Abstract
Although suicidal ideation is one of the most consistent symptoms across recurrent episodes of depression, the mechanisms underpinning its maintenance are poorly understood. In order to develop effective treatments for suicidally depressed patients, understanding what maintains suicidal distress is critical. We hypothesised that Thought–Action Fusion (TAF), i.e., to assume that having a thought has real world consequences, originally described in Obsessive–Compulsive Disorder, might be a bias in recurrently suicidally depressed people. To assess this, we revised the original TAF scale, and assessed TAF in three samples: healthy controls, recurrently depressed individuals with no history of suicidality (D-NS) and individuals with a history of recurrent suicidal depression (D-S). Exploratory and confirmatory factor analyses indicated a three-factor solution of TAF: (1) TAF for uncontrollable events, (2) self-suicidal TAF for suicidal acts related to oneself, and (3) TAF for positive controllable events. Compared to healthy controls, the D-NS group reported significantly higher total TAF, TAF uncontrollable, and TAF self-suicidal subscales, whilst positive controllable TAF was lower compared to healthy controls. Both D-S and D-NS samples reported higher TAF for suicidal thought compared to healthy controls, i.e., believing that having suicidal thoughts means they will act on them, however in the context of low mood this became more pronounced for the D-S group. These findings suggest that targeting TAF both in suicidal and non-suicidal depression has merit.
Highlights
Suicidal cognitions are a common feature of major depression, they are prevalent among people seeking health care (Scott et al 2012) and observed to some degree in general population samples (Crosby et al 2011)
We have previously suggested that vulnerable individuals’ relationship with and responses to suicidal cognitions are critical in determining whether suicidal cognitions persist and potentially escalate and that such persistence is most likely when individuals respond to suicidal thoughts with rumination and suppression (Williams et al 2016)
It is established that differences in response to suicidal cognitions exist in patient and general population samples, relatively little is known about the factors that determine these
Summary
Suicidal cognitions are a common feature of major depression, they are prevalent among people seeking health care (Scott et al 2012) and observed to some degree in general population samples (Crosby et al 2011). We have previously suggested that vulnerable individuals’ relationship with and responses to suicidal cognitions are critical in determining whether suicidal cognitions persist and potentially escalate and that such persistence is most likely when individuals respond to suicidal thoughts with rumination and suppression (Williams et al 2016). In line with this hypothesis Pettit et al (2009) have found that suppression of suicidal thoughts increases their severity over time. Models of Obsessive–Compulsive Disorder (OCD); (e.g., Clark 1999), in which distressing and intrusive thoughts are core symptoms, may suggest
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