Qualitative analysis of hospital patient narratives of warning signs on the day of their suicide attempt

Abstract

Objective: Research on warning signs, defined as acute risk factors for suicide or suicide attempt, has been slow due to the difficulty of examining the hours and minutes preceding suicidal behavior. This study sought to identify new warning signs and to re-examine warning signs that have been proposed.

Method: Narrative stories of adult patients with substance use problems hospitalized following a suicide attempt were transcribed. The narrative segments describing the 24-h period prior to suicide attempt were examined with directed qualitative content analysis using codes based on prior literature and new codes developed inductively.

Results: The sample (N = 35) was mean age = 40, 51% female, and 49% White non-Hispanic. Analysis of the transcripts of the 24-h periods (M word count = 637) yielded a broad range of cognitive (e.g., cognitive disturbance such as rumination), behavioral (e.g., alcohol use), emotional (e.g., dramatic mood changes), and social (e.g., social withdrawal) warning signs, along with a small number of cognitions and behaviors that appeared to mark a dangerous shift to acute preparation and intent for attempt, for example 'self-persuasion to attempt suicide.'

Conclusion: We posit that a broad range of cognitive, behavioral, emotional, and social warning signs increase acute risk for suicidal behavior by creating the conditions for a shift to acute preparation and intent, a highly potent category of warning signs.

Trial registration: ClinicalTrials.gov NCT03300596.

Keywords: Acute risk; Qualitative; Risk factor; Suicide; Suicide attempt; Warning sign.

Figure 1.

Conceptual model of warning signs for suicide attempt illustrating proposed associations of drivers and warning signs of acute preparation or intent. Note. Shown are the percentages of participants with one or more of each type of driver and one or more of each warning sign of acute preparation or intent.