Mattering and Feelings of Not Mattering in Suicide Risk and Prevention: Conceptualization, Review, and Public Health Recommendations
The theme “You Matter” is arguably one of the most important public health mes-sages in existence when it comes to understanding and preventing mental health problems. The national suicide prevention program in the United States focused on youth is based on this theme, and it has been a constant focus for over a decade. Initiatives with the “You Matter” theme have emerged throughout North America and around the world.
This universal emphasis on the theme “You Matter” reflects the belief that people who are considering suicide are in need of reasons for living, and one very compel-ling reason is having suicidal people realize they matter and they would indeed be missed. It is difficult to think of a more poignant and timely message than this one. The emphasis on “You Matter” captures a feeling and a quest for the type of life existence that resonates with virtually everyone. Given the visibility and core importance of this theme, it is remarkable that the need for people to matter is not a central focus in research on suicide and its preven-tion. There is mounting research evidence of the benefits of mattering, but program-matic research on mattering and suicide has not yet been conducted. Similarly, feelings of not mattering are not measured routinely in clinical assessments of sui-cide risk, and there is no programmatic emphasis on people’s need to matter in most prevention frameworks; however, there are some notable and noble exceptions that have been effective (for a discussion, see Flett, 2018b). These exceptions serve as clear illustrations that mattering can be an acquired characteristic. Moreover, exten-sive financial resources are not required in order to implement ways to make people feel valued in ways that mitigate risk. Most notably, the individual person can show someone who is in need that she or he matters, and this may be enough to save them.
This was demonstrated poignantly in the movie It’s A Wonderful Life when the angel Clarence earned his wings by showing George Bailey, portrayed by Jimmy Stewart, how abjectly horrible the local community would have become if George had not been in it to make a difference in so many lives.
Accordingly, in light of these observations and the vital importance of more emphasis on the need for vulnerable people to feel they matter, the current chapter considers the role of feelings of mattering in suicide prevention. The overarching premise of this chapter is that mattering is a unique factor that is unlike any other psychological factor and, given its unique protective powers, mattering needs to become a focal point in the assessment, treatment, and prevention of suicidal ten-dencies. The uniqueness of mattering is supported by numerous studies in the depression field which shown that mattering is both a significant and unique predic-tor of distress, even after taking into account the proportion of distress accounted for by other potent predictors such as mastery, self-criticism, self-esteem, social sup-port, and insecure attachment (Flett et al., 2021; Flett & Nepon, 2020; Taylor & Turner, 2001). Moreover, mattering mediates key associations such as the associa-tion between socially prescribed perfectionism and depression (Flett et al., 2012) and key outcomes linked with stress (see Giangrasso Casale et al., 2022).
Flett (2022) characterized mattering as double-edged in that people have a vital resource when they feel like they matter and this sets the stage for happiness and life satisfaction, but people also have an immense source of vulnerability when they feel like they don’t matter. Given that mattering has a role in both resilience and risk, this chapter will address mattering and the need to promote mattering in public health initiatives, but also the need to focus on feelings of not mattering when someone has become suicidal. It is these people who need to come to the potentially lifesaving realization that they do indeed matter. One overarching theme of this chapter is that the failure to consider mattering and those people who desperately feel a need to matter is a major and costly omission that weakens public health initiatives and their possibilities. This chapter begins with a description of mattering and its various facets. Next, a summary and review is provided of select research that links feelings of not mat-tering with suicidal tendencies. This overview is not exhaustive and focuses primar-ily on research conducted with university students and adults. The need to matter is then considered in terms of its conceptual and applied significance. At a conceptual level, it is uniquely proposed that just as there is an unbearable form of psychologi-cal pain that is central to suicide risk, for many people, there is also an unbearable form of feelings of not mattering to others and this results in people feeling like they can’t bear to live any longer. The person characterized jointly by unbearable feel-ings of psychache and personal insignificance is at grave risk. Accordingly, it is suggested that levels of mattering or not mattering should be assessed in any person who either has a high level or is suspected of having a high level of unbearable psychache.