How do people move from contemplating to attempting suicide: Investigating the cognitive mechanisms of loss of control and limited awareness of goals

自杀是一个全球性的问题，目前尚不清楚个体如何从考虑自杀的人(理想者)转变为企图自杀的人(未遂者)。需要解决可能导致这一转变的心理机制方面的知识差距，以便为企图自杀的个人提供新的治疗目标和制定干预措施。这个混合方法项目旨在通过使用知觉控制理论(PCT)作为理论框架来测试从自杀意念到尝试的潜在心理机制来解决这一知识鸿沟。它将检验以下假设：1.当个人无法控制自己生活的重要方面(目标)时，他们试图自杀，以此作为重新控制自己经历的一种手段。2.试图自杀的人比理想者更少意识到自杀会如何影响这些目标。本项目的目标是开发和评估一种心理学工具，用于评估自杀人群中的控制和意识机制，并调查使用该工具的理想者和策划者之间的差异。项目的所有阶段将由一名服务用户顾问和PPIE小组的意见指导。参与者将从法定和非法定服务机构(例如急症室)招募，并将被邀请参加随后的研究。研究一采用认知访谈的方法，考察了未遂者和意念者(n~8)对其重要生活目标的控制经历，以及他们对自杀死亡将如何影响他们的目标的认识。这一方法将能够生成问题题库。研究二将使用项目库开发一种心理工具，用于评估自杀个体实现其目标的能力，以及他们对自杀将如何对其目标产生负面影响的意识。这项研究将通过在多个时间点评估自杀个体，并将其结果与其他控制和意识措施进行比较，来评估该工具的可靠性和有效性。研究3将使用新开发的心理学工具来比较思考者和计划者(每组40人)的控制和意识的心理机制。这项研究将为理解自杀意念到行为的转变做出重要的理论贡献。使用分层医学方法，它将为自杀预防的心理评估提供信息，通过尊重客户的个人关切对其进行个性化评估，这是改善治疗结果的关键组成部分(Schauman&Mansell，2012)。

Suicide is a global problem and it remains unclear how individuals transition from contemplating suicide (ideators) to attempting suicide (attempters). The knowledge gap on the psychological mechanisms which may underlie this transition needs to be addressed in order to provide new treatment targets and develop interventions for individuals who attempt suicide. This mixed-methods project aims to address this knowledge gap by testing psychological mechanisms underlying the transition from suicidal ideation to attempts using Perceptual Control Theory (PCT) as a theoretical framework. It will test the following hypotheses: 1. Individuals attempt suicide as a means of regaining control of their experiences when they are unable to control important aspects of their lives (goals). 2. Individuals who attempt suicide are less aware than ideators of how these goals would be affected by suicide. The objectives of this project are to develop and evaluate a psychological tool for assessing the mechanisms of control and awareness in a suicidal population, and to investigate differences between ideators and attempters using this tool. All stages of the project will be guided by a service user consultant and input from a PPIE group. Participants will be recruited from statutory and non-statutory services (e.g. A&E departments), and will be invited to participate in subsequent studies. Study 1 will use cognitive interviews to investigate attempters' and ideators' (n~8) experiences of control over their important life goals and their awareness of how their death by suicide would impact on their goals. This methodology will enable an item pool of questions to be generated. Study 2 will use the item pool to develop a psychological tool for assessing suicidal individuals' ability to achieve their goals and their awareness of how their goals would be negatively impacted on by suicide. This study will evaluate the reliability and validity of the tool by assessing suicidal individuals at multiple timepoints and comparing its results with other measures of control and awareness. Study 3 will use the newly developed psychological tool to compare the psychological mechanisms of control and awareness between ideators and attempters (40 per group). This research will make a substantial theoretical contribution to understanding the transition from suicidal ideation to behaviour. Using a stratified medicine approach, it will inform psychological assessment for suicide prevention which is personalised to clients by respecting their individual concerns, a critical component in improving treatment outcomes (Schauman & Mansell, 2012).