Unitary Cognitive Control and Suicide Risk: An Emphasis on Interpersonal Stress

One way of understanding suicide, a global health concern is viewing it as a decision. Although theories on suicide differ on the critical components, they often conceptualize suicide as a choice between life and death, and propose that individuals endorse suicidal thoughts and behaviors (STB) when the pain of living outweighs the costs of dying. Understanding the intricate decision-making processes involved in suicide may begin by examining basic cognitive functions such as inhibition, cognitive flexibility, and working memory. A higher-order cognitive system that accounts for these basic functions and is crucial in goal-directed behaviors is cognitive control. Cognitive control has been associated with suicide as those with a history of STBs often exhibit difficulties in inhibiting attention from suicide related stimuli, demonstrating flexibility and switching cognitive strategies based on environmental feedback, and processing information in working memory.

Thus far, subcomponents of cognitive control (i.e., inhibition, cognitive flexibility, and working memory) have often been used to represent the whole, which can be misleading and the whole may be greater than the sum of its parts. For example, the implications of cognitive flexibility, which is usually perceived as a positive construct, may change when examined in conjunction with inhibition. That is, if an individual has difficulty in inhibiting from negative information, then flexibility may indicate an increased ability to generate negative strategies that lead to maladaptive outcomes. Furthermore, past studies have not examined how specific contexts may alter the relationship between cognitive control and suicide even though cognitive control is significantly influenced by stress.

This study aims to look at cognitive control as a unitary construct formed by three causal indicators: inhibition, working memory, and cognitive flexibility. Using casual indicator models in structural equation modeling, this study examines how susceptibility to interpersonal stress moderates the effects of cognitive control on suicide risk among individuals who endorse suicide. This study contributes to the existing literature by considering cognitive control as a system can considering specific contexts in which its effect on suicide may differ. The findings of this study have the potential of elucidating the decision-making processes that are involved in suicide and can provide important implications that can be used for prevention and intervention.

自杀作为一项全球公共卫生议题，对其的一种理解路径是将其视作一种决策行为。尽管不同自杀理论的核心构成要素存在分歧，但大多将自杀概念化为生与死之间的抉择，并提出当生存之痛超过死亡之代价时，个体便会产生自杀意念与自杀行为(Suicidal Thoughts and Behaviors, STB)。要理解自杀背后复杂的决策过程，可从考察抑制、认知灵活性、工作记忆等基础认知功能入手。认知控制(Cognitive Control)是支撑上述基础认知功能、且对目标导向行为至关重要的高阶认知系统。认知控制与自杀存在关联：有自杀意念与自杀行为史的个体，往往难以将注意力从自杀相关刺激上转移，无法灵活根据环境反馈调整认知策略，也难以在工作记忆中加工信息。
迄今为止，学界常将认知控制的子成分（即抑制、认知灵活性与工作记忆）直接等同于整体的认知控制，这一做法可能存在误导性，因为整体往往大于部分之和。例如，通常被视为积极特质的认知灵活性，在与抑制功能结合考察时，其意义可能发生转变。换言之，若个体难以抑制对负面信息的关注，那么认知灵活性反而可能使其更易生成导致适应不良结果的消极策略。此外，尽管压力会显著影响认知控制，但既往研究尚未考察特定情境会如何改变认知控制与自杀之间的关联。
本研究旨在将认知控制视为由抑制、工作记忆与认知灵活性三个因果指标构成的统一构念。本研究采用结构方程模型中的因果指标模型，考察在存在自杀意念的个体中，人际压力易感性如何调节认知控制对自杀风险的影响。本研究将认知控制视作一个整体系统，并纳入会改变其对自杀影响的特定情境，这一研究设计为现有文献提供了新的贡献。本研究结果有望阐明自杀背后的决策过程，并为自杀预防与干预工作提供重要的实践启示。