Understanding Suicidal Thoughts: A Personal Perspective

Since the loss of my son Joey, I have developed a profound curiosity about suicidal thoughts and ideations. It is a complex and sensitive topic that impacts many lives. I find myself wanting to understand when these thoughts begin, how they develop, where they often stem from, and why they manifest.

Various factors can contribute to suicidal ideations, including mental health disorders, personal trauma, or overwhelming feelings of hopelessness. In many cases, individuals may feel trapped in their pain, leading to thoughts of ending their suffering. It's important to recognize the signs and understand that these feelings can occur in anyone, regardless of age, background, or circumstance.

Exploring this topic not only helps me make sense of my personal grief but also enables me to raise awareness and support those who may be struggling. I believe understanding the root causes can foster empathy and encourage open conversations, which are critical for prevention and healing.

In sharing this quest for knowledge, I hope to contribute to a greater understanding of mental health challenges and the importance of compassion in the face of such profound struggles. Below are some highlights from the AFSP Research Newsletter, it really is an interesting read and does provide a glimpse of some understanding to this complex subject.

Imagine a future where we understand the interplay of factors that contribute to someone’s risk for suicidal behavior so well that we can catch warning signs early and step in before a crisis happens.

Suicide risk is complex and ever changing, and stress can precipitate a suicidal crisis for a person with multiple potential contributors. Researchers have identified many different types of contributors (e.g., biological, psychological, social, and environmental). Now, researchers are turning their attention to how age and the process of aging may play a role in risk. Knowing this could guide opportunities for effective treatments.

One area of particular interest when it comes to aging is neurocognitive function, which is the brain’s ability to manage tasks like memory, language, concentration, and comprehension. Researchers are studying how these mental abilities connect to different brain regions and how changes in neurocognition over the lifespan may impact underlying suicide risk.

As part of an AFSP Linked Standard Research Grant involving three separate research groups, Drs. Jeffrey Bridge, John Keilp, and Katalin Szanto set out to understand how certain thinking skills and clinical risk factors relate to suicidal behavior across different ages.

The study had two main goals. First, the team wanted to see if any cognitive and clinical factors were consistently associated with suicidal behavior across all ages or if certain factors mattered more at specific ages.

Second, they wanted to identify which specific cognitive and clinical characteristics were better at distinguishing people who had a history of suicidal behavior from those who did not. The team recruited 309 participants, aged 16 to 80, from three distinct groups:

1. People experiencing depression with at least one past suicide attempt
2. People experiencing depression without any history of suicide attempts
3. People with no history of mental health diagnoses or suicidal thoughts or behaviors

Each person took tests to measure different aspects of neurocognitive function, like memory, language, decision-making, and executive functioning. These tests helped the researchers see how people process information and make decisions.

In addition to these cognitive assessments, the researchers also measured several clinical factors often linked to suicidal behavior. These included:

• Depression severity
• Feelings of hopelessness
• Traits of borderline personality disorder, like emotional instability and identity issues
• A tendency for impulsive problem-solving
• Aggressive behavior
• Depressive rumination, or the habit of repeatedly focusing on negative thoughts
• Feelings of being trapped

The findings from this study could provide a clearer picture of how thinking patterns and potential risk for suicidal behavior may evolve over a person’s life, helping to inform age-specific prevention and intervention strategies.

RESULTS:

The research team found that the contributions of cognitive and clinical factors to suicide attempt change as people get older. Some clinical risk factors, like borderline personality traits, impulsive problem-solving, and aggression, were consistently higher in people with a history of suicide attempts, regardless of age. However, cognitive skills –– especially memory –– showed different patterns. While memory declined naturally with age in all groups, this decline was more pronounced in older adults who had previously attempted suicide compared to those who had not. Older adults with a history of suicide attempts also scored lower in category fluency, a measure of verbal skills and cognitive flexibility, which suggests that cognitive differences between attempters and non-attempters increase with age.

Notably, two clinical factors stood out in distinguishing attempters from non-attempters starting in middle age: depressive rumination and feelings of entrapment. Rumination involves dwelling on negative thoughts or past events, and it became a stronger marker for suicide attempter status as people got older. Entrapment (the feeling of being trapped by inescapable life stresses) followed a similar pattern, showing up more in older adults with a history of attempts than in younger ones.

The researchers believe that, in older adults, these feelings of entrapment may interact with rumination, intensifying suicidal thoughts and raising potential risk. Rumination itself is linked to worsening depression and hopelessness and has even been associated with biological markers related to dementia and faster brain aging. These factors may relate to the loss of flexible thinking and problem solving during a suicidal crisis.

The study assessed only one point in time, so we don’t know if the differences were always present, or changed with time. The findings indicate a need for further research. Nonetheless, these findings support the idea that aging may significantly change the influence of various factors for suicidal behavior, either increasing or reducing their impact. This insight highlights the importance of uncovering age-specific contributors to risk to improve suicide prevention efforts.

As we often say at AFSP, “The more we understand suicide, the more we can do to prevent it.” This study deepens our understanding of how risk factors vary across the lifespan, and provides valuable information for clinicians assessing suicide risk, especially among older adults: an age group with the highest rate of suicide.

TAKEAWAYS:

• Contributors to suicidal behavior may vary or remain consistent across different life stages.
• Researchers are investigating contributors that persist throughout the lifespan and those that distinguish suicide attempters from non-attempters.
• Key factors like borderline traits, impulsive problem-solving, and aggression were found to be consistently higher in suicide attempters across all ages.
• Depressive rumination and feelings of entrapment strongly differentiated suicide attempters, especially in older adults.
• These findings suggest that aging alters the impact of various risk factors, highlighting the need for more research and tailored intervention