Near-term predictors of the intensity of suicidal ideation: an examination of the 24 h prior to a recent suicide attempt

Abstract

Background: The extent to which acute exposures such as alcohol use (AU) and negative life events (NLE) are uniquely associated with intensity of suicidal ideation during the hours leading up to a suicide attempt is unknown. The main aim of the current study was to quantify the unique effect of acute exposures on next-hour suicidal ideation when adjusting for previous hour acute exposures and suicidal ideation. An exploratory aim of the current study was to examine the effect of non-alcohol drug use (DU) on suicidal ideation.

Methods: Participants included 166 (61.0% female) recent suicide attempters presenting to a Level 1 trauma hospital. A timeline follow-back methodology was used to assess acute exposures and intensity of suicidal ideation within the 24h prior to the suicide attempt.

Results: Findings indicated that acute AU (b=.20, p<.01) and NLE (b=.58, p<.01) uniquely predicted increases in next-hour suicidal ideation, over and above previous hour suicidal ideation, whereas acute DU did not.

Limitations: The current study׳s methodology provides continuous hourly snapshots prior to the suicide attempt, quite close to when it happened, but is retrospective and causality cannot be inferred.

Conclusions: Understanding that, within a patient, AU and NLE predict near-term increases in suicidal ideation has practical utility impacting providers׳ clinical decision-making, safety concerns, and ultimate determination of level of risk for suicide.

Keywords: Acute risk factors; Alcohol; Negative life events; Substance use; Suicide attempt; Suicide ideation; Warning signs.