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Cited by 11Suicide and Self-Harm StudiesMental Health and Patient InvolvementGrief, Bereavement, and Mental Health

Theoretical model of recovery following a suicidal episode (COURAGE): scoping review and narrative synthesis

Open access
Sokol, Yosef, Levin, Chynna, Linzer, Mairav, Rosensweig, Chayim, Hubner, Shifra, Gromatsky, Molly, Walsh, Samantha, Dixon, Lisa +1 more·2022·BJPsych Open
DOI 10.1192/bjo.2022.599PMC PMC9707512
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Abstract

Background: Despite a significant need, there are currently no rigorously developed empirically based models for what personal recovery from a suicidal episode looks like. Aims: To develop a theoretical model of personal recovery after a suicidal episode, based on a comprehensive literature review and stakeholder feedback. Method: A scoping review of all empirical studies on this topic was conducted, followed by a thematic analysis to create a preliminary framework. Consultation-based revisions were then made based on feedback from a stakeholder panel to develop the final theoretical model. Results: The final model comprised seven themes: choosing life, optimising identity, understanding oneself, rediscovering meaning, acceptance, growing connectedness and empowerment (acronym ‘COURAGE’). Although there are some similarities between COURAGE and other models of personal recovery, there are components, such as ‘choosing life’ and ‘understanding oneself’, that are specific to recovery after an acute suicidal episode. Conclusions: To our knowledge, this is the first study to use a comprehensive literature review with stakeholder feedback to develop a conceptual model of personal recovery after an acute suicidal episode. This model has important implications for both researchers and clinicians to consider. Looking ahead, COURAGE can inform the reconceptualisation of assessment, research and clinical care of individuals who have experienced a suicidal episode.

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Crossref · 10.1192/bjo.2022.599

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26 of 26 references verified0 citation errors · 0 not checkable

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  • Both studies describe the recovery process as unique to each individual and emphasize the importance of service users being able to define recovery for themselves rather than being pressured to meet standards set by services.

    “Both studies describe the recovery process as unique to each individual and emphasize the importance of service users being able to define recovery for themselves rather than being pressured to meet standards set by services.”

    From Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis (2024) · cites this paper as [18]

    The Discussion (page unavailable) describes recovery after a suicidal episode as an individualistic journey and says not every journey will fit the COURAGE model. The paper discusses patient-centred care, but the passages do not say service users should define recovery for themselves rather than face pressure to meet service-set standards. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Sokol et al. presented a theoretical model of recovery from a suicidal episode based on a literature review, and Ropaj et al. a Delphi consensus on what recovery from suicidal behavior entails from the perspective of those with lived experience.

    “Recently, Sokol et al. [18] presented a theoretical model of recovery from a suicidal episode based on a literature review, and Ropaj et al. [19] a Delphi consensus on what recovery from suicidal behavior entails from the perspective of those with lived experience.”

    From Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis (2024) · cites this paper as [18]

  • The participants' accounts illustrated the highly idiosyncratic, person-specific nature of recovery goals and processes described by models of personal recovery from suicidality.

    “The participants’ accounts also illustrated the highly idiosynchratic, i.e., person-specific, nature of recovery goals and processes that is described by models of personal recovery from suicidality [18, 19].”

    From Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis (2024) · cites this paper as [18]

  • An understanding of recovery as co-created is in line with both the self-determination theory and recovery models of suicidality.

    “An understanding of recovery as co-created is in line with both the SDT [10, 12] and recovery models of suicidality [18, 19].”

    From Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis (2024) · cites this paper as [18]

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Cites

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2 of the 28 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [6]Sheedy CK, Whitter M. Guiding principles and elements of recovery-oriented systems of care: what do we know from the research? J Drug Addict Educ Eradica 2013; 9(4): 225.
  2. [23]Joiner TE. Why People Die by Suicide. Harvard University Press, 2005.

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Authors
Sokol, Y., Levin, C., Linzer, M., Rosensweig, C., Hubner, S., Gromatsky, M., Walsh, S., Dixon, L., & Goodman, M.
Affiliations
  • James J. Peters VA Medical Center (US)
  • Long Island University (US)
  • Yeshiva University (US)
  • Touro College (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • New York State Psychiatric Institute (US)
Corresponding author
Sokol, Yosef
ORCID
Venue
BJPsych Open
Publisher
Royal College of Psychiatrists
Published
2022-11
Volume
8
Issue
6
Pages
e200-e200
ISSN
2056-4724 (ISSN-L)
DOI
10.1192/bjo.2022.599
PMC
PMC9707512
OpenAlex
W4309367883
Cited by
11
References
28
Citations by year
2026: 2 · 2025: 5 · 2024: 2 · 2023: 2
FWCI
0.38
Type
journal article
Language
en
Open access
Licence
Locations
  • BJPsych Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Touro Scholar (Touro College) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs (IK2 RX003571)
  • Health Services Research and Development
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
Keywords
personal recovery, theoretical model, identity, self-understanding, meaning, acceptance, connectedness, empowerment, stakeholder feedback, conceptual modeling

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