Cognitive predictors of suicide risk among hospitalized psychiatric patients: a prospective study

This prospective study examined the utility of several cognitive variables as predictors of suicide risk among 79 hospitalized psychiatric patients. These variables included pessimism (measured by the Hopelessness Scale), perceived and actual problem-solving ability (indexed by the Problem-Solving Inventory and Means-End Problem-Solving test, respectively), and polarized thinking, self-negativity, and construct system constriction and differentiation (derived from a repertory grid). Suicide risk was operationalized in terms of subsequent self-report of suicide ideation and staff records of time spent on suicide precautions. Results indicated that hopelessness, self-negativity, and poor problem-solving performance functioned as reliable predictors of suicide risk, whereas self-evaluated problem-solving ability did not. Interestingly, constriction emerged as a significant inverse predictor across criterion measures, suggesting that it might better be conceived as a measure of subjective uncertainty. Finally, patients at highest risk for actual suicidal behaviors could be discriminated on the basis of a unique cognitive structure marked by high degrees of differentiation and polarization, suggesting that conceptual disorganization and all-or-nothing thinking may provide an instigating context for suicidal or parasuicidal behavior.