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

Introduction: Suicide ideation (SI) may provide relief from aversive affective states, thereby serving an affect regulation function. Though some studies suggest that SI reduces affective distress, this evidence is inconclusive and suffers from methodological limitations. Methods: We used dynamic structural equation models (DSEM) to test whether the bidirectional associations between SI and both negative affect (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 ecological momentary assessment (EMA) with seven daily assessments for 21 days. Results: Results demonstrated reciprocal effects such that within-person increases in NA and decreases in PA were associated with increases in SI two hours later, and increases in SI were associated with increases in NA and decreases in PA two hours later. In addition, the occurrence of SI did not significantly moderate the persistence of NA or PA over two-hour intervals. Supplemental analyses demonstrated how distinct analytic methods can lead to divergent conclusions regarding the affect regulation function of SI. Conclusions: Contrary to an affect regulation model, results suggest that affective distress and SI maintain each other in vicious cycles or feedback loops.