ABSTRACT
Background
Recent evidence has found that reporting post-traumatic growth (PTG) from a past stressful life event is associated with lower reports of suicidal ideation. Perceptions of PTG measure the extent to which an individual reports positive changes in their identity, relationships, and worldviews after a stressful event. However, little is known about how perceptions of PTG interact with feelings of defeat and entrapment to influence suicidal ideation. The current study examined this question through the Integrated Motivational-Volitional (IMV) Model of Suicidal Behavior.
Methods
521 adult participants (315 females with age range of 18–82, M = 30.4 years, SD = 13.6) completed an online cross-sectional questionnaire with defeat, entrapment, suicidal ideation, PTG, depression and anxiety measures. Hypotheses and data analysis plans were pre-registered prior to data collection.
Results
PTG negatively correlated with defeat, entrapment and suicidal ideation. PTG predicted lower suicidal ideation when controlling for entrapment, depression and anxiety. PTG did not moderate the relationship between defeat on entrapment or the relationship between entrapment on suicidal ideation.
Limitations
The findings were based on cross-sectional data where participants recalled experiences of defeat, entrapment and suicidal ideation from the past year. The sample was a large community (non-clinical) sample, and most of the participants identified as white (85%).
Conclusion
Although PTG did not function as a moderator within the IMV model of suicidality, it predicted lower suicidal ideation while controlling for other known predictors of suicidal ideation.
Future research could explore the function of PTG in appraisal-based models of suicidality.
Introduction
Suicide is a global public health problem and a leading cause of death worldwide – with more than 800,000 people dying by suicide each year (World Health Organisation, 2014). Suicidal ideation is one of the strongest predictors of suicide attempts (Nock et al., 2018) and deaths by suicide (Brown et al., 2005). Therefore, it is essential that researchers examine risk and protective factors that affect suicide ideation (Jobes and Joiner, 2019).
Inreasingly, suicide research has focused on examining protective factors (e.g., trait resilience) that may function to reduce the saliency of negative feelings and thoughts that lead to suicidal ideation (O’Connor and Kirtley, 2018). The current study extended this research within the Integrated Motivational-Volitional Model of Suicidal Behavior (IMV; O’Connor and Kirtley, 2018) to investigate whether perceptions of post-traumatic growth (PTG; Tedeschi and Calhoun, 1996) have a protective function against suicide ideation. Perceptions of PTG are the extent to which individuals report positive changes in their identity, relationships and worldviews after a highly distressing life event. Some research has found perceptions of PTG are associated with lower reports of suicidal ideation among military samples (Bush et al., 2011; Gallaway et al., 2011; Strader, 2018) and college students (Sheline, 2013).
This study examined PTG within the IMV model (O’Connor and Kirtley, 2018) as it is one of the most robustly tested empirical models of suicidal behavior to date (Dhingra et al., 2015, 2016; O’Connor et al., 2013), and provides a clear framework to test how and when perceptions of PTG may affect suicide ideation. The IMV model posits that coping and resiliency processes interact with key risk factors to reduce their effect on suicide ideation. This study examined whether perceptions of PTG interacted with two risk factors for suicide ideation – feelings of defeat and entrapment.
The IMV Model (O’Connor and Kirtley, 2018) provides a comprehensive understanding of the suicidal mind by outlining the directional pathways that may lead individuals to think about, plan and act on suicidal thoughts. As outlined in Fig. 1, certain background factors (e.g., vulnerabilities, traumatic life events, and genetics) may create a risk for suicide ideation. The focus in this study is on the motivational phase, which explains the formation of suicide ideation through the experience of defeat and entrapment appraisals. For example, a person may experience an adverse event and feel overwhelmed and incapable to change the situation (defeated), which in turn might lead to feelings that they cannot escape the situation (entrapment), which increases suicide ideation.
O’Connor and Kirtley (2018) have specified risk and protective factors – referred to as moderators in the IMV model – that act to strengthen or weaken the transition from defeat to entrapment (threat to self moderators) and from entrapment to suicide ideation (motivational moderators). The protective moderators in the motivational phase of the IMV model (e.g., coping, hope, resilience, positive future thinking, and social support; Fig. 1) help individuals manage their negative appraisals of the situation, thereby lowering suicidal ideation.
Research on the IMV model has found support for the protective function of hope and resilience in cross-sectional studies. Hope was shown to be a significant motivational moderator and weakened the relationship between entrapment and suicidal ideation in students by Tucker et al. (2016). Individuals who set goals and were motivated to achieve these goals were at lower risk of developing suicidal thoughts even when experiencing entrapment due to difficult circumstances. Wetherall et al. (2019) explored the effect of resilience on the entrapment to suicidal ideation relationship and found a significant interaction between entrapment and resilience: individuals high in resilience reported lower suicidal ideation even when they experienced feelings of entrapment.
These findings, along with other research validating the model (e.g., Dhingra et al., 2015; Teismann and Brailovskaia, 2020), highlight the applicability of the IMV model in identifying protective factors that decrease the emergence of suicidal thoughts. However, continued research is needed to enhance such findings through this theoretical framework to aid prevention efforts.
PTG warrants further investigation as a protective factor against suicide ideation. PTG measures the extent to which people report positive changes in their identity, relationships, and outlook following highly distressing life events. PTG is measured through reports of a greater appreciation of life, improved relationships, feelings of personal strength, identification of new possibilities, and greater spirituality (Tedeschi and Calhoun, 1996). Although the concept of PTG as defined by Tedeschi and Calhoun (1996) implies a real post-event transformation in character, research examining PTG longitudinally has not found people’s perceptions to be strongly correlated with change in PTG-related domains over time (Boals et al., 2019; Frazier et al., 2009). These researchers have argued that perceptions of PTG may function more as a coping strategy, and therefore there is value in expanding the scope of the IMV model to examine whether perceptions of PTG function as a coping mechanism to reduce suicidal ideation.
The case for examining PTG as a protective moderator for suicidal ideation is strengthened through existing research, evidencing an inverse relationship between PTG and suicidal ideation. For example, Yu et al. (2010) investigated perceptions of PTG and suicide ideation among Chinese adolescents 1-month after an earthquake in 2008. Results suggested that PTG and reduced suicidal ideation were significantly correlated. Gallaway et al. (2011), Bush et al. (2011) and Strader (2018) found that PTG was inversely related to suicide ideation among US Army soldiers with deployment experience. Sheline (2013) found that PTG moderated the relationship between the severity of lifetime trauma exposure on suicide risk; at low levels of PTG, the severity of traumatic life events was positively associated with suicide risk, whereas at higher levels of PTG, the severity of traumatic life events was negatively associated with suicide risk. While these findings are promising in showing PTG may reduce the saliency of suicidal ideation, further research is needed to situate PTG within existing models of suicidal behavior to understand how PTG interacts with other known risk factors. This study was designed to address this question.
This study aimed to examine the extent to which PTG interacted with two key risk factors outlined in the IMV model – defeat and entrapment – to reduce suicidal ideation. Our primary focus was on the interaction between defeat and PTG on entrapment, which examined PTG as a threat to self moderator within the IMV model (Fig. 1). This hypothesis was derived from research that has conceptualized PTG as a coping response (Jayawickreme and Blackie, 2014) and is in line with related research on positive illusions that found people perceive benefits to reduce the threat of stressful experiences on their self-concepts (Taylor and Brown, 1988). However, given that research has found a direct inverse relationship between PTG and suicide ideation, we also examined the interaction between PTG and entrapment on suicide ideation (i.e., PTG as a motivational moderator; Fig. 1).
To examine these questions in a methodologically rigorous and transparent scientific manner, we conducted a priori power analyses to determine sample size and pre-registered our hypotheses prior to data collection. We collected a large community sample, which is important given the hidden nature of suicidal thoughts and the fact that the majority of people who think about suicide do not seek treatment (Bruffaerts et al., 2011).
H1: We hypothesised that PTG would interact with defeat appraisals and hamper the transition from defeat to entrapment. In other words, individuals high in PTG would report lower suicidal ideation even when they experience high feelings of defeat.
H2: We also examined an alternative hypothesis to determine if PTG interacted with entrapment appraisals to hamper the transition from entrapment to suicide ideation. In other words, individuals high in PTG would report lower suicidal ideation even when they experience high feelings of entrapment.
Link to Article https://www.sciencedirect.com/science/article/abs/pii/S0165032721014336?via%3Dihub
