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Highly variable suicidal ideation: a phenotypic marker for stress induced suicide risk

Molecular Psychiatry volume 26, pages 5079–5086 (2021)Cite this article

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Abstract

Suicidal behavior (SB) can be impulsive or methodical; violent or not; follow a stressor or no obvious precipitant. This study tested whether childhood trauma, affective lability, and aggressive and impulsive traits predicted greater SI variability. We also assessed whether affective lability, aggressive or impulsive traits explain childhood trauma’s effects on SI variability and whether those with highly variable SI respond to stressful events with increases in SI. Finally, we assessed variable SI’s trajectory over 2 years. Depressed participants (n = 51) had ecological momentary assessments (EMA) over 7 days at baseline, 3, 6, 12, 18, and 24 months. SI variability was assessed using the square Root of the Mean Square of Successive Deviations. Mixed Effects Models were fit as appropriate. Childhood trauma was associated with subsequent aggression. Physical abuse predicted both aggression and affective lability as well as SI variability, but not impulsivity. In two-predictor models, physical abuse’s effect on SI variability was no longer significant, when controlling for the effect of higher aggression and impulsivity. Those with high SI variability exhibited greater increases in SI after stressors compared with those with less variability. We did not find that SI variability changed over time, suggesting it might be trait-like, at least over 2 years. Variable SI predisposes to marked SI increases after stressful events and may be a trait increasing risk for impulsive SB, at least over 2 years.

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Fig. 1: Trajectory of suicidal ideation over a two year period for individuals with high and low suicidal ideation variability.

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Acknowledgements

This work is supported by R01 MH109326 and P50 MH090964.

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Authors and Affiliations

  1. University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA

    Maria A. Oquendo

  2. Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA

    Hanga C. Galfalvy, Tse-Hwei Choo, Ainsley K. Burke, M. Elizabeth Sublette, Jeffrey M. Miller, J. John Mann & Barbara H. Stanley

  3. New York State Psychiatric Institute, New York, NY, USA

    Raksha Kandlur

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  1. Maria A. Oquendo
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Correspondence to Maria A. Oquendo.

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Conflict of interest

AKB, JJM, MAO, and BHS receive royalties for the commercial use of the Columbia Suicide Severity Rating Scale from the Research Foundation for Mental Hygiene. MAOquendo owns shares in Mantra, Inc. and her family owns stock in Bristol Myers Squibb. The rest of the authors report no conflicts of interest.

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Oquendo, M.A., Galfalvy, H.C., Choo, TH. et al. Highly variable suicidal ideation: a phenotypic marker for stress induced suicide risk. Mol Psychiatry 26, 5079–5086 (2021). https://doi.org/10.1038/s41380-020-0819-0

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