The online version of this article (https://doi.org/10.1186/s12888-018-1587-0) contains supplementary material, which is available to authorized users.
Prior research has validated the construct of a suicide crisis syndrome (SCS), a specific psychological state that precedes and may precipitate suicidal behavior. The feeling of entrapment is a central concept of the SCS as well as of several other recent models of suicide. However, its exact relationship with suicidality is not fully understood. In efforts to clarify the exact role of entrapment in the suicidal process, we have examined if entrapment mediates the relationship of other components of the SCS, including ruminative flooding, panic-dissociation, fear of dying and emotional pain, with suicidal ideation (SI) in recently hospitalized psychiatric inpatients.
The Suicide Crisis Inventory (SCI) and Beck Scale for Suicidal Ideation (BSS) were administered to 200 high-risk adult psychiatric inpatients hospitalized following SI or suicide attempt, assessing SCS and SI levels at admission, respectively. The possible mediation effects of entrapment on the relationship between the other components of the SCS and SI at admission were evaluated.
Entrapment significantly and fully mediated the relationship of ruminative flooding, panic-dissociation, and fear of dying with SI, with no direct relationships between these variables and SI reaching statistical significance. Further, no reverse mediation relationships between these variables and SI were found, indicating that the mediation effects of entrapment were unidirectional. While entrapment did mediate the association between emotional pain and SI, the direct relationship between emotional pain and SI was also significant. Moreover, in reverse mediational analysis, emotional pain was a partial mediator of the relationship between entrapment and SI.
Entrapment and emotional pain may have a more direct association with SI than the other components of the SCS, including ruminative flooding, panic-dissociation, and fear of dying, the effects of which are mediated by the former. This suggests entrapment and emotional pain may represent key symptomatic targets for intervention in acutely suicidal individuals. Further research is needed to determine the relationship of these constructs to suicidal behavior.
Additional file 1: Mediation models controlling for age and depression. Results of mediation analyses controlling for age and depression. (DOC 63 kb)12888_2018_1587_MOESM1_ESM.doc
Additional file 2: Mediation models demonstrating mutual partial mediation of entrapment and emotional pain by depression. Results of mediation analyses demonstrating mutual partial mediation of entrapment and emotional pain by depression. (DOC 57 kb)12888_2018_1587_MOESM2_ESM.doc
Control, C.f.D. and Prevention, WISQARS™(web-based injury statistics query and reporting system). 2014.
Pandey GN, Dwivedi Y. Peripheral biomarkers for suicide. In: Dwivedi Y, editor. The neurobiological basis of suicide. London: CRC Press; 2012. p. 407-24.
Rogers ML, et al. An overview and comparison of two proposed suicide-specific diagnoses: acute suicidal affective disturbance and suicide crisis syndrome. Psychiatr Ann. 2017;47(8):416–20. CrossRef
Galynker I. The suicidal crisis: clinical guide to the assessment of imminent suicide risk. New York: Oxford University Press; 2017. CrossRef
Hendin H, Maltsberger JT, Szanto K. The role of intense affective states in signaling a suicide crisis. J Nerv Ment Dis. 2007;195(5):363–8. PubMed
Williams JMG, Pollock LR. Psychological aspects of the suicidal process. Underst Suicidal Behav. 2001:76–93.
O'Connor RC, Cleare S, Eschle S, Wetherall K, Kirtley OJ. The integrated motivational-volitional model of suicidal behavior. In: O'Connor RC, Pirkis J, editors. The international handbook of suicide prevention. Chichester: John Wiley & Sons, Ltd; 2016. p. 220–40. CrossRef
Maria P, et al. Negative self-appraisals and suicidal behavior among trauma victims experiencing Ptsd symptoms: the mediating role of defeat and entrapment. Depress Anxiety. 2012;29(3):187–94. CrossRef
Tucker RP, et al. Rumination and suicidal ideation: the moderating roles of hope and optimism. Personal Individ Differ. 2013;55(5):606–11. CrossRef
Garcia-Campayo J, et al. The reason for medical consultations in patients with psychiatric diseases: somatization phenomena and suicide attempts. Medicina Clinica. 1997;108(9):321–4. PubMed
Yaseen ZS, et al. Fear of dying in panic attacks predicts suicide attempt in comorbid depressive illness: prospective evidence from the national epidemiological survey on alcohol and related conditions. Depress Anxiety. 2013;30(10):930–9. PubMed
Shneidman ES. Suicide as psychache: a clinical approach to self-destructive behavior. Northfield: Jason Aronson; 1993.
Orbach I. Mental pain and suicide. Isr J Psychiatry Relat Sci. 2003;40(3):191. PubMed
Troister T, Holden RR. Factorial differentiation among depression, hopelessness, and psychache in statistically predicting suicidality. Meas Eval Couns Dev. 2013;46(1):50–63. CrossRef
Beck AT, Steer RA. BSI, Beck scale for suicide ideation: manual. San Antonio: Psychological Corporation; 1991.
Beck AT, Steer RA, Brown GK. Beck depression inventory-II. San Antonio. 1996;78(2):490–8.
Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Press; 2013.
Flamenbaum R, Holden RR. Psychache as a mediator in the relationship between perfectionism and suicidality. J Couns Psychol. 2007;54(1):51. CrossRef
Flamenbaum, R., Testing Shneidman's theory of suicide: Psychache as a prospective predictor of suicidality and comparison with hopelessness. 2009.
Klonsky ED, May AM. The three-step theory (3ST): a new theory of suicide rooted in the “ideation-to-action” framework. Int J Cogn Ther. 2015;8(2):114–29. CrossRef
Williams M. Cry of pain: understanding suicide and the suicidal mind. London: Little, Brown Book Group; 2014.
- Entrapment as a mediator of suicide crises
Zimri S. Yaseen
Lisa J. Cohen
Igor I. Galynker
- BioMed Central
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