Symposia
Suicide and Self-Injury
Adam Jaroszewski, Ph.D.
Postdoctoral Fellow
Massachusetts General Hospital
Boston, Massachusetts
Millner Alexander, Ph.D.
Director of Mental Health Research
Franciscan Children's Hospital
Brighton, Massachusetts
Samuel Gershman, Ph.D.
Professor
Harvard University
Cambridge, Massachusetts
Matthew Nock, Ph.D.
Professor
Harvard University
Cambridge, Massachusetts
Suicidal thoughts and behavior (STB) represents a crisis of staggering proportions. Prior work suggests that people select suicide primarily to escape aversive contexts (e.g., intolerable emotional pain); however, there are many ways to escape (e.g., drugs, social support), thus it is not clear why some choose suicide specifically. Qualitative data suggest that self-relevant suicide-information per se (e.g., suicidal thoughts, possible suicide methods) pushes/biases people toward escaping via suicide specifically, but this effect has not been experimentally examined.
Using a novel behavioral task, we tested whether self-relevant suicide (vs. positive) pictures biased participants’ decision-making while they attempted to escape an aversive context. Participants (N = 360) had either recently (< 3 months) thought about suicide (n = 120), experienced elevated psychiatric symptoms but no STB (n = 152), or had no STB nor elevated symptoms (n = 88). At baseline, participants completed the task and rated pictures. Suicidal participants completed a follow-up assessment three months later. We used a computational model to capture latent decision-making biases based on task behavior (choice and RT). We expected that the suicide pictures would cause suicidal (but not other) participants to make more impulsive decisions, which would be driven by a stronger latent bias toward the suicide pictures, related to how aversive they seemed.
Bayesian mixed effects regression indicated that suicidal (not psychiatric nor healthy) participants displayed (i) higher impulsivity to the suicide (relative to positive) pictures (ORs = 1.30-1.36, posterior probabilities [pp] = 99.99%) and (ii) a stronger latent bias toward the suicide pictures (OR = 0.83, pp = 93.33%). Perceiving the self-relevant suicide pictures as less aversive was associated with higher risk of suicide attempt at baseline (OR=1.75, pp = 100%) and during follow-up (OR=2.20, pp = 99.5%). These associations were mediated by the latent bias (proportion mediated: 33.2% [baseline], 33.5% [follow-up]).
The way suicidal people perceive self-relevant suicide-information biases how they make decisions while attempting to escape an aversive context, and this bias mediates the association between how bad suicide seems and actually attempting suicide, both in the past and future. This represents a novel STB risk factor and mechanism. Clinical interventions that increase how bad/costly suicide seems might help people who are considering suicide to select more adaptive ways to escape pain.