UCSF

Suicide is a leading cause of death among adolescents in the United States 13-21 years. As rates rise, little remains known about the experience of suicidal ideation (SI) – suicide’s most closely linked symptom. Recent research suggests that dynamic characteristics of SI may help reveal risk for suicide. The aims of this study were to describe patterns of SI characteristics in a sample of adolescents at risk for suicide and describe within-person associations among adolescent’s SI characteristics and potential risk factors over time, using intensive longitudinal design. SI characteristics and SI risk factors of 10 adolescents were measured nine times daily for two weeks with brief electronic surveys in response to regularly scheduled text messages. Survey questions built upon empirical and theoretical foundations from the Columbia Suicide Severity Rating Scale and the Interpersonal Theory of Suicide. Participants ranged from 13 to 19 years of age, reported histories of SI with a planned method for suicide, and were receiving regular mental health treatment while in the study. Participants completed 1,054 surveys resulting in 11,594 individual data points. Aims were explored by computing intraindividual item means, item variability statistics, time-of-day effects on SI using a one-way Analysis of Variance, and time-series network models using unified structural equation modeling (uSEM). Results indicated that SI characteristics and SI risk factors varied significantly over hours, days, and weeks. However, there was substantial between-person heterogeneity in the occurrence, patterns, and relationships between SI characteristics and SI risk factors. Additionally, results show the consistent presence of an important bi-directional relationship between SI characteristics and SI risk factors, indicating that, not only did risk factors influence the severity of SI, but fluctuations in SI may have important impacts on factors such as loneliness, anger, and hopelessness. Findings from this research suggest promising strategies for future research, implications for precision-based suicide risk assessment, and important considerations for suicide theory.