Modeling suicide risk among parents during the COVID-19 pandemic: Psychological inflexibility exacerbates the impact of COVID-19 stressors on interpersonal risk factors for suicide

Abstract

Public health researchers have raised the concern that both the 2019 coronavirus disease (COVID-19) pandemic and the ensuing public health response will increase interpersonal stressors associated with suicide risk. The Acceptance and Commitment Therapy (ACT) framework conceptualizes psychological flexibility as an important way to reduce the impact of painful and even catastrophic events on psychological suffering. The current study examines psychological flexibility as a potential moderator of the prevailing interpersonal model of suicide risk. METHODS: A sample of 1003 parents (73% female, 82% Caucasian 86% in romantic relationships) were recruited as part of a larger study on the COVID-19 pandemic and family functioning from Mach 27th to the end of April 2020, the height of the United States’ “first wave.” Participants completed measures of psychological flexibility (the Multidimensional Psychological Flexibility inventory; MPFI), interpersonal constructs (perceived burdensomeness and thwarted belongingness), desire for death, COVID-19 related stressors (resource strain and loss due to COVID-19). RESULTS: Moderated-mediation path models highlighted a significant indirect association between COVID-19 stressors and desire for death mediated by perceived burdensomeness to others. This indirect pathway was moderated by psychological inflexibility such that links were strongest at high levels of inflexibility and weak or non-significant at low levels of inflexibility. Results were generally consistent across five of the six facets of inflexibility. DISCUSSION: The findings highlight the value of targeting psychological inflexibility as an important strategy to reduce suicide risk during the COVID-19 pandemic. Implications of patterns of results across different facets for treatment approach are discussed.

The Psychological Functioning in the COVID-19 Pandemic and Its Association With Psychological Flexibility and Broader Functioning in People With Chronic Pain

“…In a study in Italy, 51 PF processes including cognitive defusion, self-as-context, values and committed action were found to moderate the relations between lockdown risk factors and mental health. It was also observed that psychological inflexibility moderated the association between COVID-19 stressors and suicide risks, 13 and the association between social isolation and mental health. 59 Further longitudinal studies including moderation and mediation analysis are needed to understand the PF as a potential mechanism for reducing the impact of the pandemic on people with chronic pain.…”

“…In a study investigating the impact of lockdowns on mental health in Italy, 51 it was found that PF processes, including cognitive defusion, self-as-context, values, and committed action, moderated the impact of lockdown risk factors on COVID-19 peritraumatic distress (distress due to COVID-19 lockdown), general anxiety, and depression. Psychological inflexibility was also found to moderate the association between COVID-19 stressors and suicide risks among parents, 13 as well as the association between social isolation and mental health in the general population. 59 There is also supporting evidence for the association between PF and anxiety disorders.…”

Patterns of Psychological Responses among the Public during the Early Phase of COVID-19: A Cross-Regional Analysis

“…Indeed, several recent studies conducted in Italy [ 37 ], the United Kingdom [ 38 , 39 ], the United States [ 40 , 41 , 42 ], and Poland [ 43 ] have indicated how the facets of psychological flexibility play an important role in mitigating the impacts of the COVID-19 pandemic on mental health [ 37 , 38 , 39 , 40 , 41 , 43 , 44 ]. Of the aforementioned studies, some have further shown that the opposite processes of psychological flexibility, that is, the psychological inflexibility or experiential avoidance were positively associated with parenting stress and family discord [ 44 ], and moderated the suicidal risk in the context of COVID-19 stressors such as resource constraints and loss arising from the pandemic [ 42 ]. In literature, psychological flexibility has been regarded as a typical model of clinical psychological treatment, comprising the psychological processes related to acceptance, mindfulness and committed actions based on values [ 16 , 32 , 45 ].…”

Mechanisms of parental distress during and after the first COVID-19 lockdown phase: A two-wave longitudinal study

“…Although some parents mobilize coping and resilience strategies in the face of the COVID-19 threats [1,2], some are at risk of experiencing worsened mental health problems or developing new stress-related disorders [3,4]. The initial evidence obtained indicating how the ongoing pandemic has negatively affected the health and well-being of parents and children [4][5][6][7][8][9][10] probably barely scratches the surface of the potential long-term effects of the pandemic on families' health and well-being. These problems may continue even after the pandemic has abated and the distancing measures have been lifted due to self-sustaining processes.…”