Resilience to suicidality: The buffering hypothesis Judith Johnson ⁎, Alex M. Wood, Patricia Gooding, Peter J. Taylor, Nicholas Tarrier School of Psychological Sciences, 2nd Floor Zochonis Building, University of Manchester, Oxford Road, Manchester, M139PL, UK abstract article info Article history: Received 1 October 2010 Received in revised form 19 December 2010 Accepted 21 December 2010 Available online 12 January 2011 Keywords: Resilience Suicide Suicidal ideation Recent years have seen a growing interest into resilience to suicidality, which has been described as a perception or set of beliefs which buffer individuals from suicidality in the face of stressors. The current review extends this research by introducing the buffering hypothesis, a framework for the investigation of resilience to suicidality. The key proposal of this is that psychological resilience factors should be viewed as existing on a separate dimension to risk which acts to moderate the impact of risk on suicidality. Furthermore, like risk factors, resilience factors are bipolar, with their positive pole conferring resilience and their negative pole acting to amplify suicidality. Seventy-seven studies were identified which investigated (a) whether psychological moderators of risk exist and (b) the particular psychological constructs which may act as moderators. The review found strong support for the existence of psychological moderators and indicated a moderating impact of attributional style, perfectionism, agency and hopelessness. These findings support the buffering hypothesis and suggest that a range of psychological factors may confer resilience to suicidality. These results suggest that the identification of moderators may improve estimates of suicide risk and that the development of buffering factors could be a key focus of suicide interventions. © 2011 Elsevier Ltd. All rights reserved. Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 564 1.1. The buffering hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 564 1.1.1. Resilience as a separate dimension to risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 564 1.1.2. Risk and resilience as bipolar dimensions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565 1.1.3. Resilience as a psychological construct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565 1.2. Goals of the current review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566 2. Selection of research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566 2.1. Eligibility criteria of the studies included in the review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566 2.2. Search strategy for the identification of relevant articles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566 3. Research review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566 3.1. Cognitive abilities, processes and tendencies as resilience to suicidality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566 3.1.1. Attributional style. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566 3.1.2. Coping and problem solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 567 3.1.3. Personality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 572 3.1.4. Emotional intelligence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 572 3.1.5. Cognitive biases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573 3.2. Beliefs and attitudes as resilience to suicidality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573 3.2.1. Self-related beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573 3.2.2. Other-related beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 3.2.3. Religious beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581 3.2.4. Future-related beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581 3.2.5. Suicide-related beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 582 4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 582 4.1. Summary of findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 584 Clinical Psychology Review 31 (2011) 563–591 ⁎ Corresponding author. Tel.: + 44 161 306 0428; fax: + 44 161 2060406. E-mail addresses: Jxj007@bham.ac.uk (J. Johnson), alex.wood@manchester.ac.uk (A.M. Wood), patricia.a.gooding@manchester.ac.uk (P. Gooding), p.j.taylor@postgrad.manchester.ac.uk (P.J. Taylor), nicholas.tarrier@manchester.ac.uk (N. Tarrier). 0272-7358/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.cpr.2010.12.007 Contents lists available at ScienceDirect Clinical Psychology Review