Live or Die? Exploring Suicidal Ambivalence Among Young Adult Suicide Attempt Survivors: A Qualitative Study

Background and purpose: Suicide is a major public health concern shaped by a range of risk and protective factors. Yet it is a complex phenomenon characterized by the simultaneous desire to live and die. Suicidal ambivalence, the co-occurring desire to live and die, is widely recognized in clinical settings but understudied in empirical research. Previous research describes suicidal ambivalence as an internal debate between life and death as individuals grapple with the desire to live and die. Therefore, this study explores suicidal ambivalence among young adult suicide attempt survivors to understand how they experience and describe suicidal ambivalence. The following research questions guided this study: 1) How do attempt survivors describe suicidal ambivalence? 2) What was it like for attempt survivors to experience suicidal ambivalence?

Methods: This qualitative study used a phenomenological design to understand the common meaning among a group of individuals who have shared lived experience. For eligibility criteria, participants must be between the ages of 18-29, reside in the 50 states in the U.S., and be fluent in English. For safety, participants had to feel comfortable discussing their suicide attempt, be at least 12 months removed from their most recent attempt and have no active suicidal ideation in the past month. A semi-structured interview guide was developed to guide the interviews conducted via Zoom. All interviews were transcribed and checked for accuracy. Braun and Clarke’s (2006) six steps in thematic analysis were employed for data analysis using the qualitative software NVivo. Throughout each step in thematic analysis, the researcher ensured that the themes generated reflected participants’ voices and extracted representative quotes for each theme.

Findings: A total of 19 suicide attempt survivors participated in this study, and five themes emerged across two areas. First, participants described suicidal ambivalence as 1) an internal struggle between life and death, 2) a dynamic state that can fluctuate, and, for some, 3) a source of comfort and relief. Second, participants’ experiences of suicidal ambivalence were characterized by 1) conflicting desires to live and to die, and 2) feelings of emotional numbness, highlighting the complex nature of suicidality. Together, these findings highlight suicidal ambivalence as a complex, non-linear experience among suicide attempt survivors.

Conclusions and Implications: This study highlights suicidal ambivalence as a dynamic psychological construct characterized by the co-occurring desires to live and to die. In social work practice, the findings underscore the need to move beyond a dichotomous conceptualization of suicide and to attend to internal conflict and lived experiences when engaging with clients who experience suicidality. Future research should investigate how suicidal ambivalence can serve as a protective factor and a potential entry point for crisis intervention.