The ebb and flow of the wish to live and the wish to die among suicidal military personnel.
Abstract
Background The relative balance between the wish to live and the wish to die (i.e., suicidal ambivalence) is a robust predictor of suicidal behavior and may be a mechanism underlying the effectiveness of treatments that reduce suicidal behaviors. To date, however, few studies have explored possible mechanisms of action in these treatments.Method Active duty Soldiers (N=152) with a recent suicide attempt and/or active suicide ideation were randomized to receive brief cognitive behavioral therapy (BCBT) or treatment as usual (TAU). The Suicide Attempt Self-Injury Inventory (Linehan et al., 2006a) was used to assess the incidence of suicide attempts during the 2-year follow-up. The wish to live and the wish to die were assessed with items 1 and 2, respectively, of the Beck Scale for Suicide Ideation (Beck and Steer, 1991).Results Across both treatments, the wish to live was significantly weaker among patients who attempted suicide but the wish to die was stronger only among patients who attempted suicide in TAU. Among nonattempters, the wish to die stabilized the wish to live, but among attempters the wish to live and the wish to die were not associated with each other. In BCBT the wish to live destabilized the wish to die among nonattempters.Limitations Self-report methodology, predominantly male sample.Conclusions The emergence of suicidal behavior is driven primarily by the absence of the wish to live. BCBT is associated with a unique coupling of an ambivalent wish to live and wish to die, which may suggest an underlying mechanism of action.
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Individuals who both contemplate suicide and make a suicide attempt can experience ambivalence about suicide if they have motivations for suicide and reasons for staying alive.
“Individuals who both contemplate suicide (ideators) and make a suicide attempt (attempters) can experience ambivalence about suicide, if they have motivations for suicide and reasons for staying alive (Bryan et al., 2016).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Bryan et al., 2016
An individual's suicide risk can fluctuate over a period of days or even hours, and the period of time between considering suicide and making an attempt can be as short as ten minutes.
“An individual’s suicide risk can fluctuate over a period of days or even hours (Bryan et al., 2016), and the period of time between considering suicide and making an attempt can be as short as ten minutes (Deisenhammer et al., 2009).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Bryan et al., 2016
Individuals' desire to attempt suicide at any given moment depends on their control over goals which could be achieved by suicide.
“Since control is a dynamic process (Powers, 1973), this may explain fluctuations in suicide risk (Bryan et al., 2016); it is posited that individuals’ desire to attempt suicide at any given moment depends on their control over goals which could be achieved by suicide.”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Bryan et al., 2016
Investigating psychological processes involved in ambivalence about suicide may lead to a greater understanding of the mechanisms underlying suicide attempts, particularly since ambivalence can deter individuals from attempting suicide.
“Investigating psychological processes involved in ambivalence about suicide may lead to a greater understanding of the mechanisms underlying suicide attempts, particularly since ambivalence can deter individuals from attempting suicide (Jobes, 2006; Bryan et al., 2016).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Bryan et al., 2016
Few theoretical models which follow an ideation-to-action framework include ambivalence about suicide as a key concept, despite its important role in suicide.
“However, a limitation of existing literature is that few theoretical models which follow an ideation-to-action framework include ambivalence about suicide as a key concept, despite its important role in suicide (Jobes, 2006; Bryan et al., 2016).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Bryan et al., 2016
It does not explain fluctuations in individuals' ambivalence about attempting suicide.
“Furthermore, it does not explain fluctuations in individuals’ ambivalence about attempting suicide (Bryan et al., 2016; Bergmans et al., 2017).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Bryan et al., 2016
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References 23 · Cited by 82
- Authors
- Bryan, C. J., Rudd, M. D., Peterson, A. L., Young-McCaughan, S., & Wertenberger, E. G.
- Affiliations
- University of Utah (US)
- University of Memphis (US)
- The University of Texas at San Antonio Health Science Center (US)
- United States Army (US)
- Corresponding author
- Bryan, Craig J.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 202
- Pages
- 58-66
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2407815740
- Cited by
- 82
- References
- 23
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 7 · 2023: 6 · 2022: 11 · 2021: 7 · 2020: 17 · 2019: 5 · 2018: 6 · 2017: 7 · 2016: 2
- FWCI
- 8.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- desire for death, suicidal ideation, suicide attempts, military personnel, active duty military personnel, brief cognitive behavioral therapy, suicide prevention, therapeutic mechanisms
- MeSH terms
- Suicide Prevention, Adult, Attitude to Health, Female, Humans, Male, Military Personnel, Psychotherapy, Brief, Suicide, Suicide, Attempted, Cognitive Behavioral Therapy, Self-Injurious Behavior, Treatment Outcome, Self Report, Suicidal Ideation
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