Negative self-evaluation and the genesis of internal threat: beyond a continuum of suicidal thought and behaviour

Abstract

BackgroundDeath by suicide is often preceded by attempted suicide, suicidal ideation and non-suicidal self-injury. These extreme thoughts and behaviours have been considered in terms of a continuum of suicidality. Little known research, however, has considered a suicide continuum that extends beyond these extreme thoughts and behaviours and incorporates a much wider array of phenomena that may vary in severity and may constitute a broader negative self-evaluation (NSE) continuum.MethodHarvesting key indicators of NSE from a British epidemiological survey (N = 8580), the current study used exploratory factor analysis, confirmatory factor analysis and factor mixture modelling to (i) identify the dimensional structure of NSE in the general population and (ii) profile the distribution of the resultant NSE dimensions. Multinomial logistic regression was then used to differentiate between classes using an array of risk variables, psychopathology outcome variables and a suicide attempt indicator.ResultsA 4-factor model that reflected graded levels of NSE was identified; (F1) Low self-worth & subordination (F2) depression, (F3) suicidal thoughts, (F4) self-harm (SH). Seven classes suggested a clear pattern of NSE severity. Classes characterised by higher levels across the dimensions exhibited greater risk and poorer outcomes. The greatest risk for suicide attempt was associated with a class characterised by engagement in SH behaviour.ConclusionsLow self-worth, subordination and depression, while representative of distinct groups in the population are also highly prevalent in those who entertain suicidal thoughts and engage in SH behaviour. The findings promote further investigation into the genesis and evolution of suicidality and internal threat.

Network structure of depression and anxiety symptoms in Chinese female nursing students

“…A recent study found that only 3 symptoms from the first 8 PHQ-9 questions (i.e., the second symptom “depressed or sad mood”, the sixth symptom “feeling of worthlessness”, and the eighth symptom “psychomotor agitation/retardation”) were significant explanatory variables for suicidal ideation among adult primary care patients [ 63 ]. Previous studies also found that negative beliefs about the self (e.g., low self-worth) is highly prevalent in those who entertain suicidal thoughts [ 64 ]. In addition, the relations between “thoughts of death” and “anhedonia” and “depressed or sad mood” are weak which indicate inadequacy of the PHQ-2 (i.e., the first 2 questions of PHQ-9) for identifying Chinese female nursing students with suicide ideations.…”

Externalizing the threat from within: A new direction for researching associations between suicide and psychotic experiences

“…For example, in a qualitative study of clinical voice hearers, it was possible to clearly formulate the underlying emotional conflicts embodied by the voices (e.g., low self-worth) in 94% of cases, while representations for voice identity (e.g., disowned aspects of self) were formulated in 78% of cases ( N = 100; Corstens & Longden, 2013). Moreover, while suicidality may constitute the most severe form of internal threat, it is possible that psychosis may also be consequential to less severe thoughts and beliefs that ultimately fuel suicidality, for example low self-esteem, feelings of inadequacy, self-criticism, shame, submissive behavior, self-disgust, and so on (Butter, Shevlin, & Murphy, 2019). It was notable also that several adolescents’ case notes referred to feelings of worthlessness and low self-esteem.…”

“…First, the analyses were not inclusive of suicidal ideation. Suicidal ideation has been shown to be highly predictive of both SIB and suicide attempts and has previously been conceptualized as a constituent “component” of a proposed suicidality continuum (Butter et al, 2019; Klonsky, May, & Saffer, 2016; Ribeiro et al, 2016). While its absence in the current study was unlikely to have negated the suicidal drive pathway identified (i.e., supplementing the SIB variable with suicidal ideation would likely have amplified this association) its inclusion and exploration in future prospective analyses will be important.…”

Suicide Attempts in Turkish University Students: The Role of Cognitive Style, Hopelessness, Cognitive Reactivity, Rumination, Self-esteem, and Personality Traits

“…Moreover, these experiences seem to be temporally associated. De Leo et al (2005) for example, showed that over 99% of suicide attempters planned their attempt or experienced suicidal ideation before their attempt and that over 50% of individuals who reported suicidal ideation or behaviour experienced all levels of 'less severe' suicidal thoughts and behaviours preceding their most severe experience (e.g.life not worth living, seriously considering suicide) (Butter et al 2019). Non-suicidal self injury which can be defined as self-inflicted damage to one's self that lack evidence of suicidal intent, and suicidal ideation have each been shown to confer risk for suicidal attempts (Ribeiro et al 2016); Washburn et al 2012)There are many studies aimed to search the relationship between these entities and evaluate the risk factors.…”