Difficulties in Identifying Causes of Emotions Prospectively Predict the Persistence of Suicidal Thoughts: A Six-Week Longitudinal Study

Background: Suicidal thoughts affect approximately 10% of the population during their lifetime. In about one-third of cases, these thoughts persist, contributing to poorer health and elevated suicide risk. Emotion regulation deficits were found to be a central prospective risk factor for suicidal thought persistence. Still, little is known about the mechanisms driving these deficits. Difficulties in identifying causes of emotions could undermine emotion regulation by limiting the ability to target the source of distress. Recent cross-sectional evidence suggests that such difficulties are linked to the occurrence of suicidal thoughts. However, these associations were never examined longitudinally. This study tested whether difficulties in identifying the cause of negative emotions predicted the persistence and severity of suicidal thoughts over 6 weeks, and whether perceived regulatory success mediated this link. Methods: Participants who reported suicidal thoughts in the past week (N=138) completed baseline and 6-week follow-up assessments including questionnaires and Ecological Momentary Assessments (EMAs). Difficulties in identifying causes of emotions were assessed using EMAs and language processing. Results: Difficulties in identifying causes of negative emotions predicted greater persistence of suicidal thoughts at follow-up, even after accounting for initial suicidal thought severity and initial depressive and psychiatric symptoms. Mediation analysis revealed that this effect was partly accounted for by lower perceived success in emotion regulation. However, such difficulties did not predict suicidal thought severity. Conclusion: Findings point to difficulties in identifying causes of emotions as a novel predictor for the persistence of suicidal thoughts, and as a potential target for intervention.