Suicide attempts among adults denying active suicidal ideation: An examination of the relationship between suicidal thought content and suicidal behavior

Wastler, Heather M.; Bryan, AnnaBelle O.; Bryan, Craig J.

doi:10.1002/jclp.23268

Cited by 28 publications

(23 citation statements)

References 40 publications

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“…Having recent panic attacks and histories of illicit drug use or suicide attempt were significantly associated with SI at both time points, as well as change over time, although only correlations with baseline SI were of any magnitude ( r =0.08-0.10). Again, these findings are in line with prior research [ 22 , 64 - 66 ], although it is important to note that approximately 11% of those who attempt suicide deny ever having experienced any SI [ 66 ]. Therefore, SI is insufficient to explain all suicide attempts and completions.…”

Section: Discussionsupporting

confidence: 88%

Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study

O’Callaghan¹,

Mahrer

Belanger

et al. 2022

JMIR Form Res

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Background Suicide is a leading cause of death in the United States, and suicidal ideation (SI) is a significant precursor and risk factor for suicide. Objective This study aimed to examine the impact of a telepsychiatric care platform on changes in SI over time and remission, as well as to investigate the relationship between various demographic and medical factors on SI and SI remission. Methods Participants included 8581 US-based adults (8366 in the treatment group and 215 in the control group) seeking treatment for depression, anxiety, or both. The treatment group included patients who had completed at least 12 weeks of treatment and had received a prescription for at least one psychiatric medication during the study period. Providers prescribed psychiatric medications for each patient during their first session and received regular data on participants. They also received decision support at treatment onset via the digital platform, which leveraged an empirically derived proprietary precision-prescribing algorithm to give providers real-time care guidelines. Participants in the control group consisted of individuals who completed the initial enrollment data and completed surveys at baseline and 12 weeks but did not receive care. Results Greater feelings of hopelessness, anhedonia, and feeling bad about oneself were most significantly correlated (r=0.24-0.37) with SI at baseline. Sleep issues and feeling tired or having low energy, although significant, had lower correlations with SI (r=0.13-0.14). In terms of demographic variables, advancing age and education were associated with less SI at baseline (r=−0.16) and 12 weeks (r=−0.10) but less improvement over time (r=−0.12 and −0.11, respectively). Although not different at baseline, the SI expression was evident in 34.4% (74/215) of the participants in the control group and 12.32% (1031/8366) of the participants in the treatment group at 12 weeks. Although the participants in the treatment group improved over time regardless of various demographic variables, participants in the control group with less education worsened over time, after controlling for age and depression severity. A model incorporating the treatment group, age, sex, and 8-item Patient Health Questionnaire scores was 77% accurate in its classification of complete remission. Those in the treatment group were 4.3 times more likely (odds ratio 4.31, 95% CI 2.88-6.44) to have complete SI remission than those in the control group. Female participants and those with advanced education beyond high school were approximately 1.4 times more likely (odds ratio 1.38, 95% CI 1.18-1.62) to remit than their counterparts. Conclusions The results highlight the efficacy of an antidepressant intervention in reducing SI, in this case administered via a telehealth platform and with decision support, as well as the importance of considering covariates, or subpopulations, when considering SI. Further research and refinement, ideally via randomized controlled trials, are needed.

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Section: Discussionsupporting

confidence: 88%

Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study

O’Callaghan¹,

Mahrer

Belanger

et al. 2022

JMIR Form Res

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“…Second, there is emerging evidence suggesting the existence of non-linear processes that lead to suicide attempts ( 9 – 11 ). In a recent study by Wastler et al ( 12 ), 54% of the participants who had recently attempted suicide denied having had active suicidal thoughts leading up to that event, and 23% denied having had any recent suicidal thoughts at all. Some individuals with active suicidal thoughts also deny experiencing a passive desire to die, and up to two-thirds deny having made a plan before their attempt ( 12 , 13 ).…”

Section: Limitations Of Current Suicide Researchmentioning

confidence: 96%

“…In a recent study by Wastler et al ( 12 ), 54% of the participants who had recently attempted suicide denied having had active suicidal thoughts leading up to that event, and 23% denied having had any recent suicidal thoughts at all. Some individuals with active suicidal thoughts also deny experiencing a passive desire to die, and up to two-thirds deny having made a plan before their attempt ( 12 , 13 ). Furthermore, recent studies also indicate that suicidal ideation and associated risk factors highly fluctuate within hours and show significant temporal instability ( 14 , 15 ).…”

Section: Limitations Of Current Suicide Researchmentioning

confidence: 96%

“…Lowlevel identities encompass more lower-level acts or lowerorder goals like speeding up or crossing the street, although phenomenologically the person is doing the same thing. This concept might be especially relevant with regard to results of the study by Wastler et al (12) showing that 31% of suicide attempters only experienced passive suicidal ideation before their suicide attempt. They named this the "passive suicidal ideation only" pathway to suicidal behavior in which individuals experienced thoughts like "I wish I could go to sleep and never wake up" or "I cannot imagine anyone being able to withstand this kind of pain."…”

Section: High-level Vs Low-level Identification Of Goalsmentioning

confidence: 99%

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Understanding suicidal pathways through the lens of a Dual-System Model of Suicidality in real-time: The potential of ecological momentary assessments

et al. 2022

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Within the ideation-to-action framework, existing theories of suicidal thoughts and behaviors (STBs) primarily focus on the linear progression of suicide risk. This, however, neglects growing evidence that many suicidal individuals do not experience their suicide attempt as a planned action, and in some instances deny even having experienced any suicidal thoughts. Furthermore, recent research has found that risk factors differ substantially between persons and that this is reflected in the variety of suicidal pathways. Considering the strong variability of STBs, new innovative theoretical concepts and assessment methods are needed to advance our understanding of multiple suicidal pathways. In this review, we apply a dual-system framework to suicidality, the Dual-System Model of Suicidality (DSMS), which accounts for two different systems of information processing and behavior. The first of these described is the reflective system, whereby STBs are viewed from a self-regulation perspective and thusly considered as maladaptive coping behavior to perceived discrepancies regarding important goals. Applying a feedback-based view such as this to STBs provides a deeper understanding into underlying psychological processes involved in the development of STBs. The second system described by the DSMS is the impulsive system. Here, STBs are seen as a maladaptive self-organizing pattern that gets activated in high-risk situations of acute stress, negative affect, and when resources of the reflective system are depleted. In this context, the DSMS is informed by a strength model of self-regulation, which assumes that self-regulation resources are limited, an aspect with important theoretical and clinical implications for the development of STBs. In order to demonstrate the theoretical and practical utility of the DSMS, this review draws mainly on studies using ecological momentary assessment (EMA), a technology that allows to investigate moment-to-moment changes in STBs, and is therefore well suited for capturing the complex interplay of self-regulatory and impulsive processes proposed by the DSMS. The application of a dual-system framework to suicide research represents an innovative and integrative approach for expanding our knowledge about fundamental processes and how their dynamics lead to STBs. The usefulness of the DSMS, implications for future suicide research with EMA, and clinical implications are discussed.

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“…3. Suizidales Verhalten scheint einen Teil der Betroffene relativ unvorbereitet zu treffen: In einer Studie verneinten beispielsweise 11 % der Befragten, die im Laufe ihres Lebens einen Suizidversuch unternommen hatten, jemals unter Suizidgedanken gelitten zu haben [21]. Setzt man das Fehlen von Suizidgedanken mit dem Fehlen eines Suizidrisikos gleich, dann wird ein Teil der Betroffenen potenziell deshalb übersehen, weil sie selbst von der akuten suizidalen Krise überrascht werden.…”

Section: Suizidales Erleben Unterliegt Raschen Intensitätsschwankun-unclassified

Prädiktion suizidalen Verhaltens

Teismann¹,

Hilbert²,

Forkmann³

2022

Nervenheilkunde

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ZUSAMMENFASSUNGEine Vorhersage suizidalen Verhaltens ist nicht sicher möglich. Frühe Arbeiten zeigen genauso wie aktuelle Metaanalysen, dass weder das klinische Urteil noch Risikoskalen und Fragebögen eine zufriedenstellende Vorhersage suizidalen Verhaltens erlauben. Gründe für die unzureichende Prädiktion werden erläutert und Chancen sowie Grenzen der Anwendung künstlicher Intelligenz werden reflektiert. Abschließend wird hervorgehoben, dass Suizidprävention möglich ist, auch wenn sichere Suizidprädiktion nicht möglich ist.

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Suicide attempts among adults denying active suicidal ideation: An examination of the relationship between suicidal thought content and suicidal behavior

Cited by 28 publications

References 40 publications

Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study

Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study

Understanding suicidal pathways through the lens of a Dual-System Model of Suicidality in real-time: The potential of ecological momentary assessments

Prädiktion suizidalen Verhaltens

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