Preliminary Evidence Suggests Suicidal Thinking Is Self-Reinforcing

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Suicidal thinking may influence affect in a reinforcing manner, partially explaining its persistent nature in subsets of patients.
Suicidal thinking may influence affect in a reinforcing manner, partially explaining its persistent nature in subsets of patients.

The findings of a preliminary, real-time monitoring study published in the Journal of Affective Disorders suggest that suicidal thinking is reinforcing as a result of shifts in affect that follow suicidal thoughts.

For this study, the authors employed a smartphone-based ecological momentary assessment to observe changes in affect. This set the study apart from previous research, which historically relied on patient recall.

The authors recruited 43 adults (78% female, 78% white, average age 23.28 years) on reddit.com message boards related to suicide. Participants were fluent in English, had access to a smartphone, and had ≥1 suicide attempt in the year before index.

For 28 days, participants were prompted 4 times a day to assess themselves on the Positive and Negative Affect Schedule, plus some suicide-specific items. Follow-up data were collected 4 to 8 hours after each report. Participants also had the option to initiate their own reports at any time of suicidal thinking or nonsuicidal self-injury.

Analyses demonstrated a significant downward shift in the survey item "sad" (P =.01), and significant upward shifts in "active" (P =.01) and the overall Positive Affect Composite (P =.03).

Although the preliminary study was novel in its design, the authors noted its limitations, such as a single follow-up window of 4 to 8 hours.

They also pointed to previous research on diurnal mood, which has suggested that fluctuations in affect occur naturally. Thus, the changes in affect that participants reported might not be related to suicidal thinking.

"Taken together, [these findings] might mean that increases in negative affect and decreases in positive affect drive increases in suicidal thinking and as negative affect subsides and positive affect increases...suicidal thinking also subsides," the authors concluded.

Reference

Kleiman E, Coppersmith D, Millner A, et al. Are suicidal thoughts reinforcing? A preliminary real-time monitoring study on the potential affect regulation function of suicidal thinking. J Affect Disord. 2018;232:122-126.

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