Abstract
Problem-solving deficits and poor health–related quality of life are associated with suicide risk; yet, little is known about the interrelations between these variables. In 220 primary care patients, we examined the potential mediating role of physical and mental health–related quality of life on the relation between social problem–solving ability and suicidal behavior. Participants completed the Suicidal Behaviors Questionnaire-Revised, Social Problem Solving Inventory-Revised, and Short-Form 36 Health Survey. Utilizing bootstrapped mediation, our hypotheses were partially supported; mediating effects were found for mental health–related quality of life on the relation between social problem-solving and suicidal behavior. Physical health–related quality of life was not a significant mediator. Greater social problem–solving ability is associated with better mental health–related quality of life and, in turn, to less suicidal behavior. Interventions promoting social problem–solving ability may increase quality of life and reduce suicide risk in primary care patients.
Similar content being viewed by others
References
Bartley, C. E., & Roesch, S. C. (2011). Coping with daily stress: the role of conscientiousness. Personality and Individual Differences, 50(1), 79–83. https://doi.org/10.1016/j.paid.2010.08.027.
Bauer, A. M., Chan, Y., Huang, H., Vannoy, S., & Unützer, J. (2013). Characteristics, management, and depression outcomes of primary care patients who endorse thoughts of death or suicide on the PHQ-9. Journal of General Internal Medicine, 28(3), 363–369. https://doi.org/10.1007/s11606-012-2194-2.
Becker-Weidman, E., Jacobs, R., Reinecke, M., Silva, S., & March, J. (2010). Social problem-solving among adolescents treated for depression. Behaviour Research and Therapy, 48(1), 11–18. https://doi.org/10.1016/j.brat.2009.08.006.
Bell, A. C., & D’Zurilla, T. J. (2009). Problem solving therapy for depression: a meta-analysis. Clinical Psychology Review, 29(4), 348–353. https://doi.org/10.1016/j.bbr.2011.03.031.
Bostwick, J. M., & Rackley, S. (2012). Addressing suicidality in primary care settings. Current Psychiatry Reports, 14(4), 353–359. https://doi.org/10.1007/s11920-012-0286-7.
Bryan, C. J., & Rudd, M. (2011). Managing suicide risk in primary care. New York: Springer Publishing Co.
Catalan, J., Gath, D. H., Anastasiades, P., Bond, S. A., Day, A., & Hall, L. (1991). Evaluation of a brief psychological treatment for emotional disorders in primary care. Psychological Medicine, 21(4), 1013–1018.
CDC. (2013). Morbidity and Mortality Weekly Report. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a1.htm
Centers for Disease Control and Prevention [CDC]. (2015). Suicide and self-inflicted injury. Retrieved from http://www.cdc.gov/nchs/fastats/suicide.htm
Chang, E. C., Watkins, A. F., & Banks, K. H. (2004). How adaptive and maladaptive perfectionism relate to positive and negative psychological functioning: testing a stress-mediation model in black and white female college students. Journal of Counseling Psychology, 51, 93–102. https://doi.org/10.1037/0022-0167.51.1.93.
Chen, C., Tsai, Y., Hsu, H., Wu, I., Sun, C., Chou, C., et al. (2010). Depression and suicide risk in hemodialysis patients with chronic renal failure. Psychosomatics: Journal of Consultation Liaison Psychiatry, 51(6), 528–528.e6. https://doi.org/10.1176/appi.psy.51.6.528.
Conwell, Y., Duberstein, P. R., Hirsch, J. K., Eberly, S., Conner, K. R., & Caine, E. D. (2010). Health status and suicide in the second half of life. International Journal of Geriatric Psychiatry, 25(4), 371–379. https://doi.org/10.1002/gps.2348.
Crosby, A. E., Han, B., Ortega, L. A. G., Parks, S. E., & Gfroerer, J. (2011). Suicidal thoughts and behaviors among adults aged > 18 years -- United States, 2008-2009. Surveillance Summaries, 60(SS13), 1–22 Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6013a1.htm.
Druss, B., & Pincus, H. (2000). Suicidal ideation and suicide attempts in general medical illnesses. Archives of Internal Medicine, 160(10), 1522–1526.
D’Zurilla, T., Nezu, A. M., & Maydeu-Olivares, A. (2002). Social problem solving inventory – revised: technical manual. North Tonawanda: Multi-Health Systems.
D’Zurilla, T. J., & Nezu, A. M. (2010). Problem-solving therapy. In K. S. Dobson (Ed.), Handbook of cognitive-behavioral therapies (3rd ed., pp. 197–225). New York: The Guilford Press.
D'Zurilla, T. J., & Nezu, A. (1982). Social problem solving in adults. In P. C. Kendall (Ed.), Advances in cognitive-behavioral research and therapy (Vol. 1, pp. 201–274). New York: Academic Press.
D'Zurilla, T. J., & Nezu, A. M. (1990). Development and preliminary evaluation of the Social Problem-Solving Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2(2), 156–163. https://doi.org/10.1037/1040-3590.2.2.156.
D'Zurilla, T. J., Chang, E. C., Nottingham, E., & Faccini, L. (1998). Social problem-solving deficits and hopelessness, depression, and suicidal risk in college students and psychiatric inpatients. Journal of Clinical Psychology, 54(8), 1091–1107. https://doi.org/10.1002/(SICI)1097-4679(199812)54:8<1091::AID-JCLP9>3.0.CO;2-J.
Field, A. P. (2005). Discovering statistics using SPSS (2nd ed.). Sage: London.
Fishbain, D. A. (1999). The association of chronic pain and suicide. Seminars in Clinical Neuropsychiatry, 4(3), 221–227. https://doi.org/10.153/SCNP00400221.
Fox, B. H., Stanek, E. J., Boyd, S. C., & Flannery, J. T. (1982). Suicide rates among cancer patients in Connecticut. Journal of Chronic Diseases, 35(2), 89–100. https://doi.org/10.1016/0021-9681(82)90110-2.
Ghahramanlou-Holloway, M. M., Bhar, S. S., Brown, G. K., Olsen, C. C., & Beck, A. T. (2012). Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide. Psychological Medicine, 42(6), 1185–1193. https://doi.org/10.1017/S0033291711002169.
Goodwin, R., & Olfson, M. (2002). Self-perception of poor health and suicidal ideation in medical patients. Psychological Medicine, 32(7), 1293–1299. https://doi.org/10.1017/S0033291702006323.
Hann, M., & Reeves, D. (2008). The SF-36 scales are not accurately summarised by independent physical and mental component scores. Quality of Life Research, 17(3), 413–423. https://doi.org/10.1007/s11136-008-9310-0.
Hawkins, D., Sofronoff, K., & Sheffield, J. (2009). Psychometric properties of the Social Problem Solving Inventory-Revised Short-Form: is the short form a valid and reliable measure for young adults? Cognitive Therapy and Research, 33(5), 462–470. https://doi.org/10.1007/s10608-008-9209-7.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: The Guilford Press.
Heisel, M. J., Duberstein, P. R., Lyness, J. M., & Feldman, M. D. (2010). Screening for suicide ideation in older primary care patients. Journal of the American Board of Family Medicine, 23(2), 260–269. https://doi.org/10.3122/jabfm.2010.02.080163.
Hirsch, J. K., & Cukrowicz, K. C. (2014). Suicide in rural areas: an updated review of the literature. Journal of Rural Mental Health, 38(2), 65–78. https://doi.org/10.1037/rmh0000018.
Hirsch, J. K., Chang, E. C., & Jeglic, E. L. (2012). Social problem solving and suicidal behavior: ethnic differences in the moderating effects of loneliness and life stress. Archives of Suicide Research, 16(4), 303–315. https://doi.org/10.1080/13811118.2013.722054.
Hirsch, J. K., Duberstein, P. R., & Unützer, J. (2009). Chronic medical problems and distressful thoughts of suicide in primary care patients: mitigating role of happiness. International Journal of Geriatric Psychiatry, 24(7), 671–679. https://doi.org/10.1002/gps.2174.
Jenkinson, C., Stewart-Brown, S., Petersen, S., & Paice, C. (1999). Assessment of the SF-36 version 2 in the United Kingdom. Journal of Epidemiology and Community Health, 53(1), 46–50. https://doi.org/10.1136/jech.53.1.46.
Katon, W., & Schulberg, H. (1992). Epidemiology of depression in primary care. General Hospital Psychiatry, 14(4), 237–247. https://doi.org/10.1016/0163-8343(92)90094-Q.
Kirschner, A., Berry, E. H., & Glasgow, N. (2009). Changing demographics of rural areas. Retrieved from https://cardi.cals.cornell.edu/sites/cardi.cals.cornell.edu/files/shared/documents/NYminute/01-2009-RNYM.pdf
Kleepsies, P. M., Hughes, D. H., & Gallacher, F. P. (2000). Suicide in the medically and terminally ill: psychological and ethical considerations. Journal of Clinical Psychology, 56(9), 1153–1171. https://doi.org/10.1002/1097-4679(200009)56:9<1153::AID-JCLP4>3.0.CO;2-Y.
Koivumaa-Honkanen, H., Honkanen, R., Viinamäki, H., Heikkilä, K., Kaprio, J., & Koskenvuo, M. (2001). Life satisfaction and suicide: a 20-year follow-up study. The American Journal of Psychiatry, 158(3), 433–439. https://doi.org/10.1176/appi.ajp.158.3.433.
Linda, W. P., Marroquin, B., & Miranda, R. (2012). Active and passive problem solving as moderators of the relation between negative life event stress and suicidal ideation among suicide attempters and non-attempters. Archives of Suicide Research, 16(3), 183–197. https://doi.org/10.1080/13811118.2012.695233.
Linehan, M. M., Camper, P., Chiles, J. A., Strosahl, K., & Sherin, E. (1987). Interpersonal problem solving and parasuicide. Cognitive Therapy and Research, 11, 1–12.
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(6), 909–916. https://doi.org/10.1176/appi.ajp.159.6.909.
Mackenzie, T. B., & Popkin, M. K. (1990). Medical illness and suicide. In S. J. Blumenthal & D. J. Kupfer (Eds.), Suicide over the life cycle: Risk factors, assessment, and treatment of suicidal patients (pp. 205–232). Washington, DC US: American Psychiatric Association.
Marks, R., Allegrante, J. P., & Lorig, K. (2005). A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part ii). Health Promotion Practice, 6(2), 148–156. https://doi.org/10.1177/1524839904266792.
Maydeu-Olivares, A., & D'Zurilla, T. J. (1996). A factor-analytic study of the social problem-solving inventory: an integration of theory and data. Cognitive Therapy and Research, 20(2), 115–133. https://doi.org/10.1007/BF02228030.
McAuley, E., Konopack, J. F., Motl, R. W., Morris, K. S., Doerksen, S. E., & Rosengren, K. R. (2006). Physical activity and quality of life in older adults: influence of health status and self-efficacy. Annals of Behavioral Medicine, 31(1), 99–103. https://doi.org/10.1207/s15324796abm3101_14.
McAuliffe, C., Corcoran, P., Keeley, H., Arensman, E., Bille-Brahe, U., de Leo, D., et al. (2006). Problem-solving ability and repetition of deliberate self-harm: a multicentre study. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 36(1), 45–55. https://doi.org/10.1017/S0033291705005945.
McHorney, C. A., Ware, J. E., & Raczek, A. E. (1993). The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31(3), 247–263. https://doi.org/10.1097/00005650-199303000-00006.
McLaughlin, J., Miller, P., & Warwick, H. (1996). Deliberate self-harm in adolescents: hopelessness, depression, problems and problem-solving. Journal of Adolescence, 19(6), 523–532. https://doi.org/10.1006/jado.1996.0051.
Morera, O. F., Maydeu-Olivares, A., Nygren, T. E., White, R. J., Fernandez, N. P., & Skewes, M. C. (2006). Social problem solving predicts decision-making styles among US Hispanics. Personality and Individual Differences, 41(2), 307–317. https://doi.org/10.1016/j.paid.2005.08.016.
Mynors-Wallis, L. M., Gath, D. H., Day, A., & Baker, F. (2000). Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care. BMJ, 320(7226), 26–30.
Nezu, A. M., Maguth-Nezu, C., & D'Zurilla, T. J. (2013). Problem-solving therapy: a treatment manual. New York: Springer Publishing Co..
Nezu, A. M., Nezu, C. M., & Perri, M. G. (1989). Problem-solving therapy for depression: theory, research, and clinical guidelines. Oxford: Wiley.
Nezu, A. M., Nezu, C. M., Saraydarian, L., Kalmar, K., & Ronan, G. F. (1986). Social problem solving as a moderating variable between negative life stress and depressive symptoms. Cognitive Therapy and Research, 10(5), 489–498.
Nimalasuriya, K., Compton, M. T., & Guillory, V. J. (2009). Screening adults for depression in primary care: a position statement of the American College of Preventive Medicine. The Journal of Family Practice, 58(10), 535–538.
Nock, M. K., & Mendes, W. B. (2008). Physiological arousal, distress tolerance, and social problem solving deficit among adolescent self-injurers. Journal of Consulting and Clinical Psychology, 76(1), 28–38. https://doi.org/10.1037/0022-006X.76.1.28.
Norlev, J., Davidsen, M., Sundaram, V., & Kjøller, M. (2005). Indicators associated with suicidal ideation and suicide attempts among 16-35-year-old Danes: a national representative population study. Suicide and Life-threatening Behavior, 35(3), 291–308. https://doi.org/10.1521/suli.2005.35.3.291.
O’Connor, E., Gaynes, B. N., Burda, B. U., Soh, C., & Whitlock, E. P. (2013). Screening for and treatment of suicide risk relevant to primary care: a systematic review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 158(10), 741–754. https://doi.org/10.7326/0003-4819-158-10-201305210-00642.
Osman, A., Bagge, C., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclincal samples. Assessment, 8, 443–454. https://doi.org/10.1177/107319110100800409.
Pagura, J., Stein, M. B., Bolton, J. M., Cox, B. J., Grant, B., & Sareen, J. (2010). Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population. Journal of Psychiatric Research, 44(16), 1190–1198. https://doi.org/10.1016/j.jpsychires.2010.04.016.
Pollock, L., & Williams, J. (2004). Problem-solving in suicide attempters. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 34(1), 163–167. https://doi.org/10.1117/S0033291703008092.
Pompili, M., Lester, D., Innamorati, M., De Pisa, E., Amore, M., Ferrara, C., et al. (2009). Quality of life and suicide risk in patients with diabetes mellitus. Psychosomatics: Journal of Consultation and Liaison Psychiatry, 50(1), 16–23. https://doi.org/10.1176/appi.psy.50.1.16.
Razvi, S., Ingoe, L. E., McMillan, C. V., & Weaver, J. U. (2005). Health status in patients with sub-clinical hypothyroidism. European Journal of Endocrinology, 152(5), 713–717. https://doi.org/10.1530/eje.1.01907.
Resch, F., Parzer, P., & Brunner, R. (2008). Self-mutilation and suicidal behaviour in children and adolescents: prevalence and psychosocial correlates: results of the BELLA study. European Child & Adolescent Psychiatry, 17(Suppl 1), 92–98. https://doi.org/10.1007/s00787-008-1010-3.
Robison-Smith, G., Johnston, M. V., & Allen, J. (2000). Self care self-efficacy, quality of life, and depression after stroke. Archives of Physical Medicine and Rehabilitation, 81(4), 460–464. https://doi.org/10.1053/mr.2000.3863.
Roškar, S., Zorko, M., Bucik, V., & Marušič, A. (2007). Problem solving for depressed suicide attempters and depressed individuals without suicide attempt. Psychiatria Danubina, 19(4), 296–302.
Schulberg, H. C., Bruce, M. L., Lee, P. W., Williams, J. r., & Dietrich, A. J. (2004). Preventing suicide in primary care patients: the primary care physician’s role. General Hospital Psychiatry, 26(5), 337–345. https://doi.org/10.1016/j.genhosppsych.2004.06.007.
Speckens, A. M., & Hawton, K. (2005). Social problem solving in adolescents with suicidal behavior: a systematic review. Suicide and Life-threatening Behavior, 35(4), 365–387. https://doi.org/10.1521/suli.2005.35.4.365.
Spence, S. H., Sheffield, J., & Donovan, C. (2002). Problem-solving orientation and attributional style: moderators of the impact of negative life events on the development of depressive symptoms in adolescence? Journal of Clinical Child and Adolescent Psychology, 31(2), 219–229. https://doi.org/10.1207/153744202753604494.
Stewart, C. D., Quinn, A., Plever, S., & Emmerson, B. (2009). Comparing cognitive behavior therapy, problem solving therapy, and treatment as usual in a high-risk population. Suicide and Life-threatening Behavior, 39(5), 538–547. https://doi.org/10.1521/suli.2009.39.5.538.
Storm, H. H., Christensen, N., & Jensen, O. M. (2006). Suicides among Danish patients with cancer: 1971 to 1986. Cancer, 69(6), 1509–1512.
Szanto, K., Dombrovski, A. Y., Sahakian, B. J., Mulsant, B. H., Houck, P. R., Reynolds, C., & Clark, L. (2012). Social emotion recognition, social functioning, and attempted suicide in late-life depression. The American Journal of Geriatric Psychiatry, 20(3), 257–265. https://doi.org/10.1097/JGP.0b013e31820eea0c.
Taft, C., Karlsson, J., & Sullivan, M. (2004). Performance of the Swedish SF-36 version 2.0. Quality of Life Research, 13(1), 251–256.
Unützer, J., Tang, L., Oishi, S., Katon, W., Williams, J. r., Hunkeler, E., et al. (2006). Reducing suicidal ideation in depressed older primary care patients. Journal of the American Geriatrics Society, 54(10), 1550–1556. https://doi.org/10.1111/j.1532-5415.2006.00882.x.
Ware Jr., J. E. (2004). SF-36 health survey update. Retrieved from http://www.sf-36.org/tools/sf36.shtml.
Ware Jr., J. E., & Kosinski, M. (2001). Interpreting SF-36 summary health measures: a response. Quality of Life Research, 10(5), 405–413. https://doi.org/10.1023/A:1012588218728.
Ware Jr., J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473–483. https://doi.org/10.1097/00005650-199206000-00002.
Ware Jr., J. E., Kosinski, M., & Dewey, J. E. (2000). How to score version two of the SF-36 health survey. Lincoln: Quality Metric.
Ware, J. E., Kosinski, M., & Keller, S. D. (1994). SF-36 Physical and Mental Health Summary Scales: a user’s manual. Boston: The Health Institute.
Ware, J. E., Kosinski, M., & Keller, S. D. (1995a). SF-12: How to score the SF-12 physical and mental health summary scales (2nd ed.). Boston: The Health Institute, New England Medical Center.
Ware, J. E., Kosinski, M., Bayliss, M. S., & McHorney, C. A. (1995b). Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the medical outcomes study. Medical Care, 33(4, Suppl), 264–279.
Winter, Y., Epifanova-Bertschi, N., Sankowski, R., Zhukova, T. V., Oertel, W. H., Dodel, R., & Korchounov, A. (2012). Health-related quality of life and its determinants in the urban Russian population with major depressive disorder: a cross-sectional study. International Journal of Psychiatry in Medicine, 43(1), 35–49. https://doi.org/10.2190/PM.43.1.c.
Wintersteen, M. B. (2010). Standardized screening for suicidal adolescents in primary care. Pediatrics, 125(5), 938–944. https://doi.org/10.1542/peds.2009-2458.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in the current study were approved by our University Institutional Review Board and are in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Walker, K.L., Kaniuka, A., Sirois, F.M. et al. Improving Health-Related Quality of Life and Reducing Suicide in Primary Care: Can Social Problem–Solving Abilities Help?. Int J Ment Health Addiction 17, 295–309 (2019). https://doi.org/10.1007/s11469-018-0019-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11469-018-0019-1