Revisiting the Affect Regulation Model of Suicide Ideation: Bidirectional Effects of Momentary Suicide Ideation and Affect

Introduction: Suicide ideation (SI) may provide relief from negative affect (NA), thereby making future SI more likely through reinforcement processes. Though some studies suggest that SI reduces NA, this evidence is limited and inconclusive. Methods: We used dynamic structural equation models (DSEM) to test whether bidirectional associations between SI and both NA and positive affect (PA) over two-hour intervals support an affect regulation model of SI. Participants were 140 young adults with SI or suicidal behaviors in the past four months who completed a 21-day ecological momentary assessment (EMA) with seven daily assessments. Results: Results demonstrated reciprocal effects over two-hour intervals, such that within-person increases in NA and decreases in PA were associated with subsequent increases in SI, and increases in SI were associated with subsequent increases in NA and decreases in PA. The occurrence of SI did not significantly moderate the persistence of NA or PA over two-hour intervals. However, we replicated prior findings of decreases in affective distress following SI when analysis was restricted to occasions when SI occurred and resolved by the next occasion. Conclusions: Results suggest that distinct analytic and sampling methods can lead to divergent conclusions regarding whether SI provides relief from affective distress.