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Rumination and Hopelessness as Mediators of the Relation Between Perceived Emotion Dysregulation and Suicidal Ideation

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Abstract

The present study examined whether particular emotion dysregulation dimensions were associated with suicidal ideation through their effects on ruminative thinking and hopelessness. Emerging adults (ages 18–25) with (n = 32) and without (n = 111) a suicide attempt history completed an emotion dysregulation measure at baseline and measures of rumination, hopelessness, depressive symptoms, and suicidal ideation 2–3 years later. Multiple suicide attempters (n = 15) were distinguished by elevated scores on emotion dysregulation dimensions involving impulse control difficulties and inability to access effective emotion regulation strategies. The Strategies dimension, assessed at baseline, was significantly associated with both rumination and hopelessness at follow-up, and with higher ideation at follow-up. Rumination and hopelessness mediated the relation between Strategies and ideation, even when adjusting for depressive symptoms. Perceived inability to access emotion regulation strategies may increase vulnerability to suicidal ideation through its effects on rumination and hopelessness.

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Notes

  1. We did not conduct path analysis, because our sample was not of the recommended size to detect a small effect of a predictor on a potential mediator and of a potential mediator on the outcome (see Fritz and MacKinnon 2007).

References

  • Aldao, A., & Nolen-Hoeksema, S. (2012). When are adaptive strategies most predictive of psychopathology? Journal of Abnormal Psychology, 121, 276–281.

    Article  PubMed  Google Scholar 

  • Alloy, L. B., & Abramson, L. Y. (2007). The adolescent surge in depression and emergence of gender differences: A biocognitive vulnerability-stress model in developmental context. In D. Romer & E. F. Walker (Eds.), Adolescent psychology and the developing brain: Integrating brain and prevention science (pp. 284–312). New York: Oxford University Press.

    Chapter  Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Amstadter, A. (2008). Emotion regulation and anxiety disorders. Anxiety Disorders, 22, 211–221.

    Article  Google Scholar 

  • Anestis, M. D., Bagge, C. L., Tull, M. T., & Joiner, T. E. (2011). Clarifying the role of emotion dysregulation in the interpersonal-psychological theory of suicidal behavior in an undergraduate sample. Journal of Psychiatric Research, 45, 603–611.

    Article  PubMed  Google Scholar 

  • Anestis, M. D., & Joiner, T. E. (2011). Examining the role of emotion in suicidality: Negative urgency as an amplifier of the relationship between components of the interpersonal-psychological theory of suicidal behavior and lifetime number of suicide attempts. Journal of Affective Disorders, 129, 261–269.

    Article  PubMed  Google Scholar 

  • Apter, A., Gothelf, D., Orbach, I., Weizman, R., Ratzoni, G., Har-Even, D., et al. (1995). Correlation of suicidal and violent behavior in different diagnostic categories in hospitalized adolescent patients. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 912–918.

    Article  PubMed  CAS  Google Scholar 

  • Apter, A., & Wasserman, D. (2003). Adolescent attempted suicide. In R. A. King & A. Apter (Eds.), Suicide in children and adolescents (pp. 63–86). Cambridge, UK: Cambridge University Press.

    Chapter  Google Scholar 

  • Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469–480.

    Article  PubMed  CAS  Google Scholar 

  • Arria, A. M., O’Grady, K. E., Caldeira, K. M., Vincent, K. B., Wilcox, H. C., & Wish, E. D. (2009). Suicide ideation among college students: A multivariate analysis. Archives of Suicide Research, 13, 230–246.

    Article  PubMed  Google Scholar 

  • Baumeister, R. F. (1990). Suicide as escape from self. Psychological Review, 97, 90–113.

    Article  PubMed  CAS  Google Scholar 

  • Beck, A. T., & Steer, R. A. (1988). Manual for the Beck Hopelessness Scale. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Beck, A. T., & Steer, R. A. (1993). Manual for the Beck Scale for Suicide Ideation. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Bender, T. W., Gordon, K. H., Bresin, K., & Joiner, T. E., Jr. (2011). Impulsivity and suicidality: The mediating role of painful and provocative experiences. Journal of Affective Disorders, 129, 301–307.

    Article  PubMed  Google Scholar 

  • Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S. G., & Junghanns, K. (2011). Deficits in emotion-regulation skills predict alcohol use during and after cognitive-behavioral therapy for alcohol dependence. Journal of Consulting and Clinical Psychology, 79, 307–318.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2011). WISQARS fatal injury reports. Retrieved October 23, 2011, from http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html.

  • Cheetham, A., Allen, N. B., Yucel, M., & Lubman, D. I. (2010). The role of affective dysregulation in drug addiction. Clinical Psychology Review, 30, 621–634.

    Article  PubMed  Google Scholar 

  • Crane, C., Barnhofer, T., & Williams, J. M. G. (2007). Reflection, brooding, and suicidality: A preliminary study of different types of rumination in individuals with a history of major depression. British Journal of Clinical Psychology, 46, 497–504.

    Article  PubMed  Google Scholar 

  • Davis, R. N., & Nolen-Hoeksema, S. (2000). Cognitive inflexibility among ruminators and nonruminators. Cognitive Therapy & Research, 24, 699–711.

    Article  Google Scholar 

  • Dour, H. J., Cha, C. B., & Nock, M. K. (2011). Evidence for an emotion-cognition interaction in the statistical prediction of suicide attempts. Behaviour Research and Therapy, 49, 294–298.

    Article  PubMed  Google Scholar 

  • Ehring, T., Tuschen-Caffier, B., Schnulle, J., Fischer, S., & Gross, J. (2010). Emotion regulation and vulnerability to depression: Spontaneous versus instructed use of emotion suppression and reappraisal. Emotion, 10, 563–572.

    Article  PubMed  Google Scholar 

  • Eshun, S. (2000). Role of gender and rumination in suicide ideation: A comparison of college samples from Ghana and the United States. Cross-Cultural Research, 34, 250–263.

    Article  Google Scholar 

  • Fairweather, A. K., Anstey, K. J., Rodgers, B., Jorm, A. F., & Christensen, H. (2007). Age and gender differences among Australian suicide ideators: Prevalence and correlates. Journal of Nervous and Mental Disease, 195, 130–136.

    Article  PubMed  Google Scholar 

  • Fritz, M. S., & MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18, 233–239.

    Article  PubMed  Google Scholar 

  • Giegling, I., Olgiati, P., Hartmann, A. M., Calati, R., Moller, H.-J., Rujescu, D., et al. (2009). Personality and attempted suicide. Analysis of anger, aggression and impulsivity. Journal of Psychiatric Research, 43, 1262–1271.

    Article  PubMed  Google Scholar 

  • Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.

    Article  Google Scholar 

  • Gratz, K. L., & Roemer, L. (2008). The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university. Cognitive Behaviour Therapy, 37, 14–25.

    Article  PubMed  Google Scholar 

  • Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Lejuez, C. W., & Gunderson, J. G. (2006). An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of Abnormal Psychology, 115, 850–855.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  • Gross, J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, 281–291.

    Article  PubMed  Google Scholar 

  • Gross, J. J., & Muñoz, R. F. (1995). Emotion regulation and mental health. Clinical Psychology: Science and Practice, 2, 151–164.

    Article  Google Scholar 

  • Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling. [White paper]. Retrieved from http://www.afhayes.com/public/process2012.pdf.

  • Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29, 409–416.

    Article  PubMed  Google Scholar 

  • Hughes, E. K., & Gullone, E. (2011). Emotion regulation moderates relationships between body image concerns and psychological symptomatology. Body Image, 8, 224–231.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  • Just, N., & Alloy, L. B. (1997). The response styles theory of depression: Tests and an extension of the theory. Journal of Abnormal Psychology, 106, 221–229.

    Article  PubMed  CAS  Google Scholar 

  • Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56, 617–626.

    Article  PubMed  CAS  Google Scholar 

  • Kingsbury, S., Hawton, K., Steinhardt, K., & James, A. (1999). Do adolescents who take overdoses have specific psychological characteristics? A comparative study with psychiatric and community controls. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1125–1131.

    Article  PubMed  CAS  Google Scholar 

  • Lam, D., Schuck, N., Smith, N., Farmer, A., & Checkley, S. (2003a). Response style, interpersonal difficulties and social functioning in major depressive disorder. Journal of Affective Disorders, 75, 279–283.

    Article  PubMed  Google Scholar 

  • Lam, D., Smith, N., Checkley, S., Rijsdijk, F., & Sham, P. (2003b). Effect of neuroticism, response style and information processing on depression severity in a clinically depressed sample. Psychological Medicine, 33, 469–479.

    Article  PubMed  CAS  Google Scholar 

  • Lau, M. A., Segal, Z. V., & Williams, J. M. G. (2004). Teasdale’s differential activation hypothesis: Implications for mechanisms of depressive relapse and suicidal behaviour. Behaviour Research and Therapy, 42, 1001–1007.

    Article  PubMed  Google Scholar 

  • Liverant, G., Kamholz, B., Sloan, D., & Brown, T. (2011). Rumination in clinical depression: A type of emotional suppression? Cognitive Therapy & Research, 35, 253–265.

    Article  Google Scholar 

  • Lyubomirsky, S., Caldwell, N. D., & Nolen-Hoeksema, S. (1998). Effects of ruminative and distracting responses to depressed mood on retrieval of autobiographical memories. Journal of Personality and Social Psychology, 75, 166–177.

    Article  PubMed  CAS  Google Scholar 

  • Lyubomirsky, S., & Nolen-Hoeksema, S. (1995). Effects of self-focused rumination on negative thinking and interpersonal problem-solving. Journal of Personality and Social Psychology, 69, 176–190.

    Article  PubMed  CAS  Google Scholar 

  • MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104.

    Article  PubMed  Google Scholar 

  • Mennin, D. S., & Fresco, D. M. (2009). Emotion regulation as an integrative framework for understanding and treating psychopathology. In A. M. Kring & D. M. Sloan (Eds.), Emotion regulation in psychopathology: A transdiagnostic approach to etiology and treatment (pp. 356–379). New York: Guilford.

    Google Scholar 

  • Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9, 85–90.

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., et al. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry, 192, 98–105.

    Article  PubMed  Google Scholar 

  • Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569–582.

    Article  PubMed  CAS  Google Scholar 

  • Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504–511.

    Article  PubMed  CAS  Google Scholar 

  • Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61, 115–121.

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • O’Connor, D. B., O’Connor, R. C., & Marshall, R. (2007). Perfectionism and psychological distress: Evidence of the mediating effects of rumination. European Journal of Personality, 21, 429–452.

    Article  Google Scholar 

  • Palmier-Claus, J. E., Taylor, P. J., Gooding, P., Dunn, G., & Lewis, S. W. (2011). Affective variability predicts suicidal ideation in individuals at ultra-high risk of developing psychosis: An experience sampling study. British Journal of Clinical Psychology, 51, 72–83.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Rajappa, K., Gallagher, M., & Miranda, R. (2012). Emotion dysregulation and vulnerability to suicidal ideation and attempts. Cognitive Therapy and Research, 36, 833–839.

    Article  Google Scholar 

  • Sarin, S., Abela, J. R. Z., & Auerbach, R. P. (2005). The response styles theory of depression: A test of specificity and causal mediation. Cognition and Emotion, 19, 751–761.

    Article  Google Scholar 

  • Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38.

    Article  PubMed  CAS  Google Scholar 

  • Simon, N. M., Pollack, M. H., Ostacher, M. J., Zalta, A. K., Chow, C. W., Fishmann, D., et al. (2007). Understanding the link between anxiety symptoms and suicidal ideation and behavior in outpatients with bipolar disorder. Journal of Affective Disorders, 97, 91–99.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ Primary Care Study. The Journal of the American Medical Association, 282, 1737–1744.

    Article  CAS  Google Scholar 

  • Tamás, Z., Kovacs, M., Gentzler, A. L., Tepper, P., Gadoros, J., Kiss, E., et al. (2007). The relations of temperament and emotion self-regulation with suicidal behaviors in a clinical sample of depressed children in Hungary. Journal of Abnormal Child Psychology, 35, 640–652.

    Article  PubMed  Google Scholar 

  • Tarrier, N., Gooding, P., Gregg, L., Johnson, J., & Drake, R. (2007). Suicide schema in schizophrenia: The effect of emotional reactivity, negative symptoms, and schema elaboration. Behaviour Research and Therapy, 45, 2090–2097.

    Article  PubMed  Google Scholar 

  • Teasdale, J. D. (1988). Cognitive vulnerability to persistent depression. Cognition and Emotion, 2, 247–274.

    Article  Google Scholar 

  • Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59, 25–52.

    Article  PubMed  CAS  Google Scholar 

  • Thomsen, D. K., Schnieber, A., & Olesen, M. H. (2011). Rumination is associated with the phenomenal characteristics of autobiographical memories and future scenarios. Memory, 19, 574–584.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  • Williams, J. M. G. (1997). Cry of pain: Understanding suicide and self-harm. Harmondsworth, England: Penguin.

    Google Scholar 

  • Williams, J. M. G. (2006). Capture and rumination, functional avoidance, and executive control (CaRFAX): Three processes that underlie overgeneral memory. Cognition and Emotion, 20, 548–568.

    Article  Google Scholar 

  • Wu, C.-S., Liao, S.-C., Lin, K. M., Tseng, M. M., Wu, E. C., & Liu, S. K. (2009). Multidimensional assessments of impulsivity in subjects with history of suicidal attempts. Comprehensive Psychiatry, 50, 315–321.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by PSC-CUNY Grant PSCREG-41-1351. Thanks to Valerie Khait, Alyssa Wheeler, Monique Fontes, Shirley Chan, Shama Goklani, Judelysse Gomez, Marta Krajniak, Wendy Linda, Brett Marroquín, Kai Monde, Lillian Polanco-Roman, and Jessica Silver for their assistance with data collection. Thanks also to Sa Shen (New York State Psychiatric Institute) for comments on a previous version of this manuscript.

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Authors and Affiliations

  1. Department of Psychology, Hunter College, City University of New York, 695 Park Ave., Room 611HN, New York, NY, 10065, USA

    Regina Miranda, Aliona Tsypes, Michelle Gallagher & Kristin Rajappa

  2. The Graduate Center, City University of New York, New York City, NY, USA

    Regina Miranda

  3. University of North Carolina, Chapel Hill, NC, USA

    Michelle Gallagher

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  1. Regina Miranda
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  2. Aliona Tsypes
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Correspondence to Regina Miranda.

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Miranda, R., Tsypes, A., Gallagher, M. et al. Rumination and Hopelessness as Mediators of the Relation Between Perceived Emotion Dysregulation and Suicidal Ideation. Cogn Ther Res 37, 786–795 (2013). https://doi.org/10.1007/s10608-013-9524-5

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