Skip to main content
SpringerLink
Log in

Stress-Related Symptoms and Suicidal Ideation: The Roles of Rumination and Depressive Symptoms Vary by Gender

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

There is a growing body of literature suggesting that reactions to stressful life events, such as intrusive thoughts, physiological hyperarousal, and cognitive/behavioral avoidance (i.e., stress-related symptoms) may increase risk for thinking about and attempting suicide. Cognitive vulnerability models have identified rumination (i.e., perseverating on a negative mood) as a maladaptive response that may increase risk for suicidal behavior, as it has also been linked to depression. The present study examined the direct and indirect effects of stress-related symptoms on suicidal ideation through rumination and depressive symptoms. Participants were 1375 young adults, primarily non-White (78 %) females (72 %), recruited from a public university in the Northeastern U.S., who completed measures of stress-related symptoms (as a response to a stressful event), rumination, depressive symptoms, and suicidal ideation. The relation between stress-related symptoms and suicidal ideation was accounted for by the brooding subtype of rumination and depressive symptoms among females. Depressive symptoms, but not rumination, better accounted for suicidal ideation among males. These findings suggest that the role of brooding and depressive symptoms in the relationship between stress-related symptoms and suicidal ideation may vary by gender.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. To rule out moderation (vs. mediation), a linear regression analysis was conducted to examine brooding as a potential moderator of the relation between stress-related symptoms and suicidal ideation, adjusting for age and gender. There was a significant main effect of stress-related symptoms (b = 0.005, 95 % CI 0.002–0.007, p < .001), and a significant main effect of brooding (b = 0.04, 95 % CI 0.03–0.05, p < .001) on suicidal ideation. However, the interaction between stress-related symptoms and brooding was not significant (b = 0.0001, 95 % CI −0.0003 to 0.0006, p = .46).

  2. A linear regression analysis was conducted to examine reflection rumination as a potential moderator of the relation between stress-related symptoms and suicidal ideation, adjusting for age and gender. There was a significant main effect of stress-related symptoms (b = 0.007, 95 % CI 0.005–0.009, p < .001), and a significant main effect of reflection (b = 0.02, 95 % CI 0.01–0.03, p < .001). However, the interaction effect between stress-related symptoms and reflection was not significant (b = 0.0002, 95 % CI −0.0003–0.001, p = .48).

References

  • Abramson, L. Y., Alloy, L. B., Hogan, M. E., Whitehouse, W. G., Cornette, M., Akhavan, S., & Chiara, A. (1998). Suicidality and cognitive vulnerability to depression among college students: A prospective study. Journal of Adolescence, 21, 473–487.

    Article  CAS  PubMed  Google Scholar 

  • Abramson, L. Y., Alloy, L. B., Hogan, M. E., Whitehouse, W. G., Donovan, P., Rose, D. T., et al. (1999). Cognitive vulnerability to depression: Theory and evidence. Journal of Cognitive Psychotherapy, 13, 5–20.

    Google Scholar 

  • American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (DSM-IV-TR). American Psychiatric Pub.

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory-II. San Antonio, TX: The Psychological Corporation.

  • Blanco, C., Okuda, M., Wright, C., Hasin, D. S., Grant, B. F., Liu, S. M., & Olfson, M. (2008). Mental health of college students and their non-college-attending peers: Results from the national epidemiologic study on alcohol and related Conditions. Archives of General Psychiatry, 65, 1429–1437.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research, 60, 113–124.

    Article  PubMed  Google Scholar 

  • Burke, T. A., Connolly, S. L., Hamilton, J. L., Stange, J. P., Abramson, L. Y., & Alloy, L. B. (2015). Cognitive risk and protective factors for suicidal ideation: A two-year longitudinal study in adolescence. Journal of Abnormal Child Psychology. doi:10.1007/s10802-015-0104-x.

  • Centers for Disease Control and Prevention. (2013). U.S. Department of Health and Human Services. Retrieved on January 5, 2015 from http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html

  • Chan, S., Miranda, R., & Surrence, K. (2009). Subtypes of rumination in the relationship between negative life events and suicidal ideation. Archives of Suicide Research, 13, 123–135.

    Article  PubMed  Google Scholar 

  • Conner, K. R., Meldrum, S., Wieczorek, W. F., Duberstein, P. R., & Welte, J. W. (2004). The association of irritability and impulsivity with suicidal ideation among 15- to 20-year-old males. Suicide and Life-Threatening Behavior, 34, 363–373.

    Article  PubMed  Google Scholar 

  • Dumais, A., Lesage, A. D., Alda, M., Rouleau, G., Dumont, M., Chawky, N., et al. (2005). Risk factors for suicide completion in major depression: A case-control study of impulsive and aggressive behaviors in men. American Journal of Psychiatry, 162, 2116–2124.

    Article  CAS  PubMed  Google Scholar 

  • Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.

    Article  CAS  PubMed  Google Scholar 

  • Elwood, L. S., Hahn, K. S., Olatunji, B. O., & Williams, N. L. (2009). Cognitive vulnerabilities to the development of PTSD: A review of four vulnerabilities and the proposal of an integrative vulnerability model. Clinical Psychology Review, 29, 87–100.

    Article  PubMed  Google Scholar 

  • Gold, D. B., & Wegner, D. M. (1995). Origins of ruminative thought: Trauma, incompleteness, nondisclosure, and suppression. Journal of Applied Social Psychology, 25, 1245–1261.

    Article  Google Scholar 

  • Grover, K. E., Green, K. L., Pettit, J. W., Monteith, L. L., Garza, M. J., & Venta, A. (2009). Problem solving moderates the effects of life event stress and chronic stress on suicidal behaviors in adolescence. Journal of Clinical Psychology, 65(12), 1281–1290.

    Article  PubMed  Google Scholar 

  • Hayes, A. F. (2013). An introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press.

    Google Scholar 

  • Jaccard, J. (2001). Interaction effects in logistic regression. Thousand Oaks, CA: Sage.

    Book  Google Scholar 

  • Kessler, R. C., Berglund, P., Borges, G., Nock, M., & Wang, P. S. (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. Journal of the American Medical Association, 293, 2487–2495.

    Article  CAS  PubMed  Google Scholar 

  • King, R. A., Schwab-Stone, M., Flisher, A. J., Greenwald, S., Kramer, R. A., Goodman, S. H., et al. (2001). Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 837–846.

    Article  CAS  PubMed  Google Scholar 

  • Kraemer, H. C., Stice, E., Kazdin, A., Offord, D., & Kupfer, D. (2001). How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. American Journal of Psychiatry, 158, 163–171.

    Article  Google Scholar 

  • Linehan, M. M., & Nielsen, S. L. (1981). Assessment of suicide ideation and parasuicide: Hopelessness and social desirability. Journal of Consulting and Clinical Psychology, 49, 773.

    Article  CAS  PubMed  Google Scholar 

  • Marshall, R. D., Olfson, M., Hellman, F., Blanco, C., Guardino, M., & Struening, E. L. (2001). Comorbidity, impairment, and suicidality in subthreshold PTSD. American Journal of Psychiatry, 158, 1467–1473.

    Article  CAS  PubMed  Google Scholar 

  • Mazza, J. J. (2000). The relationship between posttraumatic stress symptomatology and suicidal behavior in school-based adolescents. Suicide and Life-Threatening Behavior, 30, 91–103.

    CAS  PubMed  Google Scholar 

  • Miranda, R., & Nolen-Hoeksema, S. (2007). Brooding and reflection: Rumination predicts suicidal ideation at 1-year follow-up in a community sample. Behaviour Research and Therapy, 45, 3088–3095.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morrison, R., & O’Connor, R. C. (2008). A systematic review of the relationship between rumination and suicidality. Suicide and Life-Threatening Behavior, 38, 523–538.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal behavior. Epidemiologic Reviews, 30, 133–154.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nolen-Hoeksema, S., Larson, J., & Grayson, C. (1999). Explaining the gender difference in depressive symptoms. Journal of Personality and Social Psychology, 77, 1061.

    Article  CAS  PubMed  Google Scholar 

  • Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3, 400–424.

    Article  PubMed  Google Scholar 

  • Oquendo, M. A., Sullivan, G. M., Sudol, K., Baca-Garcia, E., Stanley, B. H., Sublette, M. E., & Mann, J. J. (2014). Toward a biosignature for suicide. American Journal of Psychiatry, 171, 1259–1277.

    Article  PubMed  PubMed Central  Google Scholar 

  • Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8, 443–454.

    Article  CAS  PubMed  Google Scholar 

  • Pettit, J. W., & Joiner, T. J. (2006). Cognitive vulnerability to suicide. In L. B. Alloy, J. H. Riskind, L. B. Alloy, & J. H. Riskind (Eds.), Cognitive vulnerability to emotional disorders (pp. 125–154). Mahwah, NJ: Lawrence Erlbaum Associates Publishers.

    Google Scholar 

  • Polanco-Roman, L., Jurska, J., Quiñones, V., & Miranda, R. (2015). Brooding, reflection, and distraction: Relation to non-suicidal self-injury versus suicide attempts. Archives of Suicide Research, 19, 350–365.

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavioral Research Methods, 40, 879–891.

    Article  Google Scholar 

  • Selaman, Z. M., Chartrand, H. K., Bolton, J. M., & Sareen, J. (2014). Which symptoms of post-traumatic stress disorder are associated with suicide attempts? Journal of Anxiety Disorders, 28, 246–251.

    Article  PubMed  Google Scholar 

  • Smith, J. M., Alloy, L. B., & Abramson, L. Y. (2006). Cognitive vulnerability to depression, rumination, hopelessness, and suicidal ideation: Multiple pathways to self-injurious thinking. Suicide and Life-threatening Behavior, 36, 443–454.

    Article  PubMed  Google Scholar 

  • Surrence, K., Miranda, R., Marroquin, B. M., & Chan, S. (2009). Brooding and reflective rumination among suicide attempters: Cognitive vulnerability to suicidal ideation. Behaviour Research and Therapy, 47, 803–808.

    Article  PubMed  Google Scholar 

  • Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27, 247–259.

    Article  Google Scholar 

  • Wang, Y., Sareen, J., Afifi, T. O., Bolton, S. L., Johnson, E. A., & Bolton, J. M. (2012). Recent stressful life events and suicide attempt. Psychiatric Annals, 42(3), 101–108.

  • Weiss, D. S. (2007). The impact of event scale: Revised. In J. P. Wilson, & C. S. Tang (Eds.), Cross-cultural assessment of psychological trauma and PTSD (pp. 219–238). New York, NY, US: Springer Science + Business Media.

  • Wenzel, A., & Beck, A. T. (2008). A cognitive model of suicidal behavior: Theory and treatment. Applied and Preventive Psychology, 12, 189–201.

    Article  Google Scholar 

  • Wu, K., Zhang, Y., Liu, Z., Zhou, P., & Wei, C. (2015). Coexistence and different determinants of posttraumatic stress disorder and posttraumatic growth among Chinese survivors after earthquake: Role of resilience and rumination. Frontiers in Psychology, 6(1043), 1–9.

    Google Scholar 

  • Zetsche, U., Ehring, T., & Ehlers, A. (2009). The effects of rumination on mood and intrusive memories after exposure to traumatic material: An experimental study. Journal of Behavior Therapy and Experimental Psychiatry, 40, 499–514.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This study was funded, in part, by National Institutes of Health/National Institute of General Medical Sciences (Grant Number GM056833).

Author information

Authors and Affiliations

  1. Department of Psychology, The Graduate Center, CUNY, 365 Fifth Avenue, New York, NY, 10016, USA

    Lillian Polanco-Roman, Regina Miranda & Elizabeth Jeglic

  2. Department of Psychology, City College of New York, CUNY, New York, NY, USA

    Lillian Polanco-Roman

  3. Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Judelysse Gomez

  4. Department of Psychology, Hunter College, CUNY, New York, NY, USA

    Regina Miranda

  5. Department of Psychology, John Jay College of Criminal Justice and The Graduate Center, CUNY, New York, NY, USA

    Elizabeth Jeglic

Authors
  1. Lillian Polanco-Roman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Judelysse Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Regina Miranda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth Jeglic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lillian Polanco-Roman.

Ethics declarations

Conflict of Interest

Lillian Polanco-Roman, Judelysse Gomez, Regina Miranda and Elizabeth Jeglic declare that they have no conflict of interest.

Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual subjects participating in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Polanco-Roman, L., Gomez, J., Miranda, R. et al. Stress-Related Symptoms and Suicidal Ideation: The Roles of Rumination and Depressive Symptoms Vary by Gender. Cogn Ther Res 40, 606–616 (2016). https://doi.org/10.1007/s10608-016-9782-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-016-9782-0

Keywords

Search

Navigation