Investigating the internal struggle hypothesis of suicide: Differential assessments of suicidal states using reasons for living and reasons for dying qualitative responses

Résumé

Suicide is a national health crisis, with over 32,000 people taking their own lives each year in the United States alone (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2014). Despite the seriousness of the behavior, mental health providers are often ill-equipped to effectively assess and treat suicidal individuals (Jobes, Rudd, Overholser, & Joiner, 2008). Researchers have proposed various theories and conducted extensive empirical research in attempts to develop more effective clinical assessments of suicidal risk. Of particular interest to the current study are efforts to understand suicide risk as a spectrum of suicidal thinking. Kovacs and Beck (1977) were among the first to theorize and investigate suicide risk in this fashion when they developed their "Internal Struggle Hypothesis," that describes the phenomenon of psychological ambivalence towards living and dying that is commonly seen among people experiencing a suicidal crisis (Brown et al., 2005; Jobes & Mann, 1999; Linehan, Goodstein, Nielsen, & Chiles, 1983). Jobes and Mann (1999) examined aspects of the "internal struggle" by developing the qualitative "Reasons for Living vs. Reasons for Dying (RFL/RFD) Assessment." They theorized that combining both of these constructs into a single assessment could lead to much more clinically significant information that would inform the overall suicide risk assessment and provide useful information relevant to treatment. The primary purpose of this exploratory investigation was to reliably code a sample of suicide attempters' qualitative written content responses to the RFL/RFD Assessment developed by Jobes (2006) as a first step in a new line of research in this area. Beyond reliably coding these qualitative data, the study examined psychological differences between sub-types of suicide attempters derived from the coding as measured on 10 different standardized measures pertaining to suicide risk and mental health. Regression analyses found significant differences among suicidal patient typologies on multiple standardized risk assessment measures. Overall, relationally-oriented, life-motivated patients present the lowest level of suicide risk, while self-oriented, death-motivated patients presented the highest level of suicide risk. These findings suggest that developing social connectedness and cultivating reasons for living may reduce suicide risk. (PsycINFO Database Record (c) 2016 APA, all rights reserved) DÉPISTAGE POTENTIEL-SUICIDAIRE AMBIVALENCE RAISON-VIVRE RAISON-MOURIR PSYCHOMÉTRIE