Short‐term change and prediction of suicidal ideation among adolescents: a daily diary study following psychiatric hospitalization

Abstract

Background: Our understanding of suicidal ideation (SI) and its risk precursors is largely informed by studies spanning over wide time intervals (weeks, months, years). Little is known about SI as it occurs in daily lives of individuals at risk for suicide, the extent to which suicidal thoughts are dynamic over short periods of time, and the degree to which theoretically informed risk factors predict near-term SI. Methods: Thirty-four adolescents hospitalized due to last-month suicide attempt and/or last-week SI (76% female; ages 13-17) responded to daily surveys sent to their cell phones for four consecutive weeks after discharge (n = 652 observations). Results: There was notable variability in day-to-day SI, with half of ideation ratings changing at least one within-person standard deviation from one day to the next. Results of mixed effects models revealed concurrent (same-day), but not shortterm prospective (next-day), associations between SI (frequency, duration, urge) and well-established predictors (connectedness, burdensomeness, hopelessness). However, synergistic effects of low connectedness with either high burdensomeness or high hopelessness were reliably associated with more severe same-and next-day suicidal ideation. Conclusions: This study adds to emerging literature indicating that suicidal thoughts fluctuate considerably among individuals at risk for suicide, further extending it by focusing on adolescents in the critical posthospitalization period. Fostering high-risk adolescents' sense of connectedness to others may be an especially promising intervention target. Frequent assessment of SI and its predictors, independently and in combination, could help identify promising predictors of short-term risk and meaningful intervention targets in high-risk teens.Little is known about the dynamic nature of suicidal ideation and its near-term association with risk factors; this study of adolescent utilized daily electronic diaries for a month after psychiatric hospitalization. Suicidal ideation, and its risk factors (hopelessness, connectedness, burdensomeness), fluctuated considerably day-to-day in the postdischarge period. These risk factors were concurrently, but not short-term prospectively, associated with suicidal ideation. Low connectedness combined with either high hopelessness or high burdensomeness was reliability associated with more severe same-and next-day ideation.

Proximal Correlates of Suicidal Ideation and Behaviors: A Test of the Interpersonal‐Psychological Theory of Suicide

“…Our results regarding passive suicidal ideation replicate prior findings that unmet interpersonal needs were a proximal correlate of suicidal ideation (Czyz et al, ; Kleiman et al, ; Rogers & Joiner, ). Regarding proximal causes of active suicidal ideation, the present study is of the first to support the three‐way interaction among thwarted belongingness, perceived burdensomeness, and hopelessness.…”

“…Regarding proximal causes of active suicidal ideation, the present study is of the first to support the three‐way interaction among thwarted belongingness, perceived burdensomeness, and hopelessness. This finding is a meaningful extension to prior work finding that various two‐way interactions among these variables proximally relate to active suicidal ideation or suicidal ideation in general (Czyz et al, ; Hallensleben et al, ). The present study had a large number of observations compared to prior work (Czyz et al, ; Hallensleben et al, ), allowing for a more powerful test of the three‐way interaction.…”

“…This finding is a meaningful extension to prior work finding that various two‐way interactions among these variables proximally relate to active suicidal ideation or suicidal ideation in general (Czyz et al, ; Hallensleben et al, ). The present study had a large number of observations compared to prior work (Czyz et al, ; Hallensleben et al, ), allowing for a more powerful test of the three‐way interaction. However, these prior studies also differed from the present study in timing of the measurements (e.g., everyday vs. every few hours), as well as the items used for the IPTS constructs and suicidal ideation.…”

“…Testing the IPTS within shorter time frames is critical given that the theory specifies proximal causes of suicidal ideation and attempts (Van Orden et al, ). Moreover, research revealed that suicidal ideation fluctuates within and across days (Czyz, Horwitz, Arango, & King, ; Hallensleben et al, ; Kleiman et al, ), suggesting the need for more nuanced, within‐person investigation of its causes.…”

“…Regarding active suicidal ideation, one study found that perceived burdensomeness, thwarted belongingness, and hopelessness were concurrent correlates, while the interaction between thwarted belongingness and perceived burdensomeness was a prospective predictor (Hallensleben et al, ). Among adolescents recently discharged for a suicide attempt or suicidal ideation, hopelessness, perceived burdensomeness, and thwarted belongingness predicted same‐day, but not next‐day, suicidal ideation, and belongingness reduced the effects of high burdensomeness or hopelessness on same‐day suicidal ideation (Czyz et al, ). Finally, among individuals at risk for suicide, only perceived burdensomeness predicted suicidal ideation 3 days later (Rogers & Joiner, ).…”