Modeling suicide risk among parents during the COVID-19 pandemic: Psychological inflexibility exacerbates the impact of COVID-19 stressors on interpersonal risk factors for suicide

Public health researchers have raised the concern that both the 2019 coronavirus disease (COVID-19) pandemic and the ensuing public health response will increase interpersonal stressors associated with suicide risk. The Acceptance and Commitment Therapy (ACT) framework conceptualizes psychological flexibility as an important way to reduce the impact of painful and even catastrophic events on psychological suffering. The current study examines psychological flexibility as a potential moderator of the prevailing interpersonal model of suicide risk. METHODS: A sample of 1003 parents (73% female, 82% Caucasian 86% in romantic relationships) were recruited as part of a larger study on the COVID-19 pandemic and family functioning from Mach 27th to the end of April 2020, the height of the United States’ “first wave.” Participants completed measures of psychological flexibility (the Multidimensional Psychological Flexibility inventory; MPFI), interpersonal constructs (perceived burdensomeness and thwarted belongingness), desire for death, COVID-19 related stressors (resource strain and loss due to COVID-19). RESULTS: Moderated-mediation path models highlighted a significant indirect association between COVID-19 stressors and desire for death mediated by perceived burdensomeness to others. This indirect pathway was moderated by psychological inflexibility such that links were strongest at high levels of inflexibility and weak or non-significant at low levels of inflexibility. Results were generally consistent across five of the six facets of inflexibility. DISCUSSION: The findings highlight the value of targeting psychological inflexibility as an important strategy to reduce suicide risk during the COVID-19 pandemic. Implications of patterns of results across different facets for treatment approach are discussed.