Phenotyping suicidal ideation and behavior: Comparing clinical characteristics and future suicide attempts between suicidal subtypes in two clinical samples

Abstract

Objectives: To further validate the concept of suicidal subtypes distinguished by indicators of suicidal thinking and behavior with regard to clinical characteristics and past and future suicide attempts.Methods: Psychiatric inpatients were assessed (study 1: ecological momentary assessments in 74 depressed inpatients with suicidal ideation; study 2: clinical assessments in 224 inpatients after a suicide attempt and over a 12-month follow-up period). Subtypes were identified using latent profile analysis (based on indicators of real-time suicide ideation) and latent class analysis (based on features of past suicide ideation and suicide attempt characteristics). Comparisons between subtypes included clinical characteristics (depression, suicidal ideation, trait impulsivity, childhood trauma) as well as past (study 1) and future (study 2) suicide attempts.Results: Suicidal subtypes emerged that are characterized by suicidal ideation means and stability and features of past suicidal behavior (four in study 1, three in study 2). The subtypes differed in terms of depression/suicidal ideation, but not in terms of trait impulsivity/childhood trauma. Although not significant, the subtypes "high-stable" and "low-moderate stable" reported multiple re-attempts more frequently during follow-up than the "low-stable" subtype in study 2. Conclusion: Differences in clinical variables (and by trend in future suicide attempts) clearly point to the clinical relevance of suicidal subtypes (with variability of suicidal thoughts playing a particularly important role).

Subgrouping suicidal ideations: An ecological momentary assessment study in psychiatric inpatients

“…In our study, the four-subgroup solution best represented the data. Only one other study also suggested four subgroups (33), while the others suggested five (31) and two (32). Of those, two studies (31,33) were similar in design, approach, and study population, thus comparable to this study.…”

“…Using the information on SI temporal characteristics (i.e., differences in mean and volatility) for subgrouping builds on prior work (31)(32)(33). So far, the number of subgroups suggested has differed between studies.…”

“…Longitudinal studies (27)(28)(29)(30) used SI trajectories or repeated measures (30) and found that the chronic, more stable SI subgroup was related to depression (28), impulsivity and perfectionism (30), had higher odds of making another suicide attempt (27,30) and get rehospitalized (27), have more suicide attempts and hospitalizations in the 6 months post-discharge (29), and showed greater non-acceptance of emotional responses and had less emotion regulation strategies (29). More recent EMA studies (31)(32)(33) used SI variability and found that the subgroup with high mean and low variability SI was associated with prior suicide attempts the month before (31) while the subgroup with high variability SI was associated with no prior suicide attempts (31) but greater increases in response to stressful events (32) and greatest levels of SI and depression (33). Taken together, lessons from these findings are twofold: (1) examining the temporal dynamics of SI for subtyping reveals distinct SI patterns, and (2), the number and characteristics of subgroups vary by study and warrant further investigation.…”

A computational model of general suicide ideation

“…The motivations behind suicide can vary widely, ranging from intense despair and anger to intentions of punishing others or conveying specific information, and sometimes, they manifest even without explicit reason (Meyer et al, 2017). Clinically, suicide ideation displays significant heterogeneity in their causes, stability, duration, frequency (Czyz et al, 2022;Shiratori et al, 2014;Spangenberg et al, 2023).…”

Specificity, frequency, and intent: Multiple characteristics of adolescents' suicide plan correlate with their history of suicidal behavior

“…A reason for these findings may be that SB is characterized by at least two phenotypes (Bernanke et al, 2017). These include impulsive SB, which is driven by fluctuating severity of suicidal ideation, and planned SB, resulting from persistent and severe suicidal ideation (Bernanke et al, 2017), both of which have been documented in work characterizing patterns of suicidal ideation (Kleiman et al, 2018; Spangenberg et al, 2023) and behavior (Kim et al, 2018; Lopez‐Castroman et al, 2016). Given this, it is possible these patterns extend to suicide planning, meaning some individuals develop SPs in short, sporadic periods, while others extensively plan for SB.…”