Anticipatory, relief-oriented and permissive beliefs in patients with suicidal behaviors: An exploratory case-control study

Objective: The objective is to propose a specific understanding of decision-making in suicidal behavior by using a psychometric instrument, namely the Suicidal Ambivalence Scale (SAS). The SAS, initially used in addictive disorders, allows to distinguish 3 types of thoughts: first anticipatory beliefs [A] (positive expectations regarding behavior); second relief-oriented beliefs [R] (aim to reduce the feeling of suffering) and finally, permissive beliefs [P] (authorize the passage to the act). In addictions disorders, these thoughts favor craving and the act of consumption. We make the hypothesis that the processes of suicidal thoughts function similarly to thought processes in addiction and that all thoughts [A, S and P] are significantly more present in suicidal patients.

Methods: 120 suicidal crisis patients and 161 healthy controls were compared on clinical dimensions (levels of depression, hopelessness). Anticipatory, relief-oriented and permissive beliefs were evaluated with the suicidal ambivalence scale.

Results: Patients have statistically more of beliefs in favor of suicidal behavior to compared healthy controls (t = 2.375, p = 0.019, d = 0.57), more particularly, anticipatory and permissive beliefs. Conversely, patients have statistically less of protective thoughts against the suicidal behavior to compared healthy controls (t = 2.195, p = 0.03, d = 0.499).

Conclusion: This study showed the role of anticipatory, relief-oriented and permissive beliefs in the suicidal crisis and the need to create a simple and easy to use clinical tool for more accurate assessments of beliefs in patients with the suicidal crisis.