Cognitive inflexibility as a prospective predictor of suicidal ideation among young adults with a suicide attempt history

BACKGROUND: Previous studies suggest that people attempt suicide because they are cognitively inflexible, but past research suggesting a link between cognitive inflexibility and suicidal thoughts and behavior has been limited by cross-sectional designs. This study examined whether cognitive inflexibility differentially and prospectively predicted suicidal ideation among young adults with and without a history of a suicide attempt. METHODS: A sample of 45 young adults with (n = 13) or without (n = 32) a suicide attempt history completed the Wisconsin Card Sorting Test (WCST), a diagnostic interview, and self-report measures of hopelessness, depressive symptoms, and suicidal ideation, and were followed up 6 months later to reassess suicidal ideation. RESULTS: Cognitive inflexibility, as measured by perseverative errors on the WCST, predicted suicidal ideation at 6-month follow-up, among suicide attempters, but not among nonattempters, adjusting for the presence of a baseline mood or anxiety diagnosis, hopelessness, and baseline suicidal ideation. CONCLUSIONS: Cognitive inflexibility may increase vulnerability to suicidal ideation over time among individuals with a previous suicide attempt history. Implications for interventions with suicide attempters are discussed.