Abstract
Objective: Although there is clear evidence that low levels of positive future thinking (anticipation of positive experiences in the future) and hopelessness are associated with suicide risk, the relationship between the content of positive future thinking and suicidal behavior has yet to be investigated. This is the first study to determine whether the positive future thinking–suicide attempt relationship varies as a function of the content of the thoughts and whether positive future thinking predicts suicide attempts over time. Method: A total of 388 patients hospitalized following a suicide attempt completed a range of clinical and psychological measures (depression, hopelessness, suicidal ideation, suicidal intent and positive future thinking). Fifteen months later, a nationally linked database was used to determine who had been hospitalized again after a suicide attempt. Results: During follow-up, 25.6% of linked participants were readmitted to hospital following a suicide attempt. In univariate logistic regression analyses, previous suicide attempts, suicidal ideation, hopelessness, and depression—as well as low levels of achievement, low levels of financial positive future thoughts, and high levels of intrapersonal (thoughts about the individual and no one else) positive future thoughts predicted repeat suicide attempts. However, only previous suicide attempts, suicidal ideation, and high levels of intrapersonal positive future thinking were significant predictors in multivariate analyses. Discussion: Positive future thinking has predictive utility over time; however, the content of the thinking affects the direction and strength of the positive future thinking–suicidal behavior relationship. Future research is required to understand the mechanisms that link high levels of intrapersonal positive future thinking to suicide risk and how intrapersonal thinking should be targeted in treatment interventions.
Highlights
The different categories of positive future thinking were negatively correlated with depression, hopelessness, and suicidal ideation
In the univariate analyses, high levels of intrapersonal positive future thinking were associated with the risk of repetition, whereas low levels of achievement and financial positive future thinking were associated with repeat suicidal behavior
As all of the participants had attempted suicide at baseline, it is unclear whether high levels of intrapersonal positive future thinking predict a first episode suicide attempt. This is the first study to investigate whether the content of positive future thinking predicts repeat suicidal behavior over the medium term
Summary
We recruited 388 patients who were seen by the liaison psychiatry service the morning after presenting at a single general hospital in Edinburgh, Scotland, following a suicide attempt between January 2008 and September 2009. The hospital provides a full range of acute medical and surgical services, including an accident and emergency service. The vast majority of patients had presented with overdose (93%, n ϭ 361). Exclusions were limited to participants who were unfit to participate (e.g., actively psychotic), who were unable to give informed consent (e.g., medically unfit to give informed consent), who were participating in one of the other studies being conducted in the hospital, or who were unable to understand English. There were 220 females and 168 males, with an overall mean age of 35.3 years (SD ϭ 13.91, range ϭ 16 –71 years).
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