Mapping the timescale of suicidal thinking

Abstract

Suicide is one of the most devastating aspects of human nature and has puzzled scholars for thousands of years. Most suicide research to date has focused on establishing the prevalence and predictors of the presence or severity of suicidal thoughts/behaviors. Surprisingly little research has documented the fundamental properties of suicidal thoughts/behaviors, such as: when someone has a suicidal thought, how long do such thoughts last? Documenting the basic properties of a phenomenon is necessary to understand, study, and treat it. This study aims to identify the timescale of suicidal thinking, leveraging novel real-time monitoring data and a number of different novel analytic approaches. Participants were 105 adults with past week suicidal thoughts who completed a 42-day real-time monitoring study (total number of observations=20,255). Participants completed two forms of real time assessments: traditional real-time assessments (spaced hours apart each day) and high-frequency assessments (spaced 10 minutes apart over one hour). We found that suicidal thinking changes rapidly. Both descriptive statistics and Markov-Switching models indicated that that elevated states of suicidal thinking lasted on average 1 to 3 hours. Individuals exhibited considerable heterogeneity in how often and for how long they reported elevated suicidal thinking, and our analyses suggest that different aspects of suicidal thinking operated on different timescales. Continuous-time autoregressive models suggest that current suicidal intent is predictive of future intent levels for 2 to 3 hours, while current suicidal desire predictive of future suicidal desire levels for 20 hours. Multiple models found that elevated suicidal intent has on average shorter duration than elevated suicidal desire. Finally, our ability to capture within-person dynamics of suicidal thinking was improved using high-frequency sampling. For example, traditional real-time assessments alone estimated the duration of severe suicidal states of suicidal desire as 9.5 hours, whereas, the high-frequency assessments shifted the estimated duration to 1.4 hours. The high-frequency assessments identified 19% more participants with a high-risk response than the traditional real-time assessment, and high frequency measurements were shown to capture considerable levels of variation across consecutive measurement occasions. These results provide the most detailed characterization to date of the temporal dynamics of suicidal thinking. Furthermore, these findings highlight the importance of sampling frequency in capturing the dynamics of a phenomenon.

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