Executive functioning and suicidality

Consistent with the literature that has highlighted the importance of executive functioning in promoting healthy psychological functioning (Becker et al., 2011; Keilp et al., 2008, 2013), the current findings add support to the existing literature and reveals how

difficulties in executive function link to suicidality. In particular, difficulties in emotional control, inhibition, shifting, working memory, initiate, organization of material,

plan/organization, and task monitor were all found to be linked to increased suicidality. The only executive functioning component that did not correlate with suicidality was self-monitor. This suggest that the awareness of personal strengths and weaknesses, and how they influence others do not have a significant impact on suicide behaviour.

The significant correlation between executive function difficulties and suicidality complements a recent study conducted by Bredemeier and Miller (2015) who explained why deficits in specific executive functions might contribute to suicide risk. It is reasoned that executive function deficits can lead to a wide range of difficulties such as regulating one’s own emotions, thoughts, and actions, which in turn increases the risk of suicide attempt. For instance, individuals with deficits in shifting may have more difficulty diverting attention away from thoughts about self-harm, and they may struggle in switching to more positive or adaptive forms of coping in response to stress. Similarly, individuals with inhibition deficits might have difficulty resisting the urge to self-harm

when the suicidal thoughts become overwhelming. Similar to this postulation, Dougherty et al. (2004) have previously documented that those with a history of suicidal behaviour show deficits in inhibition compared to healthy controls. The ability to inhibit becomes crucial during suicide crisis where the urge of carrying out the suicide attempt may occur within 10 minutes of having had suicide ideation (Deisenhammer et al., 2009). Therefore, impairment in multiple aspects of executive function, especially inhibitory deficits, may exacerbate the problems in regulating emotions, thoughts, and actions, which ultimately increases suicidality (Ballenger, 2009; Miyake & Friedman, 2012). The current results support that individuals with inhibition deficits might have difficulty resisting the urge to act on thoughts about self-harm when they occur. These impaired executive functions, together with impulsivity may manifest to suicidality (Ballenger, 2009).

2.5.5.2 Executive functions and coping

Aside from the main investigation of how different executive functions impact suicide behaviour, the current findings revealed important links between executive functions and coping strategies. With the prediction that problem-focused coping strategies (e.g., active coping and positive growth) require cognitive abilities and good problem solving skills to directly resolve a stressor, therefore, utilizing these coping strategies may be especially problematic for those who have difficulties with executive functions. Under these

circumstances, individuals may turn to other ways to cope rather than the use of problem- focused coping strategies. In support of this assumption, it is evident that executive function difficulties (as indexed by increased scores on BRIEF-A) were significantly correlated with increased use of avoidance-focused coping. These include venting of

emotion, mental disengagement, alcohol-drug disengagement, behavioural

disengagement, and humor. In contrast, difficulties in executive functions (indicated by the GEC scores) were not associated with any problem-focused coping and emotion- focused coping except for increased use of denial. However, perceived difficulties in behavioural regulation was found to be associated with decreased use of planning (coping strategy). From these results, it is inferred that the use of planning requires adequate cognitive resources and is associated with better abilities in regulating one’s own

behaviour. When individuals have more difficulties with behavioural regulation they may turn to use more of the strategies that are generally considered as maladaptive. This may be partly because the alternative coping strategies require fewer cognitive demands. Examples include denial, disengagement, and avoidance. The result also supports the assumption that effective coping strategies require appropriate selection and

incorporation of different executive function components. Nonetheless, the present findings are consistent with past literature that has reported that cognitive dysfunction is associated with greater use of disengagement or avoidance coping (Arnett et al., 2002). It also compliments earlier findings that individuals with good working memory, planning, cognitive flexibility, and inhibition are better able to cope effectively with a stressor (Morris et al., 2014).

In Study 1, regression analyses were conducted on numerous coping and executive functions in predicting suicidality. As emotional control, organization, and initiate were identified as the most significant predictors, this suggests that individuals who have difficulty in regulating their emotions, problems with initiation, and issues in organizing tasks are critical in the recurrence of suicide behaviour. Consistent with the

findings, Williams et al. (1996) posited that deficits in updating and organizing were associated with difficulty retrieving past memories. This in turn leads to difficulty imagining possible future outcomes when faced with stressors in the form of life

adversities. Subsequently, such cognitive difficulties are also shown to impede the ways individuals flexibly deal with stressors because they have difficulty in organizing their thoughts. Aside from the impact of initiation and organization, which are aspects of meta- cognition, difficulties in behavioural regulation such as emotion control is another

important aspect of executive functions identified in this study. It was not only a key predictor for suicidality, but was also significantly associated with greater use of

avoidance-focused coping (i.e., mental disengagement, behavioural disengagement, and venting of emotion). This suggests that difficulty in emotion control may lead to

difficulty in selecting adaptive coping strategies and implementing these coping strategies. The lack of effective coping strategies, especially emotion-focused coping because it was found to reduce suicidality, may subsequently lead to more suicidal thoughts.