Emotion Regulation in Daily Life among Adults with Suicidal Thoughts

Background. Emotion regulation difficulties are highlighted as a risk factor for suicidal thoughts. However, little is known on how people with suicidal thoughts regulate emotions in daily life using ecologically valid methods. Prior research also rarely differentiated between emotion regulation deficits that are specifically associated with suicidal thoughts, and deficits that characterize high levels of psychopathology, regardless of suicidality. Methods. We conducted two Ecological Momentary Assessment studies (EMA; N1=396; N2=195). We compared adults with current suicidal thoughts to adults with and without a history of suicidal thoughts (Study 1), and to adults with low or high levels of psychiatric symptoms (Study 2). Participants completed a week-long EMA period with 6 surveys per day, assessing emotion regulation attempts, strategies, perceived regulatory success and effort. Results. Participants with suicidal thoughts differed from participants with high psychiatric symptoms only in their regulatory effort and in their use of alcohol or drugs to regulate emotions. Elevated use of distraction, rumination, and self-injury did not differentiate between participants with suicidal thoughts and participants with high psychiatric symptoms but no suicidality. Among participants with suicidal thoughts, self-injury and the use of substances were the only emotion regulation strategies that predicted momentary suicidal thinking. Conclusions. Suicidal thoughts are associated with the use of less effective emotion regulation strategies and difficulties in implementing strategies in daily life. However, many difficulties are not specific to suicidal thoughts. The use of substances to regulate emotions and heightened regulatory effort may be unique to suicidal populations.