Abstract
Suicide rates are elevated in individuals with chronic illness, yet few studies have examined risk factors for suicide in this population. Drawing from theoretical models and risk factors identified in the suicide literature more broadly, this article provides a conceptual overview of cognitive (e.g., pain catastrophizing, self-criticism), affective (e.g., emotion dysregulation), interpersonal (e.g., perceived burdensomeness, thwarted belongingness, critical expressed emotion), and behavioral factors that may contribute, at least in part, to the link between chronic illness, and illness-specific factors, and suicidal thoughts and behaviors. We also outline several avenues for future research in this area and provide specific considerations and recommendations for the screening, assessment, and initial intervention of suicide risk within individuals with chronic health conditions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ahmedani, B. K., Peterson, E. L., Hu, Y., Rossom, R. C., Lynch, F., Lu, C. Y., … & Simon, G. E. (2017). Major physical health conditions and risk of suicide. American Journal of Preventive Medicine, 53, 308–315. https://doi.org/10.1016/j.amepre.2017.04.001
Akechi, T., Okuyama, T., Sugawara, Y., Nakano, T., Shima, Y., & Uchitomi, Y. (2004). Suicidality in terminally ill Japanese patients with cancer. Cancer, 100, 183–191. https://doi.org/10.1002/cncr.11890
Ali, S., Stone, M. A., Peters, J. L., Davies, M. J., & Khunti, K. (2006). The prevalence of co-morbid depression in adults with Type 2 diabetes: A systematic review and meta-analysis. Diabetic Medicine, 23, 1165–1173. https://doi.org/10.1111/j.1464-5491.2006.01943.x
Aliu, O., & Chung, K. C. (2012). Assessing strength of evidence in diagnostic tests. Plastic and Reconstructive Surgery, 129, 989–998. https://doi.org/10.1097/PRS.0b013e31824ecd61
APA Work Group on Suicidal Behaviors. (2003). Practice guideline for the assessment and treatment of patients with suicidal behaviors. The American Journal of Psychiatry, 160, 1–60.
Assessment and Management of Risk for Suicide Working Group, Department of Veterans Affairs/Department of Defense. (2013). VA/DoD clinical practice guideline for assessment and management of patients at risk for suicide. https://www.healthquality.va.gov/guidelines/MH/srb/VADODCP_SuicideRisk_Full.pdf.
A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84, 30–36. https://doi.org/10.1159/000365764
Awang, H., Mansor, N., Nai Peng, T., & Nik Osman, N. A. (2018). Understanding ageing: Fear of chronic diseases later in life. The Journal of International Medical Research, 46, 175–184. https://doi.org/10.1177/0300060517710857
Bakhiyi, C. L., Calati, R., Guillaume, S., & Courtet, P. (2016). Do reasons for living protect against suicidal thoughts and behaviors? A systematic review of the literature. Journal of Psychiatric Research, 77, 92–108. https://doi.org/10.1016/j.jpsychires.2016.02.019
Beck, A. T., & Steer, R. A. (1991). Manual for the Beck Scale for suicide ideation. San Antonio, TX: Psychological Corporation.
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100. https://doi.org/10.1016/0272-7358(88)90050-5
Bergbom, S., Boersma, K., Overmeer, T., & Linton, S. J. (2011). Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments. Physical Therapy, 91, 754–764. https://doi.org/10.2522/ptj.20100136
Bernell, S., & Howard, S. W. (2016). Use your words carefully: What is a chronic disease? Frontiers in Public Health, 4, 159. https://doi.org/10.3389/fpubh.2016.00159
Bhugra, D., & McKenzie, K. (2003). Expressed emotion across cultures. Advances in Psychiatric Treatment, 9, 342–348. https://doi.org/10.1192/apt.9.5.342
Blatt, S. J. (1974). Levels of object representation in anaclitic and introjective depression. The Psychoanalytic Study of the Child, 29, 107–157.
Bodenheimer, T., Chen, E., & Bennett, H. D. (2009). Confronting the growing burden of chronic disease: Can the U.S. health care workforce do the job? Health Affairs, 28, 64–74. https://doi.org/10.1377/hlthaff.28.1.64
Bolton, J. M., Walld, R., Chateau, D., Finlayson, G., & Sareen, J. (2015). Risk of suicide and suicide attempts associated with physical disorders: A population-based, balancing score-matched analysis. Psychological Medicine, 45, 495–504. https://doi.org/10.1017/S0033291714001639
Boudreaux, E. D., & Horowitz, L. M. (2014). Suicide risk screening and assessment: Designing instruments with dissemination in mind. American Journal of Preventive Medicine, 47, S163–S169. https://doi.org/10.1016/j.amepre.2014.06.005
Brown, G. W. (1985). The discovery of expressed emotion: Induction or deduction? In J. Leff & C. Vaughn (Eds.), Expressed emotion in families (pp. 7–25). New York, NY: Guilford Press.
Bryan, C. J., Stone, S. L., & Rudd, M. D. (2011). A practical, evidence-based approach for means-restriction counseling with suicidal patients. Professional Psychology: Research and Practice, 42, 339–346. https://doi.org/10.1037/a0025051
Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., … & Rudd, M. D. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial. Journal of Affective Disorders, 212, 64–72. https://doi.org/10.1016/j.jad.2017.01.028
Calati, R., Ferrari, C., Brittner, M., Oasi, O., Olié, E., Carvalho, A. F., & Courtet, P. (2019). Suicidal thoughts and behaviors and social isolation: A narrative review of the literature. Journal of Affective Disorders, 245, 653–667. https://doi.org/10.1016/j.jad.2018.11.022
Campos, R. C., Besser, A., Ferreira, R., & Blatt, S. J. (2012). Self-criticism, neediness, and distress among women undergoing treatment for breast cancer: A preliminary test of the moderating role of adjustment to illness. International Journal of Stress Management, 19, 151–174. https://doi.org/10.1037/a0027996
Centers for Disease Control and Prevention [CDC]. (2018). National Center for Chronic Disease Prevention and Health Promotion: About Chronic Diseases. https://www.cdc.gov/chronicdisease/about/index.htm.
Centers for Medicare and Medicaid Services [CMS]. (2017). Chronic conditions. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/CC_Main.html.
Chaves, J. F., & Brown, J. M. (1987). Spontaneous cognitive strategies for the control of clinical pain and stress. Journal of Behavioral Medicine, 10, 263–276.
Chu, C., Klein, K. M., Buchman-Schmitt, J. M., Hom, M. A., Hagan, C. R., & Joiner, T. E. (2015). Routinized assessment of suicide risk in clinical practice: An empirically informed update. Journal of Clinical Psychology, 71, 1186–1200. https://doi.org/10.1002/jclp.22210
Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R., … & Joiner, T. E. (2017). The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychological Bulletin, 143, 1313–1345. https://doi.org/10.1037/bul0000123
Coyle, L., & Atkinson, S. (2018). Imagined futures in living with multiple conditions: Positivity, relationality and hopelessness. Social Science & Medicine, 198, 53–60. https://doi.org/10.1016/j.socscimed.2017.12.022
Cukrowicz, K. C., Cheavens, J. S., Van Orden, K. A., Ragain, R. M., & Cook, R. L. (2011). Perceived burdensomeness and suicide ideation in older adults. Psychology and Aging, 26, 331–338. https://doi.org/10.1037/a0021836
Czyz, E. K., Horwitz, A. G., Eisenberg, D., Kramer, A., & King, C. A. (2013). Self-reported barriers to professional help seeking among college students at elevated risk for suicide. Journal of American College Health, 61, 398–406. https://doi.org/10.1080/07448481.2013.820731
Devoulyte, K., & Sullivan, M. J. L. (2003). Pain catastrophizing and symptom severity during upper respiratory tract illness. The Clinical Journal of Pain, 19, 125–133.
Dunkley, D. M., Zuroff, D. C., & Blankstein, K. R. (2003). Self-critical perfectionism and daily affect: Dispositional and situational influences on stress and coping. Journal of Personality and Social Psychology, 84, 234–252.
Dunn, S. L. (2005). Hopelessness as a response to physical illness. Journal of Nursing Scholarship, 37, 148–154.
Ebrahim, S., Barer, D., & Nouri, F. (1986). Use of the Nottingham Health Profile with patients after a stroke. Journal of Epidemiology and Community Health, 40, 166–169.
Edwards, R. R., Bingham, C. O., Bathon, J., & Haythornthwaite, J. A. (2006). Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis and Rheumatism, 55, 325–332. https://doi.org/10.1002/art.21865
Ellis, A. J., Portnoff, L. C., Axelson, D. A., Kowatch, R. A., Walshaw, P., & Miklowitz, D. J. (2014). Parental expressed emotion and suicidal ideation in adolescents with bipolar disorder. Psychiatry Research, 216, 213–216. https://doi.org/10.1016/j.psychres.2014.02.013
Erlangsen, A., Stenager, E., & Conwell, Y. (2015). Physical diseases as predictors of suicide in older adults: A nationwide, register-based cohort study. Social Psychiatry and Psychiatric Epidemiology, 50, 1427–1439. https://doi.org/10.1007/s00127-015-1051-0
Eskelinen, M., Korhonen, R., Selander, T., & Ollonen, P. (2015). Suicidal ideation versus hopelessness/helplessness in healthy individuals and in patients with benign breast disease and breast cancer: A prospective case-control study in Finland. Anticancer Research, 35, 3543–3551.
Everson, S. A., Goldberg, D. E., Kaplan, G. A., Cohen, R. D., Pukkala, E., Tuomilehto, J., & Salonen, J. T. (1996). Hopelessness and risk of mortality and incidence of myocardial infarction and cancer. Psychosomatic Medicine, 58, 113–121.
Fässberg, M. M., Cheung, G., Canetto, S. S., Erlangsen, A., Lapierre, S., Lindner, R., … & Wærn, M. (2016). A systematic review of physical illness, functional disability, and suicidal behaviour among older adults. Aging & Mental Health, 20, 166–194. https://doi.org/10.1080/13607863.2015.1083945
Filiberti, A., Ripamonti, C., Totis, A., Ventafridda, V., De Conno, F., Contiero, P., & Tamburini, M. (2001). Characteristics of terminal cancer patients who committed suicide during a home palliative care program. Journal of Pain and Symptom Management, 22, 544–553.
Fujisawa, D., Tanaka, E., Sakamoto, S., Neichi, K., Nakagawa, A., & Ono, Y. (2005). The development of a brief screening instrument for depression and suicidal ideation for elderly: The Depression and Suicide Screen. Psychiatry and Clinical Neurosciences, 59, 634–638. https://doi.org/10.1111/j.1440-1819.2005.01429.x
Golics, C. J., Basra, M. K. A., Salek, M. S., & Finlay, A. Y. (2013). The impact of patients’ chronic disease on family quality of life: An experience from 26 specialties. International Journal of General Medicine, 6, 787–798. https://doi.org/10.2147/IJGM.S45156
Gotlib, I. H., & Hammen, C. L. (1992). Psychological aspects of depression: Toward a cognitive–interpersonal integration. Chichester, UK: Wiley.
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2, 271–299.
Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, 281–291. https://doi.org/10.1017/S0048577201393198
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362. https://doi.org/10.1037/0022-3514.85.2.348
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.
Hayes, S., Strosahl, K., & Wilson, K. (1999). Acceptance and commitment therapy. New York, NY: Guilford Press.
Heisel, M. J., Duberstein, P. R., Talbot, N. L., King, D. A., & Tu, X. M. (2009). Adapting interpersonal psychotherapy for older adults at risk for suicide: Preliminary findings. Professional Psychology, Research and Practice, 40, 156–164. https://doi.org/10.1037/a0014731
Hodes, M., Garralda, M. E., Rose, G., & Schwartz, R. (1999). Maternal expressed emotion and adjustment in children with epilepsy. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 40, 1083–1093.
Hom, M. A., Stanley, I. H., & Joiner, T. E., Jr. (2015). Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: A review of the literature. Clinical Psychology Review, 40, 28–39. https://doi.org/10.1016/j.cpr.2015.05.006
Hooley, J. M. (2007). Expressed emotion and relapse of psychopathology. Annual Review of Clinical Psychology, 3, 329–352. https://doi.org/10.1146/annurev.clinpsy.2.022305.095236
Hopman, P., Heins, M. J., Korevaar, J. C., Rijken, M., & Schellevis, F. G. (2016). Health care utilization of patients with multiple chronic diseases in the Netherlands: Differences and underlying factors. European Journal of Internal Medicine, 35, 44–50. https://doi.org/10.1016/j.ejim.2016.08.025
Horowitz, L. M., Ballard, E. D., & Pao, M. (2009). Suicide screening in schools, primary care and emergency departments. Current Opinion in Pediatrics, 21, 620–627. https://doi.org/10.1097/MOP.0b013e3283307a89
Houtsma, C., Butterworth, S. E., & Anestis, M. D. (2018). Firearm suicide: Pathways to risk and methods of prevention. Current Opinion in Psychology, 22, 7–11.
Ilgen, M. A., Kleinberg, F., Ignacio, R. V., Bohnert, A. S. B., Valenstein, M., McCarthy, J. F., … & Katz, I. R. (2013). Noncancer pain conditions and risk of suicide. JAMA Psychiatry, 70, 692–697. https://doi.org/10.1001/jamapsychiatry.2013.908
Jensen, M. P., Turner, J. A., Romano, J. M., & Karoly, P. (1991). Coping with chronic pain: A critical review of the literature. Pain, 47, 249.
Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York: Guilford Press.
Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
Joiner, T. E., Jr., Walker, R. L., Rudd, M. D., & Jobes, D. A. (1999). Scientizing and routinizing the assessment of suicidality in outpatient practice. Professional Psychology: Research and Practice, 30, 447–453. https://doi.org/10.1037/0735-7028.30.5.447
Juurlink, D. N., Herrmann, N., Szalai, J. P., Kopp, A., & Redelmeier, D. A. (2004). Medical illness and the risk of suicide in the elderly. Archives of Internal Medicine, 164, 1179–1184. https://doi.org/10.1001/archinte.164.11.1179
Katon, W. J. (2003). Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biological Psychiatry, 54, 216–226.
Klonsky, E. D., & May, A. M. (2015). The Three-Step Theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy, 8, 114–129. https://doi.org/10.1521/ijct.2015.8.2.114
Kohl, A., Rief, W., & Glombiewski, J. A. (2013). Acceptance, cognitive restructuring, and distraction as coping strategies for acute pain. The Journal of Pain, 14, 305–315. https://doi.org/10.1016/j.jpain.2012.12.005
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.
Kuo, C., Chen, V. C., Lee, W., Chen, W. J., Ferri, C. P., Stewart, R., … & Ko, Y. (2010). Asthma and suicide mortality in young people: A 12-year follow-up study. American Journal of Psychiatry, 167, 1092–1099. https://doi.org/10.1176/appi.ajp.2010.09101455
Leung, L. (2012). Pain catastrophizing: An updated review. Indian Journal of Psychological Medicine, 34, 204–217. https://doi.org/10.4103/0253-7176.106012
Lim, J., & Zebrack, B. (2004). Caring for family members with chronic physical illness: A critical review of caregiver literature. Health and Quality of Life Outcomes, 2, 50. https://doi.org/10.1186/1477-7525-2-50
Linehan, M. M., Comtois, K. A., & Ward-Ciesielski, E. F. (2012). Assessing and managing risk with suicidal individuals. Cognitive and Behavioral Practice, 19, 218–232. https://doi.org/10.1016/j.cbpra.2010.11.008
Luo, Y., Hawkley, L. C., Waite, L. J., & Cacioppo, J. T. (2012). Loneliness, health, and mortality in old age: A national longitudinal study. Social Science & Medicine, 74, 907–914. https://doi.org/10.1016/j.socscimed.2011.11.028
Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. The American Journal of Psychiatry, 159, 909–916. https://doi.org/10.1176/appi.ajp.159.6.909
Markowitz, J. C. (2003). Interpersonal psychotherapy for chronic depression. Journal of Clinical Psychology, 59, 847–858. https://doi.org/10.1002/jclp.10177
Marroquín, B., Tennen, H., & Stanton, A. L. (2017). Coping, emotion regulation, and well-being: Intrapersonal and interpersonal processes. In M. D. Robinson & M. Eid (Eds.), The happy mind: Cognitive contributions to well-being (pp. 253–274). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-58763-9_14
Masi, C. M., Chen, H., Hawkley, L. C., & Cacioppo, J. T. (2011). A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review. https://doi.org/10.1177/1088868310377394
McCracken, L. M., & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain? Pain, 105, 197–204.
McDowell, A. K., Lineberry, T. W., & Bostwick, J. M. (2011). Practical suicide-risk management for the busy primary care physician. Mayo Clinic Proceedings, 86, 792–800. https://doi.org/10.4065/mcp.2011.0076
Melzack, R. (1987). The short-form McGill pain questionnaire. Pain, 30, 191–197. https://doi.org/10.1016/0304-3959(87)91074-8
Mezuk, B., Eaton, W. W., Albrecht, S., & Golden, S. H. (2008). Depression and type 2 diabetes over the lifespan: A meta-analysis. Diabetes Care, 31, 2383–2390. https://doi.org/10.2337/dc08-0985
Nakaya, N., Nakamura, T., Tsuchiya, N., Tsuji, I., Hozawa, A., & Tomita, H. (2016). Unemployment risk among individuals undergoing medical treatment for chronic diseases. Occupational Medicine, 66, 143–149. https://doi.org/10.1093/occmed/kqv159
Noyman-Veksler, G., Lerman, S. F., Joiner, T. E., Brill, S., Rudich, Z., Shalev, H., & Shahar, G. (2017). Role of pain-based catastrophizing in pain, disability, distress, and suicidal ideation. Psychiatry, 80, 155–170. https://doi.org/10.1080/00332747.2016.1230984
O’Connor, R. C., & Noyce, R. (2008). Personality and cognitive processes: Self-criticism and different types of rumination as predictors of suicidal ideation. Behaviour Research and Therapy, 46, 392–401. https://doi.org/10.1016/j.brat.2008.01.007
O’Connor, E., Gaynes, B. N., Burda, B. U., Williams, C., & Whitlock, E. P. (2013). Screening for suicide risk in primary care: A systematic evidence review for the U.S. Preventive Services Task Force (No. 13-05188-EF-1). Rockville, MD: Agency for Healthcare Research and Quality.
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. https://doi.org/10.1177/107319110100800409
Ost, L. (2014). The efficacy of Acceptance and Commitment Therapy: An updated systematic review and meta-analysis. Behaviour Research and Therapy, 61, 105–121. https://doi.org/10.1016/j.brat.2014.07.018
Patten, S. B. (2001). Long-term medical conditions and major depression in a Canadian population study at waves 1 and 2. Journal of Affective Disorders, 63, 35–41.
Petitte, T., Mallow, J., Barnes, E., Petrone, A., Barr, T., & Theeke, L. (2015). A systematic review of loneliness and common chronic physical conditions in adults. The Open Psychology Journal, 8, 113–132. https://doi.org/10.2174/1874350101508010113
Piburn, G. (1999). Beyond chaos: One man’s journey alongside his chronically ill wife. Cincinnati, OH: The Arthritis Foundation.
Poleshuck, E. L., Gamble, S. A., Cort, N., Hoffman-King, D., Cerrito, B., Rosario-McCabe, L. A., & Giles, D. E. (2010). Interpersonal psychotherapy for co-occurring depression and chronic pain. Professional Psychology, Research and Practice, 41, 312–318. https://doi.org/10.1037/a0019924
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., … & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. The American Journal of Psychiatry, 168, 1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704
Priel, B., & Shahar, G. (2000). Dependency, self-criticism, social context and distress: Comparing moderating and mediating models. Personality and Individual Differences, 28, 515–525. https://doi.org/10.1016/S0191-8869(99)00116-6
Quartana, P. J., Campbell, C. M., & Edwards, R. R. (2009). Pain catastrophizing: A critical review. Expert Review of Neurotherapeutics, 9, 745–758.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.
Ribeiro, J. D., Huang, X., Fox, K. R., & Franklin, J. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts and death: Meta-analysis of longitudinal studies. The British Journal of Psychiatry, 212, 279–286.
Rico-Uribe, L. A., Caballero, F. F., Martín-María, N., Cabello, M., Ayuso-Mateos, J. L., & Miret, M. (2018). Association of loneliness with all-cause mortality: A meta-analysis. PLoS One. https://doi.org/10.1371/journal.pone.0190033
Robson, A., Scrutton, F., Wilkinson, L., & MacLeod, F. (2010). The risk of suicide in cancer patients: A review of the literature. Psycho-Oncology, 19, 1250–1258.
Rogers, M. L., & Joiner, T. E. (2017). Rumination, suicidal ideation, and suicide attempts: A meta-analytic review. Review of General Psychology, 21, 132–142.
Rudich, Z., Lerman, S. F., Gurevich, B., Weksler, N., & Shahar, G. (2008). Patients’ self-criticism is a stronger predictor of physician’s evaluation of prognosis than pain diagnosis or severity in chronic pain patients. The Journal of Pain, 9, 210–216.
Sarkar, S., & Balhara, Y. P. S. (2014). Diabetes mellitus and suicide. Indian Journal of Endocrinology and Metabolism, 18, 468–474. https://doi.org/10.4103/2230-8210.137487
Shahar, G. (2015). Erosion: The psychopathology of self-criticism. Oxford, England: Oxford University Press.
Shahar, G. (2016). Criticism in the self, brain, relationships, and social structure: Implications for psychodynamic psychiatry. Psychodynamic Psychiatry, 44, 395–421.
Shahar, G., & Priel, B. (2003). Active vulnerability, adolescent distress, and the mediating/suppressing role of life events. Personality and Individual Differences, 35, 199–218. https://doi.org/10.1016/S0191-8869(02)00185-X
Shahar, G., & Henrich, C. C. (2013). Axis of criticism model (ACRIM): An integrative conceptualization of person–context exchanges in vulnerability to adolescent psychopathology. Journal of Psychotherapy Integration, 23, 236–249.
Shahar, G., Rogers, M. L., Shalev, H., & Joiner, T. E. (2020). Self-criticism, interpersonal conditions, and biosystemic inflammation in suicidal thoughts and behaviors within mood disorders: A bio-cognitive–interpersonal hypothesis. Journal of Personality, 88, 133–145.
Shain, B. N., & Committee on Adolescence. (2007). Suicide and suicide attempts in adolescents. Pediatrics, 120, 669–676. https://doi.org/10.1542/peds.2007-1908
Shea, S. C. (2002). The practical art of suicide assessment: A guide for mental health professionals and substance abuse counselors. New York, NY: Wiley.
Sheppes, G., & Levin, Z. (2013). Emotion regulation choice: Selecting between cognitive regulation strategies to control emotion. Frontiers in Human Neuroscience. https://doi.org/10.3389/fnhum.2013.00179
Siddaway, A. P., Taylor, P. J., Wood, A. M., & Schulz, J. (2015). A meta-analysis of perceptions of defeat and entrapment in depression, anxiety problems, posttraumatic stress disorder, and suicidality. Journal of Affective Disorders, 184, 149–159.
Sidell, N. L. (1997). Adult adjustment to chronic illness: A review of the literature. Health & Social Work, 22, 5–11.
Soo, H., Burney, S., & Basten, C. (2009). The role of rumination in affective distress in people with a chronic physical illness: A review of the literature and theoretical formulation. Journal of Health Psychology, 14, 956–966. https://doi.org/10.1177/1359105309341204
Spanos, N. P., Radtke-Bodorik, H. L., Ferguson, J. D., & Jones, B. (1979). The effects of hypnotic susceptibility, suggestions for analgesia, and the utilization of cognitive strategies on the reduction of pain. Journal of Abnormal Psychology, 88, 282–292.
Spijkerman, T., de Jonge, P., van den Brink, R. H. S., Jansen, J. H. C., May, J. F., Crijns, H. J. G. M., & Ormel, J. (2005). Depression following myocardial infarction: First-ever versus ongoing and recurrent episodes. General Hospital Psychiatry, 27, 411–417.
Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19, 256–264.
Stanley, I. H., Hom, M. A., Rogers, M. L., Anestis, M. D., & Joiner, T. E. (2017). Discussing firearm ownership and access as part of suicide risk assessment and prevention: “Means safety” versus “means restriction.” Archives of Suicide Research, 21, 237–253.
Stene-Larsen, K., & Reneflot, A. (2017). Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scandinavian Journal of Public Health. https://doi.org/10.1177/1403494817746274
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7, 524–532.
Taylor, P. J., Wood, A. M., Gooding, P., Johnson, J., & Tarrier, N. (2009). Are defeat and entrapment best defined as a single construct? Personality and Individual Differences, 47, 795–797. https://doi.org/10.1016/j.paid.2009.06.011
Taylor, P. J., Gooding, P., Wood, A. M., & Tarrier, N. (2011). The role of defeat and entrapment in depression, anxiety, and suicide. Psychological Bulletin, 137, 391–420.
Theeke, L. A., & Mallow, J. (2013). Loneliness and quality of life in chronically ill rural older adults. The American Journal of Nursing, 113, 28–37.
Tighe, J., Nicholas, J., Shand, F., & Christensen, H. (2018). Efficacy of Acceptance and Commitment Therapy in reducing suicidal ideation and deliberate self-harm: Systematic review. JMIR Mental Health, 5, e10732. https://doi.org/10.2196/10732
Tiwari, G. K. (2015). Chronic physical illness affects emotion regulation process: A case of HIV/AIDS. The International Journal of Indian Psychology, 3, 158–166.
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27, 247–259.
Uebelacker, L. A., German, N. M., Gaudiano, B. A., & Miller, I. W. (2011). Patient Health Questionnaire Depression Scale as a suicide screening instrument in depressed primary care patients: A cross-sectional study. The Primary Care Companion to CNS Disorders, 13, e1–e6.
Van der Kooy, K., van Hout, H., Marwijk, H., Marten, H., Stehouwer, C., & Beekman, A. (2007). Depression and the risk for cardiovascular diseases: Systematic review and meta analysis. International Journal of Geriatric Psychiatry, 22, 613–626.
Van Eijsden-Besseling, M. D. F., van Attekum, A., de Bie, R. A., & Staal, J. B. (2010). Pain catastrophizing and lower physical fitness in a sample of computer screen workers with early non-specific upper limb disorders: A case-control study. Industrial Health, 48, 818–823.
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600. https://doi.org/10.1037/a0018697
Voinov, B., Richie, W. D., & Bailey, R. K. (2013). Depression and chronic diseases: It is time for a synergistic mental health and primary care approach. The Primary Care Companion for CNS Disorders. https://doi.org/10.4088/PCC.12r01468
Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. Journal of Consulting and Clinical Psychology, 76, 397–407. https://doi.org/10.1037/0022-006X.76.3.397
Walby, F. A., Myhre, M. Ø., & Kildahl, A. T. (2018). Contact with mental health services prior to suicide: A systematic review and meta-analysis. Psychiatric Services, 69, 751–759.
Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134, 163–206. https://doi.org/10.1037/0033-2909.134.2.163
Wearden, A. J., Tarrier, N., Barrowclough, C., Zastowny, T. R., & Rahill, A. A. (2000). A review of expressed emotion research in health care. Clinical Psychology Review, 20, 633–666.
Webb, R. T., Kontopantelis, E., Doran, T., Qin, P., Creed, F., & Kapur, N. (2012). Suicide risk in primary care patients with major physical diseases: A case-control study. Archives of General Psychiatry, 69, 256–264. https://doi.org/10.1001/archgenpsychiatry.2011.1561
Wedig, M. M., & Nock, M. K. (2007). Parental expressed emotion and adolescent self-injury. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1171–1178.
Wells, K. B., Golding, J. M., & Burnam, M. A. (1988). Psychiatric disorder in a sample of the general population with and without chronic medical conditions. The American Journal of Psychiatry, 145, 976–981. https://doi.org/10.1176/ajp.145.8.976
Whisman, M. A. (2010). Loneliness and the metabolic syndrome in a population-based sample of middle-aged and older adults. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 29, 550–554.
Wikman, A., Wardle, J., & Steptoe, A. (2011). Quality of life and affective well-being in middle-aged and older people with chronic medical illnesses: A cross-sectional population based study. PLoS One. https://doi.org/10.1371/journal.pone.0018952
Wilson, K. G., Curran, D., & McPherson, C. J. (2005). A burden to others: A common source of distress for the terminally ill. Cognitive Behaviour Therapy, 34, 115–123.
Wilson, K. G., Kowal, J., Henderson, P. R., McWilliams, L. A., & Péloquin, K. (2013). Chronic pain and the interpersonal theory of suicide. Rehabilitation Psychology, 58, 111–115. https://doi.org/10.1037/a0031390
World Health Organization [WHO]. (2001). International classification of functioning, disability, and health. World Health Organization
World Health Organization [WHO]. (2014). Preventing suicide: A global imperative. Geneva: World Health Organization.
Yang, Y. (2006). How does functional disability affect depressive symptoms in late life? The role of perceived social support and psychological resources. Journal of Health and Social Behavior, 47, 355–372. https://doi.org/10.1177/002214650604700404
Zelkowitz, R. L., & Cole, D. A. (2018). Self-criticism as a transdiagnostic process in nonsuicidal self-injury and disordered eating: Systematic review and meta-analysis. Suicide & Life-Threatening Behavior. https://doi.org/10.1111/sltb.12436
Acknowledgements
This work was in part supported by the Military Suicide Research Consortium (MSRC), an effort supported by the Department of Defense (W81XWH-16-20003). Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Military Suicide Research Consortium or the Department of Defense. Golan Shahar was supported by a grant from the Israeli Science Foundation on suicidality in chronic physical pain (Grant No. 751/08).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Megan L. Rogers, Thomas E. Joiner, and Golan Shahar declare that they have no conflicts of interest to disclose.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Rogers, M.L., Joiner, T.E. & Shahar, G. Suicidality in Chronic Illness: An Overview of Cognitive–Affective and Interpersonal Factors. J Clin Psychol Med Settings 28, 137–148 (2021). https://doi.org/10.1007/s10880-020-09749-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-020-09749-x