Brooding and reflection: rumination predicts suicidal ideation at 1-year follow-up in a community sample

The cognitive processes underlying suicidal thinking and behavior are not well understood. The present study examined brooding and reflection, two dimensions of rumination, as predictors of suicidal ideation among a community sample of 1134 adults. Participants completed self-report measures of rumination and depression, and a semi-structured clinical interview that included an assessment of suicidal ideation, at baseline and 1-year follow-up. Brooding was more strongly related to degree of ideation at baseline than was reflection. However, both brooding and reflection predicted whether an individual thought about suicide at 1-year follow-up, even after adjusting for baseline suicidal ideation. Symptoms of depression mediated the relationship between brooding and ideation but not that between reflection and ideation. Implications for the nature of thought processes that result in suicidal thinking 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.     

Rumination and suicidal ideation: The moderating roles of hope and optimism

The current study aimed to investigate whether the correlation between rumination and suicidal ideation is moderated by the presence of hope and optimism. It was hypothesized that both hope and optimism would moderate (weaken) the relationship between rumination and suicidal ideation. Two hundred and ninety-eight participants completed self-report measures of hope, optimism, rumination (brooding and reflection), and depression. Results demonstrated that both hope and optimism weakened the relationship between rumination and suicidal ideation, as well as the relationships between both subscales of rumination and suicidal thinking. These results were found when controlling for symptoms of depression. Results suggest that a ruminative thinking style may be most harmful when an absence of hope or optimism is also present.     

Naturalistic evaluation of suicidal ideation: variability and relation to attempt status

Suicidal ideation has been thought to have a relatively stable course across weeks and months. However, daily changes in levels of ideation have not been adequately examined despite the importance of potential variability clinically and conceptually. For example, it has been suggested that variability in suicidal ideation may become less closely tied to variability in other mood symptoms (e.g., depression, hopelessness) among individuals with multiple suicide attempts. The present report had two related goals: (1) to prospectively evaluate suicidal ideation and related mood symptoms, and (2) to determine whether suicide attempt status predicted a decreased association between ideation and other mood symptoms. Non-clinical participants (N=108) with varying levels of suicidal ideation and number of previous suicide attempts completed the beck hopelessness scale (BHS), beck depression inventory (BDI), and suicide probability scale (SPS) every day for 4 weeks. Findings suggested considerable variability in suicidal ideation, especially for multiple attempters. Multiple attempt status predicted a decreased association between suicidal ideation and depression, although the results were only marginally significant. These findings have implications for conceptual models of suicide risk as well as assessment and treatment of suicidal individuals.     

Current suicide proneness and past suicidal behavior in adjudicated adolescents

Youth recently assigned to probation (n = 233) were assessed for current suicide proneness, depression, and hopelessness, as well as for recent suicide ideation, previous suicide ideation, or suicide attempt(s). The Life Attitudes Schedule-Short Form (LAS-SF) was used to assess suicide proneness. As per the LAS-SF, suicide proneness was defined broadly to include current engagement in overtly suicidal behavior as well as in risk-taking and potentially injury-producing behaviors, coupled with a lack of engagement in health and safety behaviors, or self-enhancement behaviors. As expected, current suicide proneness was significantly associated with a history of suicide ideation and attempts, recent ideation, and current depression and hopelessness for adjudicated youth. Gender differences were obtained between the strength of the association between suicide proneness and depressive symptoms. A subgroup of adjudicated youth (n = 39) was then interviewed about their suicidal behaviors. Among other things, these youth indicated that the majority of their previous suicide attempts were committed impulsively.     

Toward an integrative model of suicide attempt: a cognitive psychological approach.

Applying a cognitive approach, the purpose of the present study was to expand previous research on stress-vulnerability models of depression and problem-solving deficits, as it relates to suicide attempt. Structural equation modelling, involving latent variables, was used to evaluate (a) whether low self-esteem, a low sense of self-efficacy, loneliness, and divorce constituted vulnerability factors for the development of depression; (b) whether hopelessness and suicidal ideation mediated the relationship between depression and suicide attempt; and (c) whether problem-solving deficits mediated the relationship between the vulnerability factors and suicide attempt, separate from depression/hopelessness. A total of 123 individuals, aged 18-75 years, participated in the study (72 suicide attempters and 51 psychiatric outpatients with no history of suicidal behavior). The results indicated a two path model of suicide attempt. The first path began with low self-esteem, loneliness, and separation or divorce, which advanced to depression, and was further mediated by hopelessness and suicidal ideation which led to suicide attempt. The second path developed from low self-esteem and a low sense of self-efficacy and advanced to suicide attempt, mediated by a negative appraisal of one's own problem-solving capacity, and poor interpersonal problem-solving skills. The importance of addressing both depression/hopelessness, and problem-solving deficits when working with suicide attempters is noted.     

Cognitive vulnerability to depression, rumination, hopelessness, and suicidal ideation: multiple pathways to self-injurious thinking

In order to advance the detection and prevention of suicide, recent research has focused on predictors of suicidal ideation and behavior such as negative cognitive styles, dysfunctional attitudes, hopelessness, and rumination. In this study the relationships among these risk factors in the context of the Attention Mediated Hopelessness (AMH) theory of depression are examined. One hundred and twenty-seven undergraduates in the Cognitive Vulnerability to Depression (CVD) project were followed for 2.5 years. The CVD project followed initially nondepressed freshmen, at either high or low cognitive risk for depression, in order to predict onsets and recurrences of depressive disorders. The presence and duration of suicidal ideation were predicted prospectively by rumination and hopelessness, and hopelessness partially mediated the relationship between rumination and ideation and fully mediated the association between rumination and duration of suicidality. Further, rumination mediated the relationship between cognitive vulnerability and suicidal ideation.     

Suicidal ideation and attitudes toward suicide

Although hopelessness and depression are known risk factors for suicide, most individuals who are hopeless or depressed never make a suicide attempt. In this study, we tested the hypothesis that college students' (n = 230) attitudes toward suicide (the degree to which they see it as an acceptable option under some circumstances) would moderate the link between both hopelessness and depressive symptoms and their levels of suicidal ideation. This moderation hypothesis was supported, but only among men. Specifically, among men, levels of hopelessness and depressive symptoms were significantly related to suicidal ideation among only those with relatively positive attitudes toward suicide.     

Psychopathology of adolescent suicide: hopelessness, coping beliefs, and depression

Two studies of adolescents examined the relation of several cognitive variables and depression to suicide-related behaviors. Study 1 compared hopelessness and depression in 281 high school students. Unlike research with adults, depression was significantly related to suicidal behaviors, even after hopelessness was statistically controlled. When depression was controlled, hopelessness was unrelated to suicidal behaviors for boys and only modestly related for girls. Study 2 examined depression, hopelessness, survival-coping beliefs, fear of social disapproval, and social desirability in relation to suicidal behaviors in 53 male juvenile delinquents. Again, hopelessness did not account for a significant proportion of the variance in suicide. Depression was uniquely related to past suicide attempts. Survival-coping beliefs were associated with self-predicted future suicide and other suicidal behaviors. Survival-coping beliefs are discussed as a cognitive buffer to suicidal ideation in adolescence.     

Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression,Suicidal Ideation,and Suicidal Behavior in High‐Risk Adolescents

The relationship between hopelessness and depression in predicting suicide‐related outcomes varies based on the anticipation of positive versus negative events. In this prospective study of adolescents at elevated risk for suicide, we used two Beck Hopelessness Scale subscales to assess the impact of positive and negative expectations in predicting depression, suicidal ideation, and suicidal behavior over a 2‐ to 4‐year period. In multivariate regressions controlling for depression, suicidal ideation, and negative‐expectation hopelessness, positive‐expectation hopelessness was the only significant predictor of depressive symptoms and suicidal behavior. Clinical interventions may benefit from bolstering positive expectations and building optimism.     

Relationship Between Religious Coping and Suicidal Behaviors Among African American Adolescents

This study investigated whether hopelessness and depression were risk factors for suicidal thoughts and behaviors in African American adolescents and looked at whether religious participation and religious coping protected these students from suicidality. Participants were 212 African American high school students (133 females, 79 males). The results of multiple and logistic regression analyses found that hopelessness and depression were risk factors for suicidal ideation and attempts. Religious coping style was significantly related to suicidal behaviors: Self-directed coping was related to increased hopelessness, depression, and suicide attempts, and collaborative coping was related to increased reasons for living. Gender differences were found in symptoms of depression, religious coping style and religious participation. Results provide additional support for suicide interventions to target hopelessness and depressive symptoms and highlight the importance of examining the role of culturally salient variables, such as religious participation and religious coping style, when developing intervention programs for suicide.     

The differential impact of brooding and reflection on the relationship between perceived stress and suicide ideation

This study investigated whether brooding and reflection moderated the relationship between perceived stress and suicide ideation. It was hypothesized that brooding, but not reflection, would strengthen the effect of perceived stress on suicide ideation above and beyond depression symptoms. Hypotheses were supported. Results suggest the assessment of a brooding response style may help identify clients who are more likely to contemplate suicide when confronted with life stress.     

Testing a model of suicide ideation in college students

This study examined several risk factors-negative life events (NLE), hopelessness, and depressive symptoms-believed to commonly precipitate suicide ideation in college students. A total of 345 undergraduates participated in the study. Students completed four self-report questionnaires. Hierarchical regression analyses were used to construct a risk model of suicide ideation. This study confirmed depressive symptoms and hopelessness as predictors of suicide ideation in college students; however, NLE impacted suicidal thoughts through hopelessness and depressive symptoms. Interestingly, depressive symptoms exerted a stronger influence on suicide ideation than hopelessness. Hopelessness served as a partial mediator in the relationship between NLE and depressive symptoms; however, depressive symptoms fully mediated the relationship between NLE and hopelessness. Clinical implications for understanding suicide risk in college students are discussed.     

Suicidal Ideation in Elderly Bereaved: The Role of Complicated Grief

This study examined whether symptoms of complicated grief at baseline predicted suicidal ideation during a depressive episode in elderly bereaved individuals. Over a 17-month period, serial ratings of suicidal ideation, hopelessness, and symptoms of depression, anxiety, and complicated grief were obtained from 130 elderly participants who had lost their spouses within the past 2 years. Groups of active and passive suicidal ideators, as well as nonideator controls, were compared via analysis of variance (ANOVA) with respect to levels of complicated grief, depression, and anxiety. Elderly bereaved with both active and passive suicidal ideation were found to have higher symptomatic levels of depression, hopelessness, complicated grief, and anxiety, as well as lower levels of perceived social support, than nonideators at study entry. Fifty-seven percent of the patients with high complicated grief scores were found to be ideators during the follow-up versus 24% of the patients with low complicated grief scores. Patients with any suicidal ideation had higher symptom levels of depression, anxiety, and complicated grief when they were ideators as compared with periods when they denied ideation. Fifteen out of the 39 ideators had recurrent depressive episodes versus 5 of the 91 nonideators. Patients with a history of suicide attempts were more likely to be ideators after loss than other bereaved. Thus, the condition of having high levels of complicated grief symptoms and depressive symptoms appears to make bereaved individuals vulnerable to suicidal ideation. Detection of high levels of complicated grief could help clinicians identify patients who may be at heightened risk for suicide.     

Are Reports of Life Event Stress among Suicidal Youth Subject to Cognitive Bias?

Severity of depressive symptoms, hopelessness, and suicidal ideation were examined to determine whether they were significantly associated with the accuracy of suicidal adolescents' ratings of stressful life events. The sample included 130 inpatient adolescents who endorsed suicide‐related behaviors. Stress interviews were administered, and the severity of stressful events was rated separately by adolescents and an independent team. A residualized cognitive bias score was created by regressing adolescents' severity ratings to the independent team's severity ratings of the same events. Depressive symptoms, but not hopelessness or suicidal ideation, were significantly associated with cognitive bias scores. A negative cognitive bias in adolescents' reports of life stress may be present at higher levels of depression relative to minimal levels of depression. Further research on the relations between stress and suicide‐related behaviors is encouraged to include independent ratings of stress severity.     

Stressful segregation housing and psychosocial vulnerability in prison suicide ideators

Psychosocially vulnerable prisoners under stressful conditions of confinement are ill prepared to cope and at risk for developing suicide intention. The present study examined the relationships of depression, hopelessness, reasons for living, mental health problem history, suicide attempt lethality history, and stressful segregation housing with suicide ideation in 134 prisoners. Prisoners housed in segregation were found to have significantly higher levels of depression and suicide ideation than prisoners in general population. A hierarchical regression model of suicide ideation found significant interactions between mental health problem history, suicide attempt lethality history, and hopelessness with anticipated segregation stress, independent of depressed mood. Results of the study are discussed in terms of the stress-vulnerability model, various methodological limitations, and future research.     

Current suicide ideation and prior suicide attempts of bipolar patients as influences on caregiver burden

We examined whether caregivers of bipolar patients reporting current suicidal ideation and/or a history of a suicide attempt reported higher levels of burden and/or poorer health compared to caregivers of patients without these suicidality indices. In a cross-sectional design, caregivers (N = 480) associated with (a) patients with current suicidal ideation or (b) patients with a positive lifetime history of at least one suicide attempt, reported lower general health scores than caregivers associated with patients with neither of these indices. Parents of patients with at least one lifetime attempt reported more burden secondary to role dysfunction than spouses. Levels of depression in caregivers varied with whether the caregiver was a spouse or a parent, and whether patients had a history of suicide attempts, current suicidal ideation, or both.     

Differentiating Adolescent Suicide Attempters from Ideators: Examining the Interaction between Depression Severity and Alcohol Use

Depressed mood, frequency of alcohol use, and their combination were examined to see if they differentiated nonsuicidal adolescents from those with suicidal ideation and adolescents with suicidal ideation from those who have made a suicide attempt. Hierarchical logistic regressions indicated that frequency of alcohol use did not differentiate nonsuicidal adolescents from those with current suicidal ideation, but severity of depressed mood did so. In contrast, alcohol use was a significant differentiating factor between adolescents who had attempted suicide compared to those with suicidal ideation only, with severity of depressed mood not being significant. However, there was also a significant interaction effect such that for adolescents with suicidal ideation and low levels of depression, increased frequency of alcohol use was associated with increased odds of a suicide attempt. These findings suggest that alcohol use may hasten the transition from suicidal ideation to suicide attempt in adolescents with low levels of depressed mood.     

Emotions and suicidal ideation among depressed women with childhood sexual abuse histories

Depressed women with sexual abuse histories have a heightened risk of suicidal ideation (SI), which may be only in part attributable to psychiatric symptoms of depression and posttraumatic stress disorder (PTSD). Emotions and SI were studied among 106 women with histories of childhood sexual abuse enrolled in treatment trials for major depression. Assessments were conducted at baseline, 10, 24, and 36 weeks. Sadness, guilt, and shame-proneness were associated with self-reported and observer-rated SI across time after adjusting for depressive and PTSD symptoms, suicide attempt history, and sociodemographic characteristics associated with SI. These findings highlight the need for clinical attention to self-directed negative emotions to potentially reduce suicide-related risk.     

The relationship between posttraumatic stress symptomatology and suicidal behavior in school-based adolescents

This study investigated the relationship between posttraumatic stress disorder (PTSD) symptomatology and suicidal behavior, specifically suicidal ideation and suicide attempt history, while controlling for depression and gender in 106 adolescents in an urban high school. Participants completed self-report measures of the Adolescent Psychopathology Scales-Posttraumatic Stress Disorder Subscale (APS-PTS), the APS-Suicide Attempt History (APS-SAH), the Suicidal Ideation Questionnaire-Junior (SIQ-JR), and the Reynolds Adolescent Depression Scale (RADS). Analyses were conducted using a hierarchical multiple regression design to account for the relationship between PTSD symptomatology and depression. Regression results showed that after controlling for depression and gender, PTSD symptomatology was significantly related to suicidal ideation and showed a trend toward suicide attempt history. In addition, adolescents with high levels of PTSD symptomatology were more likely than peers with "average" levels of PTSD symptomatology to be currently thinking about suicide and to have made a past suicide attempt. These findings show that PTSD symptomatology has a unique relationship to adolescent suicidal behavior that cannot be explained by depression or gender. The importance of these results and their implications for future research are discussed.