Suicidal ideation arises from a complex interplay of multiple interacting risk factors over time. Recently, ecological momentary assessment (EMA) has increased our understanding of factors associated with real-time suicidal ideation, as well as those predicting ideation at the level of hours and days. Here we used statistical network methods to investigate which cognitive-affective risk and protective factors are associated with the temporal dynamics of suicidal ideation.

The SAFE study is a longitudinal cohort study of 82 participants with current suicidal ideation who completed 4×/day EMA over 21 days. We modeled contemporaneous (t) and temporal (t + 1) associations of three suicidal ideation components (passive ideation, active ideation, and acquired capability) and their predictors (positive and negative affect, anxiety, hopelessness, loneliness, burdensomeness, and optimism) using multilevel vector auto-regression models.

Contemporaneously, passive suicidal ideation was positively associated with sadness, hopelessness, loneliness, and burdensomeness, and negatively with happiness, calmness, and optimism; active suicidal ideation was positively associated with passive suicidal ideation, sadness, and shame; and acquired capability only with passive and active suicidal ideation. Acquired capability and hopelessness positively predicted passive ideation at t + 1, which in turn predicted active ideation; acquired capability was positively predicted at t + 1 by shame, and negatively by burdensomeness.

Our findings show that systematic real-time associations exist between suicidal ideation and its predictors, and that different factors may uniquely influence distinct components of ideation. These factors may represent important targets for safety planning and risk detection.

The Interpersonal-Psychological Theory of Suicide (IPTS) specifically predicts that acquired capability, perceived burdensomeness, and low belongingness are collectively necessary and sufficient proximal causes of serious suicidal behavior. Although the interpersonal theory of suicide is clinically reliable, most previous studies have been conducted on clinical groups including suicidal ideators with no suicide attempters or including only a few suicide attempters

This study aims to investigate interpersonal needs and acquired capability for suicide through questionnaire surveys following suicide attempts in people admitted to hospitals for medical treatment.

A total of 344 participants (200 depressed patients with attempted suicide, 144 depressed patients with suicidal ideation) were enrolled for this study. Depression, anxiety, emotional regulation, interpersonal needs, and acquired capability for suicide were evaluated. A model with pathways from emotional regulation difficulties and interpersonal needs to suicide attempts was proposed. Participants were divided into two groups according to the presence of suicide attempts or suicidal ideation.

Acquired capability for suicide mediated the path from depression to suicide attempts. In the path model, difficulties in emotional regulation and interpersonal needs predicted depression significantly. Although depression itself was not significantly related to acquired capability for suicide, depression was significantly related to acquired capability for suicide in suicide attempter group.

Interventions with two factors affecting suicide attempts will clarify the suicide risk and contribute to finding risk factors. It will also help reduce suicide rates through interventions in the processes leading to suicide attempts by identifying variables to predict the attempts through the path to suicide attempts.

No significant relationships.