Association of suicidality with positive mental health: results from a nationwide cross-sectional study

Positive mental health (PMH) has been identified as a factor of resilience against suicidality. However, PMH encompasses different domains across cultural contexts. This study aimed to investigate the association between PMH and lifetime suicidality and analyse the association between each PMH domain and lifetime suicidality in Singapore.

This cross-sectional analysis comprised 2270 residents aged ≥18 years who participated in the Singapore Mental Health Study 2016, a population-level survey in which the lifetime prevalence of physical disorders, psychiatric disorders and suicidality was measured. Total PMH among participants was estimated using the PMH Instrument. The associations were investigated using logistic regression models, adjusted for sociodemographic characteristics, mental disorders, perceived social support and number of adverse childhood events.

Findings showed that individuals with lifetime suicidality had lower scores for PMH and its components compared with those without lifetime suicidality. Logistic regression models showed that PMH was negatively associated with lifetime suicidality (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.36-0.86). Specifically, higher scores for general coping (OR 0.68, 95% CI 0.48-0.96) and emotional support (OR 0.68, 95% CI 0.48-0.96) were significantly associated with lower odds of lifetime suicidality.

The findings imply that interventions that include PMH may be beneficial in supporting individuals experiencing suicidality. Future studies can examine the relationship between PMH and lifetime suicidality using longitudinal study designs and employ qualitative methods to provide insights into how individual experiences influence this association.