Top

Published in:

01-10-2021 | Suicide | Original Paper

Clarifying the Role of Multiple Self-Damaging Behaviors in the Association Between Emotion Dysregulation and Suicide Risk Among College Students

Authors: Lauren A. Haliczer, Lauren E. Harnedy, Marykate Oakley, Katherine L. Dixon-Gordon

Published in: Journal of Prevention | Issue 5/2021

Abstract

Suicidal behaviors are increasingly prevalent among college students. Although emotion dysregulation is theorized to increase suicide risk, research supporting this relationship is mixed. Engagement in self-damaging behaviors may play a role in the relationship between emotion dysregulation and suicide risk, theoretically by increasing one’s capability of engaging in suicidal behaviors. Such behaviors may interact with emotion dysregulation to predict suicide risk. Alternatively, engaging in self-damaging behaviors may mediate the emotion dysregulation-suicide risk relationship. We examined the potential moderating and mediating roles of engagement in multiple self-damaging behaviors in the relationship between emotion dysregulation and suicide risk among college students. Participants were 181 undergraduate students who reported a history of self-damaging behaviors (i.e., non-suicidal self-injury, alcohol misuse, drug misuse, disordered eating), overall emotion dysregulation, and suicide risk. Findings revealed an interactive effect of emotion dysregulation and self-damaging behaviors on suicide risk, with engagement in more forms of self-damaging behaviors conferring higher risk for suicide, particularly in the context of greater emotion dysregulation. The model testing self-damaging behaviors as a mediator was also significant, such that greater emotion dysregulation had an indirect effect on elevated suicide risk via number of self-damaging behaviors. These findings help clarify associations among emotion dysregulation, self-damaging behaviors, and suicide risk, and have implications for specific targets of intervention and for the prevention of suicide by college students.

Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237. https://doi.org/10.1016/j.cpr.2009.11.004CrossRef

American Foundation for Suicide Prevention. (2019). Suicide statistics. Retrieved from: https://afsp.org/suicide-statistics/

Anestis, M. D., Bagge, C. L., Tull, M. T., & Joiner, T. E. (2011). Clarifying the role of emotion dysregulation in the interpersonal-psychological theory of suicidal behavior in an undergraduate sample. Journal of Psychiatric Research, 45, 603–611. https://doi.org/10.1016/j.jpsychires.2010.10.013CrossRefPubMed

Anestis, M. D., Khazem, L. R., & Law, K. C. (2015). How many times and how many ways: The impact of number of nonsuicidal self-injury methods on the relationship between nonsuicidal self-injury frequency and suicidal behavior. Suicide and Life-Threatening Behavior, 45, 164–177. https://doi.org/10.1111/sltb.12120CrossRefPubMed

Anestis, M. D., Kleiman, E. M., Lavender, J. M., Tull, M. T., & Gratz, K. L. (2014). The pursuit of death versus escape from negative affect: An examination of the nature of the relationship between emotion dysregulation and both suicidal behavior and non-suicidal self-injury. Comprehensive Psychiatry, 55, 1820–1830. https://doi.org/10.1016/j.comppsych.2014.07.007CrossRefPubMed

Arria, A. M., O’Grady, K. E., Caldeira, K. M., Vincent, K. B., Wilcox, H. C., & Wish, E. D. (2009). Suicide ideation among college students: A multivariate analysis. Archives of Suicide Research, 13, 230–246. https://doi.org/10.1080/13811110903044351CrossRefPubMedPubMedCentral

Babor, T. F., & Grant, M. (1989). From clinical research to secondary prevention: International collaboration in the development of the Alcohol Use Disorders Identification Test (AUDIT). Alcohol Health & Research World, 13, 371–375.

Barrios, L. C., Everett, S. A., Simon, T. R., & Brener, N. D. (2000). Suicide ideation among US college students associations with other injury risk behaviors. Journal of the American College Health Association, 48, 229–233. https://doi.org/10.1080/07448480009599309CrossRef

Berman, A. H., Bergman, H., Palmstierna, T., & Schlyter, F. (2005). Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. European Addiction Research, 11, 22–31. https://doi.org/10.1159/000081413CrossRefPubMed

Bohn, M. J., Babor, T. F., & Kranzler, H. R. (1995). The Alcohol Use Disorders Identification Test (AUDIT): Validation of a screening instrument for use in medical settings. Journal of Studies on Alcohol, 56, 423–32. https://doi.org/10.3922/j.psns.2009.1.12CrossRefPubMed

Bohnert, K. M., Ilgen, M. A., Louzon, S., McCarthy, J. F., & Katz, I. R. (2017). Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration. Addiction, 112, 1193–1201. https://doi.org/10.1111/add.13774CrossRefPubMed

Bonn-Miller, M. O., Vujanovic, A. A., & Zvolensky, M. J. (2008). Emotional dysregulation: Association with coping-oriented marijuana use motives among current marijuana users. Substance Use & Misuse, 43), 1653-1665. http://doi.org/https://doi.org/10.1080/10826080802241292

Brausch, A. M., Decker, K. M., & Hadley, A. G. (2011). Risk of suicidal ideation in adolescents with both self-asphyxial risk-taking behavior and non-suicidal self-injury. Suicide and Life-Threatening Behavior, 41, 424–434. https://doi.org/10.1111/j.1943-278X.2011.00042.xCrossRefPubMed

Brezo, J., Paris, J., Hébert, M., Vitaro, F., Tremblay, R., & Turecki, G. (2008). Broad and narrow personality traits as markers of one-time and repeated suicide attempts: a population-based study. BMC Psychiatry, 8, 1–11. https://doi.org/10.1186/1471-244X-8-15CrossRef

Centers for Disease Control and Prevention. (2018). Suicide rising across the US: More than a mental health concern. Retrieved from: https://www.cdc.gov/vitalsigns/suicide/index.html

Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371–394. https://doi.org/10.1016/j.brat.2005.03.005CrossRefPubMed

Coxe, S., West, S. G., & Aiken, L. S. (2009). The analysis of count data: A gentle introduction to Poisson regression and its alternatives. Journal of Personality Assessment, 91, 121–136. https://doi.org/10.1080/00223890802634175CrossRefPubMed

Downs, M. F., & Eisenberg, D. (2012). Help seeking and treatment use among suicidal college students. Journal of American College Health, 60, 104–114. https://doi.org/10.1080/07448481.2011.619611CrossRefPubMed

Drum, D. J., Brownson, C., Burton Denmark, A., & Smith, S. E. (2009). New data on the nature of suicidal crises in college students: Shifting the paradigm. Professional Psychology: Research and Practice, 40, 213–222. https://doi.org/10.1037/a0014465CrossRef

Dvorak, R. D., Sargent, E. M., Kilwein, T. M., Stevenson, B. L., Kuvaas, N. J., & Williams, T. J. (2014). Alcohol use and alcohol-related consequences: Associations with emotion regulation difficulties. American Journal of Drug and Alcohol Abuse, 40, 125–130. https://doi.org/10.3109/00952990.2013.877920CrossRef

Eisenberg, D., Nicklett, E. J., Roeder, K., & Kirz, N. E. (2011). Eating disorder symptoms among college students: Prevalence, persistence, correlates, and treatment-seeking. Journal of American College Health, 59, 700–707. https://doi.org/10.1080/07448481.2010.546461CrossRefPubMed

Franklin, J. C., Hessel, E. T., & Prinstein, M. J. (2011). Clarifying the role of pain tolerance in suicidal capability. Psychiatry Research, 189, 362–367. https://doi.org/10.1016/j.psychres.2011.08.001CrossRefPubMed

Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143, 187–232. https://doi.org/10.1037/bul0000084CrossRefPubMed

Franko, D. L., & Keel, P. K. (2006). Suicidality in eating disorders: Occurrence, correlates, and clinical implications. Clinical Psychology Review, 26, 769–782. https://doi.org/10.1016/j.cpr.2006.04.001CrossRefPubMed

Goldman-Mellor, S. J., Caspi, A., Harrington, H., Hogan, S., Nada-Raja, S., Poulton, R., & Moffitt, T. E. (2014). Suicide attempt in young people: A signal for long-term health care and social needs. JAMA Psychiatry, 71, 119–127. https://doi.org/10.1001/jamapsychiatry.2013.2803CrossRefPubMedPubMedCentral

Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253–263. https://doi.org/10.1023/A:1012779403943CrossRef

Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10, 192–205. https://doi.org/10.1093/clipsy/bpg022CrossRef

Gratz, K. L., Conrad, S. D., & Roemer, L. (2002). Risk factors for deliberate self-harm among college students. The American Journal of Orthopsychiatry, 72, 128–140. https://doi.org/10.1037//0002-9432.72.1.128CrossRefPubMed

Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94CrossRef

Gratz, K. L., & Tull, M. T. (2010). The relationship between emotion dysregulation and deliberate self-harm among inpatients with substance use disorders. Cognitive Therapy and Research, 34, 544–553. https://doi.org/10.1007/s10608-009-9268-4CrossRefPubMedPubMedCentral

Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2, 271–299. https://doi.org/10.1037/1089-2680.2.3.271CrossRef

Hamza, C. A., & Willoughby, T. (2013). Nonsuicidal self-injury and suicidal behavior: A latent class analysis among young adults. PloS one, 8(3), e59955.

Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348–358. https://doi.org/10.1016/j.biopsych.2006.03.040CrossRefPubMed

International Society for the Study of Self-injury. (2018). What is self-injury? Retrieved from https://itriples.org/about-self-injury/what-is-self-injury.

Joiner, T. E., Jr. (2005). Why people die by suicide. Harvard University Press.

Joiner, Jr. T. E., Conwell, Y., Fitzpatrick, K. K. Witte, T. K., Schmidt, N. B., Berlim, M. T., Fleck, M. P. A., & Rudd, M. D. (2005). Four studies on how past and current suicidality relate even when "everything but the kitchen sink" is covaried. Journal of Abnormal Psychology, 114(2), 291-303. http://https://doi.org/10.1037/0021-843X.114.2.291.

Kisch, J., Leino, E. V., & Silverman, M. M. (2005). Aspects of suicidal behavior, depression, and treatment in college students: Results from the spring 2000 National College Health Assessment Survey. Suicide & Life-Threatening Behavior, 1, 3–12.CrossRef

Law, K. C., Khazem, L. R., & Anestis, M. D. (2015). The role of emotion dysregulation in suicide as considered through the ideation to action framework. Current Opinion in Psychology, 3, 30–35. https://doi.org/10.1016/j.copsyc.2015.01.014CrossRef

Morey, L. C. (1991). The personality assessment inventory: Professional manual. Lutz, FL: Psychological Assessment Resources.

Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Bruffaerts, R., & Williams, D. R. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British Journal of Psychiatry, 192, 98–105. https://doi.org/10.1192/bjp.bp.107.040113CrossRefPubMedPubMedCentral

Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885–890. https://doi.org/10.1037/0022-006X.72.5.885CrossRefPubMed

O’Malley, P. P. M., & Johnston, L. D. (2002). Epidemiology of alcohol and other drug use among American college students. Journal of Studies on Alcohol, Supplement, 14, 23–39.CrossRef

Oh, H. Y., Marinovich, C., Jay, S., Zhou, S., & Kim, J. H. J. (2021). Abuse and suicide risk among college students in the United States: Findings from the 2019 Healthy Minds Study. Journal of Affective Disorders, 282, 554–560.CrossRef

Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8, 443–454. https://doi.org/10.1177/107319110100800409CrossRefPubMed

Paul, E., Tsypes, A., Eidlitz, L., Ernhout, C., & Whitlock, J. (2015). Frequency and functions of non-suicidal self-injury: Associations with suicidal thoughts and behaviors. Psychiatry Research, 225, 276–282. https://doi.org/10.1016/j.psychres.2014.12.026CrossRefPubMed

Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36, 717–731.CrossRef

Ribeiro, J. D., Franklin, J. C., Fox, K. R., Bentley, K. H., Kleiman, E. M., Chang, B. P., & Nock, M. K. (2016). Self-injurious thoguhts and behaviors as risk factors for future suicide ideation, attempts, and death: A meta-analysis of longitudinal studies. Psychological Medicine, 46, 225–236. https://doi.org/10.1017/S0033291715001804CrossRefPubMed

Saunders, J. B., Aasland, O. G., Babor, T. F., De la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88, 791–804.CrossRef

Serras, A., Saules, K. K., Cranford, J. A., & Eisenberg, D. (2010). Self-injury, substance use, and associated risk factors in a multi-campus probability sample of college students. Psychology of Addictive Behaviors, 24, 119–128. https://doi.org/10.1037/a0017210CrossRefPubMed

Shepard, D. S., Gurewich, D., Lwin, A. K., Reed, G. A., Jr., & Silverman, M. M. (2016). Suicide and suicidal attempts in the United States: Costs and policy implications. Suicide and Life-Threatening Behavior, 46, 352–362. https://doi.org/10.1111/sltb.12225CrossRefPubMed

St. Germain, S. A., & Hooley, J. M. . (2012). Direct and indirect forms of non-suicidal self-injury: Evidence for a distinction. Psychiatry Research, 197, 78–84. https://doi.org/10.1016/j.psychres.2011.12.050CrossRef

Stewart, J. G., Esposito, E. C., Glenn, C. R., Gilman, S. E., Pridgen, B., Gold, J., & Auerbach, R. P. (2017). Adolescent self-injurers: Comparing non-ideators, suicide ideators, and suicide attempters. Journal of Psychiatric Research, 84, 105–112. https://doi.org/10.1016/j.jpsychires.2016.09.031CrossRefPubMed

Stice, E., Fisher, M., & Martinez, E. (2004). Eating disorder diagnostic scale: Additional evidence of reliability and validity. Psychological Assessment, 16, 60–71. https://doi.org/10.1037/1040-3590.16.1.60CrossRefPubMed

Stice, E., Telch, C. F., & Rizvi, S. L. (2000). Development and validation of the Eating Disorder Diagnostic Scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychological Assessment, 12, 123–131. https://doi.org/10.1037//1040-3590.12.2.123CrossRefPubMed

Tompkins, T. L., & Witt, J. (2009). The short-term effectiveness of a suicide prevention gatekeeper training program in a college setting with residence life advisers. Journal of Primary Prevention, 30, 131–149. https://doi.org/10.1007/s10935-009-0171-2CrossRef

Turner, B. J., Layden, B. K., Butler, S. M., & Chapman, A. L. (2013). How often, or how many ways: Clarifying the relationship between non-suicidal self-injury and suicidality. Archives of Suicide Research, 17, 397–415. https://doi.org/10.1080/13811118.2013.802660CrossRefPubMed

Turner, B. J., Yiu, A., Layden, B. K., Claes, L., Zaitsoff, S., & Chapman, A. L. (2015). Temporal associations between disordered eating and nonsuicidal self-injury: Examining symptom overlap over 1 year. Behavior Therapy, 46, 125–138. https://doi.org/10.1016/j.beth.2014.09.002CrossRefPubMed

Van der Kolk, B. A., Pelcovitz, D., Roth, S., & Mandel, F. S. (1996). Dissociation, somatization, and affect dysregulation. The American Journal of Psychiatry, 153, 83–93.CrossRef

Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S., Selby, E. A., & Joiner, T. E., Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. https://doi.org/10.1037/a0018697CrossRefPubMedPubMedCentral

Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76, 72–83. https://doi.org/10.1037/0022-006X.76.1.72CrossRefPubMed

Victor, S. E., & Klonsky, E. D. (2014). Correlates of suicide attempts among self-injurers: A meta-analysis. Clinical Psychology Review, 34, 282–297. https://doi.org/10.1016/j.cpr.2014.03.005CrossRefPubMed

Voluse, A. C., Gioia, C. J., Sobell, L. C., Dum, M., Sobell, M. B., & Simco, E. R. (2012). Psychometric properties of the Drug Use Disorders Identification Test (DUDIT) with substance abusers in outpatient and residential treatment. Addictive Behaviors, 37, 36–41. https://doi.org/10.1016/j.addbeh.2011.07.030CrossRefPubMed

Weiss, N. H., Sullivan, T. P., & Tull, M. T. (2015). Explicating the role of emotion dysregulation in risky behaviors: A review and synthesis of the literature with directions for future research and clinical practice. Current Opinion in Psychology, 3, 22–29. https://doi.org/10.1016/j.copsyc.2015.01.013CrossRefPubMedPubMedCentral

Whiteside, U., Chen, E., Neighbors, C., Hunter, D., Lo, T., & Larimer, M. (2007). Difficulties regulating emotions: Do binge eaters have fewer strategies to modulate and tolerate negative affect? Eating Behaviors, 8, 162–169. https://doi.org/10.1016/j.eatbeh.2006.04.001CrossRefPubMed

Wilcox, H. C., Arria, A. M., Caldeira, K. M., Vincent, K. B., Pinchevsky, G. M., & O’Grady, K. E. (2010). Prevalence and predictors of persistent suicide ideation, plans, and attempts during college. Journal of Affective Disorders, 127, 287–294. https://doi.org/10.1016/j.jad.2010.04.017CrossRefPubMedPubMedCentral

World Health Organization. (2018). Mental health: Suicide data. Retrieved from https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

Title: Clarifying the Role of Multiple Self-Damaging Behaviors in the Association Between Emotion Dysregulation and Suicide Risk Among College Students
Authors: Lauren A. Haliczer
Lauren E. Harnedy
Marykate Oakley
Katherine L. Dixon-Gordon
Publication date: 01-10-2021
Publisher: Springer US
Keywords: Suicide
Suicide
Eating Disorder
Eating Disorder
Published in: Journal of Prevention / Issue 5/2021
Print ISSN: 2731-5533
Electronic ISSN: 2731-5541
DOI: https://doi.org/10.1007/s10935-021-00639-y

At a glance: The STEP trials

Springer Medicine

Clarifying the Role of Multiple Self-Damaging Behaviors in the Association Between Emotion Dysregulation and Suicide Risk Among College Students

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2021

Health Information Source Characteristics Matter: Adapting the Dissemination of an HPV Vaccine Intervention to Reach Latina and Vietnamese Women

Contextual Fit of a Family Evidence-Based Intervention for Preventing Youth Alcohol Use in Mexico

Evaluation of the SPARK Child Mentoring Program: A Social and Emotional Learning Curriculum for Elementary School Students

Predictors of Attendance Patterns in a Universal Family-Based Preventive Intervention Program

A Cross-Sectional Comparison of US Adult Diabetes Screening Levels by Disability Status

Sun Exposure, Tanning Behaviors, and Sunburn: Examining Activities Associated With Harmful Ultraviolet Radiation Exposures in College Students