Short CommunicationThe differential impact of brooding and reflection on the relationship between perceived stress and suicide ideation
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.
Section snippets
Participants
Participants were 360 undergraduate students, 239 (66.4%) females and 121 (33.6%) males recruited from a large Midwestern university. Participants were granted course credit for participation and completed all study materials online. Participants’ ages ranged from 18 to 56 (M = 19.72). This sample contained 286 (79.4%) Caucasians, 25 (6.9%) American Indians, 18 (5.0%) African Americans, 14 (3.9%) Asian Americans, eight (2.2%) Biracial individuals, seven (1.9%) Hispanic/Latinos, one (.3%) who
Results
Zero-order correlation analyses demonstrated brooding, reflection, perceived stress, and suicide ideation were significantly positively associated. Descriptive statistics, correlations, and variable ranges are reported in Table 1. These results are in line with previous research that found positive associations between rumination, perceived stress, and suicide ideation (Morrison & O’Connor, 2008a) (see Table 2).
Discussion
Both rumination and the subjective experience of stress may be prominent predictors of suicide ideation (Morrison & O’Connor, 2008a). The current study sought to further this investigation by examining the relationship between perceived stress, brooding, reflection, and suicide ideation. Study hypotheses were supported, as results illustrated the moderating effect of brooding (in the context of reflection) on the relationship between perceived stress and suicide ideation.
Previous research has
References (24)
- et al.
Adaptive and maladaptive components of rumination? Diagnostic specificity and relation to depressive biases
Behavior Therapy
(2006) - et al.
Brooding and reflection: Rumination predicts suicidal ideation at 1-year follow-up in a community sample
Behaviour Research and Therapy
(2007) - et al.
Personality and cognitive processes: Self-criticism and different types of rumination as predictors of suicidal ideation
Behaviour Research and Therapy
(2008) - et al.
Mindfulness tempers the impact of personality on suicidal ideation
Personality and Individual Differences
(2014) - et al.
Rumination-focused cognitive behaviour therapy for residual depression: A case series
Behaviour Research and Therapy
(2007) - et al.
Subtypes of rumination in adolescence: Associations between brooding, reflection, depressive symptoms, and coping
Journal of Clinical Child and Adolescent Psychology
(2007) - et al.
A global measure of perceived stress
Journal of Health and Social Behavior
(1983) - et al.
A prospective study of brooding and reflection as moderators of the relationship between stress and depressive symptoms in adolescence
Cognitive Therapy and Research
(2012) - et al.
Reflection, brooding, and suicidality: A preliminary study of different types of rumination in individuals with a history of major depression
British Journal of Clinical Psychology
(2007) - et al.
The impact of insomnia and sleep disturbances on depression and suicidality
Dreaming
(2006)
Stressors of college: A comparison of traditional and nontraditional students
Journal of Psychology: Interdisciplinary and Applied
Rumination and lifetime history of suicide attempts
International Journal of Cognitive Therapy
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2018, Journal of Affective DisordersCitation Excerpt :Further, experimental designs that examine the effects of sleep restriction or extension on rumination and vice versa over the course of days or weeks would help to disentangle the effects and help to inform priorities for intervention that may help lessen future suicidal ideation and attempts. Our finding that greater brooding was associated with greater suicide risk, ideation, and attempts in a college sample is consistent with previous findings (Cole et al., 2015; Tucker et al., 2013) and with response styles theory (Nolen-Hoeksema, 1991). Specifically, passively fixating on negative situations and actions appears to be cognitive response style that has a particularly negative relationship with suicide risk, ideation, and attempts.
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2018, Current Opinion in PsychologyCitation Excerpt :Theoretically, rumination has been posited to increase and maintain levels of suicidal ideation [11]. Brooding, specifically, has been found to intensify the detrimental effect perceived stress has on ideation [12] and mediate the relationship between ideation and negative life events [13], stress-related symptoms in women [14], and scars from past episodes of non-suicidal self-injury (NSSI; [15]). Krajnak and colleagues [16] also demonstrated that a greater number of past suicide attempts combined with elevated levels of rumination prospectively predicted future ideation.