Changes in suicide capability during short-term partial hospital treatment

Abstract

Suicide capability (fearlessness about death [FAD], preparation, and perceived capability [PC]) is presumed to be static, or to increase with exposure to provocative events. However, tests of this assumption have primarily used non-clinical samples. We examined short-term changes in capability among patients in a partial hospital program. We enrolled 296 adult patients (186 [62.7%] female; Mage=36.13, SDage=14.75) who completed diagnostic interviews and questionnaires assessing demographics, capability, and suicide ideation (SI) at intake. Capability was re-assessed twice during treatment and again at discharge, and SI was re-assessed at discharge. We used latent growth modeling (LGM) to quantify changes in capability. FAD, preparation, and PC decreased from intake to discharge (ps<0.001, ds=0.24–0.63) and unconditional LGM models suggested that all facets changed significantly throughout treatment. FAD was positively associated with preparation (r = 0.57) and PC (r = 0.25) at intake (ps<0.001), but changes in FAD did not predict changes in other facets. Greater SI at intake was concurrently associated with higher capability (βs=0.26–1.83, ps<0.01) and predicted steeper declines in preparation (β=-0.23) and PC (β=-0.04), ps=0.04. Finally, higher intake preparation predicted more severe SI at discharge (β=0.16, p<.001). There was no control group and there was unequal spacing between in-treatment assessments among participants. Results for SI may have been impacted by floor effects. Results suggest that aspects of capability can change over a short time. Conceptually related facets of capability did not change together; thus, future investigations of the short-term dynamics of capability should not treat it as a unitary construct.