Context-Specific Interpersonal Problem-Solving and Suicidal Thoughts and Behaviors
Abstract
Abstract.Background: Interpersonal problem-solving difficulties constitute a suicide risk factor that may be particularly relevant among college students. Most studies have examined general interpersonal problem-solving; however, context-specific abilities may have greater clinical implications. Aim: This study examined whether individuals with and without a history of suicidal thoughts and behaviors differed in context-specific interpersonal problem-solving. Method: Undergraduate students (n = 112) completed a brief interview and interpersonal problem-solving tasks with positive (e.g., initiating romantic relationship) and negative (i.e., physical revenge) resolutions. Results: Individuals with a history of suicide ideation generated more effective solutions and more alternatives in the negative-resolution scenario; no significant differences were identified for the positive-resolution scenarios. No group differences were found based on suicide attempt status. Limitations: Our results do not account for the mechanisms that influence problem-solving abilities in negative-resolution scenarios. Conclusion: Clinical efforts may benefit from targeting the translation of interpersonal problem-solving abilities to situations with positive resolutions.
Theories highlight the importance of interpersonal factors in relation to suicidal thoughts and behaviors (STBs), arguing that STBs often occur within interpersonal contexts (Durkheim, 1897; Joiner, 2005; Van Orden et al., 2010). Indeed, interpersonal negative life events are identified as proximal risk factors of STBs (Bagge et al., 2014), and quality of interpersonal relationships, abuse history, and isolation are reported predictors of STBs (e.g., Franklin et al., 2017).
Interpersonal problem-solving, which itself is associated with STB risk (Gibbs et al., 2009; Speckens & Hawton, 2005), may impact the relationship between interpersonal factors and STBs. Given the importance of interpersonal relationship quality on psychological well-being during major environmental changes (Bowman, 2010), interpersonal problem-solving may be particularly relevant for college students (Hirsch et al., 2012). Thus, examining its association with STBs in this population may be informative in developing targeted prevention and intervention strategies.
Previous research has primarily examined interpersonal problem-solving as a general ability (e.g., Marx et al., 1992). While studies have examined positive and negative orientations of interpersonal problem-solving (e.g., Jeglic et al., 2005), interpersonal problem-solving in different contexts (i.e., situations leading to positive or negative resolutions) have yet to be examined. As interpersonal problem-solving is dependent on the recall of specific memories (Pollock & Williams, 1998), individuals who endorse STBs may be more capable of generating solutions to interpersonal situations with negative resolutions, which may be more accessible due to a negative bias (Richard-Devantoy et al., 2015; Thompson & Ong, 2018).
Given the theoretical and clinical importance (e.g., Klonsky & May, 2014) of differentiating between distinct STBs – suicide ideation (SI) and suicide attempts (SAs) – this study examined whether individuals differed in interpersonal problem-solving in the context of interpersonal scenarios that lead to positive or negative resolutions based on SI and SA status.
Method
Participants and Procedures
Participants were 112 undergraduates from an urban university. Participants were, on average, 20.57 years old (SD = 3.53); 78.6% identified as female, 62.6% identified as white, and 90.7% identified as Non-Hispanic/Latinx. Participants completed a brief diagnostic interview and interpersonal problem-solving tasks. Participants received course credit. Procedures were approved by the Institutional Review Board.
Measures
Suicidal Thoughts and Behaviors
The Lifetime Parasuicide Count (Comtois & Linehan, 1999), a semi-structured interview, was used to assess for lifetime presence of SI and SA. The interview assesses several characteristics (i.e., method, intent, etc.) of one's STB history. The psychometrics of the original interview are supported (Comtois & Linehan, 1999).
Interpersonal Problem-Solving
The Means–Ends Problem-Solving Task (MEPS; Platt et al., 1975) assessed interpersonal problem-solving ability. Participants are presented with hypothetical interpersonal problem scenarios and linked final resolutions. Participants describe how the scenario protagonist dealt with the problem leading to the outcome. They receive 60 s (each) to describe: (1) the most effective strategy to solve the problem (rated as 1 = not at all effective, 7 = very effective); (2) potential obstacles to their strategy; (3) alternative strategies for solving the problem. On the basis of MEPS administration procedures (Platt et al., 1975), participants were presented with three positive-resolution scenarios (e.g., romantic relationship initiation) and one negative-resolution scenario (i.e., physical revenge). Scenarios were randomly presented and protagonists were modified to match the participant's identified gender. The coding scheme of Pollock and Williams (2004) was adopted. All responses were coded by at least two independent raters (intraclass correlations = 0.82–0.94).
Data Analysis
Interpersonal problem-solving outcomes (i.e., effectiveness, obstacles, alternative strategies) were averaged across the positive resolution scenarios. Results did not differ when examining each of the three positive-resolution scenarios independently versus as an aggregate. A series of ANOVAs and ANCOVAs were utilized to examine group difference. Given the strong association between SI and SA (Ribeiro et al., 2016), SI was included as a covariate in SA analyses. Results did not differ when SI was removed as a covariate from the model.
Results
Preliminary Analyses
Overall, 47.3% of the participants (n = 53) reported lifetime SI and 11.6% (n = 13) reported lifetime SA. There were no differences in age, t(105) = −0.96, p = .34, gender, χ2(1) = 0.19, p = .66, or race, χ2(3) = 7.58, p = .11, based on SI history. There were no differences in age, t(105) = −1.48, p = .14, gender, χ2(1) = 0.06, p = .81, or race, χ2(3) = 8.49, p = .08, based on SA history.
Group Comparisons
Individuals with (vs. without) SI generated more effective and more alternatives solutions in the negative resolution scenario; no other differences were identified. No differences were identified based on SA history status (see Table 1).
Discussion
Individuals with SI may not necessarily have interpersonal problem-solving deficits, but their implementation may be context dependent (i.e., negative-resolution scenarios). Speculation, fluency in negative-resolutions scenarios, and the ability to generate several actions (e.g., forms of emotional and physical pain) that end in a negative resolution may be partially due to negative attentional biases among those with STBs (e.g., Thompson & Ong, 2018). The tendency to focus on negative information may provide individuals with more time to contemplate strategies for negative resolutions, enabling them to be more effective and capable of generating more alternatives. Conversely, it may be that effectiveness is limited to situations involving interpersonal violence, given the association between violence and STBs (e.g., Zimmerman & Posick, 2014); this will be an important area for future research.
While the lack of group differences based on SA history was unexpected, explanations may be found in theoretical models of suicide. Theories of suicide often directly link interpersonal difficulties with SI but not SA (e.g., Joiner, 2005). Moreover, the mechanisms of SA are conceptualized as behavioral; thus, interpersonal problem-solving, reflecting cognitive abilities, may not be directly related to SA. Empirical support is required for this postulation.
Limitations
The study limitations should be considered. The MEPS evaluates the end strategy, rather than the process, to generate solutions (D'Zurilla & Maydeu-Olivares, 1995), limiting our ability to interpret mechanisms of problem-solving. The MEPS also does not differentiate passive versus active problem-solving (Pollock & Williams, 1998). Because avoidant (passive) problem-solving is associated with STBs (Becker-Weidman et al., 2010), a more sophisticated measure may be informative. Finally, we examined only lifetime history of SI/SA among a relatively small sample size, influencing the generalizability of results.
Conclusion
The present study highlights the unique performance in negative interpersonal situations among those who endorse SI. The findings suggest that individuals with SI history do not lack interpersonal problem-solving abilities, but rather may need help applying their abilities across all interpersonal situations. Clinical efforts should focus on being more efficient with negative strategies as well as mitigating one's negative proneness, which may exacerbate interpersonal conflict and, ultimately, suicidality.
Yeonsoo Park earned his BA in psychology from New York University and his MA in clinical and counseling psychology from Sogang University. He is currently a doctoral student in the clinical psychology program at the University of Notre Dame, IN, USA. Mr. Park's main interests are the biopsychosocial risk factors of self-injurious thoughts and behaviors.
Michael McCloskey, PhD, is an associate professor in the clinical psychology program at Temple University, Philadelphia, PA, USA. His research examines the interplay of cognitive-affective, psychosocial, and biologic processes involved in the development and maintenance of affect dysregulation, with an emphasis on self- and other-directed aggression.
Brooke A. Ammerman, PhD, is an assistant professor in the clinical psychology program at the University of Notre Dame, IN, USA. Her research seeks to understand how various intra- and interpersonal factors interact to increase chronic or imminent risk of self-injurious thoughts and behaviors.
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