(PS2-A3) The Role of Emotion Dysregulation in Suicide Ideation and Attempts

Suicide is a leading cause of death, yet meaningful improvements in suicide prediction remain elusive despite decades of studies. Research has begun disentangling the role of emotion dysregulation (ED) in the suicide ideation-to-action framework, which acknowledges that the development of suicidal ideation (SI) and the transition to suicide attempts (SA) are distinct processes. Higher ED has been linked to increased SI, including SI intensity. However, the role of ED in SA is mixed, with varying reports of positive, neutral, and even negative associations. Moreover, not many studies have investigated aborted or interrupted SA, which may relate to ED. Based on the assertion that some individuals with high ED may be more prone to engage in suicidal behavior, this study aimed to investigate the associations between SI, ED, and SA in a cross-sectional sample.

Data were collected through an online self-report survey assessing suicidal thoughts and behaviors among individuals calling the Crisis Support Services of Nevada, a national lifeline call center. ED was measured with the Difficulties of Emotion Regulation Scale (DERS), and SI and SA were assessed with the Columbia Suicide Severity Rating Scale (CSSRS). Specifically, SI intensity was calculated by summing SI frequency, duration, and controllability, while lifetime SA, aborted SA, and interrupted SA were all dichotomously coded as present or absent. A series of linear and logistic regressions were conducted. Coefficients in logistic regression models were exponentiated and interpreted as odds ratios (OR).

The sample (N=224) was predominantly female (61%), with an average age of 30.9 (SD=11.94). SI intensity was a significant predictor of SA (OR=1.19, p< 0.001), aborted SA (OR=1.16, p< 0.001), and interrupted SA (OR=1.19, p< 0.001). ED significantly predicted SI intensity (p< 0.001, R²=0.12), SA (OR=1.02, p=0.02), and aborted SA (OR=1.02, p=0.04), but not interrupted SA (p >0.05). In multivariate logistic regression models with both SI and ED, SI significantly predicted SA (OR=1.18, p< 0.001), interrupted SA (OR=1.2, p< 0.001), and aborted SA (OR=1.14, p=0.002), while ED was not a significant predictor in any models (all p > 0.05). Moderated logistic regressions showed that ED was not a significant moderator of SI intensity on either SA, aborted SA, or interrupted SA (all p > 0.05), although the significance was trending for aborted SA (p=0.07).

ED was not a significant moderator of SI intensity on any SA, suggesting that the effect of SI intensity on the likelihood of lifetime SA, aborted SA, or interrupted SA does not depend on levels of ED. This study is still in ongoing data collection, and a larger sample may be necessary to detect moderation effects. Nevertheless, SI intensity was a significant predictor of SA, suggesting that more intense SI, as characterized by frequency, duration, and controllability, plays an important role in attempting suicide. Moreover, ED was a significant predictor of SI intensity and SA, showing that difficulties in regulating emotions are an important factor in the intensity of suicidal thoughts and suicide attempts. Interestingly, higher ED was also associated with a higher likelihood of aborted SA, and future research should further explore this relationship.