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SUICIDAL BEHAVIOUR IN POSTTRAUMATIC STRESS DISORDER
[Thesis]. Manchester, UK: The University of Manchester; 2011.
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Abstract
A growing body of research has indicated that the levels of suicidal behaviour are particularly heightened among individuals with Posttraumatic Stress Disorder (PTSD). Two theoretical models of suicide, the Cry of Pain Model of suicide (CoP; Williams, 1997) and the Schematic Appraisals Model of Suicide (SAMS; Johnson, Gooding & Tarrier, 2008) have proposed that perceptions of defeat and entrapment are key components of the psychological mechanisms which drive suicidal behaviour. The SAMS has also emphasized the importance of psychological resilience factors for preventing suicide risk. Resilience to suicide has been recently defined as a set of appraisals which buffer the impact of risk factors on suicidal behaviour. The first aim of this thesis was to investigate the role of perceptions of defeat and entrapment in suicidal behaviour in those with full or subthreshold PTSD. The second aim of this thesis was to obtain empirical evidence for the presence of resilience factors to suicidal behaviour in PTSD. Initially, a comprehensive narrative review and a meta-analysis were conducted to examine the magnitude of the association between various forms of suicidal behaviour and a PTSD diagnosis and the role of comorbid depression in this association. Both, the narrative review and the meta-analysis demonstrated a strong positive association between suicidal behaviour and PTSD, and supported the mediating impact of comorbid depression in this association. A re-analysis of a previous dataset of individuals with PTSD was also pursued to establish the relevance of negative perceptions/appraisals to suicidal behaviour in those with PTSD. Next, three empirical studies were designed to investigate the utility of perceptions of defeat and entrapment in explaining suicidal behaviour in those with full or subthreshold PTSD. The outcomes across the three studies supported the hypothesis that defeat and entrapment represent the proximal psychological drivers of suicidal behaviour in PTSD and fully account for the suicidogenic effects of negative self-appraisals and PTSD symptoms.Two additional empirical studies were conducted to examine resilience factors to suicidal behaviour among individuals with full or subthreshold PTSD. The first of these studies provided evidence that high levels of perceived social support buffered the impact of PTSD symptoms on suicidal behaviour. The last study supported the efficacy of a resilience-boosting technique, the Broad-Minded Affective Coping procedure (BMAC), to enhance the experience of positive emotions and improve mood amongst individuals diagnosed with PTSD. Together, the current results support the SAMS’ postulation concerning the role of perceptions of defeat and entrapment in the emergence of suicidal behaviour in PTSD and highlight the importance of boosting resilience as a means of targeting suicidal behaviour in those with PTSD. Clinical implications of these findings are outlined throughout the thesis.