Exploring the dynamic nature of suicidal ideation and its associated factors

Zheng, Yawen (2025) Exploring the dynamic nature of suicidal ideation and its associated factors. PhD thesis, University of Glasgow.

Abstract

Background: Suicide is a major global public health concern, resulting in over 720,000 deaths annually, with an estimated 20 suicide attempts for every suicide death worldwide. In the UK, approximately one in five adults report experiencing suicidal ideation at some point in their lives, with a significant proportion reporting past suicide attempts. The high prevalence of suicidal ideation has positioned it as a primary focus of research and clinical intervention, aiming to prevent its progression to suicidal attempts and eventual death. Suicide is widely recognised as a complex phenomenon arising from the interplay of biological, psychological, social, and environmental factors. To advance our understanding of suicidal behaviour, it is essential to investigate the psychological processes underlying suicidal ideation and suicide attempts. Despite extensive research that incorporates both theoretical frameworks and empirical investigations, our ability to predict and prevent suicide remains limited. Key shortcomings in current research include a lack of insight into the short-term fluctuations in suicide risk and insufficient attention to the multidimensional nature of suicidal ideation. Furthermore, while qualitative approaches can provide rich and complementary insights into the lived experience of suicide risk, the field remains predominantly focused on quantitative methodologies.

Aims: The current thesis aimed to investigate suicide risk by examining psychological factors within the overarching framework of the Integrated Motivational-Volitional model, supplemented by insights from the self-regulation perspective, with a central focus on fluctuations in suicidal ideation. Specifically, it addressed three overarching aims: (1) To what extent is suicidal ideation a dynamic process? (2) What factors are associated with different patterns of suicidal ideation? (3) With a particular focus on cognitive reactivity and ego depletion, what psychological factors are associated with suicidal ideation and suicide attempts?

Methods: To develop a comprehensive understanding of suicide risk, this thesis comprised three distinct studies employing diverse methodologies. First, a systematic review was conducted using a narrative synthesis approach to examine dynamic indicators of suicidal ideation and their associated factors, across different pattens of dynamic association and assessment frequencies (Chapter 2; 112 studies from 109 articles included in the synthesis). Next, a cross-sectional online survey was administered to a general population sample of adults living in the UK, recruited through opportunity sampling. This study explored psychological factors (e.g., entrapment, impulsivity, depression, resilience, and mindfulness) in relation to suicidal ideation and suicide attempts, as well as parameters of suicidal ideation (i.e., frequency, duration, and intensity), with a particular focus on the effects of cognitive reactivity and ego depletion (Chapter 3; N = 312; Mage = 28.44, SD = 10.0; 80.4% White; 64.7% Female). Furthermore, a subsample of survey participants with a history of suicidal ideation and suicide attempts was drawn to examine the role of cognitive reactivity and ego depletion in the relationship between entrapment and suicidal ideation through mediation analyses (Chapter 4; N = 269; Mage = 28.50, SD = 10.06; 82.9% White; 66.5% Female). Building on insights from the preceding chapters, the final study used Interpretative Phenomenological Analysis to explore individuals’ lived experiences of fluctuations in suicidal ideation in the context of their daily lives (Chapter 5; N = 10; 6 females, 4 males; Mage = 28; age range = 20 to 36 years).

Results: The systematic review (Chapter 2) indicated that suicidal ideation fluctuates significantly over periods ranging from hours to days. On average, suicidal ideation exhibited substantial within-person variability, alongside small to moderate instability (i.e., changes in suicidal ideation between consecutive time points) and temporal dependency (i.e., the carryover effect where prior levels of suicidal ideation influenced subsequent time points). The complex nature of suicidal ideation was further emphasised by its associations with a range of psychological and contextual factors, which varied based on the dynamic pattern examined (i.e., concurrent, prospective, and time-invariant associations) and the frequency of assessment (i.e., multiple times per day, once per day, and every few days per week). These findings were supported and extended by the qualitative investigation from a lived experience perspective (Chapter 5). Four group themes were identified, with ‘Fluctuating Suicidal Ideation’ as the overarching theme, reflecting a shared recognition of the dynamic nature of suicidal ideation. Three additional group themes captured the experiential features and individuals’ interpretations of these fluctuations: ‘From Whisper to Scream’ described variations in intensity and duration; ‘Whole vs. Part: Timescale and Perspective’ highlighted how shifts in timescale and perspective influenced individuals’ interpretations; and ‘Breaking the Balance’ depicted circumstances that disturbed psychological stability, resulting in heightened emotional distress and increased vulnerability to suicidal ideation. Results from the cross-sectional online survey indicated that, while most psychological factors under investigation significantly distinguished between individuals with different suicidal histories (i.e., no history, ideation only, suicide attempts) in univariate models, only impulsivity (SI vs. SA) and depression (NH vs. SA, SI vs. SA) remained significant predictors in multivariate models. Additionally, most psychological factors were individually associated with all three parameters of suicidal ideation; however, only a few predicted its frequency and duration after controlling for depression. In contrast, intensity was independently predicted by most factors, except for impulsivity and some subcomponents of cognitive reactivity (Chapter 3). Results from the mediation analyses (Chapter 4) showed that entrapment fully mediated the relationship between cognitive reactivity and suicidal ideation. The relationship between entrapment and suicidal ideation was partially mediated by ego depletion, as measured by self-regulatory fatigue, but not by depletion sensitivity.

Conclusion: This thesis contributes to the existing literature by demonstrating that suicidal ideation is not a static state, but rather a fluctuating process shaped by dynamic interactions between internal and external factors in daily life. Both quantitative and qualitative evidence support these findings, with the latter emphasising the role of distraction and a key aspect of personal construct in living with suicidal ideation (i.e., the tendency to integrate experiences to foster meaning-making). Additionally, the thesis findings also highlight the challenges of predicting more dynamic aspects of suicidal ideation, such as frequency and duration, within a cross-sectional online survey. This underscores the need for further research that examines the multidimensional nature of suicidal ideation in greater depth. The findings also demonstrated the effect of cognitive reactivity and ego depletion on the suicide risk, with a particular emphasis on how incorporating a self-regulation perspective can improve our understanding of the process of suicide risk. In light of the thesis findings, clinical treatments and interventions are encouraged to adopt a dynamic perspective that is flexible, tailored to the individual, and sensitive to fluctuations in suicide risk, while also incorporating effective coping strategies. Treatment could benefit from targeting specific aspects of suicidal ideation while also focusing on long-term goals across cognitive, emotional, physiological, and behavioural domains to reduce individuals’ baseline vulnerability, in addition to addressing acute suicidal crisis. Replication of these findings is needed to strengthen their generalisability. A deeper understanding of suicide risk may be achieved through meta-analytic research on factors associated with dynamic patterns of suicidal ideation, as well as fine-grained investigations into the various dimensions of suicidal ideation.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: B Philosophy. Psychology. Religion > BF Psychology; R Medicine > R Medicine (General)
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Supervisor's Name: O'Connor, Professor Rory and Evans, Professor Jonathan
• Date of Award: 2025
• Depositing User: Theses Team
• Unique ID: glathesis:2025-85580
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 10 Nov 2025 11:55
• Last Modified: 10 Nov 2025 11:58
• Thesis DOI: 10.5525/gla.thesis.85580
• URI: https://theses.gla.ac.uk/id/eprint/85580