The present study results indicated that instability in emotional relationships had led to self-poisoning suicide in young people, and this concept was extracted based on the participants’ experiences and perceptions. Instability in emotional relationships had a central role in attempted self-poisoning. It is usually associated with feelings of humiliation, worthlessness, disgrace, and the feeling that one does not matter. A change in communication distance (reduction in closeness or intimacy) can predict the nature and severity of consequences of suicide .
Betrayal in couples’ relationships can lead to conflicts, quarrels, and eventually suicide attempts. Sometimes, one of the spouses accuses the other of betrayal, which results in impulsive suicide in the accused party. Impulsive suicide may happen when one of the spouses accuses the other of infidelity in the presence of others, making them feel debased and defamed and possibly driving them towards an impulsive act of suicide at a time close to the accusation being made. Sometimes, a person might impose limitations on their spouse’s social relationships to prevent betrayal, leading to conflict, quarrels, and attempted suicide. In such situations, people usually feel worthless. In one study, three-quarters of the participants mentioned communication problems related to feelings, such as betrayal, rejection, shame, and the spouse’s failure in their responsibilities, as the main reason for attempting suicide. When couples have problems in their relationship (e.g., communication breakdown), these problems can increase the risk of suicide . Relationship problems are one of the main causes of suicide [27, 28]. These studies have generally suggested that infidelity and problems in couples’ relationships can lead to suicide; however, the most important issue discussed in the present study is suicide due to feelings of disgrace and worthlessness. In some cases, the individual tried to change the conditions that had led to these feelings. The resulting conflict may cause more humiliation, and ultimately, being unable to change the conditions can lead to suicide. When individuals cheat on their spouse, they hide it. Being accused of betrayal can cause feelings of disgrace and worthlessness in some cases and lead to suicide attempts because it can change how people treat that person. If an individuals’ social interactions are limited by their spouses to prevent betrayal in a way that their relatives realize it, conflicts can break out between the couples over the limitations. If these limitations are not removed, others might assume that the individual is not trusted by their spouse, which leads to the feeling of worthlessness and, in some cases, suicide attempts.
Failure in romantic relationships resulting from betrayal or break-up by one party creates stressful conditions for the other and increases the chances of suicide attempts. In one study, people who had experienced failure in romantic relationships in the previous 3 months had a high risk of attempting suicide due to depression . People who are in romantic relationships usually hide this relationship from their family, relatives, acquaintances, and people around them. In some cases, if others find out about the romantic relationship and they break up, it can have consequences, such as being blamed for the break-up, for the individual; moreover, their families might limit their social interactions, leading to the loss of many marriage opportunities. Furthermore, others may assume that these individuals will be unfaithful to their spouses in the future.
Those who attempt suicide in front of a spouse or lover are often reacting to some reduction in closeness – what Black calls “under-intimacy.” Under-intimacy includes separation, divorce, and infidelity, all of which cause severe conflict between intimate partners [10, 11]. The abovementioned study only pointed to severe forms of conflict, whereas in those with a deep emotional relationships, encountering interpersonal factors cause them to feel worthless, disgraced, and unimportant to others as well. This leads to an effort to change the situation and can even be accompanied by conflict and physical argument. Fruitless efforts and the feeling of disappointment can lead to suicide attempts in individuals.
A lack of support by the family, being rejected by the family, or divorce and addiction problems in the family, when accompanied by a lack of emotional support for children, put a lot of stress on individuals; these problems are usually associated with feelings of not being understood, being worthless, and being a burden, which can increase chances of attempting suicide. One factor related to suicide in youth is the loss of parents or their divorce . Young people who believe that their parents do not care for them or control them too much (affectionless control) have more mental distress and are at a higher risk of suicidal thoughts and behaviors than their peers . Previous studies have reported a significant relationship between increased suicide risks in adolescents and parental factors such as low income and familial support . Familial unity and integrity and familial emotional support are protective factors against suicide and depression. Enhancing unity and integrity in families can efficiently prevent suicidal thoughts, depression, and high-risk behaviors . In Iran, parents must be over 60, or the father has to have passed away for children to be financially supported by government organizations. However, there is no governmental support for families with addicted or homeless fathers. In such cases, children are in undesirable conditions, must provide for their families, and have to experience educational and social problems, such as addiction.
When someone experiences emotional failure and emotional trauma within a period of several months, and their emotional resilience is affected, their lives become meaningless, and they may repeatedly injure themselves and attempt suicide. People who experience significant stressors are at higher risk of attempting suicide . A study reported that people who experience constant communication problems experience more suicide attempts and longer suicidal periods . The present study indicated that suicide attempts may result when the individual experiences various forms of emotional stress caused by the people who are expected to be loyal, respectful, and supportive to them but show infidelity, betrayal, insult, humiliation, and lack of support because the individual will experience feelings of disgrace, worthlessness, insignificance, and humiliation. Moreover, experiencing these feelings more frequently can lead to repeated suicide attempts and even mental problems. In another study, having meaning in life was associated with decreased emotional stress and suicide risk . In this study, when people experience several instances of emotional stress, life does not mean anything to them, and they feel that they are worthless, they are a burden, they have been humiliated, and they do not matter to others.
This study revealed that the loss of parents and intimate friends to whom people are emotionally attached leads to emotional trauma; moreover, when someone experiences the death of their parents and is not supported by their relatives, they lose their emotional resilience; this is associated with a feeling of being a burden and eventually leads to suicide attempts. Children who lose their parents and receive little support, those who are only children or single, and people who experience frequent changes in their marital status are at high risk of attempting suicide compared with people who have high levels of social support . In one study, it was reported that although the majority of people who experience their parents’ death return to normal life after a period of grief, the risk of attempting suicide increases in them [33,34,35,36,37]. The loss of integrity in families of people who have lost a relative also increases the risk of suicide .
Based on the interviews, there is an expectation of support from relatives. However, some are abused by the relatives instead. The same can happen for a person who expects to feel safe while in prison yet experiences sexual abuse instead. These situations can create a feeling of worthlessness, leading to suicide attempts. The youth who feel that they have close relationships with their peers, parents, and family members and youths who feel they are part of their school or society are less likely to have serious thoughts about suicide than their counterparts [14, 15].
According to one participant who had a disability, disabilities can lead to dysfunction, economic problems, divorce, spouse’s infidelity, and rejection or blame by the family, and are associated with feelings of being insignificant, lonely, unwanted, and worthlessness and a burden to others, which may lead to the decision to attempt suicide. Kazhem’s (2017) work suggests that the relationship between physical disability and suicide is beginning to be examined within empirically supported frameworks of suicide and reports that interpersonal factors (e.g. perceived burdensomeness) and pain are mechanisms contributing to this heightened risk of suicide .
The notable point in this study is that instability in emotional relationships creates the feeling that a person does not matter to the family, and the feelings of disgrace, humiliation, worthlessness, and burdensomeness may lead to suicide attempts. The interpersonal-psychological theory of suicidal behavior introduced by Joiner posits that people tend to attempt suicide due to feelings of burdensomeness (being a burden to others) and thwarted belongingness (not belonging to a social group) . The results of this study showed that a thwarted sense belonging and the feeling of being a burden to others lead to suicide attempts because they are accompanied by the feelings of disgrace, worthlessness, and insignificance. The more emotional stress one is subjected to, the less sense of belonging they feel and the more serious suicide attempts they will have. In Joiner’s theory the feeling of belonging is so powerful that, when satisfied, it can prevent suicide even when perceived burdensomeness and the ability to enact lethal self-injury are in place . Based on the result of this study, burdensomeness is felt when one has lost all of their belongings and is usually accompanied by feelings of being unwanted, valueless, unimportant, lonely, and a burden to others, often leading to repeated serious suicide attempts.
Fleischer (2000) focuses on the act of suicide as a normal way of communication in an extreme situation when the persons in question see verbal expression as insufficient . In this study, an extreme situation is one in which an individual expects respect and support from other people who are in this situation themselves, but instead, they are blamed, betrayed, raped, rejected, and deceived. Consequently, the individual experiences feelings of worthlessness, disgrace, humiliation, and insignificance and as a result, might attempt suicide.
In general, being accused of betrayal by a spouse or being labeled in the community (family, relatives, and acquaintances) as a failure in romantic relationships can negatively affect an individual’s social position, value, and respect and lead to changes in the behavior of people or blame by others. Therefore, the individual feels disgraced and worthless (lack of or decreased social value), which can lead to suicide attempts. Lack of familial support and being blamed and rejected by family members exacerbate the negative feelings, can make the individual feel that they are a burden, that they do not belong, or that they are not important to others, and eventually can result in frequent and serious suicide attempts. Individuals expect to be supported and respected by their family and spouse in the community.
Different emotional stressors have been mentioned in different studies as factors causing suicide, but how these stressors lead to suicide and the feelings experienced by these people resulting in their suicide have not been discussed. However, the present study revealed that when individuals experience one or more interpersonal emotional stressors, they attempt suicide because these stressors lead to feelings of disgrace, worthlessness, insignificance, burdensomeness, and humiliation caused by the people who are expected to be loyal, respectful, and supportive. This highlights the need for more studies in this field.
This study is the first of its kind in the west of Iran; however, it is limited by the small sample size and the challenge of interviewing some patients because they were discharged with personal consent. The qualitative nature of the study limits its generalizability to the broader population. However, efforts were made to enhance the representation of different voices and concerns of participants in order to increase the credibility of the data. Moreover, by clearly stating these study limitations, data collection and analysis methods, participant selection, and subject description, we hope transferability would be possible so other researchers may continue further work in this area.