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Published in final edited form as: Arch Suicide Res. 2023 Sep 28;28(3):1035–1043. doi: 10.1080/13811118.2023.2262536

The Prospective Association between Emotional Reactivity and Adolescent Suicidal Ideation

Shou-Chun Chiang 1, Wan-Chen Chen 2, Li-Tuan Chou 3
PMCID: PMC10972770  NIHMSID: NIHMS1940493  PMID: 37767810

Abstract

Despite the importance of emotions in our daily lives, less is known about the role of emotional reactivity in suicidal risk. This brief study investigated whether emotional reactivity is associated with adolescent suicidal ideation six months later. Participants were 139 adolescents (55% female; Mage = 12.79, SDage = 0.73) who completed baseline assessments, a 10-day daily diary protocol, and six-month follow-up assessments. Results showed that higher emotional reactivity indicated by increased negative emotions and decreased positive emotions was associated with a greater risk for suicidal ideation. The findings suggest that adolescents with greater emotional reactivity to daily school problems had elevated risks for suicidal ideation. This study supports the importance of emotional reactivity in daily life for preventing adolescent suicidal ideation.

Keywords: emotional reactivity, suicidal ideation, adolescent, daily diary

Introduction

Emotional experiences are central in psychological functioning and well-being. Although previous research has devoted considerable attention toward how different patterns of emotion dynamics are associated with psychological maladjustment (Houben et al., 2015; Reitsema et al., 2022), empirical evidence on the association between emotional reactivity and suicidal risk remains scarce. Among dynamic measures of emotions, emotional reactivity, which is defined by an individual’s emotional responses to stress or stimuli (Chiang et al., 2023; Silvers et al., 2012), has been identified to be a robust predictor on adolescent mental health problems, including depressive symptoms, internalizing and externalizing problems, and emotional and behavioral problems (Bai et al., 2020; Herres et al., 2016; Shapero & Steinberg, 2013). However, less is known about how emotional reactivity may be directly linked to adolescent suicidal ideation. It is therefore crucial to examine the prospective association between daily emotional reactivity and adolescent suicidal risk for informing prevention efforts.

Adolescence is characterized by heightened stress sensitivity and emotional reactivity during which adolescents develop adaptive or dysregulated responses that mark their vulnerability to psychopathology and suicidal risk (Evans et al., 2016; Spear, 2009). Past research suggests that adolescents with emotion dysregulation, such as deficits in regulating or nonaccepting emotions, reported greater suicidal risks (Rajappa et al., 2012; Weinberg & Klonsky, 2009). The interpersonal theory of suicide (ITS; Joiner, 2005) has been proposed as an important theoretical framework to characterize the links between emotion dysregulation and suicide (e.g., Eaddy et al., 2019; Heffer & Willoughby, 2018). According to ITS, suicidal ideation mainly results from perceived burdensomeness and thwarted belongingness (Van Orden et al., 2010). As emotionally dysregulated individuals may have difficulty in regulating their emotions and thus be overwhelmed by negative events, they are more likely to feel they cannot contribute to the world (i.e., perceived burdensomeness) or feel nobody cares about them (i.e., thwarted belongingness) (Anestis et al., 2011), which can jointly exacerbate the risk for suicide. Thus, ITS may provide theoretical roots in understanding the links between emotion dysregulation and suicidality, especially in adolescence of increased emotional reactivity and risk-taking behaviors (Stewart et al., 2017). Developmentally, problems at school represent significant psychosocial stress that may impact school-aged youth’s daily emotional experiences. Together, adolescents who exhibit higher emotional reactivity to school problems may experience increased perceived burdensomeness and thwarted belongingness, which then lead to greater risk for suicidal ideation. Nevertheless, limited research has examined the association between emotional reactivity and suicidal ideation. Therefore, this study aimed to investigate the association between emotional reactivity and suicidal ideation among adolescents.

The aim of the current study was to examine the predictive role of emotional reactivity for adolescent suicidal ideation six months later. We used a daily diary protocol to capture daily emotional reactivity to school problems and the longitudinal design to investigate the prospective association between emotional reactivity and six-month follow-up suicidal ideation. We hypothesized that adolescents with higher emotional reactivity to school problems, such as greater increases in negative emotions and decreases in positive emotions, would be at greater risk for the development of suicidal ideation. Given the importance of mean positive and negative emotions in suicidality (e.g., Rojas et al., 2015; Yamokoski et al., 2011), we also included mean positive and negative emotions to account for their associations with suicidal ideation. Moreover, past research indicates that it is crucial to assess the added values of dynamic measures of emotions (e.g., emotional reactivity, emotional variability) over and beyond mean levels of emotions (Dejonckheere et al., 2019). Thus, controlling for mean levels of emotions would provide the predictive values of emotional reactivity independent of one’s positive and negative emotionality.

Method

Participants

The participants were 139 adolescents between ages 12–14 (Mage = 12.79, SDage = 0.73, 55% female) recruited in Taiwan. All adolescents identified as Taiwanese, and their parents identified as Taiwanese (97%) or Chinese (3%). Parents’ education ranged from below high school degree (5%), high school degree (20.9%), college degree (56.1%), and graduate degree (18%). To be eligible to participate in the study, adolescents had to meet the following inclusion criteria: had access to online surveys through mobiles or computers; lived with the primary caregiver most of the time who provided consent; and enrolled in school with in-person classes.

All procedures were approved by the university’s institutional review board. Participants were recruited through two middle schools, where the research team introduced the study purpose and procedures with the approval of school principals. The research assistants introduced the study to adolescents across the classrooms and to their parents through emails or phone calls. Of 140 families who were interested in the study were contacted by the research assistants, 139 adolescents and their parents provided full informed assent and consent. Specifically, parents and adolescents indicated on the paper-based consent or assent form that they consented to participate at home, and adolescents returned the form to the research assistants in school.

Next, all online surveys (i.e., baseline questionnaires, daily surveys, follow-up surveys) were administered through person-specific links to participants’ preferred communication approaches (e.g., personal email or mobile apps such as LINE) with secured passwords to participants. Participants were allowed to skip questions in all surveys if the question was not applicable or not comfortable to answer. Adolescents and parents completed baseline questionnaires about demographic, family relationship, and well-being at home. The diary surveys were collected from Monday to Friday (i.e., school days) for two consecutive weeks. For this study, the daily after-school surveys were used for capturing adolescents’ school problems and emotions during the school. After the daily diary protocol, adolescents completed the six-month follow-up assessments administered by research assistants with person-specific links. During the data collection, school teachers helped remind adolescents for completing baseline, daily diary, and follow-up assessments without interfering the study. The compliance rates (numbers of days completed/total days) were high (97%) in daily diary data. No missing data were in baseline and follow-up assessments. Adolescents were compensated with cash or gift cards at each stage: $10 for the baseline surveys, $3.5 per daily diary assessment and $15 for the follow-up assessment. Parents also received $10 for completing the baseline surveys.

Measures

Daily emotion.

Adolescents reported daily emotions on ten items selected from the Positive and Negative Affect Schedule (PANAS-X, Watson et al., 1999). The items were chosen based on the most common emotions developmentally appropriate for adolescents. Five items were used for positive emotions (i.e., happy, excited, interested, proud, active) and five items were used for negative emotions (i.e., sad, angry, guilty, scared, nervous, afraid). Items were rated on a 10-point slider from 0 (not at all) to 10 (very much). Items were averaged separately to create a single score for positive and negative emotions. The average Cronbach’s α for negative emotion was α = 0.86, and for positive emotion was: α = 0.82.

Daily school problems.

Adolescents reported daily school problems on six items adapted from a previous study (Bai et al., 2017), including three items for academic problems (“I had trouble doing my schoolwork today”, “I cannot concentrate in class today”, “I had trouble learning at school today”) and three items for peer problems (“I felt that my friends didn’t want to be with me today”, “I had a fight with my friends today”, “One of my friends was mad at me today”). Items were rated on a 10-point slider from 0 (not at all) to 10 (very much). Items were averaged to create a single score for school problems. The average Cronbach’s α for school problems was α = 0.79.

Suicidal ideation.

Adolescents reported their suicidal ideation at baseline and follow-up surveys on an item from the ninth item in Patient Health Questionnaire-9 (PHQ-9, Kroenke et al., 2001) regarding how often they had suicidal thoughts during the past month (four-point scale; 0 = never, 1 = several days, 2 = more than half the days, 3 = almost every day). A single item for suicidal ideation is widely used in screening adolescent suicidal risk and minimizing participant burden (e.g., Gijzen et al., 2021; Zhu et al., 2022). In particular, the ninth item in PHQ-9 was often chosen to assess the presence of suicidal ideation among adolescents (Garlow et al., 2008; López-Torres et al., 2019; Valuck et al., 2012). A response of several days or more was considered to meet suicidal ideation.

Covariates.

We included baseline depressive symptoms using the PHQ-9, except the ninth item about suicidal ideation (PHQ-8). Although the reliability for depressive symptoms was relatively low (α = .68), further psychometric analysis using confirmatory factor analysis indicated a good validity of the measure (RMSEA = .031, CFI = .99, TLI = .98). Adolescent age and gender were also included as covariates.

Analytical Plan

All analyses were conducted in R version 4.1.2 (R Core Team, 2020). To test our hypotheses, logistic regression was used to examine association between emotional reactivity and adolescent suicidal ideation while controlling for the covariates. As in prior studies (Mroczek et al., 2015; Ong et al., 2020; Stantee & Starr, 2022), emotional reactivity is operationalized as the within-person relationship between daily school problems and emotions derived from individual-specific slopes using multilevel modeling. For illustration, higher negative emotional reactivity indicates greater increases in negative emotion on days when adolescents experienced more school problems. For positive emotional reactivity, we reverse-coded the scores (multiplying by −1) so that higher positive emotional reactivity refers to greater declines in positive emotional to simplify interpretation (Bai et al., 2018). We then used negative and positive emotional reactivity to predict adolescents’ suicidal ideation at the six-month follow-up assessment, while controlling for mean levels of emotions, baseline depressive symptoms, gender, and age.

Results

Descriptive statistics and correlations among main variables were presented in Table 1. At baseline, no adolescent reported suicidal ideation, whereas 36% adolescents reported suicidal ideation at follow-up. For correlations, mean negative emotion was positively correlated with positive emotional reactivity and negative emotional reactivity, and mean positive emotion was negatively correlated with positive emotional reactivity and negative emotional reactivity. Both positive emotional reactivity and negative emotional reactivity were positively correlated with suicidal ideation. The results of regression models were shown in Table 2. Positive emotional reactivity was significantly associated with a higher risk of suicidal ideation (odds ratio = 2.35; b = 0.85; p < .01), whereas mean positive emotion was not associated with suicidal ideation (odds ratio = 0.61; b = −0.50; p > .05) after controlling for depressive symptoms, gender, and age. Next, negative emotional reactivity was significantly associated with a higher risk of suicidal ideation (odds ratio = 1.75; b = 0.56; p < .05), whereas mean negative emotion was not associated with suicidal ideation (odds ratio = 1.48; b = 0.39; p > .05) after controlling for depressive symptoms, gender, and age.

Table 1.

Descriptive Statistics and Correlations among Main Variables

1 2 3 4 5
1. Mean positive emotion 1
2. Mean negative emotion −.60*** 1
3. Positive emotional reactivity −.45*** .18* 1
4. Negative emotional reactivity −.32*** .47*** .55*** 1
5. Suicidal ideation −.44*** .45*** .40*** .32*** 1
Mean 7.35 1.28 0.18 0.17 0.36
SD 1.90 1.43 0.07 0.14 0.48
Open in a new tab
*

p < .05,

**

p < .01,

***

p < .001

Table 2.

Logistic regression analyses predicting suicidal ideation.

Odds ratio 95% CI b SE
PE model
 PE reactivity 2.35 1.38–4.36 0.85** 0.29
 Mean PE 0.61 0.33–1.10 −0.50 0.31
 Depressive symptoms 2.82 1.68–5.11 1.04*** 0.28
 Gender 1.41 0.54–3.72 0.34 0.49
 Age 1.04 0.65–1.65 0.04 0.23
Pseudo R2 .33
NE model
 NE reactivity 1.75 1.01–3.26 0.56* 0.30
 Mean NE 1.48 0.87–2.60 0.39 0.28
 Depressive symptoms 2.03 1.18–3.67 0.71* 0.29
 Gender 1.69 0.70–4.16 0.52 0.45
 Age 1.11 0.72–1.73 0.11 0.22
Pseudo R2 .26
Open in a new tab

Note. PE: Positive Emotion. NE: Negative Emotion.

*

p < .05,

**

p < .01,

***

p < .001

Discussion

The current study examined the prospective association between emotional reactivity and suicidal ideation using daily diary and longitudinal designs among Taiwanese adolescents. Results indicated that adolescents with greater emotional reactivity in both negative and positive emotions were at higher risk for suicidal ideation six months later, even after controlling for adolescents’ mean emotion and depressive symptoms. Consistent with past work showing that emotional reactivity is linked to poor mental health (Bai et al., 2020; Herres et al., 2016), our study further extends the literature to the links between emotional reactivity and suicidal risk among adolescents. The findings suggest that daily emotional responses to life stressors, such as school problems, have continuing impact on the emergence of adolescent suicidal ideation. The results may represent that adolescents who are more reactive to school problems have difficulty in regulating their emotions or demonstrate maladaptive emotion regulation abilities. Our findings thus provide evidence that emotional reactivity may be a critical indicator for explaining the development of suicidality.

The results also have theoretical implications for expanding ITS. The findings may suggest that greater emotional reactivity can lead to impairment in relationships as they had limited connections with friends (e.g., having peer problems in school) and feelings of being a burden to others (e.g., failing to meet parents’ academic expectations), which in turn would increase thwarted belongingness and perceived burdensomeness (Anestis et al., 2011; Van Orden et al., 2010). Thus, adolescents with heightened emotional reactivity may represent high levels of thwarted belongingness and perceived burdensomeness, which in turn lead them at greater risk for developing suicidal ideation. As such, future research would benefit from assessing the relations between emotional reactivity and key constructs of ITS for strengthening the theoretical pathways of the development of suicidal ideation.

Strengths of the study include a longitudinal design with daily diary measures from a non-clinical sample of adolescents attending schools every day. In addition, most studies examining emotional reactivity are drawn from North American and European samples with limited sample diversity in current literature. Limitations include self-report measures adolescents completed across the study designs. Also, daily measures were only assessed once a day. Future research should incorporate multi-informant and multiple within-day assessments to provide a more fine-grained information about emotional experiences. Moreover, suicidal ideation was assessed with a single item, limiting the investigation of the complex nature and facets of suicidal ideation such as attributes, severity, and temporality (Posner et al., 2011; Van Spijker et al., 2014). Future research should examine the relationships between emotional reactivity and more well-validated measures of suicidal ideation. Last, the sample is collected from schools rather than clinical settings. Future studies should replicate the findings of this study in clinical sample with greater psychiatric disorders and comorbidity.

Although past research has examined emotional reactivity cross-sectionally and its relations with suicidal ideation (e.g., Liu et al., 2020; Polanco-Roman et al., 2018), this study is one of the first to assess the prospective values of emotional reactivity assessed by daily diary methods in predicting later suicidal ideation. This study extends past work by investigating the role of day-to-day emotional reactivity in predicting adolescent suicidal ideation six months later. The findings have important clinical implications, suggesting that day-to-day emotional responses to school problems may offer crucial prevention points for reducing adolescent suicidal risk. The data also underscore the need to consider dynamic features of emotions beyond mean levels to characterize adolescent emotional states in daily life and psychological well-being.

Funding details.

Data collection was supported by the Taiwan Ministry of Science and Technology under Grant MOST 110-2410-H-004 −109. MOST had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Shou-Chun Chiang was supported by the Prevention and Methodology Training Program (T32 DA017629; MPIs: J. Maggs & S. Lanza) with funding from the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.

Footnotes

Ethical consideration. The study was approved and followed by the Institutional Review Board of the National Chengchi University (NCCU-REC-202105-I038). The study is in accordance with the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.

Declaration of interest statement

The authors report there are no competing interests to declare.

Data availability statement.

The data are not available due to ethical concerns.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data are not available due to ethical concerns.

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