Entrapment as a mediator of suicide crises

Abstract

BackgroundPrior research has validated the construct of a suicide crisis syndrome (SCS), a specific psychological state that precedes and may precipitate suicidal behavior. The feeling of entrapment is a central concept of the SCS as well as of several other recent models of suicide. However, its exact relationship with suicidality is not fully understood. In efforts to clarify the exact role of entrapment in the suicidal process, we have examined if entrapment mediates the relationship of other components of the SCS, including ruminative flooding, panic-dissociation, fear of dying and emotional pain, with suicidal ideation (SI) in recently hospitalized psychiatric inpatients.MethodsThe Suicide Crisis Inventory (SCI) and Beck Scale for Suicidal Ideation (BSS) were administered to 200 high-risk adult psychiatric inpatients hospitalized following SI or suicide attempt, assessing SCS and SI levels at admission, respectively. The possible mediation effects of entrapment on the relationship between the other components of the SCS and SI at admission were evaluated.ResultsEntrapment significantly and fully mediated the relationship of ruminative flooding, panic-dissociation, and fear of dying with SI, with no direct relationships between these variables and SI reaching statistical significance. Further, no reverse mediation relationships between these variables and SI were found, indicating that the mediation effects of entrapment were unidirectional. While entrapment did mediate the association between emotional pain and SI, the direct relationship between emotional pain and SI was also significant. Moreover, in reverse mediational analysis, emotional pain was a partial mediator of the relationship between entrapment and SI.ConclusionEntrapment and emotional pain may have a more direct association with SI than the other components of the SCS, including ruminative flooding, panic-dissociation, and fear of dying, the effects of which are mediated by the former. This suggests entrapment and emotional pain may represent key symptomatic targets for intervention in acutely suicidal individuals. Further research is needed to determine the relationship of these constructs to suicidal behavior.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1587-0) contains supplementary material, which is available to authorized users.

Predictive Validity of Proposed Diagnostic Criteria for the Suicide Crisis Syndrome: An Acute Presuicidal State

“…The centrality of entrapment (Criterion A) to the syndrome is supported by the strong performance of this single symptom. This is consistent with contemporary theories of suicidality such as Galynker's Narrative Crisis model (Galynker, ) and the three‐step theory of Klonsky and May (Bagge, Littlefield, & Glenn, ; Klonsky & May, ) which posit the experience of entrapment as the central component of the presuicidal mental state, and our recent finding that entrapment severity mediates the influence of other SCS symptoms on postdischarge suicide risk (Li et al., ).…”

Suicide Crisis Syndrome: A review of supporting evidence for a new suicide‐specific diagnosis

“…Although at present entrapment remains the preferred term for Criterion A because of its acceptability and familiarity, there is some evidence that it is not entirely accurate. First, recent studies have identified emotional pain to be most highly correlated with entrapment (Galynker et al, ; Li et al, ). Second, a network analysis of the SCS (Bloch‐Elkouby et al, unpublished data) has established that entrapment is closely linked to emotional pain.…”

Suicide Risk and Emotional Responses to Thoughts of Death: The Response to Morbid Ideations Questionnaire

“…Most contemporary theories of suicide derive from an escape‐based conceptualization of the suicidal process (Baumeister, ; Gilbert & Allan, ; Li et al., ; O'Connor, ; Williams & Pollock, ). In this conceptualization, suicide represents an escape behavior and thus suicide ideation a formulation of an escape strategy (Li et al., ). This, however, leaves unasked and unanswered the question of how suicide might enter a person's consciousness in order to be selected as an escape strategy.…”