Suicidality in Chronic Illness: An Overview of Cognitive–Affective and Interpersonal Factors

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, access via your institution.

References

  1. 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

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. 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

    CAS  Article  PubMed  Google Scholar 

  4. 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

    CAS  Article  Google Scholar 

  5. 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.

    Google Scholar 

  6. 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.

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. Beck, A. T., & Steer, R. A. (1991). Manual for the Beck Scale for suicide ideation. San Antonio, TX: Psychological Corporation.

    Google Scholar 

  11. 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

    Article  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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

    Article  Google Scholar 

  15. Blatt, S. J. (1974). Levels of object representation in anaclitic and introjective depression. The Psychoanalytic Study of the Child, 29, 107–157.

    CAS  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    CAS  Article  PubMed  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. 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.

    Google Scholar 

  20. 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

    Article  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

  23. 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

    Article  Google Scholar 

  24. 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.

  25. 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.

  26. 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.

    CAS  PubMed  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    Article  PubMed  PubMed Central  Google Scholar 

  29. 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

    Article  Google Scholar 

  30. 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

    Article  PubMed  PubMed Central  Google Scholar 

  31. 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

    Article  PubMed  Google Scholar 

  32. 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.

    PubMed  Google Scholar 

  33. 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.

    PubMed  Google Scholar 

  34. Dunn, S. L. (2005). Hopelessness as a response to physical illness. Journal of Nursing Scholarship, 37, 148–154.

    PubMed  Google Scholar 

  35. 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. 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

    Article  PubMed  Google Scholar 

  37. 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

    Article  PubMed  PubMed Central  Google Scholar 

  38. 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

    Article  PubMed  Google Scholar 

  39. 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.

    PubMed  Google Scholar 

  40. 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.

    CAS  PubMed  Google Scholar 

  41. 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

    Article  Google Scholar 

  42. 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.

    CAS  PubMed  Google Scholar 

  43. 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

    Article  PubMed  Google Scholar 

  44. 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

    Article  PubMed  PubMed Central  Google Scholar 

  45. Gotlib, I. H., & Hammen, C. L. (1992). Psychological aspects of depression: Toward a cognitive–interpersonal integration. Chichester, UK: Wiley.

    Google Scholar 

  46. Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2, 271–299.

    Google Scholar 

  47. Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, 281–291. https://doi.org/10.1017/S0048577201393198

    Article  PubMed  Google Scholar 

  48. 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

    Article  PubMed  Google Scholar 

  49. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Hayes, S., Strosahl, K., & Wilson, K. (1999). Acceptance and commitment therapy. New York, NY: Guilford Press.

    Google Scholar 

  51. 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

    Article  PubMed  PubMed Central  Google Scholar 

  52. 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.

    CAS  PubMed  Google Scholar 

  53. 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

    Article  PubMed  Google Scholar 

  54. 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

    Article  PubMed  Google Scholar 

  55. 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

    Article  PubMed  Google Scholar 

  56. 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

    Article  PubMed  PubMed Central  Google Scholar 

  57. 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.

    PubMed  Google Scholar 

  58. 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

    Article  PubMed  Google Scholar 

  59. 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.

    PubMed  Google Scholar 

  60. Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York: Guilford Press.

    Google Scholar 

  61. Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.

    Google Scholar 

  62. 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

    Article  Google Scholar 

  63. 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

    Article  PubMed  Google Scholar 

  64. Katon, W. J. (2003). Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biological Psychiatry, 54, 216–226.

    PubMed  Google Scholar 

  65. 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

    Article  Google Scholar 

  66. 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

    Article  PubMed  Google Scholar 

  67. 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  68. 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

    Article  Google Scholar 

  69. Leung, L. (2012). Pain catastrophizing: An updated review. Indian Journal of Psychological Medicine, 34, 204–217. https://doi.org/10.4103/0253-7176.106012

    Article  PubMed  PubMed Central  Google Scholar 

  70. 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

    Article  PubMed  PubMed Central  Google Scholar 

  71. 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

    Article  Google Scholar 

  72. 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

    Article  Google Scholar 

  73. 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

    Article  PubMed  PubMed Central  Google Scholar 

  74. Markowitz, J. C. (2003). Interpersonal psychotherapy for chronic depression. Journal of Clinical Psychology, 59, 847–858. https://doi.org/10.1002/jclp.10177

    Article  PubMed  Google Scholar 

  75. 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

    Chapter  Google Scholar 

  76. 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

    Article  PubMed  Google Scholar 

  77. McCracken, L. M., & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain? Pain, 105, 197–204.

    PubMed  Google Scholar 

  78. 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

    Article  PubMed  PubMed Central  Google Scholar 

  79. Melzack, R. (1987). The short-form McGill pain questionnaire. Pain, 30, 191–197. https://doi.org/10.1016/0304-3959(87)91074-8

    Article  PubMed  Google Scholar 

  80. 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

    Article  PubMed  PubMed Central  Google Scholar 

  81. 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

    CAS  Article  PubMed  Google Scholar 

  82. 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

    Article  PubMed  Google Scholar 

  83. 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

    Article  PubMed  Google Scholar 

  84. 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.

    Google Scholar 

  85. 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

    CAS  Article  PubMed  Google Scholar 

  86. 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

    Article  PubMed  Google Scholar 

  87. 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.

    CAS  PubMed  Google Scholar 

  88. 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

    Article  PubMed  PubMed Central  Google Scholar 

  89. Piburn, G. (1999). Beyond chaos: One man’s journey alongside his chronically ill wife. Cincinnati, OH: The Arthritis Foundation.

    Google Scholar 

  90. 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

    Article  PubMed  PubMed Central  Google Scholar 

  91. 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

    Article  PubMed  PubMed Central  Google Scholar 

  92. 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

    Article  Google Scholar 

  93. Quartana, P. J., Campbell, C. M., & Edwards, R. R. (2009). Pain catastrophizing: A critical review. Expert Review of Neurotherapeutics, 9, 745–758.

    PubMed  PubMed Central  Google Scholar 

  94. 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.

    Google Scholar 

  95. 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.

    PubMed  Google Scholar 

  96. 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

    Article  PubMed  PubMed Central  Google Scholar 

  97. 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.

    PubMed  Google Scholar 

  98. Rogers, M. L., & Joiner, T. E. (2017). Rumination, suicidal ideation, and suicide attempts: A meta-analytic review. Review of General Psychology, 21, 132–142.

    Google Scholar 

  99. 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.

    PubMed  Google Scholar 

  100. 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

    Article  PubMed  PubMed Central  Google Scholar 

  101. Shahar, G. (2015). Erosion: The psychopathology of self-criticism. Oxford, England: Oxford University Press.

    Google Scholar 

  102. Shahar, G. (2016). Criticism in the self, brain, relationships, and social structure: Implications for psychodynamic psychiatry. Psychodynamic Psychiatry, 44, 395–421.

    PubMed  Google Scholar 

  103. 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

    Article  Google Scholar 

  104. 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.

    Google Scholar 

  105. 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.

    PubMed  Google Scholar 

  106. 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

    Article  PubMed  Google Scholar 

  107. Shea, S. C. (2002). The practical art of suicide assessment: A guide for mental health professionals and substance abuse counselors. New York, NY: Wiley.

    Google Scholar 

  108. 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

    Article  PubMed  PubMed Central  Google Scholar 

  109. 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.

    PubMed  Google Scholar 

  110. Sidell, N. L. (1997). Adult adjustment to chronic illness: A review of the literature. Health & Social Work, 22, 5–11.

    CAS  Google Scholar 

  111. 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

    Article  PubMed  Google Scholar 

  112. 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.

    CAS  PubMed  Google Scholar 

  113. 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.

    PubMed  Google Scholar 

  114. Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19, 256–264.

    Google Scholar 

  115. 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.

    PubMed  Google Scholar 

  116. 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

    Article  PubMed  Google Scholar 

  117. Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7, 524–532.

    Google Scholar 

  118. 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

    Article  Google Scholar 

  119. 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.

    PubMed  Google Scholar 

  120. 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.

    PubMed  PubMed Central  Google Scholar 

  121. 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

    Article  PubMed  PubMed Central  Google Scholar 

  122. 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.

    Google Scholar 

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

    Google Scholar 

  124. 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.

    Google Scholar 

  125. 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.

    PubMed  Google Scholar 

  126. 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.

    PubMed  Google Scholar 

  127. 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

    Article  PubMed  PubMed Central  Google Scholar 

  128. 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

    Article  PubMed  PubMed Central  Google Scholar 

  129. 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

    Article  PubMed  Google Scholar 

  130. 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.

    PubMed  Google Scholar 

  131. Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134, 163–206. https://doi.org/10.1037/0033-2909.134.2.163

    Article  PubMed  PubMed Central  Google Scholar 

  132. 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.

    CAS  PubMed  Google Scholar 

  133. 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

    Article  PubMed  Google Scholar 

  134. 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.

    PubMed  Google Scholar 

  135. 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

    CAS  Article  PubMed  Google Scholar 

  136. 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.

    Google Scholar 

  137. 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

    Article  PubMed  PubMed Central  Google Scholar 

  138. 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.

    PubMed  Google Scholar 

  139. 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

    Article  PubMed  PubMed Central  Google Scholar 

  140. World Health Organization [WHO]. (2001). International classification of functioning, disability, and health. World Health Organization

  141. World Health Organization [WHO]. (2014). Preventing suicide: A global imperative. Geneva: World Health Organization.

    Google Scholar 

  142. 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

    Article  PubMed  Google Scholar 

  143. 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

    Article  Google Scholar 

Download references

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

Affiliations

Authors

Corresponding author

Correspondence to Megan L. Rogers.

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

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

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

Download citation

Keywords

  • Suicide
  • Chronic illness
  • Disease
  • Health
  • Mechanisms