Defeat and Entrapment in Bipolar Disorder: Exploring the Relationship with Suicidal Ideation from a Psychological Theoretical Perspective

Contemporary psychological theoretical models of suicide hypothesize that defeat and entrapment underlie the development of suicidal ideation. This hypothesis has never been tested in people who experience bipolar disorder. Regression analysis revealed that defeat and entrapment significantly predicted suicidal ideation at 4‐month follow‐up. The relationship between defeat and suicidal ideation was mediated by total entrapment and internal entrapment, but not external entrapment. Results suggest that perceived defeat and entrapment underlie the development of prospective suicidal ideation in bipolar disorder. Findings could potentially improve the assessment of suicide risk in people who experience bipolar disorder.     

Low self‐esteem,entrapment, and reason for living: A moderated mediation model of suicidal ideation

Adolescent suicidal ideation has become a top public health concern. It is thus significant to explore both risk and protective factors of adolescent suicidal ideation. The present study tested a moderated mediation model of suicidal ideation in a sample of Chinese adolescents. Chinese adolescents of 1074 (54.2% females, aged between 11 and 18 years) completed questionnaires assessing self‐esteem, entrapment, reason for living, and suicidal ideation. We found that entrapment mediated the association between low self‐esteem and suicidal ideation. The association between entrapment and suicidal ideation was moderated by reason for living. Findings of this study may expand our understanding of the development of suicidal ideation, and facilitate future research exploring the interplay of risk and protective factors of suicidality. Clinical implications of these findings were also discussed.     

An Examination of Social Comparison and Suicide Ideation Through the Lens of the Integrated Motivational–Volitional Model of Suicidal Behavior

We aimed to investigate whether negative social comparisons are associated with key components of the integrated motivational‐volitional (IMV) model of suicidal behavior. Specifically, we investigated the relationship between negative social comparisons, suicide ideation, defeat, entrapment, socially prescribed perfectionism, and resilience. Adult participants (N = 422) completed an online survey comprised of a range of psychological measures. An initial regression analysis indicated that negative social comparisons were associated with suicide ideation. Three mediation models were tested based on the IMV model, all controlling for depressive symptoms. In the first, social comparison partially mediated the relationship between socially prescribed perfectionism and defeat. In the second, defeat mediated the relationship between negative social comparisons and entrapment, and resilience moderated the relationship when defeat was high. In the final model, entrapment mediated the relationship between defeat and suicide ideation, with resilience moderating this relationship when entrapment was high. These findings are novel and lend support to the IMV model. The clinical implications include highlighting the importance of targeting resilience given its potential association with defeat and entrapment.     

The Emergence of Suicidal Ideation During the Post‐Hospital Treatment of Depressed Patients

There is a paucity of research on the emergence of suicidal ideation in recently hospitalized patients undergoing treatment for depression. As part of a larger clinical trial, patients (N = 103) with major depression without suicidal ideation at hospital discharge were followed for up to 6 months while receiving study‐related outpatient treatments. Fifty‐five percent reported the emergence of suicidal ideation during the outpatient period, with the vast majority (79%) exhibiting this problem within the first 2 months post‐discharge. Seventy percent of those reporting severe suicidality prior to hospitalization exhibited a reemergence of suicidal ideation post‐discharge. However, 29% without significant suicidality at the index hospitalization later developed suicidal ideation during the outpatient treatment period. A faster time to the emergence of suicidal ideation was predicted by both higher prehospitalization levels of suicidal ideation as well as greater depression severity at hospital discharge. Overall, rates of emergent suicidal ideation found in the current sample of recently hospitalized patients were higher than those reported in previous outpatient samples.     

Health-risk behaviors and suicidal ideation: a preliminary study of cognitive and developmental factors

Various theorists have suggested that unhealthy behaviors such as cigarette smoking and problem drinking may be subtle forms of suicidality. Consistent with this view, prior research has shown an association between health risk behaviors and suicidal ideation. In the present study we examined relationships among suicidal ideation, health-related attitudes and behaviors, and adverse childhood events. We hypothesized that unhealthy attitudes, perhaps shaped by adverse childhood events, would help explain the association between suicidal phenomena and unhealthy behaviors. Three-hundred eighteen college students completed surveys covering health risk behaviors, depression, suicidal ideation, and health-related attitudes. Results supported the hypothesized associations among these variables. However, contrary to our hypotheses, the association between suicidal ideation and health-compromising behaviors was limited largely to substance-related behaviors. Moreover, the association between suicidal ideation and health-related attitudes was mediated by depression. Adverse childhood events were associated with health-related attitudes, but this relationship was mediated by depression. These results are less suggestive of the notion of unhealthy behaviors as subtle suicidality than a model in which suicidality associates specifically with psychopathological states such as depression and substance abuse. Implications for treatment and prevention programs are discussed.     

The association between homelessness and suicidal ideation and behaviors: results of a cross-sectional survey

This study was carried out with three goals: (1) to determine the prevalence of suicidal ideation and suicide attempts among the homeless; (2) to determine what aspects of homelessness predict suicidality, and (3) to determine which aspects remain predictive after controlling for key covariates, such as mental illness. A sample of 330 homeless adults were interviewed. Sixty-one percent of the study sample reported suicidal ideation and 34% had attempted suicide. Fifty-six percent of the men and 78% of the women reported prior suicidal ideation, while 28 percent of the men and 57% of the women had attempted suicide. Childhood homelessness of at least 1 week without family members and periods of homelessness longer than 6 months were found to be associated with suicidal ideation. Psychiatric diagnoses were also associated with suicidality in this sample.     

Suicidal ideation in anxiety-disordered youth

Evidence is mixed regarding an independent association between anxiety and suicidality in youth. Study 1 examined suicidal ideation in treatment-referred, anxiety-disordered youth (N = 312, aged 7-17). Forty-one percent of anxiety-disordered youth endorsed suicidal ideation. Anxiety disorder severity, global impairment, and current depressive symptoms predicted suicidal ideation in a multivariate model. Study 2 compared youth (N = 216, aged 7-14) with and without anxiety disorders. Higher rates of suicidal ideation were associated with anxiety diagnosis, and levels of anxiety predicted suicidal ideation after controlling for comorbid depressive disorders, current depressive symptoms, and global impairment. Results support an association between anxiety disorders and suicidal ideation in treatment-referred youth and recommend routine screening for suicidal ideation in this population.     

The role of defeat and entrapment in depression, anxiety, and suicide

Defeat and entrapment are psychological constructs that have played a central role in evolutionary accounts of depression. These concepts have since been implicated in theoretical accounts of anxiety disorders and suicidality. The current article reports on a systematic review of the existing research investigating the links among defeat, entrapment, and psychopathology in the domains of depression, suicidality, posttraumatic stress disorder (PTSD), and other anxiety syndromes. Fifty-one original research articles were identified and critically reviewed. There was strong convergent evidence for a link with depressive symptoms, across a variety of clinical and nonclinical samples. Preliminary support for an association with suicidality was also observed, with effects not readily explainable in terms of comorbid depression. There was strong evidence for an association between defeat and PTSD, although this may have been partly accounted for by comorbid depression. The findings for other anxiety disorders were less consistent. There was, however, evidence that social anxiety in individuals with psychosis may be related to perceptions of entrapment. Overall, there was evidence that perceptions of defeat and entrapment were closely associated with various forms of human psychopathology. These effects were often in the moderate to large range and superseded the impact of other environmental and psychological stressors on psychopathology. We provide a unified theoretical model of how defeat and entrapment may contribute to these different psychopathological conditions. Clinical implications and avenues for future research are discussed.     

Personality and cognitive processes: self-criticism and different types of rumination as predictors of suicidal ideation

Self-criticism and rumination have been related to suicidality. In the present study, we investigated the extent to which different types of rumination (brooding and reflection) mediate the relationship between self-criticism and suicidal ideation. Two hundred and thirty-two healthy adults completed a range of psychological inventories at Time 1 and were followed up approximately 3 months later (Time 2). Brooding was more strongly associated with suicidal ideation than reflection. Hierarchical regression analyses confirmed that among those who completed measures at both time points, brooding rumination fully mediated the self-criticism-Time 2 suicidal ideation relationship. Reflection did not mediate the self-criticism-suicidal ideation link. The findings support a growing corpus of research which highlights the utility of personality and cognitive factors in advancing our understanding of the suicidal process. The theoretical and clinical implications are discussed.     

What’s the Harm in Asking About Suicidal Ideation?

Both researchers and oversight committees share concerns about patient safety in the study-related assessment of suicidality. However, concern about assessing suicidal thoughts can be a barrier to the development of empirical evidence that informs research on how to safely conduct these assessments. A question has been raised if asking about suicidal thoughts can result in iatrogenic increases of such thoughts, especially among at-risk samples. The current study repeatedly tested suicidal ideation at 6-month intervals for up to 2-years. Suicidal ideation was measured with the Suicidal Ideation Questionnaire Junior, and administered to adolescents who had previously received inpatient psychiatric care. Change in suicidal ideation was tested using several analytic techniques, each of which pointed to a significant decline in suicidal ideation in the context of repeated assessment. This and previous study outcomes suggest that asking an at-risk population about suicidal ideation is not associated with subsequent increases in suicidal ideation.     

Dispositional and explanatory style optimism as potential moderators of the relationship between hopelessness and suicidal ideation

To test the hypothesis that higher levels of optimism reduce the association between hopelessness and suicidal ideation, 284 college students completed self-report measures of optimism and Beck scales for hopelessness, suicidal ideation, and depression. A statistically significant interaction between hopelessness and one measure of optimism was obtained, consistent with the hypothesis that optimism moderates the relationship between hopelessness and suicidal ideation. Hopelessness is not inevitably associated with suicidal ideation. Optimism may be an important moderator of the association. The development of treatments to enhance optimism may complement standard treatments to reduce suicidality that target depression and hopelessness.     

The Relative Contribution of Diagnostic and Psychosocial Variables to Severity of Suicidal Ideation

The present study examined the relative contribution of diagnostic and psychosocial factors to the prediction of severity of suicidal ideation in a sample of 78 college students. Using hierarchical regression analyses to control for each set of factors, psychosocial variables were found to consistently predict level of suicidal ideation. In contrast, diagnostic variables including diagnosis of substance abuse and composite scores for depression and anxiety were unrelated to level of suicidality. An examination of individual diagnoses revealed no predictable relationships with severity of suicidality in this population. The results were discussed from several methodological viewpoints.     

Psychological dimensions associated with suicidal ideation and attempts in the National Comorbidity Survey

Three important psychological dimensions in the suicide literature (neuroticism, self-criticism, and hopelessness) were examined in relation to suicidal ideation and attempts in the U.S. National Comorbidity Survey (Kessler et al., 1994; n = 5,877), after first controlling for the effects of previously identified sociodemographic and psychiatric variables related to suicidality in this nationally representative sample (Kessler, Borges, & Walters, 1999). Analyses were conducted separately for lifetime, current (12-month), and past history of suicidal ideation and attempts. Brief indices of self-criticism and hopelessness were robustly associated with suicide attempts across all three time frames. The results support the value of examining psychological individual differences over sociodemographic and psychiatric diagnoses alone in the comprehensive assessment of factors associated with suicidality in the general population.     

Peer functioning, family dysfunction, and psychological symptoms in a risk factor model for adolescent inpatients' suicidal ideation severity

Examined models of suicidal ideation severity that include two psychosocial risk factors (i.e., peer and family functioning) and four domains of psychological symptoms (i.e., generalized anxiety, depression, conduct problems, and substance abuse/dependence). Participants were 96 psychiatric inpatients (32 boys, 64 girls), ages 12 to 17, who were hospitalized because of concerns of suicidality. Adolescents completed a structured diagnostic interview, measures of suicidal ideation, and several dimensions of family and peer functioning. Results supported a model in which greater levels of perceived peer rejection and lower levels of close friendship support were associated directly with more severe suicidal ideation. In addition, indirect pathways included deviant peer affiliation and global family dysfunction related to suicidal ideation via substance use and depression symptoms. The results are among the first to demonstrate relations between suicidal ideation and several areas of adolescent peer functioning, as well as divergent processes for peer and family predictors of suicidal ideation.     

Association between loneliness and suicidality during middle childhood and adolescence: longitudinal effects and the role of demographic characteristics

The association between loneliness and suicidality has been documented in many studies, but these studies have been limited by cross-sectional designs and the use of adult-only populations. The purpose of the current study was to overcome these limitations by (a) investigating whether the link between loneliness and suicidal thoughts and behaviors occurs cross-sectionally, longitudinally, or both and (b) investigating how the link between loneliness and suicidality might be influenced by different demographic variables, including gender, ethnicity, and socioeconomic status. Logistic regression analyses were used to analyze data from a large sample (N = 937) of youth from the NICHD Study of Early Child Care. Results indicated that loneliness at age 15 years was concurrently associated with both suicidal ideation and suicidal behavior at age 15 years. Loneliness in middle childhood was longitudinally associated with suicidal behaviors at age 15 years, but not with suicidal ideation at age 15 years. None of the demographic characteristics influenced these associations.     

Gender differences in adolescent coping behaviors and suicidal ideation: findings from a sample of 73,238 adolescents

Suicide among adolescents is an emerging global public health problem as well as a socioeconomic problem. Stress-coping strategies have been shown to be associated with suicidal ideation. We examined coping behaviors related to suicidal ideation and gender differences in adolescents using the data from the 2010 Korea Youth Risk Behavior Survey (ages 12–19 years; N = 73,238). Logistic regression analysis was used to evaluate associations between suicidal ideation and specific coping behaviors while controlling for potentially confounding variables. In both male and female groups, the coping behavior “drinking alcoholic beverages” and “smoking cigarettes” were positively associated with suicidal ideation. “Watching TV,” “playing online/mobile games,” and “sleeping” were negatively associated with suicidal ideation in both groups. In males, “engaging in sports” was negatively related to suicidal ideation. In females, “venting by talking to others” and “eating” were negatively related to suicidal ideation. The results indicate that there are gender differences in the effects of coping behaviors on adolescent suicidal ideation, and that developing adaptive coping strategies may function to reduce suicidality. Future studies are needed to examine whether improving coping skills can reduce suicidal ideation in a gender-specific manner.     

Testing a Theoretical Model Based on Social Cognitive Theory for Media Influences on Suicidal Ideation: Results from a Panel Study

The influence of media representations of suicides on the subsequent increase of suicide rate has been researched for decades. Yet the underlying psychological mechanism of such media influences on individual's suicidality remains uncertain. Based on the conceptual framework of social cognitive theory, this article discusses the operationalization of media influences on suicidal ideation by using a psychometric approach. It then develops and tests a theoretical model to explain the mechanism of media influences on suicidal ideation. A two-wave panel study with a randomized population sample was carried out in the Hong Kong SAR, China with the results indicating that the proposed operationalization closely fit the data collected and empirically supported the theoretical model. Reciprocal associations between prior suicidal ideation and processes of media influences were also confirmed. The results also tested the factorial invariance across age groups and different pre-existing levels of suicidal ideation. This study reports the first individual-level finding on the theoretical relationship between media influences and suicidal ideation, as well as the first psychometrically validated operationalization of media influences on suicidal ideation.     

Posttraumatic Stress Disorder Symptom Severity and Emotion Regulation in Acute-Care Psychiatric Inpatients: Associations With Suicidality

Posttraumatic stress disorder (PTSD) symptomatology has been positively associated with suicidality (suicidal ideation and attempts), but less is known about factors that might exacerbate that association. The present study examined the main and interactive effects of PTSD symptom severity and difficulties in emotion regulation in association with four suicidality outcomes. Participants included 128 adults in an acute-care psychiatric inpatient setting. Results revealed that PTSD symptom severity was significantly incrementally associated with self-reported suicidal ideation (ß = .30, p = .02). Difficulties in emotion regulation were significantly associated with suicide as the reason for current admission (p = .01). The interactive effect of PTSD symptom severity and difficulties in emotion regulation was significant only for self-reported suicidal ideation (ß = .24, p < .001). Participants with high levels of PTSD symptom severity and difficulties in emotion regulation exhibited the highest level of suicidal ideation. Clinical implications and future directions are discussed.     

Parenting and Chinese Adolescent Suicidal Ideation and Suicide Attempts: The Mediating Role of Hopelessness

Various family factors are risk factors for adolescent suicidality (suicidal ideation and suicide attempts). However, little is known about the role of parenting in adolescent suicidality. The present study examined the unique relations between three parenting dimensions (parental warmth, behavioral control, and psychological control) and adolescent suicidality, as well as the mediating role of adolescent hopelessness among these relations. A total of 1529 Chinese adolescents (52 % male; mean age = 14.74 years, SD = 1.48) completed anonymous questionnaires designed to assess three parenting dimensions, hopelessness, suicidal ideation and suicide attempts. After controlling for gender, age, family structure, and socioeconomic status, it was found that parental warmth negatively predicted adolescent suicidality, whereas psychological control positively predicted adolescent suicidality. In addition, parental warmth negatively predicted adolescent hopelessness, whereas psychological control positively predicated adolescent hopelessness, which in turn enhanced adolescent suicidality. Although behavioral control did not predict adolescent suicidality, it did negatively predict adolescent hopelessness, which in turn promoted adolescent suicidality. These findings revealed the differential roles of different parenting dimensions in adolescent suicidality, and the mediation effect of adolescent hopelessness between parenting and adolescent suicidality. Future practices would benefit from incorporating both parenting and hopelessness for optimal intervention effect.     

Adolescent Suicidal Trajectories through Young Adulthood: Prospective Assessment of Religiosity and Psychosocial Factors among a Population‐Based Sample in the United States

The main objective was to identify distinct patterns of suicidal behaviors over the life course from adolescence to young adulthood and to determine influences of religiosity and other contextual factors on subgroup membership. Semiparametric growth mixture models were used to identify distinct clusters of suicide ideation and suicide attempt trajectories, and generalized estimating equations were used to assess individual and contextual characteristics predicting suicidal behaviors in adolescence and in young adulthood. Distinct trajectories of suicide ideation and suicide attempt were identified for the total sample and for the gender groups. Results showed marked gender differences in the trajectory of suicide ideation and attempt patterns. Religiosity effects on suicidality were prominent in adolescence but not in young adulthood. Analysis showed that an important window of opportunity for preventing the escalation of suicidality exists during the early adolescent period, an opportunity that should be emphasized in interventions on adolescence suicide prevention.