Predicting future suicide attempts among depressed suicide ideators: A 10-year longitudinal study

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Abstract

Suicidal ideation and attempts are a major public health problem. Research has identified many risk factors for suicidality; however, most fail to identify which suicide ideators are at greatest risk of progressing to a suicide attempt. Thus, the present study identified predictors of future suicide attempts in a sample of psychiatric patients reporting suicidal ideation. The sample comprised 49 individuals who met full DSM-IV criteria for major depressive disorder and/or dysthymic disorder and reported suicidal ideation at baseline. Participants were followed for 10 years. Demographic, psychological, personality, and psychosocial risk factors were assessed using validated questionnaires and structured interviews. Phi coefficients and point-biserial correlations were used to identify prospective predictors of attempts, and logistic regressions were used to identify which variables predicted future attempts over and above past suicide attempts. Six significant predictors of future suicide attempts were identified – cluster A personality disorder, cluster B personality disorder, lifetime substance abuse, baseline anxiety disorder, poor maternal relationship, and poor social adjustment. Finally, exploratory logistic regressions were used to examine the unique contribution of each significant predictor controlling for the others. Comorbid cluster B personality disorder emerged as the only robust, unique predictor of future suicide attempts among depressed suicide ideators. Future research should continue to identify variables that predict transition from suicidal thoughts to suicide attempts, as such work will enhance clinical assessment of suicide risk as well as theoretical models of suicide.

Section snippets

Participants

Data were collected as part of a larger project that examined the naturalistic course of depressive disorders over 10 years (Klein et al., 2006). Participants were outpatients who met full DSM-IV criteria for major depressive disorder and/or dysthymic disorder as determined by structured diagnostic interview. They were recruited from consecutive admissions to the State University of New York at Stony Brook (SUSB) Hospital Outpatient Psychiatric Clinic and the SUSB Psychology Center. The sample

Prediction of suicide attempts: direct effects

Attempters and non-attempters were compared on baseline diagnostic and clinical characteristics to determine which factors prospectively predicted suicide attempts. Direct effects (phi coefficients and point-biserial correlations) for all predictor variables are reported in Table 1. Phi coefficients and point-biserial correlations greater than .28 were significant at the p < .05 level.

Regarding demographic indicators, the only predictor of attempts was lower socioeconomic status (rpb = .31).

Discussion

The goal of this study was to identify prospective predictors of suicide attempts among ideators. Previous research has identified numerous risk factors associated with suicidality in general, however it remains unclear which factors predict progression to a suicide attempt among people already contemplating suicide. These analyses addressed this question by examining a broad spectrum of clinical and psychosocial variables in depressed ideators and identifying which were predictive of suicide

Role of funding source

Data collection was supported by National Institute of Mental Health Grant RO1 MH045757. Data analysis and writing were supported by research funding from the University of British Columbia Psychology Department. The funding sources had no further role in study design, the writing of the report, or in the decision to submit the paper for publication.

Contributors

DNK designed the original study and collect the data. AMM and EDK formulated the specific research questions as well as the analytic approach. AMM conducted the literature searches, performed the analyses, and wrote the first draft of the manuscript. All authors contributed to the writing of and have approved the final manuscript.

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgments

We wish to acknowledge the research funds provided by the University of British Columbia Department of Psychology and the NIMH. We also thank the study participants for contributing their experiences.

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