Research paperAre suicidal thoughts reinforcing? A preliminary real-time monitoring study on the potential affect regulation function of suicidal thinking
Introduction
Theoretical work and clinical observation suggest that many patients experience relief after thinking about suicide, which they perceive as comforting or as providing an escape from their seemingly intolerable circumstances (Gordon et al., 2010, O’Connor, 2003, Selby et al., 2007). This might mean that recurrent suicidal thinking is maintained because it leads to downward shifts in negative affect (i.e., negative reinforcement by providing an escape) or upward shifts in positive affect (i.e., positive reinforcement by providing comfort). Two prior studies that asked people who had suicidal thoughts in the past to recall how they felt when having suicidal thoughts reported that people recall feeling distressed when thinking about suicide, but some people also report comfort in the context of suicidal thinking (Crane et al., 2014, Crane et al., 2012). These earlier findings are intriguing, but are limited by a reliance on long-term retrospective recall and a failure to repeatedly assess changes in affective states from before to after the occurrence of suicidal thinking.
Smartphone-based ecological momentary assessment (EMA) approaches now allow for the collection of data about changes in affective states as they occur throughout the day (Kleiman and Nock, 2018, Shiffman et al., 2008). EMA studies on non-suicidal self-injury (NSSI) have shown, for instance, that engagement in NSSI is associated with decreases in negative affective and increases in positive affect, which seem to reinforce this behavior (Ammerman et al., 2017, Nock et al., 2009). No prior studies have examined whether thinking about suicide may be associated with similar affective changes. Here we used real-time, smartphone-based assessments to capture shifts in affect in situ. We expected to find that episodes of suicidal thinking are associated with subsequent decreases in negative affect and increases in positive affect.
Section snippets
Participants/recruitment
Inclusion criteria for this Harvard University IRB-approved study were: (1) a suicide attempt in the past year, (2) age 18 +, (3) ability to read English fluently, and (4) access to a compatible Android or iPhone smartphone. We recruited from a variety of suicide-related online message boards on Reddit (www.reddit.com). A total of 854 people completed the screener for the study, 103 of whom qualified (744 out of the 751 who did not qualify for the study had not attempted suicide in the past
Preliminary analyses
The sample was 78% female, 73% White, and had a mean age of 23.28 years (SD age = 4.38 years). There were 305 pairs of responses occurring during the same day where participants reported suicidal thinking at T but not at T + 1 (M = 7.09 pairs of responses per participant, SD = 5.23, range 1–20), out of a total of 540 pairs of responses. The average time between these pairs of responses was 7.95 h (SD = 5.35). There were 37 participant-initiated reports of suicidal thinking by 14 participants (M
Discussion
The goal of this study was to explore where the occurrence of suicidal ideation lead to downward shifts in negative affect and upward shifts in positive affect. There were two main findings that provide preliminary evidence for this hypothesis. First, we found decreases in negative affect (and its component parts) and increases in positive affect (and its component parts) when participants went from a period when they were experiencing suicidal thoughts to a period where they were no longer
Acknowledgements
Funding provided by Pershing Square Venture Fund for Research on the Foundations of Human Behavior (EMK) and the John T. and Catherine D. MacArthur Foundation (MKN).
References (18)
- et al.
Comfort from suicidal cognition in recurrently depressed patients
J. Affect. Disord.
(2014) - et al.
Real-time assessment of suicidal thoughts and behaviors
Curr. Opin. Psychol. Suicide
(2018) A practical guide to understanding reliability in studies of within-person variability
J. Res. Personal.
(2017)- et al.
Predicting nonsuicidal self-injury in borderline personality disorder using ecological momentary assessment
J. Personal. Disord.
(2017) - et al.
Fitting linear mixed-effects models using lme4
J. Stat. Softw.
(2015) - et al.
Diurnal variation in the positive affects
Motiv. Emot.
(1989) - et al.
Suicidal imagery in a previously depressed community sample
Clin. Psychol. Psychother.
(2012) - et al.
The reinforcing properties of repeated deliberate self-harm
Arch. Suicide Res.
(2010) - Kleiman, E.M., 2017. EMAtools: data management tools for real-time monitoring/ecological momentary assessment data....
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