1 - (SYM 29) Cognitive Inflexibility and Suicidal Ideation Among Adolescents Following Hospitalization: The Moderating Role of Life Stress

Background: Suicidal ideation (SI) and behavior are significant public health concerns in adolescence. Cognitive inflexibility has recently been investigated as potential vulnerability factor for the development of SI, but the context in which it may convey risk is unclear. Life stress has also been reliably associated with SI among adolescents, and following a stress-diathesis model, may be a factor that moderates the relationship between cognitive inflexibility and SI. 
Methods: Adolescents (N = 259) were followed for 18 months after discharge from psychiatric hospitalization. Semi-structured interviews assessing life stress and SI and a neurocognitive task assessing cognitive inflexibility were conducted at six- and 12-months. SI was also assessed at 18-month post-discharge. Linear mixed models were used to determine the moderating effect of stress on the relationship between cognitive inflexibility and SI, accounting for depressive symptoms and relevant demographic covariates.

Results: Chronic stress moderated the association between cognitive inflexibility and SI among adolescents, with stronger association among youth with greater chronic levels of stress compared to lower chronic stress levels. This finding was maintained after statistically adjusting for relevant demographic and clinical covariates. No prospective associations between cognitive inflexibility, life stress, and SI were found.

Conclusions: Cognitively inflexible adolescents under conditions of high chronic stress are more likely to experience increased SI severity, supporting a cognitive inflexibility stress-diathesis model of SI in adolescents. Furthermore, this association may be specific to proximal SI. The findings highlight the importance of assessing these modifiable factors among adolescents at a high risk for SI.