title: The ebb and flow of the wish to live and the wish to die among suicidal military personnel.
abstract: The relative balance between the wish to live and the wish to die (i.e., suicidal ambivalence) is a robust predictor of suicidal behavior and may be a mechanism underlying the effectiveness of treatments that reduce suicidal behaviors. To date, however, few studies have explored possible mechanisms of action in these treatments.
  
  
  
  Active duty Soldiers (N=152) with a recent suicide attempt and/or active suicide ideation were randomized to receive brief cognitive behavioral therapy (BCBT) or treatment as usual (TAU). The Suicide Attempt Self-Injury Inventory (Linehan et al., 2006a) was used to assess the incidence of suicide attempts during the 2-year follow-up. The wish to live and the wish to die were assessed with items 1 and 2, respectively, of the Beck Scale for Suicide Ideation (Beck and Steer, 1991).
  
  
  
  Across both treatments, the wish to live was significantly weaker among patients who attempted suicide but the wish to die was stronger only among patients who attempted suicide in TAU. Among nonattempters, the wish to die stabilized the wish to live, but among attempters the wish to live and the wish to die were not associated with each other. In BCBT the wish to live destabilized the wish to die among nonattempters.
  
  
  
  Self-report methodology, predominantly male sample.
  
  
  
  The emergence of suicidal behavior is driven primarily by the absence of the wish to live. BCBT is associated with a unique coupling of an ambivalent wish to live and wish to die, which may suggest an underlying mechanism of action.
authors.affiliation: National Center for Veterans Studies, The University of Utah, United States. Electronic address: craig.bryan@utah.edu.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Bryan
authors.affiliation: National Center for Veterans Studies, The University of Memphis, United States.
authors.forename: M David
authors.initials: MD
authors.lastname: Rudd
authors.affiliation: The University of Texas Health Science Center at San Antonio, South Texas Veterans Health Care System, United States.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Peterson
authors.affiliation: The University of Texas Health Science Center at San Antonio, United States.
authors.forename: Stacey
authors.initials: S
authors.lastname: Young-McCaughan
authors.affiliation: U.S. Army MEDDAC, Fort Carson, United States.
authors.forename: Evelyn G
authors.initials: EG
authors.lastname: Wertenberger
mesh_terms: D000328:Adult; D001294:Attitude to Health; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D011614:Psychotherapy, Brief; D057566:Self Report; D016728:Self-Injurious Behavior / Q000523:psychology; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology; D016896:Treatment Outcome; D000092864:Suicide Prevention
keywords: Brief cognitive behavioral therapy; Military; Suicidal ambivalence; Suicide