Fall/Winter 2006 Newsletter: Section 7

Suicide is a significant public health problem across the lifespan, and is the 5th leading cause of years of potential life lost before age 65. Suicide is also the 11th overall leading cause of death in the United States. There is, therefore, a pressing need for the development of effective suicide prevention programs targeting at-risk individuals and groups.

The effectiveness of these programs will depend largely on how well they mitigate risk for suicide ideation and behaviors; risk factors include the presence of negative life events, and medical illness and functional impairment. Depression, hopelessness, and pessimism are also well-established risk factors for suicide. The reduction of maladaptive cognitions, thus, has become a central focus of cognitive models and treatments for suicide in these populations.

Adaptive and positive cognitive characteristics, such as optimism, hope, future orientation and reasons for living, that might buffer against suicide have received comparatively less attention. Although few rigorously controlled studies have been conducted, preliminary findings suggest that adaptive cogntions are associated with reduced depressive symptoms in college students, improved psychological adjustment in patients with cancer, multiple sclerosis, and Parkinson’s disease, enhanced well being in patients with HIV and arthritis, and decreased suicide ideation and behaviors in adolescents, young adults and depressed older adults. Taken together, these interesting results suggest that individuals with a positive future-orientation may have better outcomes.

Drawing on cognitive and self-determination theories, I have begun to develop a framework for understanding suicide prevention that emphasizes positive psychological growth through enhancement of positively-valenced future-oriented thoughts, self-determination and goal achievement, and interpersonal relatedness. As a protective factor, positive future-orientation may provide a measure of resilience against negative biopsychosocial outcomes through utilization of active and adaptive coping strategies. Engaging problems directly, having motivation to overcome adversity, and being persistent in the accomplishment of goals are examples; meaningful and supportive interpersonal relationships that foster future orientation may also be important. Preliminary findings with adolescents and college students suggest that training individuals to think optimistically can reduce depression; perhaps similar techniques could be used to decrease suicide ideation and behaviors in these at-risk populations.

What is interesting is that optimistic individuals appear to receive benefits even in the face of difficult circumstances. For those who have experienced negative and potentially traumatic life events, being able to foresee a positive outcome to negative life situations or positively reframe or reappraise negative life experiences may reduce risk for suicide ideation and behaviors. An individual able to engender a positive outlook toward the future, and who is encouraged to do so, may reduce their distress, thereby mitigating risk for suicidal thoughts and behaviors.

In my research, I have found that adaptive and future-oriented cognitive characteristics are associated with lower levels of current suicide ideation in college students, and with lower levels of current and worst-point suicide ideation, and fewer lifetime suicide attempts, in depressed older adults (Hirsch et al., 2005b; Hirsch et al., 2005a). I have also examined future orientation as a beneficial moderator of the relationship of several risk factors and suicide ideation and attempts, including hopelessness, negative life events, and functional impairment; in each case, future orientation exerted a buffering effect (Hirsch et al., 2005c; Hirsch et al., 2005d). All of these findings are significant after controlling for variables that are powerfully associated with suicide, including hopelessness and depression severity. This suggests that the promotion of adaptive characteristics may be a valuable adjunctive strategy for suicide prevention efforts. Although cognitively-based therapeutic interventions have been successful in the treatment of suicidal behavior, none has focused specifically on enhancing future orientation.

Future suicide research and prevention efforts should include a positive psychological perspective. Investigation of future orientation among diverse at-risk samples is also necessary, as is prospective investigation of the mechanisms by which future orientation might exert a protective effect against suicidal thoughts and behaviors. Deeper understanding of factors that influence the development and expression of suicidal thoughts and behaviors may lead to the development of better treatments.

Reference List

Hirsch, J. K., Conner, K. R., & Duberstein, P. R. (2005a). Optimism and suicide ideation in young adult college students. Submitted.

Hirsch, J. K., Duberstein, P., Conner, K. R., Heisel, M. J., Beckman, A., & Conwell, Y. (2005b). Future orientation and suicide ideation and attempts in depressed adults ages 50 and over. Submitted.

Hirsch, J. K., Duberstein, P., Conner, K. R., Heisel, M. J., Beckman, A., & Conwell, Y. (2005c). Hopelessness and future orientation as potential moderators of the relationship between functional impairment and suicide ideation in depressed adults ages 55 and over. Submitted.

Hirsch, J. K., Wolford, K., Brunk, L., & Parker-Morris, A. (2005d). Optimism as a moderator of the association between negative life events and suicide ideation and attempts. Submitted.