Trajectories of Suicidal Ideation in People Seeking Web-Based Help for Suicidality: Secondary Analysis of a Dutch Randomized Controlled Trial

Abstract

BackgroundSuicidal ideation (SI) is a common mental health problem. Variability in intensity of SI over time has been linked to suicidal behavior, yet little is known about the temporal course of SI.ObjectiveThe primary aim was to identify prototypical trajectories of SI in the general population and, secondarily, to examine whether receiving Web-based self-help for SI, psychiatric symptoms, or sociodemographics predicted membership in the identified SI trajectories.MethodsWe enrolled 236 people, from the general Dutch population seeking Web-based help for SI, in a randomized controlled trial comparing a Web-based self-help for SI group with a control group. We assessed participants at inclusion and at 2, 4, and 6 weeks. The Beck Scale for Suicide Ideation was applied at all assessments and was included in latent growth mixture modeling analysis to empirically identify trajectories.ResultsWe identified 4 SI trajectories. The high stable trajectory represented 51.7% (122/236) of participants and was characterized by constant high level of SI. The high decreasing trajectory (50/236, 21.2%) consisted of people with a high baseline SI score followed by a gradual decrease to a very low score. The third trajectory, high increasing (12/236, 5.1%), also had high initial SI score, followed by an increase to the highest level of SI at 6 weeks. The fourth trajectory, low stable (52/236, 22.0%) had a constant low level of SI. Previous attempted suicide and having received Web-based self-help for SI predicted membership in the high decreasing trajectory.ConclusionsMany adults experience high persisting levels of SI, though results encouragingly indicate that receiving Web-based self-help for SI increased membership in a decreasing trajectory of SI.

Effectiveness of a Web-Based Self-Help Program for Suicidal Thinking in an Australian Community Sample: Randomized Controlled Trial

“…However, baseline level of depression did not impact the effectiveness of the intervention, although the possibility remains that suicidal severity could interfere with program completion. It should also be noted here that the Dutch trial found more pronounced effects for severe suicidality [ 13 , 32 ], which contradicts the current findings. Another possibility relates to help-negation, which is the decreased propensity to engage in help-seeking behaviors as a consequence of more severe levels of suicidal ideation.…”

Trajectories of change in depression symptoms and suicidal ideation over the course of evidence-based treatment for depression: Secondary analysis of a randomised controlled trial of cognitive behavioural therapy plus fluoxetine in young people

“…Four distinct trajectories of suicidal ideation were identified, consistent with previous trajectory analysis in clinical trials in community-based adult populations (Allan et al, 2018; Kasckow et al, 2016; Madsen et al, 2016b). Almost two-thirds of participants were assigned to trajectories (i.e.…”

“…Suicidal ideation is often a feature of depression, with suicidal ideation a risk factor for self-harm (Ribeiro et al, 2016; Witt et al, 2018) and suicide (Ribeiro et al, 2016). Suicidal ideation severity is known to fluctuate (Selby and Yen, 2014), including over the course of evidence-based treatment for depression (Vitiello et al, 2009), and treatment-mediated improvements in depression symptomatology do not necessarily equate to improvements in suicidal ideation severity (Batterham et al, 2017, 2019; Madsen et al, 2016a, 2016b; van Spijker et al, 2014). Given most effects of current evidence-based psychological and medication treatments for depression are modest (Locher et al, 2017; Weisz et al, 2017), earlier identification of clinically relevant subgroups of patients who are likely to benefit from alternative or additional treatment might facilitate tailored and more effective intervention to improve outcomes.…”

Consistency of trajectories of suicidal ideation and depression symptoms: Evidence from a randomized controlled trial

“…While fit statistics for the GMMs identified a 2‐class solution for depressive symptoms and suicidal ideation, 3–4 class solutions are more frequently reported in the literature, based on a review of long term trajectories of depressive symptoms (Musliner et al., ) and recent studies reporting trajectories of suicidal ideation (Allan, Gros, Lancaster, Saulnier, & Stecker, ; Kasckow et al., ; Köhler‐Forsberg et al., ; Madsen et al., ,b). This discrepancy in research findings may be explained by factors such as differences in measures used to assess symptoms, differences in follow‐up periods, differences in study design (e.g., observational studies vs. trials, and variable eligibility criteria), and differences in target populations (e.g., clinical vs. population samples).…”

“…If a causal relationship between depression and suicidal thinking exists, it would be expected that individuals who experience decreases in depressive symptoms would also have decreasing suicidal thoughts, and vice‐versa, such that the measures would be tethered over time. There has been an increasing interest in analyzing longitudinal trajectories of mental health symptoms to identify subgroups with distinctive patterns of symptoms, including depressive symptoms (see Musliner, Munk‐Olsen, Eaton, & Zandi, ) and suicidal thoughts (e.g., Kasckow et al., ; Madsen, Karstoft, Secher, Austin, & Nordentoft, ; Madsen, van Spijker, Karstoft, Nordentoft, & Kerkhof, ). However, we are not aware of studies that have analyzed these factors together to examine whether tethering occurs.…”