The Suicide Crisis Syndrome: A Network Analysis

• Published in: Journal of counseling psychology 2020-10, Vol.67 (5), p.595-607
• Main Authors: Bloch-Elkouby, Sarah, Gorman, Bernard, Schuck, Allison, Barzilay, Shira, Calati, Raffaella, Cohen, Lisa J., Begum, Ferhana, Galynker, Igor
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Affective Disorders; Aged; Aged, 80 and over; Avoidance; Cognition; Cognitive Control; Cognitive-behavioral factors; Emotional disorders; Entrapment; Escape; Female; Floods; Human; Humans; Hyperarousal; Inpatient; Inpatient care; Male; Meaningfulness; Mental Disorders - psychology; Mental Disorders - therapy; Middle Aged; Motivation; Network analysis; Outpatient; Pain; Phenomenology; Physiological Processes; Psychological processes; Psychometrics - methods; Self Report; Suicidal Ideation; Suicide; Suicide - psychology; Suicide, Attempted - psychology; Suicides & suicide attempts; Syndrome; Syndromes; Withdrawal (Defense Mechanism); Withdrawal (Psychology); Young Adult
• ISSN: 0022-0167; 1939-2168
• DOI: 10.1037/cou0000423

Recent studies introduced the suicide crisis syndrome (SCS), a condition associated with imminent suicidal behavior and characterized by (a) a pervasive feeling of entrapment in which the escape from an unbearable life situation is perceived as both urgent and impossible (Criterion A) and (b) affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal (Criterion B). The goal of the present study was to use some of the analytic tools provided by network analyses to further the understanding of the psychological, emotional, cognitive, behavioral, and physiological processes involved in the SCS by testing (a) whether the different symptoms of the proposed syndrome are related to each other, (b) whether symptoms form meaningful clusters, and (c) whether certain symptoms are more central than others. The study included 500 outpatient and 223 inpatient participants. A network analysis of the participants' scores on the various symptoms of the SCS was conducted. The network analysis suggested that most SCS symptoms are linked by strong connections and that entrapment and ruminative flooding are highly correlated with the other SCS symptoms. Three clusters of symptoms were identified, suggesting the existence of several interdependent psychological processes potentially involved in SCS phenomenology. Our findings support both the suggested symptoms of the SCS and the central role of entrapment in the proposed criteria for the syndrome. Emotional pain appears to be closely linked to entrapment and may belong in Criterion A. Public Significance Statement This study suggests that the mental processes experienced by individuals who present with the suicide crisis syndrome co-occur and may cocreate or reinforce each other and that most of them may feed from and to the sense of being entrapped with no viable future life options.