Proximal Risk Factors for Suicide and Self-Harm in Young Women
Lori Scott, Ph.D., University of Pittsburgh
Mentor: Tina Goldstein, Ph.D., University of Pittsburgh
2015 Young Investigator Grant
Inside the Research
Question: What factors occur close to suicide-related events (SRE) and nonsuicidal self-injury (NSSI)?
Strategy: Employ a 21-day ecological momentary assessment (EMA) protocol to assess momentary fluctuations in SREs, NSSI, shame, anger, and thwarted belongingness in real time.
Impact: Ability to identify who is most at risk and under what conditions.
Suicidal ideation and behavior are influenced by a combination of feelings we have about ourselves and our future (internal affect) and feelings we have about others and the world around us (external affect). Recent life experiences can also contribute. In order to fully understand how suicidal thoughts and behavior emerge – and also go away – individuals must be studied over time.
Ecological momentary assessment (EMA) is a tool that can be used to assess thoughts and behaviors over time, using a smartphone. In a study conducted by Dr. Lori N. Scott at the University of Pittsburgh, EMA was used to look at the specific relationship between participants’ emotions, interpersonal experiences, and suicidal ideation and behavior over time. One way to intervene and prevent suicide is to understand the sequence of thoughts and feelings close to the moment of risk, and learn what role recent interpersonal experiences play leading up to it. This study was one of the first to look at real-time changes in emotions, experiences, and suicidal ideation and behavior.
How, and under what circumstances, do emotions and interpersonal experiences combine to provoke suicidal ideation and behavior?
Dr. Scott recruited 63 young women ages 18-24 from the Pittsburgh Girls study, which was a study that had assessed at-risk girls and women in the community repeatedly over many years. These individuals were known to have impulsive aggressive behavior, which is a risk factor for suicide, so this was an important group to study. Women and men have different avenues to becoming aggressive so it is beneficial to study them separately.
The participants selected for Dr. Scott’s study had experienced suicidal or self-injurious thoughts or behaviors (SITB) in the previous month and were thus considered at-risk for near-term future SITB. Participants were assessed at baseline (meaning the beginning of the study) for depression, self-injurious thoughts and behavior, and personality disorders.
Over a 21-day period, participants responded to six text prompts per day to share the feelings and experiences they had had over the previous 15 minutes, rating the degree to which they experienced each thought or behavior on a scale from one (not at all) to five (extremely). The assessments covered internalizing negative affect (feeling sad, anxious, scared, lonely, ashamed), and externalizing negative affect (feeling angry, hostile, irritable, annoyed, mad). They were also asked about any suicidal ideation and behavior, as well as aggressive behavior, they had experienced. Once per day, they were also asked about their experiences of feeling rejected or of being criticized.
Over the course of the study, 89 percent of the participants reported feeling rejected at least once, and 79 percent reported feeling criticized at least once. In addition, almost 10 percent of their responses to the texts referenced rejection, and seven percent referenced criticism.
With regard to suicidal thoughts and behaviors over the three-week period:
46 percent of participants reported at least one instance of thinking about engaging in non-suicidal self-injury (NSSI; self-harm without any suicide intent);
27 percent reported suicidal ideation;
14 percent reported telling someone they were going to kill themself;
and 4.7 percent reported that they engaged in self-harmful behavior, either NSSI or a suicide attempt
Internalizing negative affects like sadness and guilt were associated with suicidal ideation and behavior, but externalizing negative affects such as anger were not. Negative external feelings were found to be associated with aggressive behavior. This suggests that suicidal ideation and behavior were more associated with the negative feelings people had towards themselves (internal affect) than with their negative feelings towards others (external affect).
In addition, feeling rejected, excluded, abandoned, or left out was related to suicidal ideation and behavior, but feeling insulted or criticized was not related.
- Negative feelings that young women have towards themselves may be a contributor to suicidal ideation and behavior.
- Negative feelings young women have towards others may also be important, but the contribution to suicidal thoughts or behavior is not clear from this study.
- Feelings of rejection can be powerful and contribute to suicidal ideation and behavior.
- Improving social support and emotional coping strategies may be helpful for those at risk.
- These findings provide insights that may be useful for individuals at risk for suicide, to their therapists, and also possibly for the development of future treatment and self-management strategies.