Abstract
We still have little understanding of short-term predictors of suicidal thoughts and behaviors (STBs). Prior research links increased negative affect to STBs, but the vast majority of earlier work is limited by measuring negative affect at one time point and aiming to predict STBs months or years in the future. Recently, intensive longitudinal studies have shown that negative affect is associated with suicidal thoughts over relatively short, clinically useful time periods; however, the specific patterns and types of negative affect that predict STBs remain unclear. Using ecological momentary assessment (EMA) data from psychiatric inpatients hospitalized for suicide risk (n = 83), this study sought to test whether the patterns (means and variability) of two types of negative affect (anxiety/agitation and shame/self-hatred, which were derived from a larger EMA battery) during hospitalization predict STBs in the 4 weeks after discharge: an extremely high-risk time for suicidal behavior. The mean—but not the variability—of both anxiety/agitation and shame/self-hatred during hospitalization predicted the number of days with suicidal thoughts after discharge. The mean and the variability of shame/self-hatred—but not anxiety/agitation—predicted post-discharge suicide attempt. We discuss implications for assessment and treatment of suicidal individuals and propose key directions for future research.
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Notes
In both study waves, the second question of the 4-week follow-up survey (“about how many days in the past four weeks did you think of killing yourself?”) had an error such that the maximum number of days participants could enter was 14 (not 28). Thus, we did not analyze the “how many days” question from the 4-week follow-up.
We operationalized variability with SD instead of RMSSD or other more complex metrics for two reasons. (1) The convention is to require more data points (e.g., 20 in Dejonckheere et al., 2019) than we had here to calculate more complex, time-dependent affective metrics, whereas SD is not time-dependent (Trull et al., 2015). To reliably estimate the RMSSD, we would have needed to restrict to only those participants who completed higher numbers of EMA surveys which would have biased our sample and considerably reduced our N. (2) SD and RMSSD overlap and are highly correlated (e.g., Hisler et al., 2020; Wendt et al., 2019), and we were more interested in the relationship of NA variability with STBs rather than the unique effects of one index of variability when controlling for another.
In two additional sensitivity analyses, (1) when excluding the 5 participants who did not complete the two-week follow-up but denied suicidal thoughts since discharge on the 4-week follow-up, the same findings also held. (2) When excluding participants who completed fewer than 10 EMA surveys, only mean levels of shame/self-hatred (not anxiety/agitation) predicted days with suicidal thoughts.
When excluding the 5 participants coded as non-attempters based only on 2-week (not four-week) follow-up survey data, and when excluding participants who completed fewer than 10 EMA surveys, the same findings held.
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This research was funded by grant K23 MH120436 (KHB) from the National Institute of Mental Health, and the Chet and Will Griswold Suicide Prevention Fund (MKN).
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The code and de-identified data used for the present study are available at https://osf.io/3h7m4/.
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Code is available from the corresponding author on request.
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All procedures performed in this study involving human participants were approved by the Institutional Review Board at the Massachusetts General Hospital (IRB# 2015P000598) with reliance agreements established with other involved institutions.
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The authors declare no competing interests. Dr Nock receives publication royalties from Macmillan, Pearson, and UpToDate. He has been a paid consultant in the past year for Microsoft Corporation, the Veterans Health Administration, Cerebral, and for a legal case regarding a death by suicide. He is an unpaid scientific advisor for Empatica, Koko, and TalkLife.
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The online version contains supplementary material available at https://doi.org/10.1007/s42761-021-00058-6.
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KHB: conceptualization, methodology, investigation, formal analysis, writing–original draft/review and editing, visualization, funding. DDL: conceptualization, methodology, formal analysis, writing–review and editing, visualization. EMK: conceptualization, methodology, investigation, project administration, writing–review and editing. ECK: conceptualization, writing–review and editing. PM: methodology, software, formal analysis, writing–review and editing. AJM: investigation, writing–review and editing. ARR: writing–original draft/review and editing. SBW: writing–review and editing. RGF: writing–review and editing. MBS: investigation, writing–review and editing. SB: investigation, writing–review and editing. JCH: investigation, project administration, writing–review and editing. MKN: conceptualization, methodology, investigation, writing–review and editing, project administration, funding.
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Bentley, K.H., Coppersmith, D.L., Kleiman, E.M. et al. Do Patterns and Types of Negative Affect During Hospitalization Predict Short-Term Post-Discharge Suicidal Thoughts and Behaviors?. Affec Sci 2, 484–494 (2021). https://doi.org/10.1007/s42761-021-00058-6
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DOI: https://doi.org/10.1007/s42761-021-00058-6