Author ORCID Identifier
https://orcid.org/0000-0002-1498-4333
Defense Date
2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Integrative Life Sciences
First Advisor
Alexis Edwards
Abstract
The Interpersonal-Psychological Theory of Suicide hypothesizes that capability for suicide is acquired in part through exposure to physically painful and/or fear-inducing experiences, referred to as painful and provocative events (PPEs). Studies of PPE exposure offer an opportunity to characterize potential targets for suicide prevention and inform efforts to identify individuals at elevated suicide risk. However, the literature on PPE exposure and risk for suicidality has been limited by a reliance on cross-sectional designs, lack of genetically informed research, inclusion of risk-taking behaviors as potential PPEs, and focus on risk over resilience. In this dissertation, we aimed to address these knowledge gaps by investigating the contributions of PPE exposure, genetic liability for suicide attempt (SA), impulsivity, and parenting behaviors to risk for suicidal behavior in three longitudinal, population-based samples. The primary aims were to (1) investigate causal and non-causal explanations for the association between exposure to PPEs and risk for SA, (2) examine whether the association between genetic factors and SA risk is mediated by impulsivity and exposure to PPEs, and (3) evaluate the effects of parenting behaviors on the transition from suicide ideation to attempt in adolescence. In Study 1, we investigated the relationship between physical injuries and risk for SA within Swedish population-based registries. A series of injury types were associated with elevated SA risk, particularly within the first year of injury exposure. In addition, there was evidence to support a putative causal effect of eye injury, fracture, dislocation/sprain/strain, intracranial injury, and other and unspecified injuries on risk for SA. In Study 2, we examined whether the association between genetic liability for SA and SA risk is mediated by impulsivity and PPE exposure. Within a sample of early adolescents, there was little evidence to support mediation of genetic associations via impulsivity and PPEs, though several dimensions of impulsivity and two PPEs (non-suicidal self-injury and traumatic events) were positively related to SA risk. Finally, in Study 3, we evaluated the relationship between parenting, the development of suicidal ideation, and the transition from ideation to attempt within the Adolescent Brain Cognitive Development Study and the National Longitudinal Study of Adolescent to Adult Health. We also considered whether parenting behaviors moderated the associations of genetic liability for SA or exposure to PPEs with SA risk. In these analyses, features of the parent-adolescent relationship were primarily associated with the development of suicidal ideation, whereas PPEs were related to the transition from suicidal ideation to suicide attempt. There was no evidence to indicate that parenting behaviors moderated associations of PPE exposure with SA risk. The findings of this dissertation lend additional support for ideation-to-action theories of suicide, while also underscoring the complexity of the relationship between PPE exposure and risk for SA. Additional studies are needed to further evaluate the effects of specific PPEs on the transition from ideation to attempt, and to consider the degree to which associations between PPE exposure and SA risk vary based on the characteristics of the event and the individual.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
4-23-2024