The relationship between emotional clarity and suicidal ideation among trauma-exposed adolescents in inpatient psychiatric care: does distress tolerance matter?

ABSTRACT

The present investigation examined associations between low emotional clarity (the extent to which individuals are confused about the specific emotions they are experiencing) and suicidal ideation in a diverse sample of trauma-exposed inpatient adolescents, as well as the moderating role of distress tolerance (DT) in this association. Participants (N = 50; 52.0% female; M = 15.1 years, SD = .51; 44% White) completed measures of emotion dysregulation, posttraumatic stress disorder (PTSD), and suicidal ideation/attempts, as well as a behavioral measure of DT. Controlling for age, gender, presence of mood disorder, and past history of attempts, results revealed a significant interaction between DT and low emotional clarity in relation to suicidal ideation. Specifically, lower emotional clarity was related to suicidal ideation at higher, but not lower, levels of DT. Findings suggest that presence of suicidal ideation among traumatized youth with low emotion clarity is most likely when these emotional deficits are coupled with a high tolerance for cognitive/psychological distress. Given that the ability to withstand distress is arguably a key factor in transitioning individuals from ideation to lethal suicidal behavior, attention to the presence of this construct in the context of clinical practice may be warranted.

KEYWORDS:

• Emotion dysregulation
• suicide ideation
• distress tolerance
• trauma
• adolescents

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. All other DERS facets as well as the DERS total score were examined as predictors in separate models. No significant interactions were found between DT and these alternate predictors (ps ranging from 0.20 [DERS-nonacceptance] to 0.69 [DERS-Goals]), lending support to the specificity of our model to emotional clarity problems in particular.

2. Given nuanced relations between distress tolerance and ideation vs. attempts (Law et al., 2015), the model was also run removing suicide attempts as a covariate. The same pattern of associations was found: low emotional clarity predicted suicidal ideation at high (β = 1.33, SE = .58, p = .02, 95% CI [0.21, 2.46]), but not low, levels of distress tolerance (β = −0.44, SE = .53, p = .41, 95% CI [−1.48, 0.61]. A separate model with suicide attempts (vs. ideation) as the dependent variable was also run; the interaction between DT and emotional clarity was not significant in this model (β = 0.03, SE = .47, p = .95, 95% CI [−0.89, 0.95].