1. Do differences in suicide risk factors differentiate between suicide ideators and attempters?: An Examination of well-established suicide risk factors within the Ideation to Action Framework
Lauren R. Khazem, M.A. & Michael D. Anestis, Ph.D.
The University of Southern Mississippi
INTRODUCTION
RESULTS OF UNIVARIATE ANALYSES
DATA ANALYSIS
Limited research has examined whether well-established suicide risk factors facilitate the transition from suicidal ideation to attempts (“ideation to action”) within the framework of the Interpersonal Theory of Suicide (ITS) 1
Perceived burdensomeness-beliefs of being a burden to others
Thwarted belongingness- beliefs of lacking close relationships
Painful and provocative events- events allowing individuals to acquire the capability to make a suicide attempt
Fearlessness about death- fearlessness about death and bodily harm
Painful and provocative events and fearlessness about death are posited to facilitate the transition from suicidal ideation to attempts.
The extent to which emotion dysregulation differentiates those with prior attempts from those with only prior ideation warrants investigation.
Risk factors for suicide attempts may be more indicative of suicidal ideation.
A multivariate analysis of covariance (MANCOVA) with contrasts analyses adjusted for multiple comparisons was conducted using SPSS to examine differences in the variables of interest between controls, ideators, and attempters.
Depression, emotion dysregulation, thwarted belongingness, perceived burdensomeness, fearlessness about death, and lifetime exposure to PPEs each served as outcome variables in the analysis.
Full Sample
Controls
Ideators
Attempters M
(SD) M(
SD) F p
pη2
Depressive
Symptoms
11.00 (11.48)
4.75
(6.58)
14.02 (11.55)
16.05
(12.59)
38.51
<.001
0.13
Emotion
Dysregulation
81.35
(25.77)
63.19
(21.17)
86.78
(22.64)
92.76
(26.42)
31.56
0.55
Perceived
Burdensomeness
12.65
(8.68)
8.75
(5.21)
14.36
(9.64)
15.95
(9.39)
23.84
0.05
Thwarted
Belongingness
27.99
(14.29)
20.71
(10.90)
32.09
(14.50)
33.37
(14.08)
30.39
0.17
Fearlessness
About Death
12.29
(7.81)
10.95
(7.56)
13.40
(7.76)
14.91
(7.63)
6.91
.001
0.01
Painful and Provocative
Events
43.13
(10.51)
40.31
41.38
(8.83)
48.07
(11.15)
24.08
0.08
RESULTS
Results of the omnibus test were significant
(Wilks’ Lambda F(12,730) = 12.33, p<0.001).
Compared to controls, ideators reported greater mean levels of depressive symptoms, emotion dysregulation, perceived burdensomeness, thwarted belongingness, and fearlessness about death.
Compared to controls, attempters reported greater mean levels of depressive symptoms, emotion dysregulation, perceived burdensomeness, thwarted belongingness, fearlessness about death, and painful and provocative events.
Compared to ideators, attempters only reported significantly greater mean levels of painful and provocative events.
The current study aimed to examine which risk factors differentiate ideators from attempters in a diverse sample of individuals with various histories of suicidal ideation and behavior.
We hypothesized:
Controls (no past suicidal ideation and/or attempts) would exhibit lower levels of depressive symptoms and a range of other well-established suicide risk factors (perceived burdensomeness, thwarted belongingness, emotion dysregulation) when compared to individuals with suicidal ideation only (ideators) and those with a history of previous suicide attempts (attempters).
These between group differences would be not be present between ideators and attempters.
Suicide attempters would exhibit higher levels of lifetime Painful and Provocative events and fearlessness about death relative to ideators.
OBJECTIVES AND HYPOTHESIS
RESULTS OF CONTRASTS
Controls vs.
Ideators
Attempters
Ideators vs.
Depressive
Symptoms
p<.001
(Ideators)
(Attempters)
Not significant
Emotion
Dysregulation
Perceived
Burdensomeness
Thwarted
Belongingness
Fearlessness
About Death
p=.04
Painful and Provocative
Events
IMPLICATIONS
Factors theorized as associated with suicidal ideation but not the capability for suicide may only be well suited as risk factors for suicidal ideation, consistent with previous research
Fearlessness about death may be distinct from the acquired capability for suicide or facilitates the capability to attempt suicide in conjunction with other aspects of capability (e.g. familiarity with means, elevated pain tolerance).
Future research should focus on further identifying factors prompting the transition from suicidal ideation to suicide attempts.
Incorporating such factors in suicide risk assessments may allow clinicians to better identify those at greatest risk of death by suicide
Participants
378 adults recruited through Amazon mTurk
39.7% controls; 32.5% ideators, 27.8% attempters)
Mage = 36.09, SD = 10.69
54.8% female
75.10% White; 9.80% Asian/Pacific Islander; 8.20% African American).
13.5% with suicidal ideation
Measures
Self-Injurious Thoughts and Behaviors Interview2
Interpersonal Needs Questionnaire3
Acquired Capability for Suicide Scale-Fearless About Death4
Painful and Provocative Events Scale5
Difficulties in Emotion Regulation Scale6
Depression Anxiety Stress Scale7
Demographic covariates: Age, race, gender, family income, and sexual orientation
METHOD
NOTE: Groups in parentheses were indicated as having significantly higher mean levels
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REFRENCES
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Lovibond, P.F. & Lovibond, S.H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav. Res. Ther. 33 (3), 335– doi.org/ /0005–7967(94)00075-U.Lynch,
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