Time Varying Prediction of Thoughts of Death and Suicidal Ideation in Adolescents: Weekly Ratings over 6-month Follow-Up

Abstract

Suicidal ideation (SI) and thoughts of death are often experienced as fluctuating; therefore a dynamic representation of this highly important indicator of suicide risk is warranted. Theoretical accounts have suggested that affective, behavioral, and interpersonal factors may influence the experience of thoughts of death/SI. This study aimed to examine the prospective and dynamic impact of these constructs in relation to thoughts of death and SI. We assessed adolescents with a recent hospitalization for elevated suicide risk over 6 months. Using the methodology of the Longitudinal Interval Follow-Up Evaluation, weekly ratings for SI, course of depressive illness, affect sensitivity, negative affect intensity, behavioral dysregulation, peer invalidation, and family invalidation were obtained. Using multilevel modeling, results indicated that (a) same-week ratings between these constructs and SI were highly correlated at baseline and throughout follow-up; (b) baseline ratings of affect sensitivity, behavioral dysregulation, and peer invalidation were positive prospective predictors of SI at any week of follow-up; (c) weekly ratings of each of these constructs had significant associations with next-week ratings of SI; and (d) ratings of SI had positive significant associations with next-week ratings on each of the constructs. These results suggest that affective sensitivity, behavioral dysregulation, peer invalidation, and SI are highly associated with SI levels both chronically (over months) and acutely (one week to the next), whereas depression, negative affect intensity, and family invalidation were more acutely predictive of SI. Elevated SI may then aggravate all these factors in a reciprocal manner.