Toward an Integrative Model of Suicide Attempt: A Cognitive Psychological Approach

Abstract

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.

Evaluation of clinical prognostic models for suicide attempts after a major depressive episode

“…This increased predictive power is likely due to the inclusion of complementary information from multiple variables and to the more complex functional form of these models. This finding is in agreement with previously published studies that show that risk factors can modify each other's effects (15,13,(26)(27)(28)(29)(30)(31), and supports the need for complex theoretical models of suicidal behavior (22) that include multiple factors that mediate and moderate each other's effect.…”

Daily hassles and suicide ideation in African-American female suicide attempters: moderating effect of spiritual well-being

“…Our results may have clinical implications for working with suicidal individuals, in general, but particularly for African-American, female attempters. It may be assumed that suicide attempters are already at a disadvantage with regard to coping, as they often have poor problem-solving, interpersonal and emotion regulation skills (Dieserud, Roysamb, Ekeberg, & Kraft, 2001;Pollock & Williams, 2001). Our results indicate that, for our sample of African-American suicide attempters, perhaps a lack of spiritual well-being contributes to vulnerability to the demands of everyday life.…”

The role of moral objections to suicide in the assessment of suicidal patients

“…Rather, these studies found that the relationship is mediated by suicidal ideation. That is, suicidal ideation is influenced by level of hopelessness and suicidal ideation influences risk of suicide attempt (Valtonen et al, 2005;Sokero et al, 2003;Dieserud et al, 2001). However, it is important to note that literature in this area has been inconsistent.…”