The Ebb and Flow of the Wish to Live and the Wish to Die Among Suicidal Military Personnel

• Published in: Journal of affective disorders 2016-09, Vol.202, p.58-66
• Main Authors: Bryan, Craig J, Rudd, M. David, Peterson, Alan L, Young-McCaughan, Stacey, Wertenberger, Evelyn G
• Format: Article
• Language: English
• Subjects: Adult; Attitude to Health; Brief cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Female; Humans; Male; Military; Military Personnel - psychology; Psychiatry; Psychotherapy, Brief; Self Report; Self-Injurious Behavior - psychology; Suicidal ambivalence; Suicidal Ideation; Suicide; Suicide - prevention & control; Suicide - psychology; Suicide, Attempted - psychology; Treatment Outcome
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2016.05.049

Abstract Background The relative balance between the wish to live and the wish to die (i.e., suicidal ambivalence) is a robust predictor of suicidal behavior and may be a mechanism underlying the effectiveness of treatments that reduce suicidal behaviors. To date, however, few studies have explored possible mechanisms of action in these treatments. Method Active duty Soldiers ( N = 152) with a recent suicide attempt and/or active suicide ideation were randomized to receive brief cognitive behavioral therapy (BCBT) or treatment as usual (TAU). The Suicide Attempt Self-Injury Inventory (Linehan, Comtois, Brown, Heard, & Wagner, 2006) was used to assess the incidence of suicide attempts during the 2-year follow-up. The wish to live and the wish to die were assessed with items 1 and 2, respectively, of the Beck Scale for Suicide Ideation (Beck & Steer, 1991). Results Across both treatments, the wish to live was significantly weaker among patients who attempted suicide but the wish to die was stronger only among patients who attempted suicide in TAU. Among nonattempters, the wish to die stabilized the wish to live, but among attempters the wish to live and the wish to die were not associated with each other. In BCBT the wish to live destabilized the wish to die among nonattempters. Limitations Self-report methodology, predominantly male sample Conclusions The emergence of suicidal behavior is driven primarily by the absence of the wish to live. BCBT is associated with a unique coupling of an ambivalent wish to live and wish to die, which may suggest an underlying mechanism of action.