The differential impact of brooding and reflection on the relationship between perceived stress and suicide ideation

Highlights

• Brooding, perceived stress, and suicide ideation were positively associated.

• Brooding and reflection differently impacted the stress–suicide ideation relation.

• This relationship was present after controlling for depression and gender.

Abstract

This study investigated whether brooding and reflection moderated the relationship between perceived stress and suicide ideation. It was hypothesized that brooding, but not reflection, would strengthen the effect of perceived stress on suicide ideation above and beyond depression symptoms. Hypotheses were supported. Results suggest the assessment of a brooding response style may help identify clients who are more likely to contemplate suicide when confronted with life stress.

Introduction

Approximately 38,000 individuals complete suicide each year in the United States making suicide the fifth leading cause of death before age 65 (McIntosh & Drapeau, 2012). It is important to detect predictors of suicide to prevent deaths by suicide from occurring. Suicide ideation is a critical predictor of death by suicide (Palmer, 2004), and it is essential to examine the specific role risk factors have on suicide ideation.

Stress is a prominent contributor to the experience of depression symptoms (Ingram & Luxton, 2005). The diathesis–stress model suggests all people have some level of predisposing factors for psychopathology; however, whether an individual develops a disorder depends on the interaction between the degree to which risk factors exist and the degree of stress experienced (Ingram & Luxton, 2005). Moreover, this model posits that when predisposing vulnerabilities are activated by stress, a psychological disorder may develop (Morrison & O’Connor, 2008b). Rumination is a specific cognitive vulnerability identified in the psychopathology literature (Morrison & O’Connor, 2008b).

The Response Styles Theory of rumination suggests rumination involves responding to stress with focused attention to negative aspects of emotional states (Nolen-Hoeksema, 1991). The theory posits that ruminators focus on the causes and consequences of negative events, resulting in a negative affect (Hyde, Mezulis, & Abramson, 2008). Rumination is a cognitive vulnerability for both depression (Cox, Funasaki, Smith, & Mezulis, 2012) and suicide ideation (Morrison & O’Connor, 2008b). Two identified components of rumination are brooding and reflection (Treynor, Gonzalez, & Nolen-Hoeksema, 2003). Both components involve the cognitive process of self-focused attention; however, their content differs. Brooding is defined as focusing on negative, self-blaming, gloomy, or anxious thoughts. In contrast, reflection refers to contemplation and an attempt to deal with and overcome one’s problems (Treynor et al., 2003). Research has consistently demonstrated that brooding is associated with high rates of depression symptoms, but the relationship between reflection and depression symptoms is inconsistent in the literature (Burwell and Shirk, 2007, Treynor et al., 2003).

As rumination and stress are both conceptually related to negative affect, research has investigated their relationship on negative mental health outcomes. Cox et al. (2012) found rumination interacted with stress to prospectively predict depression symptoms; however, the relationship between rumination, stress, and depression was found only for brooding. Brooding moderated the relationship between stress and depression for nearly all stress domains. This finding provides support that the components of rumination function differently in interacting with stress to predict depression symptoms.

In a systematic review of rumination and suicide, 10 out of 11 studies found that rumination was associated with suicide ideation and/or behavior, and only three of the studies examined both brooding and reflection (Morrison & O’Connor, 2008b). One of these three studies found significantly higher levels of reflection among non-suicidal individuals compared to those who had previously attempted suicide, suggesting a protective effect of reflection (Crane, Barnhofer, & Williams, 2007). The other two studies yielded mixed results for reflection, as a study by Miranda and Nolen-Hoeksema (2007) found reflection to be predictive of suicidality, while a study by O’Connor and Noyce (2008) found brooding, but not reflection, predicted increased suicide ideation.

This study aimed to expand on previous findings by investigating the relationship between stress and suicide ideation using a two-factor model of rumination. Defining rumination as a non-unitary construct has led to further investigation of which component may be potentially more maladaptive (Cox et al., 2012). Because research suggests the components of rumination may function differently in relation to depression (Treynor et al., 2003), they may also function differently in relation to suicide ideation and stress. Previous findings indicated that psychiatric inpatients’ level of brooding, but not reflection, was significantly associated with their suicide attempt history (Grassia & Gibb, 2009). Additionally, compared to levels of reflection, brooding was more strongly related to inpatients’ history of suicide attempts, and this relationship was significant after controlling for gender and depression symptoms (Grassia & Gibb, 2009). Guided by these findings, it was hypothesized that brooding, but not reflection, would significantly moderate the relationship between perceived stress and suicide ideation above and beyond depression symptoms.