Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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


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.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Prices vary by article type



Prices may be subject to local taxes which are calculated during checkout

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


  1. Hedegaard H, Curtin SC, Warner M. Suicide mortality in the United States, 1999–2017. NCHS Data Brief. 2018;1–8.

  2. Hallensleben N, Spangenberg L, Forkmann T, Rath D, Hegerl U, Kersting A, et al. Investigating the dynamics of suicidal ideation. Crisis. 2018;39:65–69.

    Article  Google Scholar 

  3. Kleiman EM, Turner BJ, Fedor S, Beale EE, Picard RW, Huffman JC, et al. Digital phenotyping of suicidal thoughts. Depress Anxiety. 2018;35:601–8.

    Article  Google Scholar 

  4. Witte TK, Fitzpatrick KK, Joiner TE Jr, Schmidt NB. Variability in suicidal ideation: a better predictor of suicide attempts than intensity or duration of ideation? J Affect Disord. 2005;88:131–6.

    Article  Google Scholar 

  5. Rizk MM, Galfalvy H, Singh T, Keilp JG, Sublette ME, Oquendo MA, et al. Toward subtyping of suicidality: brief suicidal ideation is associated with greater stress response. J Affect Disord. 2018;230:87–92.

    Article  Google Scholar 

  6. Shrout PE, Lane SP. Psychometrics. Handbook of research methods for studying daily life. New York, NY, US: The Guilford Press; 2012, p. 302–20.

  7. Raposo SM, Mackenzie CS, Henriksen CA, Afifi TO. Time does not heal all wounds: older adults who experienced childhood adversities have higher odds of mood, anxiety, and personality disorders. Am J Geriatr Psychiatry. 2014;22:1241–50.

    Article  Google Scholar 

  8. Harford TC, Yi HY, Grant BF. Associations between childhood abuse and interpersonal aggression and suicide attempt among U.S. adults in a national study. Child Abus Negl. 2014;38:1389–98.

    Article  Google Scholar 

  9. Kelly-Irving M, Lepage B, Dedieu D, Bartley M, Blane D, Grosclaude P, et al. Adverse childhood experiences and premature all-cause mortality. Eur J Epidemiol. 2013;28:721–34.

    Article  Google Scholar 

  10. Brodsky BS, Oquendo M, Ellis SP, Haas GL, Malone KM, Mann JJ. The relationship of childhood abuse to impulsivity and suicidal behavior in adults with major depression. Am J Psychiatry. 2001;158:1871–7.

    Article  CAS  Google Scholar 

  11. Odaci H, Celik CB. The role of traumatic childhood experiences in predicting a disposition to risk-taking and aggression in Turkish university students. J Interpers Violence. 2020;35:1998–2011.

    Article  Google Scholar 

  12. Sansone RA, Leung JS, Wiederman MW. Five forms of childhood trauma: relationships with aggressive behavior in adulthood. Prim Care Companion CNS Disord. 2012;14:PCC.12m01353.

  13. Fanning JR, Lee R, Gozal D, Coussons-Read M, Coccaro EF. Childhood trauma and parental style: relationship with markers of inflammation, oxidative stress, and aggression in healthy and personality disordered subjects. Biol Psychol. 2015;112:56–65.

    Article  Google Scholar 

  14. Brent DA, Melhem NM, Oquendo M, Burke A, Birmaher B, Stanley B, et al. Familial pathways to early-onset suicide attempt: a 5.6-year prospective study. JAMA Psychiatry. 2015;72:160–8.

    Article  Google Scholar 

  15. Krause-Utz A, Erol E, Brousianou AV, Cackowski S, Paret C, Ende G, et al. Self-reported impulsivity in women with borderline personality disorder: the role of childhood maltreatment severity and emotion regulation difficulties. Borderline Personal Disord Emot Dysregul. 2019;6:6.

    Article  Google Scholar 

  16. Teicher MH, Samson JA, Polcari A, McGreenery CE. Sticks, stones, and hurtful words: relative effects of various forms of childhood maltreatment. Am J Psychiatry. 2006;163:993–1000.

    Article  Google Scholar 

  17. Horwitz AV, Widom CS, McLaughlin J, White HR. The impact of childhood abuse and neglect on adult mental health: a prospective study. J Health Soc Behav. 2001;42:184–201.

    Article  CAS  Google Scholar 

  18. Bahk YC, Jang SK, Choi KH, Lee SH. The relationship between childhood trauma and suicidal ideation: role of maltreatment and potential mediators. Psychiatry Investig. 2017;14:37–43.

    Article  Google Scholar 

  19. Bryan CJ, Rozek DC, Butner J, Rudd MD. Patterns of change in suicide ideation signal the recurrence of suicide attempts among high-risk psychiatric outpatients. Behav Res Ther. 2019;120:103392.

    Article  Google Scholar 

  20. Madsen T, van Spijker B, Karstoft KI, Nordentoft M, Kerkhof AJ. Trajectories of suicidal ideation in people seeking web-based help for suicidality: secondary analysis of a Dutch randomized controlled trial. J Med Internet Res. 2016;18:e178.

    Article  Google Scholar 

  21. Rizk MM, Choo TH, Galfalvy H, Biggs E, Brodsky BS, Oquendo MA, et al. Variability in suicidal ideation is associated with affective instability in suicide attempters with borderline personality disorder. Psychiatry. 2019;82:173–8.

    Article  Google Scholar 

  22. Sarchiapone M, Jaussent I, Roy A, Carli V, Guillaume S, Jollant F, et al. Childhood trauma as a correlative factor of suicidal behavior—via aggression traits. Similar results in an Italian and in a French sample. Eur Psychiatry. 2009;24:57–62.

    Article  CAS  Google Scholar 

  23. Oquendo MA, Perez-Rodriguez MM, Poh E, Sullivan G, Burke AK, Sublette ME, et al. Life events: a complex role in the timing of suicidal behavior among depressed patients. Mol Psychiatry. 2014;19:902–9.

    Article  CAS  Google Scholar 

  24. Paul E. Proximally-occurring life events and the first transition from suicidal ideation to suicide attempt in adolescents. J Affect Disord. 2018;241:499–504.

    Article  Google Scholar 

  25. van Eeden WA, van Hemert AM, Carlier IVE, Penninx BW, Giltay EJ. Severity, course trajectory, and within-person variability of individual symptoms in patients with major depressive disorder. Acta Psychiatr Scand. 2019;139:194–205.

    Article  Google Scholar 

  26. Czyz EK, Horwitz AG, Arango A, King CA. Short-term change and prediction of suicidal ideation among adolescents: a daily diary study following psychiatric hospitalization. J Child Psychol Psychiatry. 2019;60:732–41.

    Article  Google Scholar 

  27. Stanley B, Brown GK. Safety planning intervention: a brief intervention to mitigate suicide risk. Cogn Behav Pract. 2012;19:256–64.

    Article  Google Scholar 

  28. Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63:757–66.

    Article  Google Scholar 

  29. Brown GK, Ten Have T, Henriques GR, Xie SX, Hollander JE, Beck AT. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA. 2005;294:563–70.

    Article  CAS  Google Scholar 

  30. Gibb SJ, Beautrais AL, Fergusson DM. Mortality and further suicidal behaviour after an index suicide attempt: a 10-year study. Aust NZ J Psychiatry. 2005;39:95–100.

    Article  Google Scholar 

Download references


This work is supported by R01 MH109326 and P50 MH090964.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Maria A. Oquendo.

Ethics declarations

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.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links