Death Studies

ISSN: 0748-1187 (Print) 1091-7683 (Online) Journal homepage: https://www.tandfonline.com/loi/udst20

Grit and Perseverance in Suicidal Behavior and

Non-Suicidal Self-Injury

Michael D. Anestis & Edward A. Selby

To cite this article: Michael D. Anestis & Edward A. Selby (2015) Grit and Perseverance
in Suicidal Behavior and Non-Suicidal Self-Injury, Death Studies, 39:4, 211-218, DOI:
10.1080/07481187.2014.946629

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Death Studies, 39: 211–218, 2015
Copyright # Taylor & Francis Group, LLC
ISSN: 0748-1187 print=1091-7683 online
DOI: 10.1080/07481187.2014.946629

Grit and Perseverance in Suicidal Behavior and

Non-Suicidal Self-Injury
Michael D. Anestis
Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA

Edward A. Selby
Department of Psychology, Rutgers, The State University of New Jersey, Piscataway,
New Jersey, USA

Data indicate persistence facilitates suicidal behavior. Non-suicidal self-injury (NSSI)

is characterized by difficulty persisting while upset. The relationship between NSSI
and suicidal behavior thus may hinge upon persistence. Participants were 604
undergraduates (79.5% women; 42.4% African American; 6.1% with 1 þ prior suicide
attempt). Data were collected online via self-report and analyzed using hierarchical
multiple regression. As expected, higher levels of grit and perseverance predicted
more frequent suicide attempts. Furthermore, grit and perseverance moderated
the relationship between NSSI and suicide attempts, which increased in magnitude as
individuals reported greater persistence. Findings depict suicidal behavior as a deliberate
pursuit of death.

Suicide is the 10th leading cause of death in the United
States, with approximately 38,000 individuals engaging
in lethal self-harm each year (Centers for Disease
Control and Prevention, 2013). The obvious need for
a better understanding of this phenomenon has prompted
the development of several prominent theoretical
frameworks through which researchers and clinicians
conceptualize risk and develop prevention protocols.
One common factor amongst several theoretical
frameworks is the notion that suicidal behavior emerges
suddenly and impulsively, potentially serving as an escape
from momentary aversive states (Baumeister, 1990;
Chatard & Selimbegoic, 2011; Mann, Waternaux, Haas,
& Malone, 1999). From this perspective, suicidal behavior
can be seen as an inability to persist in life amidst distress.
Not all theoretical frameworks share this perception,
however. Indeed, the interpersonal-psychological theory
of suicidal behavior (IPTS; Joiner, 2005; Van Orden
Received 24 April 2014; accepted 17 June 2014.
Address correspondence to Michael D. Anestis, Department of
Psychology, University of Southern Mississippi, 118 College Drive,
Box #5025, Hattiesburg, MS 39406. E-mail: Michael.anestis@
usm.edu
et al., 2010) views suicidal behavior as something
individuals must develop the capacity to engage in over
time. The IPTS posits that suicidal behavior is both phy-
sically painful and emotionally distressing, and that
most individuals who experience suicidal thoughts have
not developed the ability to engage in lethal self-harm
because they have not yet developed the capacity to
overcome such sensations. From this perspective, suici-
dal behavior can thus be seen as a planned effort to pur-
sue death despite the need to confront fear, pain, and
mortality that deter most from such behavior. This per-
spective is inconsistent with escape models of suicide,
which posit that suicide attempts arise from an inability
to cope with negative emotion and distress. Thus, escape
theories may be fundamentally incompatible with sui-
cide attempts, as such behavior requires individuals to
confront discomfort rather than immediately escape
from it. It should be noted that motives to escape long
terms struggles (e.g., chronic unemployment) are not
synonymous with motives to escape momentary affect-
ive states.
Escape models might provide a more precise theoretical
framework for understanding non-suicidal self-injury
212 M. D. ANESTIS AND E. A. SELBY
(NSSI), rather than suicidal behavior. Indeed, both
theoretical and empirical work has emphasized that the
most common rationale for engaging in NSSI is to
immediately escape or at least diminish the intensity of
aversive states (Linehan & Heard, 1992; Nock & Prinstein,
2004; Selby, Anestis, Bender, & Joiner, 2009).
Accordingly, escape motives could represent a potentially
important mechanism differentiating NSSI and suicidal
behavior, with individuals motivated primarily by
immediate negative reinforcement opting for NSSI and
individuals motivated to die and capable of pursuing death
amidst the discomfort opting for suicidal behavior.
However, the association between NSSI and suicidal
behavior is well documented (e.g., Van Orden et al.,
2008), indicating that both escape theories and the IPTS
may be intertwined and relevant to the development of
suicidal behavior. One way in which these perspectives
may be intertwined is that one motivation has a direct
influence on suicidal behavior, whereas the other motiv-
ation has a powerful but indirect influence on suicidal
behavior. For example, it is posited that NSSI may
increase the capacity for enacting lethal self-harm by
enabling individuals to habituate to pain and intention-
ally self-inflicted physical harm. Thus, using NSSI to
escape from distress may serve as a precursor to suicidal
behavior, perhaps through a potential impact on both
suicidal desire and capacity (Joiner et al., 2005; Van
Orden et al., 2010). Nonetheless, if NSSI is primarily
prompted by escape motives, and suicidal behavior
requires the ability to suspend the need for immediate
escape from aversive states in the pursuit of a longer
term goal (death), consideration of potential moderating
variables seems likely to be valuable as a method of
refining the interplay between these seemingly conflict-
ing models of suicide risk.
Preliminary work along these lines has thus far
supported a moderation model. For instance, low dis-
tress tolerance is associated with high suicidal desire
but low capacity for suicidal behavior (Anestis, Bagge,
Tull, & Joiner, 2011) and high distress tolerance
increases the magnitude of the relationship between sui-
cidal behavior and both borderline personality disorder
(Anestis, Gratz, Bagge, & Tull, 2012) and posttraumatic
stress disorder (Anestis, Tull, Bagge, & Gratz, 2012).
Building on these findings, Anestis, Knorr, Tull,
Lavender, and Gratz (in press) examined the potential
moderating role of distress tolerance in the relationship
between NSSI and suicide potential. In this study, sui-
cide potential was defined as a continuum extending
from no suicidal behavior, to suicidal behavior of low
lethality, to suicidal behavior of high lethality. In a sam-
ple of 93 adult inpatients receiving treatment for
substance use disorders, the magnitude of the relation-
ship between NSSI and suicide potential increased at
higher levels of distress tolerance. Thus, these results
indicate the NSSI is more strongly associated with
suicidal behavior amongst individuals with high distress
tolerance, rather than low distress tolerance.
However, these researchers measured distress toler-
ance via self-report, which is an important consideration
as the precise operational definition of distress tolerance
depends upon measurement methods. Self-reported dis-
tress tolerance represents the extent to which an individ-
ual is overwhelmed by negative affect and capable of
continuing to function while upset (Simons & Gaher,
2005). Behaviorally indexed distress tolerance, on the
other hand, represents the extent to which an individual
can persist in goal-directed behavior while upset (Nock
& Mendes, 2008). The behavioral definition is thus more
consistent with a general construct of persistence, a vital
variable to consider in models testing the applicability of
escape motives to any behavioral outcome. As such,
self-report measures of constructs more directly related
to persistence may better capture this aspect of the model.
Although consistent with a model in which the ability
to pursue death despite discomfort is of great impor-
tance in suicidal behavior, the distress tolerance findings
assess a construct that is only tangentially related to per-
sistence. Among older adults with prior suicidal beha-
vior, individuals with more lethal attempts persisted
longer in a delay discounting task, indicating that they
are more willing to persist for a greater duration to
obtain a larger reward (Dombrovski et al., 2011).
Although such work highlights the importance of per-
sistence, further work considering variables specifically
focused on persistence towards goals would be highly
useful and two variables in particular seem to have
potential worth in this regard: grit and perseverance.
Grit is defined as the ability to strenuously pursue
long-term goals despite obstacles and adversity (Duck-
worth, Peterson, Matthews, & Kelly, 2007) and has been
linked to greater retention levels in military recruits
(Maddi, Matthews, Kelly, Villarreal, & White, 2012),
greater educational attainment (Duckworth et al.,
2007), less negative affect (Singh & Jha, 2008), and less
suicidal ideation (Kleiman, Adams, Kashdan, & Riskind,
2013). In contrast, perseverance is defined as a
component of impulsivity ([lack of] Perseverance;
Whiteside & Lynam, 2001) assessing the degree to
which an individual exhibits the tendency to quit tasks
when they become difficult or boring. Difficulties
in perseverance have been associated with lower
academic performance (Smith et al., 2007) and greater
levels of antisocial behavior (Whiteside & Lynam,
2003). Thus, it is likely that those with elevated grit
will also have a greater ability to persevere, and,
as suggested by the IPTS, both grit and perseverance
may contribute to suicidal behavior.
We hypothesized that the main effects of grit and
perseverance in predicting suicide attempts with clear
 GRIT AND PERSEVERENCE IN SUICIDAL BEHAVIOR 213

intent to die would be significant after controlling for Measures

relevant demographics, depressive symptoms, and
Short Grit Scale (Grit-S; Duckworth & Quinn, 2009) is
NSSI. Furthermore, we hypothesized that both grit
a 12-item self-report scale measuring the degree to which
and perseverance would moderate the relationship
individuals tend to persist towards long-term goals (e.g.,
between NSSI and suicidal behavior with clear intent
‘‘I finish what I begin’’ [reversed]). Items are scored on
to die, with the relationship increasing in strength at
a Likert scale ranging from 1 (very much like me) to 5
higher levels of persistence.
(not at all like me), with greater scores indicating a great-
er ability to persist. The alpha coefficient in this sample
was .76. Prior support exists for the validity of the
METHOD
Grit-S in undergraduate samples (Kleiman et al., 2013).
UPPS-P Impulsive Behavior Scale (UPPS-P; Cyders
Participants
et al., 2007; Cyders & Smith, 2007) is a 59-item
Participants were 604 undergraduate students ranging in self-report scale assessing various facets of impulsivity.
age from 18 to 55 years (M ¼ 20.72; SD ¼ 4.15). In total, Items are scored on a Likert scale ranging from 1 (agree
79.5% (n ¼ 480) of the sample were women, 52.0% was strongly) to 4 (disagree strongly), with higher scores
White (n ¼ 314), and 45.5% (n ¼ 275) reported a total indicating greater impulsivity. The UPPS-P includes five
annual family income of $50,000 or less. Additional subscales; however, in this study, only the (lack of)
demographic information can be found in Table 1. All Perseverance subscale was utilized. This subscale
procedures were approved by the Institutional Review consists of 10 items that measure the extent to which
Board, and all participants completed informed consent. an individual tends to quit when activities become diffi-
Data were collected as part of a larger, multisite project cult or boring (e.g., ‘‘I generally like to see things
investigating cohort effects on various aspects of suicide through to the end’’). The alpha coefficient in this sam-
risk. All participants were recruited from undergraduate ple was .84. Prior support exists for the validity of the
psychology courses and they received course credit in UPPS-P in undergraduate samples (Anestis et al., 2011).
return for their participation. The entire protocol was Deliberate Self-Harm Inventory (DSHI; Gratz, 2001)
completed with online questionnaires through a secure is a self-report questionnaire that assesses an indivi-
server. dual’s lifetime history of NSSI. The scale assesses the
frequency and duration of 17 forms of NSSI (e.g., cut-
ting, burning, preventing wounds from healing). A total
TABLE 1 count score representing the number of times an individ-
Demographic Information ual has engaged in any method of NSSI over the course
Demographic N (%) of his or her lifetime was used to index total NSSI fre-
quency. Internal consistency is not typically calculated
Gender for the DSHI, as the measure represents a count fre-
Men 121 (20.0%) quency of discrete behaviors across the broad spectrum
Women 480 (79.5%) of NSSI. Prior support exists for the validity of the
Undeclared 3 (0.5%) DSHI in undergraduate samples (Latimer, Meade, &
Tennant, 2013).
Race=Ethnicity Depression Anxiety Stress Scale–21 (DASS-21;
Lovibond & Lovibond, 1995) is a 21-item self-report
White 314 (52.0%)
African American 256 (42.4%)
measure that assess the presence and severity of
Hispanic=Latino 10 (1.7%) depression, anxiety, and stress symptoms over the
Asian=Pacific Islander 6 (1.0%) course of the previous 7 days. Items are rated on a
Other 17 (2.8%) Likert scale ranging from 0 (did not apply to me at all)
Undeclared 1 (0.2%) to 3 (applied to me very much), with higher scores greater
symptoms. In this study, we used only the depression
Income subscale, which had an alpha coefficient of .88. Prior
$0–$10,000 52 (8.6%)
support exists for the validity of the DASS in under-
$10,001–$25,000 89 (14.7%) graduate samples (Osman et al., 2012).
$25,001–$50,000 134 (22.2%) Measure of Episodic Planning of Suicide (MEPOS;
$50,001–$75,000 136 (22.5%) Anestis, Pennings, & Williams, in press) is a 4-item
$75,001–$100,000 95 (15.7%) self-report scale that assesses frequency and charac-
Greater than $100,000 96 (15.9%)
Undeclared 2 (0.3%)
teristics of prior suicidal behavior. Participants are first
asked whether they have ever intentionally harmed
214 M. D. ANESTIS AND E. A. SELBY

themselves with at least some intent to die (yes–no).
Participants who endorse a history of at least one such
behavior are then asked a series of follow-up questions
regarding intent (no intent to die, ambiguous intent
to die, clear intent to die), method (open ended), and
planning for suicidal behavior—for example, 1 (‘‘I had
never considered it for even a moment prior to my life’’)
to 6 (‘‘I thought about it continuously or off and on for
a period of years prior to my attempt’’ [e.g., even if days,
weeks, months, or a year or more passed between
thoughts]). For the purposes of this study, responses
to the question assessing the frequency of intentional
self-inflicted injury with clear intent to die were used
to assess lifetime number of suicide attempts. We opted
to restrict our definition of suicidal behavior to attempts
with clear intent to die to avoid any potential criterion
contamination with our measure of NSSI. This measure
has previously been used in undergraduate samples
(Anestis, Pennings, & Williams, in press).
RESULTS
In all, 37 (6.1%) participants endorsed a history of at
least one prior suicide attempt with clear intent to die.
The average number of such attempts was 1.43
(range ¼ 1–4). Of these 37, 26 (70.3%) endorsed a prior
history of NSSI. The most common method used in
the most recent suicide attempt was intentional overdose
(n ¼ 17; 45.9%).
In all, 162 (26.8%) participants endorsed a history of
at least prior episode of NSSI. The average number was
26.22 prior episodes (range ¼ 1–1,594) and an average of
1.72 methods (range ¼ 1–7). Amongst these 162, the
most common method was cutting (n ¼ 65; 40%), fol-
lowed by severely scratching self (n ¼ 39; 24.1%), carving
words in skin (n ¼ 29; 17.9%); carving pictures or
designs in skin (n ¼ 23; 14.2%), and sticking sharp
objects under skin (n ¼ 22; 13.6%). Amongst these 162,
26 (16.0%) reported a prior suicide attempt with clear
intent to die.
Both NSSI and suicide attempts with clear intent to
die exhibited significant skew and kurtosis, so we per-
formed a rank transformation using Blom’s formula.
For ease of interpretation, nontransformed descriptive
data are provided for these variables in Table 2; how-
ever, all analyses used the transformed variables.
Older participants endorsed significantly more grit,
r ¼ .14, p ¼ .001. Those with higher incomes endorsed
significantly more NSSI, r ¼ .09, p ¼ .03, and less grit,
r ¼ .10, p ¼ .02. Greater levels of depression were asso-
ciated with more pathological levels of NSSI, suicide
attempts, grit, and perseverance (r’s > .16; p’s < .001).
ANOVAs indicated that men reported greater difficulty
with perseverance, F(1,533) ¼ 4.47, p ¼ .04, l2p ¼ :01.
ANOVAs also indicated that significant differences in
NSSI by race=ethnicity F(1,592) ¼ 2.94, p ¼ .02,
l2p ¼ :02, with Hispanic individuals reporting less NSSI
than White participants and participants who endorsed
‘‘other’’ as their race=ethnicity. In addition, Asian part-
icipants reported less NSSI than did participants who
endorsed ‘‘other’’ as their race=ethnicity. Thus, age,
income, gender, race=ethnicity, and depressive symp-
toms were all included as covariates.
Primary analyses examined the main effects of grit
and perseverance on suicide attempts with clear intent
to die, controlling for demographic factors, depression,
and NSSI. With respect to grit, the overall model was
significant, F(7,554) ¼ 12.95, p < .001, and including grit
significantly improved the model, DR2 ¼ .01, p ¼ .02,
f2 ¼ .01. Similarly, with respect to perseverance, the
overall model was significant, F(7,519) ¼ 12.80, p < .001,
and including perseverance significantly improved the
model (DR2 ¼ .015, p ¼ .002, f2 ¼ .02). These results are
presented in Table 3.

TABLE 2
Descriptive Data and Correlations of Variables

Variable 1 2 3 4 5 6

1. Gender —
2. Depression .05 —
3. NSSI .05 .31 —
4. Grit .06 .40 .18 —
5. Perseverance .09 .37 .10 .67 —
6. Suicidal Behavior .01 .16 .35 .01 .06 —
M=% women 79.90 8.44 7.10 3.42 19.53 .09
SD — 9.09 78.59 .54 4.79 .40
Minimum — 0.00 0.00 1.42 10.00 0.00
Maximum — 42.00 1594.00 4.92 37.00 4.00

Note: NSSI ¼ number of lifetime episodes of non-suicidal self-injury; Perseverance ¼ (lack of) Perseverance; Suicidal behavior ¼ lifetime number
of suicide attempts with clear intent to die.

p < .05.  p < .01.
 GRIT AND PERSEVERENCE IN SUICIDAL BEHAVIOR 215

TABLE 3
Main Effects of Grit and (Lack of) Perseverance Predicting Suicide Attempts With Clear Intent to Die

Variable R2 DR2 t b R2 DR2 t B

.13 .13
Gender .10 .00 Gender .45 .02
Age .42 .02 Age .30 .01
SES 1.93 .08 SES 1.94 .08
Race .82 .03 Race .99 .04
Depression 1.33 .06 Depression 1.35 .06
NSSI 8.14 .34 NSSI 7.77 .34
Grit .14 .01 2.34 .10 Perseverance .15 .02 3.08 .14

Note: SES ¼ annual family income; Race ¼ self-reported race=ethnicity; NSSI ¼ number of lifetime episodes of non-suicidal self-injury;
Perseverance ¼ (lack of) Perseverance.

p < .05.  p < .01.  p < .001.

TABLE 4
Grit and (Lack of) Perseverance as Moderators of the Relationship Between NSSI and Suicide Attempts With Clear Intent to Die

Variable R2 DR2 t b R2 DR2 t B

.03 .03
Gender .37 .02 Gender .80 .04
Age .19 .01 Age .28 .01
SES 1.22 .05 SES 1.18 .05
Race .87 .04 Race 1.03 .05
Depression 3.81 .16 Depression 3.75 .16
.14 .11 .15 .11
Grit 2.34 .10 Perseverance 3.08 .14
NSSI 8.31 .35 NSSI 7.79 .33
.16 .02 .17 .02
Grit  NSSI 3.19 .13 Perseverance  NSSI 4.01 .16

Note: SES ¼ annual family income; Race ¼ self-reported race=ethnicity; NSSI ¼ number of lifetime episodes of non-suicidal self-injury;
Perseverance ¼ (lack of) Perseverance.

p < .05.  p < .01.  p < .001.

Next, we examined the moderating effects of grit and relationship between NSSI and suicide attempts with
perseverance on the relationship between NSSI and clear intent to die increased from high (b ¼ .124,
suicide attempts with clear intent to die, controlling for p ¼ .001) to mean (b ¼ .216, p < .001) to low (b ¼ .307
demographic factors and depression. With respect to p < .001) levels of perseverance. This indicates that, as
grit, the overall model was significant, F(8,553) ¼ 12.79,
p < .001, and adding the Grit  NSSI interaction signifi-
cantly improved the model (DR2 ¼ .015, p ¼ .002,
f2 ¼ .02). Analyses of simple slopes indicated that the
magnitude of the relationship between NSSI and suicide
attempts with clear intent to die increased from low
(b ¼ .169, p < .001) to mean (b ¼ .243, p < .001) to high
(b ¼ .318, p < .001) levels of grit. This indicates that, as
individuals exhibit greater ability to persist toward
long-term goals, the relationship between NSSI and
suicide attempts with clear intent to die becomes stronger.
These results are presented in Table 4 and Figure 1.
With respect to perseverance, the overall model was
significant (F(8,518) ¼ 13.54, p < .001) and adding the
Perseverance  NSSI interaction significantly improved
the model (DR2 ¼ .026, p < .001, f2 ¼ .03). Analyses of FIGURE 1 Grit moderates the relationship between non-suicidal self-
simple slopes indicated that the magnitude of the injury and suicide attempts with clear intent to die.
216 M. D. ANESTIS AND E. A. SELBY
FIGURE 2 (Lack of) Perseverance moderates the relationship
between non-suicidal self-injury and suicide attempts with clear intent
to die.
an individual is better able to persist during tasks that
become difficult or boring, the relationship between
NSSI and suicide attempts with clear intent to die
becomes stronger (lower scores in perseverance indicate
a greater ability to persist). These results are presented
in Table 4 and Figure 2.
DISCUSSION
Among this large undergraduate sample in which 37
students reported previous suicide attempts, greater grit
and perseverance predicted more frequent suicide
attempts with clear lethal intent. These effects remained
even when accounting for critical covariates. Also, those
who reported higher levels of NSSI simultaneously with
high grit reported the most frequent suicide attempts
with clear lethal intent. These findings suggest that
NSSI, which is a behavior that often occurs in response
to motivations to escape aversive emotional states (e.g.,
Nock & Prinstein, 2004), may increase suicidal behavior
by facilitating increased persistence in the face of pain
and death.
These findings highlight the complexity of the
relationships between emotional distress, emotional
avoidance, NSSI, and suicidal behavior. These findings
further support Joiner’s (2005) notion that to engage
in a suicide attempt with clear intent to die, one must
overcome the distress associated with pain and death.
Thus, to engage in suicidal behavior, the individual must
be able to persevere through difficult and frightening
emotional experiences. These findings are seemingly at
odds with escape theories of suicide, wherein the individ-
ual engages in suicidal behavior to escape emotional dis-
tress or aversive self-awareness. Yet, in many ways the
IPTS and escape theories complement each other when
behaviors such as NSSI are factored in. Escape motiva-
tions are highly important for those who engage in
NSSI, and furthermore, frequently engaging in NSSI
may increase one’s ability to tolerate the physical and
emotional distress of bodily harm. Importantly,
although we used NSSI as the linking variable to explain
how escape theories and IPTS can intertwine to predict
worse suicidal behavior, NSSI is not the only behavior
that could function in this manner. Joiner (2005) dis-
cusses multiple avenues through which an acquired
capability for suicidal behavior can be established,
including NSSI, physical fights, injuries from reckless
behavior, and drug use, all of which have been linked
to escaping upsetting emotional experiences (Selby
et al., 2009; Selby & Joiner, in press). Frequently engag-
ing in each of these behaviors could result in habituation
to pain and fear of death. Thus, there may be many
routes through which behaviors used to escape emotion-
al distress may result in increased ability to persevere
through the distressing aspects of suicidal behavior.
It should be noted that the motivation to escape an
acute momentary crisis is not synonymous with a motiv-
ation to escape a broader set of circumstances that take
place over an extended period of time. In this sense, an
individual who decides to engage in suicidal behavior
may simultaneously pursue death while seeking to
escape a long-term struggle. Indeed, the individual’s
desire to end a lengthy struggle may enhance his or
her ability to persist in the pursuit of death and few
would argue against the notion that suicidal individuals
are dissatisfied with life and looking to end their own
struggle. A sudden desire to escape an acute experience
of negative affect, however, represents a different
phenomenon less compatible with approaching a beha-
vior associated with immediate increases in pain and
fear. The findings of this study indicate that a general
capacity for persistence may facilitate suicidal behavior,
perhaps by enabling an individual to overcome acute
fear and pain in pursuit of death.
Present findings highlight problems with some
common assumptions made by many clinicians and
researchers. For example, if a patient exhibits a desire
to avoid or escape emotional distress that does not
necessarily mean that he or she is unable to tolerate dis-
tressing feelings in in all situations. Some patients may
have difficulty experiencing the upsetting feelings that
come along with criticism from others or feelings of fail-
ure; some may not experience difficulty with experienc-
ing physical pain or embracing the notions of death.
Thus, although grit and perseverance are likely positive
traits for most people in most situations, there may be
select scenarios in which such positive qualities may
actually confer increased risk toward suicidal behavior.
These suggestions are consistent with recent empirical
and theoretical work indicating that the way one
responds to an emotional situation is highly dependent
on the context of the situation (Aldao, 2013).

Although these findings supported our primary
hypotheses, there are some limitations to the current study.
First, an important limitation to these data is that they
were cross sectional, so this does not allow for causal infer-
ence on the impact of NSSI and persistence on suicidal
behavior with clear lethal intent. Many of the components
of both escape theories and the IPTS involve changes over
time, such as the development of increased acquired
capability through repeated NSSI, and additional studies
are needed to further clarify the interaction between these
variables over time. Second, measures involved self-report
of traits and experiences. Although our assessments of
NSSI and suicidal behavior have been validated and
frequently used (e.g., Gratz, 2001), they may be limited
by retrospective recall. Similarly, measures of grit and
perseverance are self-report, which are highly but not
perfectly correlated with behavioral indices of these same
traits. Thus, some participants may have reported having
high grit, but others observing them may not recognize
them as being particularly high on this trait. Third,
this study was conducted with undergraduates. Although
an undergraduate sample is appropriate for examining
dimension personality traits such as grit and perseverance,
because these participants may have been high functioning
the findings may not generalize to more severe clinical sam-
ples. Finally, our NSSI variable in this study was used as
a proxy for escape motivations due to the strong empirical
link between NSSI and desires to escape from emotional
states. However, because we did not directly examine
escape motivations during suicide attempts with clear
lethal intent, escapist motivations cannot necessarily be
ruled out as major motivations for suicide attempts with
clear lethal intent in this sample.
There are multiple therapeutic implications that can
be derived from the current study. Measures of grit
and persistence may prove beneficial in risk assessments
in that they are not face valid tools for determining
suicide risk. Similarly, using these measures of persist-
ence with implicit measures of suicidal ideation, which
can uncover propensity toward suicidal behavior even
when a participant does not admit to suicidal ideation
(Nock et al., 2010), could help elucidate not only who
has attempted to hide suicidal desire, but who may be
most capable of acting on those desires.
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