Escape Bias in the Context of Interpersonal Stress: Examining the Role of Emotional Vulnerabilities among Those with Suicidal Thoughts and Behaviors

Suicide is the second-leading cause of death among those aged 10-24, and this group’s suicide rate has increased by 62% from 2007 to 2021. Prior suicidal thoughts and behaviors (STBs) are the most salient risk factors for suicide attempts. Thus, it is important to understand risk factors for and contexts in which STBs are activated, particularly among this high-risk group. Ethical considerations hinder the ability to experimentally study (i.e., induce) STBs in laboratory settings. However, studying functionally similar behaviors may provide insight into the mechanisms of suicide. Indeed, STBs may represent escape from aversive life circumstances. Therefore, studying contexts that facilitate escape behavior and escape bias (i.e., the tendency to select active vs. passive escape from an aversive state) may be especially informative for STBs. Empirical work reveals that escape behavior is more common among those with (vs. without) a history of STBs, supporting the connection between in-lab escape behavior and STBs. Millner et al. also showed that an acute, highly aversive stimulus (i.e., the sound of nails on a chalkboard) immediately precipitated escape behavior in a laboratory setting, suggesting that escape behavior is a response to acute stress. However, forms of distal ecological stress (e.g., life stress, relationship stress) have not been studied. Given that suicide is an intentional act that is often a response to stress, clarifying the effect of life stressors on escape behavior may shed light on the relationship between life stress and STBs. Existing literature also supports this hypothesized relationship's likelihood mediators and moderators. For example, interpersonal stress (i.e., a salient, acute risk factor for STBs) may be particularly well suited to prime escape behavior. High negative emotionality following such stressors is also a risk factor for STBs. Thus, it may facilitate the interpersonal stress-escape behavior relationship. The present study sought to test these relationships experimentally. Participants were 120 college students (33.3% male, Mage = 19.06), half of whom reported a lifetime STB history and half of whom denied a lifetime STB history. They completed an in-person session consisting of an interview to confirm lifetime STB history and a baseline self-report measure of negative emotionality. They were then randomized to one of two experimental conditions, completing either an interpersonally focused stressor or interpersonally focused neutral task, before completing the escape behavior task and a self-report measure of negative emotionality. Results showed that starting point escape behavior was more pronounced among those with (vs. without) a lifetime history of STBs. The stress-negative mood relationship was moderated by STB history such that those who did (vs. did not) report a STB history demonstrated higher levels of negative mood following the stressor. There were no statistically significant differences in starting point escape behavior between those in the neutral and stress experimental conditions. Mediation analyses revealed no statistically significant main effect of interpersonal stress condition on starting point escape behavior, nor an indirect effect of interpersonal stress condition on starting point escape behavior through post-stressor negative emotionality. STB history did not statistically significantly moderate the path from negative emotionality to starting point escape behavior. Results replicate and extend prior work by showing that the relationship between STBs and escape bias holds among a sample of college students. However, as negative affect did not impact task performance, it is possible that escape bias is robust to changes in momentary affect. Future work should continue to experimentally examine this relationship as identifying factors that can modulate escape behavior in laboratory settings will have important implications both for understanding mechanisms of escape bias, as well as for intervention efforts.