Problem solving as a predictor of suicidal thoughts and behaviors

Suicide is a major public health concern, particularly on college campuses. A number of risk factors have been identified in the prediction of suicidal thoughts and behaviors, including difficulty with problem solving. However, great variability exists in how problem solving is defined and measured in the literature. While problem solving has traditionally been conceptualized as a major component of executive functioning involving higher order intellectual or cognitive processes, social problem solving (SPS) involves one's beliefs and emotional reactions to stressful problems that are encountered in everyday life. The current study aimed to validate existing research that both neuropsychological measures of problem solving and SPS measures are separately correlated with deliberate self-harm behaviors and suicidal ideation. In addition, this study tested the hypothesis that social problem solving mediates the relationship between the neuropsychological measures of problem solving and the outcome measures of deliberate self-harm and suicidal ideation. The study sample consisted of 191 undergraduate students at Drexel University who were recruited via a participant management software. Graduate student assessors administered a demographics questionnaire, Short Portable Mental Status Questionnaire, Iowa Gambling Task (IGT), Tower of London (ToL), Social Problem-Solving-Revised: Short Form (SPSI-R:S), Deliberate Self-Harm Inventory, and Beck Scale for Suicide Ideation. If a participant reported a current wish to die or any intent to end his/her life, the assessor administered the Suicide Behaviors Questionnaire-Revised and completed an evidence-based suicide risk assessment and safety planning intervention. At completion of the study, each participant received a debriefing statement and list of counseling and emergency services. A bivariate correlation matrix determined that self-harm behaviors and suicidal ideation were significantly correlated with the SPSI-R:S, but not the IGT or ToL. Using individual regression analyses, the IGT and ToL were not found to be significant predictors of deliberate self-harm or suicidal ideation. The data therefore did not fulfill the basic requirements of the proposed mediation models. Exploratory analyses showed that when entered into the same model, the SPSI-R:S was the only problem-solving measure to make a unique statistically significant contribution to the prediction of deliberate self-harm and suicidal ideation. This study is among the first to assess the relative importance of neuropsychological and SPS constructs of problem solving in the prediction of suicide-related outcomes. The findings suggest that clinicians should consider evaluating individuals' social problem solving as part of a comprehensive suicide risk assessment, with a focus on emotional reactions to stress rather than the more intellectual or cognitive aspects of problem solving. Given the relationship between SPS and suicidal thoughts and behaviors, college students may benefit from Emotion-Centered Problem-Solving Therapy with an emphasis on handling real-world stressful problems and regulating negative emotions that interfere with effective problem solving.