The Interplay Between Risk and Protective Factors and Suicidal Thoughts: Examining Momentary Fluctuations to Improve Suicide Risk Detection

Research Aims: Between 2007-2018, there has been an almost 60% rise in suicide deaths among young people. While research to date has focused on identifying what factors make one vulnerable to considering suicide, researchers have yet to ascertain which factors predict when suicidal thoughts emerge. Improving our ability to predict when suicidal thoughts emerge will allow researchers to identify key moments of intervention by breaking the link between risk factors and suicidal thoughts. In addition to examining factors that increase the likelihood of experiencing a suicidal thought, identifying factors that are related to a lower likelihood of suicidal thought emergence is important. More specifically, examining both risk and protective factors will allow us to determine with more certainty when thoughts are likely to arise and will point towards promising intervention targets. To identify when suicidal thoughts are likely to emerge, researchers must investigate suicidal thoughts in the real-world and as close to real-time as possible. Intensive longitudinal methods allow researchers to do this by asking participants to respond to a short survey that examines important factors and suicidal thoughts at random points throughout the day. In this study, we aim to identify risk and protective factors in the lives of young adults following their visits to an emergency department (ED) due to suicide risk. We will do this by examining the complex and dynamic interplay between risk and protective factors, using a novel statistical technique that identifies the compounding effects of these factors and predicts the emergence of suicidal thoughts in day-to-day life. Methods: Forty young adults (ages 18-25) who recently visited an ED due to a suicidal crisis will be recruited for this study. Participants will complete demographic measures and an assessment of baseline suicidal thoughts, negative and positive emotions, engagement with negative and positive stimuli, and coping effectiveness. Then, participants will be asked to complete surveys at 4 random points/day for 28 days. They will respond to questions about suicidal thoughts, risk factors (e.g., heightened negative emotions), and protective factors (e.g., savoring reward, help-seeking). Nonlinear dynamic systems models, specifically the cusp catastrophe model, will be used to identify at which point in time participants are likely to shift from a nonsuicidal to a suicidal state (i.e., when a suicidal thought is likely to emerge). Potential impact: Findings from this research have the potential to: (a) identify important and novel risk and protective factors that predict greater (or reduced) likelihood of suicidal thought emergence; (b) provide a framework for new statistical methodology to enhance risk prediction; and (c) identify key intervention targets for future intervention development. Next steps: These findings will be used to apply for a NIMH K23 grant to examine hypothesis-driven models of the dynamic interplay between risk and protective factors of momentary suicidal thoughts and to examine important baseline characteristics that predict who is more vulnerable when hypothesized risk factors are present and when hypothesized protective factors are absent.