a#e i.plication" o- t e"e -inding" -o# 1ot clinician" and "uicide p#e+ention "t#ategie"$ %o# clinician"' it #ein-o#ce" t e need to 1e a/a#e t at "uicidal client" a#e at a .ini.u. o-ten a.1i+alent a1out "ee&ing elp and .a, acti+el, #e-u"e o# #e!ect elp$ P#o1le. "ol+ing

Help-negation 25 de-icit" e9ace#1ated 1, ig le+el" o- e.otional di"t#e"" and cogniti+e di"to#tion" o-ten a""ociated /it "uicidalit, a#e li&el, e9planation" and point" -o# inte#+ention$ %#o. a p#e+ention pe#"pecti+e' it /ill 1e i.po#tant to 1ette# unde#"tand / at -acto#" cont#i1ute to t e elp negation p#oce"" in nonclinical "a.ple"$ ) at i- an, de+elop.ental t#a!ecto#, doe" elp negation ta&eM @, unde#"tanding t e"e p#oce""e" ea#l, inte#+ention p#og#a." 4eit e# ta#geted o# uni+e#"al6 .ig t 1ette# p#e+ent "ucce""-ul "uicide" i- elp negation i" de.on"t#ated to 1e a "igni-icant #i"& -acto#$ %o# e9a.ple' i- p#o1le.-"ol+ing de-icit" a#e a""ociated /it elp negation t en

inte#+ention" .ig t -ocu" on i.p#o+ing t e"e "&ill" pa#ticula#l, a#ound -eeling "uicidal$ Ho/e+e#' until /e &no/ o/ elp negation -o#." and /o#&"' /e can onl, include gene#al "t#ategie" -o# ,oung people$ T i" could in+ol+e .a&ing p#o-e""ional .ental ealt "e#+ice" .o#e accepta1le and acce""i1le$ Educating and p#epa#ing "tudent" a1out elp negation 1e-o#e it i" e9ace#1ated 1, acute "uicidal "tate"$ P#o+iding po"iti+e e9a.ple" o- app#op#iate elp "ee&ing pa#ticula#l, in t e conte9t o"uicide$

Help-negation 21 Ac&no/ledge.ent" T e aut o#" /i" to t an& t e -ollo/ing "tudent" / o a""i"ted in t e data collection $ Nat an %ulc e#' Sa" a PinaBBa' (a"on @o,d' 0a#, 0a#&o+"&a' and 0eli""a Eade"$

Help-negation 22 Re-e#ence" And#e/"' G$' Hall' )$' Tee""on' 0$' * Hende#"on' S$ 41AAA6$ National Su#+e, o- 0ental Healt and )ell1eing Repo#t 2: T e 0ental Healt o- Au"t#alian"$ Co..on/ealt o- Au"t#alia$ @eau.ont' G$A$ 41AA76$ Suicidal ideation in a non-clinical "a.ple: C#o"""ectional and longitudinal #elation" ip" /it .ino# "t#e""o#"' dep#e""ion' opele""ne"" and coping 1e a+iou#. Unpu1li" ed Docto#al Di""e#tation' 0a""e, Uni+e#"it,' Ne/ Qealand$ @ec&' A$T$' * )ei" aa#' 0$E$ 41AA36$ Cogniti+e t e#ap,$ In R$($ Co#"ini * D$ )edding 4Ed"$6' Cu##ent P",c ot e#apie" 43t Ed$6. 422A-2:16$ USA: %$E$ Peacoc& Pu1li" e#"$ @ec&' A$T$' )ei"".an' A$' Le"te#' D$' * T#e9le#' I$ 41AG76$ T e .ea"u#e.ent o- pe""i.i".: T e opele""ne"" "cale$ (ou#nal o- Con"ulting and Clinical P",c olog,' 72' I:1-I:3$ @ec&' A$T$' @#o/n' G$H$' Stee#' R$A$' Da l"gaa#d' H$H$' * G#i" a.' ($R$' 41AAA6' Suicide ideation at it" /o#"t point: A p#edicto# o- e+entual "uicide in p",c iat#ic outpatient"$ Suicide and Li-e-T #eatening @e a+io#' 2A416, p$ 1-A$ @ec&' A$ T$' Stee#' R$ A$' * @#o/n' G$ H$ 41AA:6$ @DI-II .anual 42nd ed$6$ San Antonio' TR: P",c ological Co#po#ation$ @e#gin' A$E$' * Ga#-ield' S$L$' 41AA76$ Hand1oo& o- P",c ot e#ap, and @e a+io# C ange' 7t Ed$ Canada: (o n )ile, * Son"$ @olde#o' ($' * %allon' @$ 41AA36$ Adole"cent elp-"ee&ing: ) at do t e, get elp -o# and -#o. / o.M (ou#nal o- Adole"cence' 1I' 1A8-25A$

Help-negation 28 Ca#lton' P$A$ * Deane' %$P$ 4in p#e""6$ I.pact o- attitude" and "uicidal ideation on adole"cent"C intention" to "ee& p#o-e""ional p",c ological elp$ (ou#nal oAdole"cence$ Ca" ' T$ %$' @egle,' P$ ($' 0cCo/n' D$ A$' * )ei"e' @$ C$ 41AG36$ ) en coun"elo#" a#e ea#d 1, not "een: Initial i.pact o- p ,"ical att#acti+ene""$ (ou#nal oCoun"eling P",c olog,' 22' 2G8-2GA$ Cepeda-@enito' A$' * S o#t' P$ 41AAI6$ Sel--conceal.ent' a+oidance op",c ological "e#+ice"' and pe#cei+ed li&eli ood o- "ee&ing p#o-e""ional elp$ (ou#nal o- Coun"eling P",c olog,' 73' 3I-:7$ Cla#&' D$C$' * %a/cett' ($ 41AA26$ Re+ie/ o- e.pi#ical #i"& -acto#" -o# e+aluation o- t e "uicidal patient$ In @$ @onga# 4Ed$6' Suicide: Guideline" -o# A""e"".ent' 0anage.ent and T#eat.ent$ Ne/ Jo#&: O9-o#d Uni+e#"it, P#e""$ Cole' D$E$' P#otin"&,' H$O$' * C#o""' L$H$ 41AA26$ An e.pi#ical in+e"tigation o- adole"cent "uicidal ideation$ Adole"cence' 2G415I6' I18-I1I$ Dad-a#' S$' * %#iedlande#' 0$L$ 41AI26$ Di--e#ential attitude" o- inte#national "tudent" to/a#d "ee&ing p#o-e""ional p",c ological elp$ (ou#nal o- Coun"eling P",c olog,' 2A, 883-88I$ Deane' %$P$' S&og"tad' P$' * )illia."' 0$ 41AAA6$ I.pact o- attitude"' et nicit, and >ualit, o- p#io# t e#ap, on Ne/ Qealand .ale p#i"one#"C intention" to "ee& p#o-e""ional p",c ological elp$ Inte#national (ou#nal -o# t e Ad+ance.ent oCoun"elling' 21' 33-:G$ Deane' %$P$' * Todd' D$0$ 41AA:6$ Attitude" and intention" to "ee& p#o-e""ional p",c ological elp -o# pe#"onal p#o1le." o# "uicidal t in&ing$ (ou#nal oCollege Student P",c ot e#ap,' 15' 73-3A$

Help-negation 27 Di9on' )$A$' Heppne#' P$P$' * Rudd' 0$D$ 41AA76$ P#o1le.-"ol+ing app#ai"al' opele""ne""' and "uicidal ideation: E+idence -o# a .ediational .odel$ (ou#nal o- Coun"eling P",c olog,' 71' A1-AI$ Du1o/' E$%$' Lo+&o' H$R$' (#$' * Hau" ' D$%$ 41AA56$ De.og#ap ic di--e#ence" in adole"cent"C ealt conce#n" and pe#ception" o- elping agent"$ (ou#nal o- Clinical C ild P",c olog,' 1A' 77-37$ Hin"on' ($ A$' * S/an"en' ($ L$ 41AA86$ )illingne"" to "ee& elp a" a -unction o- "el--di"clo"u#e and p#o1le. "e+e#it,$ (ou#nal o- Coun"eling * De+elop.ent' G1' 7:3-7G5$ Hug e"' S$L$' * Nei.e,e#' R$A$ 41AA86$ Cogniti+e p#edicto#" o- "uicide #i"& a.ong o"pitaliBed p",c iat#ic patient": A p#o"pecti+e "tud,$ Deat Studie"' 1G' 158-127$ (oine#' T$E$ * Rudd' 0$D$ 41AA:6$ Di"entangling t e inte##elation" 1et/een opele""ne""' loneline""' and "uicidal ideation$ Suicide and Li-e T #eatening @e a+io#' 2:' 1A-2:$ Hala-at' ($ 41AAG6$ P#e+ention o- ,out "uicide$ In )ei""1e#g' R$P$ * Gullotta' T$P$ 4Ed$"$6' Healt , C ild#en 2515: En ancing C ild#enC" )ellne""$ I""ue" in C ild#enC" and %a.ilie"C Li+e"' I. T ou"and Oa&"' CA$USA: Sage$ 1G3218$ Hala-at' ($' * Elia"' 0$ 41AA36$ Suicide p#e+ention in an education conte9t$ Suicide and Li-e-T #eatening @e a+io#' 23' 128-188$ Le+en"en' 0$' * Neu#inge#' C$ 41AG16 P#o1le.-"ol+ing 1e a+io# in "uicidal adole"cent"$ (ou#nal o- Con"ulting and Clinical P",c olog,' 37, II5-II1$ Le+,' S$R$' (u#&o+ic' G$L$' * Spi#ito' A$ 41AA36$ A .ulti",te." anal,"i" oadole"cent "uicide atte.pte#"$ (ou#nal o- A1no#.al C ild P",c og,' 28' 221-287$

Help-negation 23 0a#cu"' R$%$ 41AA:6$ T e -#iend" ip" o- delin>uent"$ Adole"cence' 81' 17313I$ 0a#9' E$ 0$' )illia."' ($0$G$' * Cla#idge' G$S$ 41AA26$ Dep#e""ion and "ocial p#o1le. "ol+ing$ (ou#nal o- A1no#.al P",c olog,' 151' GI-I:$ 0ee an' P$($' La.1' ($A$' SaltB.an' L$E$' * OCCa##oll' P$)$ 41AA26$ Atte.pted "uicide a.ong ,oung adult": P#og#e"" to/a#d a .eaning-ul e"ti.ate op#e+alence$ A.e#ican (ou#nal o- P",c iat#,' 17A' 71-77$ 0endonca' ($D$' * Holden' R$R$ 41AA:6$ A#e all "uicidal idea" clo"el, lin&ed to opele""ne""M Acta P",c iat#ica Scancina+ica' A8' 27:-231$ 0etal"&,' G$I$' * (oine#' T$E$ 41AA26$ Pulne#a1ilit, to dep#e""i+e ",.pto.atolog,: A p#o"pecti+e te"t o- t e diat e"i"-"t#e"" and cau"al .ediation co.ponent" o- t e opele""ne"" t eo#, o- dep#e""ion$ (ou#nal o- Pe#"onalit, and Social P",c olog,' :8' ::G-:G3$ No+ic&' ($ 41AA:6$ Atte.pted "uicide in adole"cence: T e "uicide "e>uence$ In 0alt"1e#ge#' ($T$' Gold1latt' 0$($' et al$ 4EdC"6' E""ential pape#" on "uicide$ E""ential pape#" in p",c oanal,"i"$ Ne/ Jo#&' NJ' USA: Ne/ Jo#& Uni+e#"it, P#e""$ 327-37I$ O--e#' D$' Ho/a#d' H$I$' Sc one#t' H$A$' * O"t#o+' E$($D$ 41AA16$ To / o. do adole"cent" tu#n -o# elpM Di--e#ence" 1et/een di"tu#1ed and nondi"tu#1ed adole"cent"$ (ou#nal o- t e A.e#ican Acade., -o# C ild and Adole"cent P",c iat#,' 85' :28-:85$ Oli+e#' ($0$' Reed' C$H$S$' HatB' @$0$' Haug ' ($A$ 41AAA6$ Student"C "el-#epo#t" o- elp-"ee&ing: T e i.pact o- p",c ological p#o1le."' "t#e""' and de.og#ap ic +a#ia1le" on utiliBation o- -o#.al and in-o#.al "uppo#t$ Social @e a+io# and Pe#"onalit,' 2G' 15A-12I$

Help-negation 2: Pe"cocolido' @$A$' * @o,e#' C$A$ 41AAA6$ Ho/ do people co.e to u"e .ental ealt "e#+ice"M Cu##ent &no/ledge and c anging pe#"pecti+e"$ In A$P$ Ho#/itB' T$L$ Sc eid' et al$ 4Ed"6$ A Hand1oo& -o# t e Stud, o- 0ental Healt : Social conte9t"' t eo#ie"' and ","te."$ Ne/ Jo#&' NJ' USA: Ca.1#idge Uni+e#"it, P#e""$ P#ice' @$H$' * 0cNeill' @$)$ 41AA26$ Cultu#al co..it.ent and attitude" to/a#d "ee&ing coun"eling "e#+ice" in A.e#ican Indian college "tudent"$ P#o-e""ional P",c olog,: Re"ea#c and P#actice' 28, 8G:-8I1$ Range' L$0$' * Penton' S$R$ 41AA76$ Hope' opele""ne""' and "uicidalit, in college "tudent"$ P",c ological Repo#t"' G3' Special I""ue: 73:-73I$ Re,nold"' )$0$' 41AIG6$ Suicidal Ideation Lue"tionnai#e$ Ode""a' %lo#ida: P",c ological A""e"".ent Re"ou#ce"$ Re,nold"' )$0$ 41AIIa6$ Suicidal Ideation Lue"tionnai#e: P#o-e""ional 0anual$ Ode""a' %lo#ida: P",c ological A""e"".ent Re"ou#ce"$ Re,nold"' )$0$ 41AII16$ Suicidal ideation and dep#e""ion in adole"cent": A la#ge "a.ple in+e"tigation$ Pape# p#e"ented at t e Inte#national Cong#e"" oP",c olog,' S,dne,' Au"t#alia$ Ric&/ood' D$($' * @#ait /aite' P$A$ 41AA76$ Social-p",c ological -acto#" a--ecting "ee&ing elp -o# e.otional p#o1le."$ Social Science and 0edicine' 8A476, 3:8-3G2$ Ro"en1e#g' 0$L$' Edd,' D$0$' )olpe#t' R$C$' * @#ou.a"' E$P$ 41AIA6$ De+eloping "t#ategie" to p#e+ent ,out "uicide$ In P-e--e#' C$R$ 4Ed6' Suicide a.ong ,out : Pe#"pecti+e" on #i"& and p#e+ention$ USA: A.e#ican P",c iat#ic P#e""$ Ro""' H$' * Ha#d,' G$ 41AAA6$ GP #e-e##al" to adult p",c ological "e#+ice": A #e"ea#c agenda -o# p#o.oting need"-led p#actice t #oug t e in+ol+e.ent o.ental ealt clinician"$ @#iti" (ou#nal o- 0edical P",c olog,' G2, G3-A1$

Help-negation 2G Rudd' 0$D$' (oine#' (#$' T$E$' * Ra!a1' 0$H$ 41AA36$ Help negation a-te# acute "uicidal c#i"i"$ (ou#nal o- Con"ulting and Clinical P",c olog,' :8' 7AA-358$ Rudd' 0$D$' Ra!a1' 0$H$' * Da .' P$%$ 41AA76$ P#o1le.-"ol+ing app#ai"al in "uicide ideato#" and atte.pte#"$ A.e#ican (ou#nal o- O#t op",c iat#,' :7, 18:17A$ Rudd' 0$D$' Ra!a1' 0$H$' O#.an' D$T$' Stul.an' D$A$' (oine#' T$' * Di9on' )$ 41AA:6$ E--ecti+ene"" o- an outpatient inte#+ention ta#geting "uicidal ,oung adult": P#eli.ina#, #e"ult"$ (ou#nal o- Con"ulting and Clinical P",c olog,' :7' 1GA1A5$ Sa#1o#nie' E$($' * Hau--.an' ($0$ 41AI36$ Regula# cla""#oo. "ocio.et#ic "tatu" o- 1e a+io#all, di"o#de#ed adole"cent"$ @e a+io#al Di"o#de#"' 12, 2:I-2G7$ Saunde#"' S$0$' Re"nic&' 0$D$' Ho1e#.an' 0$0$' * @lu.' R$)$ 41AA76$ %o#.al elp-"ee&ing 1e a+io# o- adole"cent" identi-,ing t e."el+e" a" a+ing .ental ealt p#o1le."$ (ou#nal o- t e A.e#ican Acade., o- C ild and Adole"cent P",c iat#,' 88, G1I-G2I$ Sc /eitBe#' R$' Hla,ic ' 0$' * 0cLean' ($ 41AA36$ Suicidal ideation and 1e a+iou#" a.ong uni+e#"it, "tudent" in Au"t#alia$ Au"t#alian and Ne/ Qealand (ou#nal o- P",c iat#,' 2A, 7G8-7GA$ Ste-l' 0$E$' * P#o"pe#i' D$C$ 41AI36$ @a##ie#" to .ental ealt "e#+ice utili"ation$ Co..unit, 0ental Healt (ou#nal' 21' 1:G-1GI$ Su#geno#' L$($ 41AI36$ Attitude" to/a#d "ee&ing p#o-e""ional p",c ological elp$ Ne/ Qealand (ou#nal o- P",c olog,' 17' 2G-88$ Tudi+e#' %$' * Tal1ot' J$ 41AAA6$ ) , donCt .en "ee& elpM %a.il, p ,"ician"C pe#"pecti+e" on elp-"ee&ing 1e a+iou# in .en$ (ou#nal o- %a.il, P#actice' 7I' 7G-32$

Help-negation 2I Up.an,u' P$P$' Na#ula' P$' * 0oein' L$ 41AA36$ A "tud, o- "uicide ideation: T e inte#+ening #ole o- cogniti+e #igidit,$ P",c ological Studie"' 75' 12:-181$ )ei" aa#' 0$E$ 41AA:6$ Cogniti+e #i"& -acto#" in "uicide$ In P$ Sal&o#"&i" 4Ed$6' %#ontie#" o- Cogniti+e T e#ap,. Ne/ Jo#&: Guil-o#d P#e""$ 22:-27A$ )e"tcott' H$L$' * Da+ie"' G$0$ 41AA36 C ild#enC" elp-"ee&ing 1e a+iou#$ C ild: Ca#e' Healt and De+elop.ent' 21' 233-2G5$

Help-negation 2A Ta1le 1 0ean" and "tanda#d e##o#" o- elp "ee&ing intention" -o# pe#"onal-e.otional p#o1le." 4Pe#-E.ot6' an9iet, and dep#e""ion 4An9-Dep6' "uicidal t oug t" 4Suicide-T t"6' and di--e#ent "ou#ce" o- elp

P#o1le. T,pe ++++++++++++++++++++++++++++++++++++++ Sou#ce o- Help Pe#-E.ot 0 SE An9-Dep 0 SE Suicide-T t" 0 SE

%#iend 4not #elated to ,ou6 Pa#ent Ot e# Relati+e?%a.il, 0e.1e# 0ental Healt P#o-e""ional P one Help Line Docto#?GP )ould not "ee& elp -#o. an,one

3$2: 7$2I 8$G7 2$G3a 1$G8 2$:1a 2$73

$11 $12 $12 $11 $5G $15 $11

3$1: 7$83 8$:5 2$I:a 1$G3 2$:5a 2$8:

$11 $12 $12 $12 $5I $15 $12

7$8I S 8$31aS 8$181S 8$I5aS 2$GG1S 2$GA1 2$3:

$18 $17 $18 $18 $12 $12 $12

Note$ n K 2A5' E+aluation" /e#e .ade on a G point "cale 41 K e9t#e.el, unli&el,' G K e9t#e.el, li&el,6$ T e ite. DI /ould not "ee& elp -#o. an,oneF /a" not included in t e cont#a"t"$ S0ean" t at a+e an a"te#i"& di--e# -#o. .ean" t at do not a+e an a"te#i"& /it in t e "a.e #o/ 4at t e le+el o- pN$516$ %o# e9a.ple' -o# t e "ou#ce o- elp #o/ D%#iendF' intention" -o# Suicidal-t oug t" di--e# -#o. 1ot intention" -o# Pe#"onal-E.otional and -#o. intention" -o# An9iet, and Dep#e""ion p#o1le."$

Help-negation 85
a'1

0ean" t at do not " a#e a lette# /it in t e colu.n" di--e# 4at t e le+el o- pN$516$

%o# e9a.ple' -o# t e colu.n An9iet,-Dep#e""ion' all "ou#ce" di--e# -#o. eac ot e# /it t e e9ception o- t e .ean" 1et/een 0ental Healt P#o-e""ional and Docto#?GP$

Help-negation 81 Ta1le 2 Co##elation" 1et/een "uicidal ideation 4SIL6' opele""ne"" 4@HS6' and elp-"ee&ing intention" -o# non-"uicidal and "uicidal p#o1le." and di--e#ent "ou#ce" o- elp$ +++++++++++++++++++++++++++++++++++++++++++++++++++++ Help-See&ing Intention" Suicidal Ideation Hopele""ne""

+++++++++++++++++++++++++++++++++++++++++++++++++++++ Suicidal t oug t" %a.il, -$2GSS -$28SS 0ental Healt P#o-e""ional -$22SS -$1ASS SS %#iend $21 -$28SS P one Help Line -$1AS -$17S S P ,"ical Healt P#o-e""ional -$18 -$13SS )ould not "ee& elp $23SS $21SS Ot e# p#o1le." %a.il, -$2GS -$87SS 0ental Healt P#o-e""ional $58 -$58 S %#iend -$28 -$28SS P one Help Line -$5: $52 P ,"ical Healt P#o-e""ional $52 $55 S )ould not "ee& elp $25 $2GSS ++++++++++++++++++++++++++++++++++++++++++++++++++++++ Note$ n K 2GA to 2AI' SSp N $551' Sp N $53

Help-negation 82 Ta1le 8 Su..a#, o- 0ANCOPA anal,"i" -o# "uicidal ideation 4SIL6 p#edicting elp-"ee&ing intention"$ +++++++++++++++++++++++++++++++++++++++++++++++ +++++++++ Help-"ee&ing Intention" <<<<<<<<<<<+++++++++++++++++++ Sou#ce o- Help Suicidal T oug t"a @ SE Ot e# p#o1le."1 @ SE

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 0ental Healt P#o-e""ional P one Help Line %a.il, %#iend P ,"ical Healt P#o-e""ional -$I5SS -$37S -$82 -$82 -$81 $22 $21 $25 $22 $21 -$13 -$28 -$22 -$8GS -$8GS $1: $12 $1: $1G $1:

)ould not "ee& elp $3GS $21 $2: $1I +++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Note$ ad- K 1' 2G8; 1d- K 1' 2I1' SSp N $551' Sp N $53 4"igni-icantl, di--e#ent -#o. Be#o6$