Perseverations as a Risk Factor for Suicide

Available with English captions and subtitles in Spanish.

Carolyn Rodriguez, MD, PhD, Stanford University School of Medicine, presents as part of the 2022 Suicide-Focused Assessment and Treatment: An Update for Professionals course.

Perseverations and Suicide

In their study, Rodriguez and Alan Schatzberg, MD, hypothesize that a person’s severity of perseverative thinking is a modifiable risk factor for suicide attempts across diagnoses.

Watch now to learn more about:

  • The roles perseveratory thoughts have in suicidal behavior
  • How researchers are investigating biomarkers as a means of prevention
  • Why biomarkers may also play a role in treatment and assessment

Perseverative thoughts can include three major forms:

  • Ruminations: Recurrent, self-reflective, uncontrollable focus on depressed mood and its causes and consequences
  • Obsessions: Intrusive thoughts, images, or urges that increase anxiety
  • Suicidal ideation: Thoughts about, or preoccupation with, suicide

Research has shown that ruminations are a risk factor for suicidal attempts. Increased suicidal ideation in the months before a suicide attempt is a risk factor for suicide attempts.

In their ongoing study on perseverations as a risk factor for suicide, Rodriguez and her colleagues are examining the possibility of using biomarkers to predict suicide attempts at the individual level.

Their hypothesis includes the idea that the severity of perseverative thinking is a modifiable risk factor for suicide attempts across the diagnosis.

They also hypothesize that cognitive control, which enables flexible switching and regulation of perseverative thought content, may be a modifiable risk factor for underlying vulnerability for suicidal behavior.

View the Slides

The team is working with participants who have had active suicidal ideation within the past 24 hours. Researchers conduct a baseline measure of cognitive control, suicidal behaviors, and perseveratory thoughts with participants.

They also collect salivary cortisol and DNA from one group whose members had a previous suicide attempt, and from another group whose members had active suicidal ideation within the past 24 hours but did not have a suicide attempt.

The researchers then interview participants after three months and again after 12 months. The study is still active, and half the sample is currently collected.

Rodriguez emphasizes the possibilities of the findings, including those beyond prevention.

“There’s a whole suite of biomarkers,” she says. “If we could identify a risk prediction biomarker, could it also be used to look at therapeutic monitoring?”

“If we have an intervention, it would be nice to have a measure that we could potentially target with a target engagement and actually see if we’re making progress.”

Rodriguez stresses that biomarkers should not replace clinical assessments, but could provide additional information in the assessment process.

In addition to working on biomarkers, Rodriguez’s team is looking at therapeutics that include multilevel approaches to understand how to rapidly remove symptoms, explore causes, and create more precise interventions.


You might also find this information useful:

About Carolyn Rodriguez

Dr. Carolyn Rodriguez is the associate dean for Academic Affairs at Stanford University School of Medicine and a consultation-liaison psychiatrist at the Palo Alto Veterans Affairs.

Dr. Rodriguez’s landmark clinical trials pioneer rapid-acting treatments for illnesses including OCD and related disorders, spanning glutamatergic and opioid pathway pharmacotherapy, noninvasive brain stimulation, psychotherapy, and suicide prevention.