Suicide is a significant public health problem across the lifespan,
and is the 5th leading cause of years of potential life lost before
age 65. Suicide is also the 11th overall leading cause of death in
the United States. There is, therefore, a pressing need for the development
of effective suicide prevention programs targeting at-risk individuals
The effectiveness of these programs will depend largely on how well
they mitigate risk for suicide ideation and behaviors; risk factors
include the presence of negative life events, and medical illness
and functional impairment. Depression, hopelessness, and pessimism
are also well-established risk factors for suicide. The reduction
of maladaptive cognitions, thus, has become a central focus of cognitive
models and treatments for suicide in these populations.
Adaptive and positive cognitive characteristics,
such as optimism, hope, future orientation and reasons for living,
that might buffer against suicide have received comparatively less
attention. Although few rigorously controlled studies have been
conducted, preliminary findings suggest that adaptive cogntions
are associated with reduced depressive symptoms in college students,
improved psychological adjustment in patients with cancer, multiple
sclerosis, and Parkinson’s
disease, enhanced well being in patients with HIV and arthritis,
and decreased suicide ideation and behaviors in adolescents, young
adults and depressed older adults. Taken together, these interesting
results suggest that individuals with a positive future-orientation
may have better outcomes.
Drawing on cognitive and self-determination theories, I have begun
to develop a framework for understanding suicide prevention that emphasizes
positive psychological growth through enhancement of positively-valenced
future-oriented thoughts, self-determination and goal achievement,
and interpersonal relatedness. As a protective factor, positive future-orientation
may provide a measure of resilience against negative biopsychosocial
outcomes through utilization of active and adaptive coping strategies.
Engaging problems directly, having motivation to overcome adversity,
and being persistent in the accomplishment of goals are examples;
meaningful and supportive interpersonal relationships that foster
future orientation may also be important. Preliminary findings with
adolescents and college students suggest that training individuals
to think optimistically can reduce depression; perhaps similar techniques
could be used to decrease suicide ideation and behaviors in these
What is interesting is that optimistic individuals appear to receive
benefits even in the face of difficult circumstances. For those who
have experienced negative and potentially traumatic life events, being
able to foresee a positive outcome to negative life situations or
positively reframe or reappraise negative life experiences may reduce
risk for suicide ideation and behaviors. An individual able to engender
a positive outlook toward the future, and who is encouraged to do
so, may reduce their distress, thereby mitigating risk for suicidal
thoughts and behaviors.
In my research, I have found that adaptive and future-oriented cognitive
characteristics are associated with lower levels of current suicide
ideation in college students, and with lower levels of current and
worst-point suicide ideation, and fewer lifetime suicide attempts,
in depressed older adults (Hirsch et al., 2005b; Hirsch et al., 2005a).
I have also examined future orientation as a beneficial moderator
of the relationship of several risk factors and suicide ideation and
attempts, including hopelessness, negative life events, and functional
impairment; in each case, future orientation exerted a buffering effect
(Hirsch et al., 2005c; Hirsch et al., 2005d). All of these findings
are significant after controlling for variables that are powerfully
associated with suicide, including hopelessness and depression severity.
This suggests that the promotion of adaptive characteristics may be
a valuable adjunctive strategy for suicide prevention efforts. Although
cognitively-based therapeutic interventions have been successful in
the treatment of suicidal behavior, none has focused specifically
on enhancing future orientation.
Future suicide research and prevention efforts should include a positive
psychological perspective. Investigation of future orientation among
diverse at-risk samples is also necessary, as is prospective investigation
of the mechanisms by which future orientation might exert a protective
effect against suicidal thoughts and behaviors. Deeper understanding
of factors that influence the development and expression of suicidal
thoughts and behaviors may lead to the development of better treatments.
Hirsch, J. K., Conner, K. R., & Duberstein, P. R. (2005a). Optimism
and suicide ideation in young adult college students. Submitted.
J. K., Duberstein, P., Conner, K. R., Heisel, M. J., Beckman, A., & Conwell, Y. (2005b). Future
orientation and suicide ideation and attempts in depressed adults
ages 50 and over. Submitted.
J. K., Duberstein, P., Conner, K. R., Heisel, M. J., Beckman, A., & Conwell, Y. (2005c). Hopelessness
and future orientation as potential moderators of the relationship
between functional impairment and suicide ideation in depressed adults
ages 55 and over. Submitted.
Hirsch, J. K., Wolford, K., Brunk, L., & Parker-Morris, A. (2005d).
Optimism as a moderator of the association between
negative life events and suicide ideation and attempts. Submitted.