Neuroticism and Suicidal Behavior: Conditional Indirect Effects of Social Problem Solving and Hopelessness

  • Kristin L. Walker
  • Edward C. Chang
  • Jameson K. Hirsch


Individuals with problem solving deficits, and higher levels of neuroticism and hopelessness, are at increased risk for suicide, yet little is known about the interrelationships between these vulnerability characteristics. In a sample of 223 low-income, primary care patients, we examined the potential mediating role of hopelessness on the relation between neuroticism and suicidal behavior, and the potential moderating role of social problem solving ability. Participants completed self-report questionnaires: Suicidal Behaviors Questionnaire-Revised, Social Problem Solving Inventory-Revised, Beck Hopelessness Scale, and NEO Five Factor Inventory. Models were tested using bootstrapped moderated mediation techniques. There was a significant indirect effect of neuroticism on suicidal behavior through hopelessness, and this indirect effect was moderated by social problem solving ability. Patients with greater neuroticism also manifest greater levels of hopelessness and, in turn, more suicidal behavior, and these relations are strengthened at lower levels of social problem solving. Interventions that increase social problem solving ability and reduce hopelessness may reduce suicide risk.


Suicidal behavior Neuroticism Hopelessness Social problem solving Primary care 


  1. American Association of Suicidology. (2012). National Suicide Statistics. Retrieved August, 2, 2012.
  2. Amstadter, A. (2008). Emotion regulation and anxiety disorders. Journal of Anxiety Disorders, 22(2), 211–221. doi: 10.1016/j.janxdis.2007.02.004.CrossRefPubMedGoogle Scholar
  3. Baumeister, R. F. (1990). Suicide as escape from self. Psychological Review, 97(1), 90–113. doi: 10.1037/0033-295X.97.1.90.CrossRefPubMedGoogle Scholar
  4. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford Press.Google Scholar
  5. Beck, A. T., & Steer, R. A. (1988). Manual for the Beck Hopelessness Scale. San Antonio: Psychological Corporation.Google Scholar
  6. Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: the hopelessness scale. Journal of Consulting and Clinical Psychology, 42(6), 861–865. doi: 10.1037/h0037562.CrossRefPubMedGoogle Scholar
  7. Beck, A. T., Steer, R. A., Beck, J. S., & Newman, C. F. (1993). Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide and Life-Threatening Behavior, 23(2), 139–145.PubMedGoogle Scholar
  8. Beck, A. T., Steer, R. A., Kovacs, M., & Garrison, B. (1985). Hopelessness and eventual suicide: A 10-year prospective study of patients hospitalized with suicidal ideation. The American Journal of Psychiatry, 142(5), 559–563.Google Scholar
  9. 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. doi: 10.1016/j.brat.2009.08.006.CrossRefPubMedGoogle Scholar
  10. Bostwick, J. M. & Rackley, S. (2012). Addressing suicidality in primary care settings. Current Psychiatry Reports, 14(4), 353–359. doi:  10.1007/s11920-012-0286-7.
  11. Brown, G. K., Beck, A. T., Steer, R. A., & Grisham, J. R. (2000). Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 68(3), 371–377. doi: 10.1037/0022-006X.68.3.371.
  12. Brown, G. K., Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA: Journal of the American Medical Association, 294(5), 563–570. doi: 10.1001/jama.294.5.563.CrossRefPubMedGoogle Scholar
  13. Bryan, C. J., & Rudd, M. (2011). Managing suicide risk in primary care. New York: Springer Publishing Co..Google Scholar
  14. Centers for Disease Control and Prevention. (2011). National Suicide Statistics at a Glance.
  15. Chang, E. C., Sanna, L. J., Hirsch, J. K., & Jeglic, E. L. (2010). Loneliness and negative life events as predictors of hopelessness and suicidal behaviors in Hispanics: Evidence for a Diathesis-Stress Model. Journal of Clinical Psychology, 66(12), 1242–1253. doi: 10.1002/jclp.20721.CrossRefPubMedGoogle Scholar
  16. Chapman, B. P., Lyness, J. M., & Duberstein, P. (2007). Personality and medical illness burden among older adults in primary care. Psychosomatic Medicine, 69(3), 277–282. doi: 10.1097/PSY.0b013e3180313975.CrossRefPubMedGoogle Scholar
  17. Chioqueta, A. P., & Stiles, T. C. (2005). Personality traits and the development of depression, hopelessness, and suicide ideation. Personality and Individual Differences, 38(6), 1283–1291. doi: 10.1016/j.paid.2004.08.010.CrossRefGoogle Scholar
  18. Duberstein, P. R., Conwell, Y., Seidlitz, L., Denning, D. G., Cox, C., & Caine, E. D. (2000). Personality traits and suicidal behavior and ideation in depressed inpatients 50 years of age and older. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 55B(1), P18–P26.Google Scholar
  19. Duberstein, P. R., Conner, K. R., Conwell, Y., & Cox, C. (2001). Personality correlates of hopelessness in depressed inpatients 50 years of age and older. Journal of Personality Assessment, 77(2), 380–390. doi: 10.1207/S15327752JPA7702_16.CrossRefPubMedGoogle Scholar
  20. D'Zurilla, T., Nezu, A. M., & Maydeu-Olivares, A. (2002). Social problem solving inventory – revised: technical manual. Multi-Health Systems: North Tonawanda.Google Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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. doi: 10.1037/1040-3590.2.2.156.CrossRefGoogle Scholar
  23. 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. doi: 10.1002/(SICI)1097-4679(199812)54:8<1091::AID-JCLP9>3.0.CO;2-J.CrossRefPubMedGoogle Scholar
  24. D'Zurilla, T. J., Maydeu-Olivares, A., & Gallardo-Pujol, D. (2011). Predicting social problem solving using personality traits. Personality and Individual Differences, 50(2), 142–147. doi: 10.1016/j.paid.2010.09.015.CrossRefGoogle Scholar
  25. 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. doi: 10.1007/s10608-008-9209-7.
  26. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.Google Scholar
  27. 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. doi: 10.3122/jabfm.2010.02.080163.
  28. Hirsch, J. K., & Conner, K. R. (2006). Dispositional and explanatory style optimism as potential moderators of the relationship between hopelessness and suicidal ideation. Suicide and Life-Threatening Behavior, 36(6), 661–667. doi: 10.1521/suli.2006.36.6.661.CrossRefPubMedGoogle Scholar
  29. 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. doi: 10.1002/gps.2174.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 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. doi: 10.1080/13811118.2013.722054.CrossRefPubMedGoogle Scholar
  31. Huband, N., McMurran, M., Evans, C., & Duggan, C. (2007). Social problem-solving plus psychoeducation for adults with personality disorder: pragmatic randomised controlled trial. The British Journal of Psychiatry, 190(4), 307–313. doi: 10.1192/bjp.bp.106.023341.CrossRefPubMedGoogle Scholar
  32. Klonsky, E., Kotov, R., Bakst, S., Rabinowitz, J., & Bromet, E. J. (2012). Hopelessness as a predictor of attempted suicide among first admission patients with psychosis: A 10-year cohort study. Suicide and Life-Threatening Behavior, 42(1), 1–10. doi: 10.1111/j.1943-278X.2011.00066.x.CrossRefPubMedCentralGoogle Scholar
  33. 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. doi: 10.1176/appi.ajp.159.6.909.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 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. doi: 10.1017/S0033291705005945.CrossRefGoogle Scholar
  35. McCann, S. H. (2010). Suicide, big five personality factors, and depression at the American state level. Archives of Suicide Research, 14(4), 368–374. doi: 10.1080/13811118.2010.524070.CrossRefPubMedGoogle Scholar
  36. McCrae, R. R., & Costa, P. T. (2004). A contemplated revision of the NEO Five-Factor inventory. Personality and Individual Differences, 36(3), 587–596.CrossRefGoogle Scholar
  37. Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48(9), 832–839. doi: 10.1016/j.brat.2010.05.017.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 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.PubMedGoogle Scholar
  39. 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. doi: 10.7326/0003-4819-158-10-201305210-00642.
  40. 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.Google Scholar
  41. 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. doi: 10.1117/S0033291703008092.CrossRefGoogle Scholar
  42. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. doi: 10.3758/BRM.40.3.879.CrossRefPubMedGoogle Scholar
  43. Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: theory, methods, and prescriptions. Multivariate Behavioral Research, 42(1), 185–227. doi: 10.1080/00273170701341316.CrossRefPubMedGoogle Scholar
  44. Quilty, L., Sellbom, M., Tackett, J., & Bagby, R. (2009). Personality trait predictors of bipolar disorder symptoms. Psychiatry Research, 169(2), 159–163. doi: 10.1016/j.psychres.2008.07.004.CrossRefPubMedGoogle Scholar
  45. 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.PubMedGoogle Scholar
  46. Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychological Methods, 7(4), 422–445. doi: 10.1037/1082-989X.7.4.422.CrossRefPubMedGoogle Scholar
  47. 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. doi: 10.1521/suli.2005.35.4.365.CrossRefPubMedGoogle Scholar
  48. 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. doi: 10.1207/153744202753604494.
  49. Stanley, B., Brodsky, B., Nelson, J. D., & Dulit, R. (2007). Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Archives of Suicide Research, 11(4), 337–341.CrossRefPubMedGoogle Scholar
  50. Stanley, B., Brown, G., Brent, D. A., Wells, K., Poling, K., Curry, J., et al. (2009). Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability. Journal of the American Academy of Child & Adolescent Psychiatry, 48(10), 1005–1013.CrossRefGoogle Scholar
  51. 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.CrossRefPubMedGoogle Scholar
  52. Warmerdam, L., van Straten, A., Jongsma, J., Twisk, J., & Cuijpers, P. (2010). Online cognitive behavioral therapy and problem-solving therapy for depressive symptoms: exploring mechanisms of change. Journal of Behavior Therapy and Experimental Psychiatry, 41(1), 64–70.CrossRefPubMedGoogle Scholar
  53. Wintersteen, M. B. (2010). Standardized screening for suicidal adolescents in primary care. Pediatrics, 125(5), 938–944. doi: 10.1542/peds.2009-2458.

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Kristin L. Walker
    • 1
  • Edward C. Chang
    • 2
  • Jameson K. Hirsch
    • 3
  1. 1.Semel Institute for NeuroscienceUniversity of California at Los AngelesLos AngelesUSA
  2. 2.Department of PsychologyUniversity of MichiganAnn ArborUSA
  3. 3.Department of PsychologyEast Tennessee State UniversityJohnson CityUSA

Personalised recommendations