Unitary Cognitive Control and Suicide Risk: An Emphasis on Interpersonal Stress

One way of understanding suicide, a global health concern is viewing it as a decision. Although theories on suicide differ on the critical components, they often conceptualize suicide as a choice between life and death, and propose that individuals endorse suicidal thoughts and behaviors (STB) when the pain of living outweighs the costs of dying. Understanding the intricate decision-making processes involved in suicide may begin by examining basic cognitive functions such as inhibition, cognitive flexibility, and working memory. A higher-order cognitive system that accounts for these basic functions and is crucial in goal-directed behaviors is cognitive control. Cognitive control has been associated with suicide as those with a history of STBs often exhibit difficulties in inhibiting attention from suicide related stimuli, demonstrating flexibility and switching cognitive strategies based on environmental feedback, and processing information in working memory. Thus far, subcomponents of cognitive control (i.e., inhibition, cognitive flexibility, and working memory) have often been used to represent the whole, which can be misleading and the whole may be greater than the sum of its parts. For example, the implications of cognitive flexibility, which is usually perceived as a positive construct, may change when examined in conjunction with inhibition. That is, if an individual has difficulty in inhibiting from negative information, then flexibility may indicate an increased ability to generate negative strategies that lead to maladaptive outcomes. Furthermore, past studies have not examined how specific contexts may alter the relationship between cognitive control and suicide even though cognitive control is significantly influenced by stress. This study aims to look at cognitive control as a unitary construct formed by three causal indicators: inhibition, working memory, and cognitive flexibility. Using casual indicator models in structural equation modeling, this study examines how susceptibility to interpersonal stress moderates the effects of cognitive control on suicide risk among individuals who endorse suicide. This study contributes to the existing literature by considering cognitive control as a system can considering specific contexts in which its effect on suicide may differ. The findings of this study have the potential of elucidating the decision-making processes that are involved in suicide and can provide important implications that can be used for prevention and intervention.