Suicide has been recognized for several decades as a major public health issue; up to 80% of patients admitted to the Austen Riggs Center report a recent history of suicidal ideation, and a substantial portion of these report a further history of past suicide attempts and other self-harming behaviors. Given that suicidal ideation is known to fluctuate drastically over time, methods that move beyond single assessment point approaches and a reliance on retrospective self-report are urgently needed.
Over the past decade, Drs. Jane Tillman and Katie Lewis have incorporated innovative mixed methods approaches to study factors affecting momentary changes in suicide risk and proximal states of mind preceding near-lethal suicidal action. In addition to identifying implicit personality processes associated with more chronic suicidal behavior (Lewis et al., 2016, 2019), these studies have illuminated common themes and conflicts that emerge in the thoughts of suicidal individuals shortly before an attempt (Tillman, Stevens, & Lewis, 2021), and trajectories of change in resilience and psychic pain over the course of several years in individuals known to be at elevated risk for suicide (Tillman et al., 2019). Other recently completed studies have focused on the development and psychometric evaluation of a new theoretically grounded measure of psychic pain (the Psychic Pain Scale; Lewis et al., 2021), and factors affecting risk for suicidal ideation during the COVID-19 pandemic (Lewis et al., 2022a and b; Lewis et al., 2023).
Currently, two active studies are underway which employ smartphone-based experience sampling methods to evaluate proximal changes in suicide risk over time. Rooted in the broader Riggs belief that relationships are instrumental in supporting long-term adaptive functioning and resilience, these studies examine how daily interpersonal exchanges, social perceptions and beliefs, and emotional functioning influence short-term changes in suicidal thoughts and impulses. Other relevant physiological factors such as sleep disturbance are incorporated to address a fuller range of potential biopsychosocial risk factors. Together, these studies seek to advance understanding of the impact of relationships, emotional functioning, and health on short-term changes in suicide risk, with the goal of informing treatment and advancing clinical knowledge.
Relevant selected studies:
Lewis, K., Roche, M. J., Brown, F., Tillman, J. (2023). Intolerance of aloneness as a prospective predictor of suicidal ideation during COVID-19. Journal of Affective Disorders-Reports
. DOI: 10.1016/j.jadr.2023.100469
Lewis, K., Roche, M. J., Brown, F., Tillman, J. (2022). Attachment, loneliness, and social connection as prospective predictors of suicidal ideation during the COVID-19 pandemic: a relational diathesis-stress experience sampling study. Suicide & Life-Threatening Behavior. DOI: 10.1111/sltb.12922
Tillman, J. G., Stevens, J. L., & Lewis, K. (2021). States of mind preceding a near-lethal suicide attempt: A mixed methods study. Psychoanalytic Psychology
. Advance online publication. DOI: 10.1037/pap0000378
Lewis, K., Good, E., Tillman, J., Hopwood, C. (2021). Assessment of psychological pain in clinical and non-clinical samples: A preliminary investigation using the Psychic Pain Scale. Archives of Suicide Research
, 25(3), 552-569. DOI: 10.1080/13811118.2020.1729914
Lewis, K., Meehan, K., Cain, N., Wong, P., Clemence, A.J., Stevens, J., & Tillman, J. (2021). Quality of internalized object representations and suicidality in individuals with anaclitic and introjective personality styles. Journal of Personality Disorders
, 35(1), 145-160. DOI: 10.1521/pedi_2019_33_435
Tillman, J., Clemence, A. J., Hopwood, C., Lewis, K., Stevens, J. (2017). Suicidality in high-risk psychiatric patients: The role of protective factors in predictive validity. Psychiatry: Interpersonal and Biological Processes
, 80(4), 357-373. DOI: 10.1080/00332747.2017.1296309
Tillman, J. G., Clemence, A. J., Cree, R., Lewis, K. C., Stevens, J. L., & Reiss, D. (2017). The persistent shadow of suicide ideation and attempts in a high-risk group of psychiatric patients: A focus for intervention. Comprehensive Psychiatry
, 77, 20–26. DOI: 10.1016/j.comppsych.2017.05.005