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

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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).