An Examination of Risk and Protective Factors for Suicidal Behavior in a Low-Income, Underserved Primary Care Sample

Suicidal behavior, including ideation and attempts, is a significant public health problem. Due to the complexity of suicidal behavior, it is necessary to consider an array of factors that could serve as risk and protective factors. Previous research has shown that deficits in social problemsolving ability are associated with increased risk for suicidal ideation and attempts; conversely, problem solving strengths are associated with reduced risk. This dissertation project, consisting of 3 individual manuscripts, was designed to explore the relationship between social problemsolving ability and suicidal behavior in low-income primary care patients. Furthermore, additional constructs including health related quality of life, interpersonal needs, neuroticism, and hopelessness were also explored as they related to social problem solving and suicidal behavior. In a sample of 220 primary care patients ages 19-79 (M = 44.08; SD = 12.11), we examined the following: 1) health related quality of life as a mediator of the relationship between social problem solving and suicidal behavior, 2) interpersonal needs as a mediator of the relationship between social problem solving and suicidal behavior, and 3) the potential mediating role of hopelessness on the relation between neuroticism and suicidal behavior and the moderating role of social problem-solving ability on these associations. Participants completed self-report questionnaires including the Social Problem Solving Inventory-Revised-Short Form, Suicidal Behaviors Questionnaire-Revised, Short-Form 36, Interpersonal Needs Questionnaire, NEO-Five Factor Inventory, and the Beck Hopelessness Scale. Scores were analyzed using bootstrapped mediation and moderated mediation techniques. In Manuscript 1 mediating effects were found for mental health related quality of life. In Manuscript 2 thwarted belongingness and perceived burdensomeness mediated the relationship between social problem solving and suicidal behavior. Finally, in Manuscript 3 there was a significant indirect effect of neuroticism on suicidal behavior through hopelessness, and this indirect effect was moderated by social problem-solving ability. Our findings indicate that social problem-solving ability serves as both a risk and protective factor for suicidal behavior and impacts other variables that influence suicide risk among primary care patients. Interventions that bolster social problem-solving ability may reduce suicide risk in primary care