Cognition and Suicide

Abstract

We have brought together a compilation, and analyses, of research conducted by cognitive psychologists, and specialists in the field of suicide, and the ideation of suicide. The research articles analyzed used various research methods for the studies, and encompassed a diverse array of theories as to the cognitive processes that lead to suicide. Or at the very least, the ideation of the act of suicide. What are the influences, disorders, or traumas that could lead someone to create the judgement in their mind that their life is no longer worth living? What do we now know about the connection between cognition and suicide? And what more is there to learn about this issue in order to better understand, and possibly make a difference in people's lives.

Cognition and Suicide

Our biggest questions and concerns for this research was to seek an understanding of suicide attempts and suicidal ideation and the cognitions that affect this type of behavior. Additionally, we wanted to find out what treatments are available out there that may help an individual who struggles with thoughts of suicide, or may be in the process of or have attempted suicide in the past. Suicide, according to the Webster dictionary, is the act or an instance of taking one's own life voluntarily and intentionally. What is the leading cause for a person to decide that they want to end their life and what additional cognitions lead to the action itself? Not surprisingly, we found that much research has been conducted on soldiers and veterans of the United States armed forces and though we are fully aware that suicide is a global problem not limited to soldiers and victims of trauma alone, we still believe the following studies open a window of understanding into the complicated cognitive process that leads to suicide and suicidal ideation.

In the research done by Shelef, Fruchter, Mann, & Yacobi, (2014), they were seeking to develop more effective intervening and screening processes. They discuss two different theories regarding cognition. The first theory, or model, is known as the interpersonal (IP) theory. This model suggests three components that must be in play for the individual to engage in suicidal behavior. The three are as follows: A sense that one does not belong to a significant social group, which leads to low belonging and loneliness; the sense that one has become a burden on others, which is perceived burdensomeness; and the third is an acquired ability to inflict serious, and quite lethal, self-injury, known as habituation. The second theory, or model, is known as the cognitive-deficit model. This model proposes that persons with difficulties in problem solving will find it harder to decide on effective solutions to situations that are life threatening while experiencing stress. Especially if they are emotionally sensitive at the time. Consequently, the individual might become overwhelmed by hopelessness and helplessness, feel trapped, and decide that suicide is the only way out (Dour, Cha, & Nock ; Labelle, Breton, Pouliot, Dufresne, & Berthiaume, 2012). The article also states that the deficiencies fall into two categories; the cognitive field, whereby cognitive rigidity hinders the identification of alternative solutions (Labelle, Breton, Pouliot, Dufresne, & Berthiaume, 2012); and the emotional“experiential field which is in regards to the perception of a problem as a challenge or a threat (Orbach, Mikuilincer, Gilboa-Schectman, Rigolsky, & Retzoni, 2007). The study was seeking to combine variable from the two aforementioned theories so that a better understanding of their relationship to the severity of suicidal ideation might be realized. The study population consisted of 103 participants, which was comprised of 66 males, and 37 females. All subjects were regular military service between the ages of 18-21 years, with the average age being 19.7 years. The participants were divided into three groups: suicide attempters (SA group, n=32); psychologically treated subjects (PT group, n=38); control group (C group, n=33). Data was garnered by the use of self-report surveys, and was collected by several measurement tools. The study found that suicide attempters did have negative emotion regulation, and difficulty in problem solving when compared to their peers. They also experienced more pronounced feelings of burdensomeness and suicidal ideation. Both of the suicide attempter groups and the psychologically treated groups' participants suffered from similar feelings of loneliness and the perception that the life problems were a threat. This greatly differed from the control group. It should be noted that the study found that habituation was the only variable that was the same across the board. In conclusion, the study found that while poor problem-solving capabilities may lead to a sense of helplessness and hopelessness, this not the complete picture. The difficulties with problem solving is enmeshed with the inability to regulate emotions, and the sense that one is isolated and a burden upon others. This complex of cognitions may not only lead a person to the inability to find possible solutions, but the added sense that there is no one that they can turn to for help. Thus, leaving them with only one viable solution, suicide. Lastly, while loneliness may seem to be a factor in general, but not actually in the area of suicide attempts; it can be a predictor of suicidal ideation severity when combined with all of the aforementioned factors. This would be especially true with the severe episode, and the prediction of suicide.

Sivak, Swartz, & Swenson (1999) looked at Post Traumatic Stress Disorder (PTSD) and the methods used by victims to survive during periods of suicidal ideation. The main argument of the article is that there are methods used by veterans diagnosed with PTSD that allow them to stave off their commitment to attempt suicide. These are called, Counter Suicidal Cognitions. This study examines the frequency of suicidal ideation, how often the participant may share these cognitions with another person, and the counter-suicidal cognitions they may employ to keep them from committing suicide. The article goes on to assert that this is what clinicians should focus on as a means to intervene when a patient is in a state of suicidal ideation. One of the main points of the authors was that there are two types of suicidal ideation; There is chronic suicidal ideation (CSI), which is ongoing and passing in nature meaning the person may be living with this for a long period of time, but never actually attempts suicide. Therefore, these patients are not necessarily in need of hospitalization. Then there is suicidal ideation that is acute and active; the latter which is the type that leaves a patient in imminent danger of killing themselves which is considered to be more dangerous because it is a spur of the moment thing that can lead to a bad decision driven by an impulse. Another main point that was stated in the article is that there is a high incidence of anxiety disorders, PTSD in particular, in relation to the group of completed suicides (Lehmann, Mc Cormick, &Mc Cracken, 1995). It has also been found that veterans that have been wounded in combat or experienced physical injury have increased suicidal behavior (Bullman & Kang, 1996). The article goes on to mention that these findings are not solely related to veterans. Victims of sexual and physical violence, tragic accidents, and natural disaster survivors experience similar ongoing anxiety and feeling of intrusion. These reactions can draw an unusual amount of emotional and cognitive energy from the sufferer, energy that one needs to exist on a day to day basis. Another idea is that patients with a chronic form of PTSD can commonly have other difficulties such as substance abuse, mood disorders, other anxiety disorders, and somatoform disorders.

In regards to the counter-suicidal cognitions, there were some examples listed in this article, these include, but are not limited to, thinking about friends and family in one's life; others relied on their beliefs, faith, spirituality, or religion to keep them from hurting themselves. A very small amount of people relied on thoughts of financial responsibilities and work to help them avoid a suicide attempt. Lastly, there are a good percentage who claim to not use any counter-suicidal cognitions to keep them from hurting themselves. There were 100 participants, all male, and the study was conducted by having the participants complete a survey that inquired as to past and present suicidality, coping strategies, and suicidal ideations. Information garnered by the survey included behavioral responses to suicidal cognitions, counter-suicidal cognitions which illustrated their usual coping cognitions, and help seeking methods employed while experiencing suicidal cognitions. The type of survey was a self-rating survey, which took approximately 10 minutes to complete. The study confirmed that there is a relationship between chronic PTSD and suicidal ideation. Also, that the participants did not normally discuss their ongoing suicidal thinking with anyone. The study also found that with this population of military veterans, many comorbid diagnoses are connected to feelings of hopelessness that may already be present. Lastly, the study found that since the participants rarely spoke of their suicidal ideations, it is prudent for the clinician to discuss counter-suicidal cognitions with them, instead of discussing suicide, when evaluating safety.

In conclusion, our analysis of the aforementioned research articles led us to find that chronic suicidal ideation can be something a person may be living with for a prolonged period of time, however, it does not necessarily have to lead to the act of suicide itself. Rather, other maladaptive cognitions such as feelings of hopelessness that may be triggered by PTSD, and other anxiety disorders, were the ones which put a person at a higher risk of suicidal ideation and suicide attempts. There were some encouraging observations that were discovered during this analysis. Counter-Suicidal Cognitions are a method by which a person can persevere through times of suicidal ideation, and the related cognitive processes. Lastly, one thing that must be noted is that the studies we are presenting are conducted mainly on soldiers and veterans in the United States which are predominantly male; and no studies on general populations that include women or teenagers were included in this paper.

References

Bullman, T.A. & Kang, H.K. (1996). The risk of suicide among combat wounded veterans. American Journal of Public Health, 86, 662-667.

Dour, H.J., Cha, C.B., Nock. M.K., Evidence for an emotion-cognition interaction in the statistical prediction of suicide attempts. Behavior Research and Therapy, 49 (4), 294-298

Labelle, R., Breton, J.J., Pouliot, L., Dufresne, M.J., Berthiaume, C., (2013), Cognitive correlates of serious suicidal ideation in a community sample of adolescents Journal of Affective Disorders, 145 (3) 370-377

Lehmann, L., McCormick, R., & McCracken, L. (1995). Suicidal behavior among patients in the

VA health care system. Psychiatric Services, 46, 1069-1071.

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Orbach, I.B., Mikulincer, R., Gilboa-Schechtman, M., Rogolsky, E., Retzoni, M., (2007)

Perceiving a problem-solving task as a threat and suicidal behavior in adolescents

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Shelef, L., Fruchter, E., Mann, J.J., & Yacobi, A. (2014). correlations between interpersonal and cognitive difficulties: Relationship to suicidal ideation in military suicide attempters. European Psychiatry, 269(8), 498-502. doi:10.1016/j.eurpsy.2014.01.006

Sivack, J., Swartz, J.L., & Swenson, D.X. (1999). PTSD and chronic suicidal ideation: the role of counter suicidal cognition. US: Academy of Traumatology, 5(3), 1-6. doi:10.1177/153476569900500301

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