Suicidality and cognition: towards an explanation of why some people believe they should die

This thesis is organised around three chapters. Each examine patterns of cognition that can lead some people toward or away from the various stages of suicidality; thoughts, plans or attempts to die. Chapter 1 presents a systematic review of the literature, examining the relationship between optimism and suicidal ideations. The emerging evidence-base suggests the existence of a weak to moderate negative relationship; as levels of optimism increase, so the strength of suicidal thoughts are weakened. The studies reviewed also indicate that the utility of optimism is more evident in terms of its moderating or mediating effect on other prominent variables such as hopelessness and life-stressors. The clinical significance of these findings are discussed and suggestions for future research considered. Chapter 2 details an empirical investigation of Rudd’s Suicidal Belief System (SBS) and its role, alongside other psycho-social factors, in formulating a risk prediction model of suicidality. The study adopted a cross-sectional design, employing a range of psychometrically valid self-report measures. The sample population consisted of 114 participants, representing a control group: ‘Nevers’; and three different levels of suicidality: ‘Thinkers’; ‘Planners’; ‘Attempters’. Principal Axis Factoring confirmed the existence of Rudd’s underlying SBS. That is, a pattern of cognitions characterised by a pervasive sense of hopelessness; that life was ‘unbearable’, problems were ‘unsolvable’, and the suicidal person was ‘unlovable’. Analysis of Variance suggested that the intensity of these cognitions were strongly differentiated by depression severity, though the causal nature of the relationship between cognitive and affective states was difficult to determine. Binary Logistic Regression helped formulate a tentative risk prediction model of suicidality, organised around the traits of hopelessness, low resilience, and neurotic personality-type. Clinical implications of the findings are discussed, alongside suggestions for future research on patterns of suicidality and cognition. Chapter 3 recounts my reflections on the research process and its influence on my personal and professional development. This discussion is framed around Beck’s cognitive triad; reflections linked with my ‘self’, the world in which I live and work, and my future-outlook