Are suicidal thoughts reinforcing? A preliminary real-time monitoring study on the potential affect regulation function of suicidal thinking

Background: Theoretical work and clinical observation suggest that many patients experience relief from negative affect after thinking about suicide, which may increase the likelihood of future suicidal thoughts. Accordingly, our objective was to examine whether the occurrence of suicidal thinking was followed by decreased negative affect and increased positive affect.

Methods: Participants were 43 adults who attempted suicide at least once in the past year (78% female, 78% White, M age = 23.28 years, SD age = 4.38 years) who completed 28 days of smartphone-based real-time monitoring, where they were signaled four times/day to report on current affect and whether they were having suicidal thoughts. Participants could initiate a survey whenever they had a suicidal thought.

Results: First, we examined changes in affect that occurred when suicidal thinking at the current time (T) but not at T + 1 (approximately 4-8 h later). Negative affect decreased and positive affect increased when participants went from a period when they were experiencing suicidal thoughts to a period where they were not. Second, to assess the time course of changes in affect, we examined changes in affect before and after participant-initiated reports of suicidal thinking. Positive affect increased and sadness decreased.

Limitations: Given its preliminary nature, the study has some limitations including insufficient power to expand beyond a 4-8 h timespan.

Conclusions: Findings provide preliminary evidence that suicidal thinking leads to shifts in affect. These shifts in affect may be reinforcing, helping to explain (in part) why suicidal thinking is so persistent for some patients.