Understanding the Transition from Suicidal Desire to Planning and Preparation: Correlates of Suicide Risk within a Psychiatric Inpatient Sample of Ideators and Attempters

• Published in: Journal of affective disorders 2020-09, Vol.274, p.159-166
• Main Authors: Marie, Laura, Poindexter, Erin K., Fadoir, Nicholas A., Smith, Phillip N.
• Format: Article
• Language: English
• Subjects: Adult; Cross-Sectional Studies; Fearlessness about death; Female; Humans; Ideation-to-action; Inpatients; Male; Psychological pain; Resolved plans and preparations; Suicidal desire; Suicidal Ideation; Suicide attempt; Suicide, Attempted; Violence
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2020.05.037

•Psychological pain and fearlessness about death are uniquely associated with suicidal desire and suicidal plans and preparations, controlling for hopelessness, trauma exposure, and alcohol use symptoms.•Suicidal ideators do not significantly differ from suicide attempters on measures of psychological pain, hopelessness, fearlessness about death, trauma exposure, or alcohol use symptoms.•Psychological pain and fearlessness about death may function as transitional factors, which in the presence of desire, will transform into intent to engage in suicidal behavior.•Clinical interventions targeting suicidality should reduce psychological pain, increase safety, and reduce access to means. There is a clear need to better understand the trajectory from suicidal ideation to enactment of lethal suicidal behavior. Identification of factors that promote desire and the transition to intent and behavior is critical for the advancement of theory, risk formulation, and prevention. In this cross sectional study, correlates of suicide risk were examined at theoretically distinct points along the trajectory from suicidal thinking to behavior (i.e., desire, plans and preparations, suicide attempt) in a manner consistent with the Three-Step Theory and an ideation-to-action framework. The sample included 197 adult inpatients (60% male, 40% white) hospitalized due to ideation or a recent suicide attempt. Psychological pain and fearlessness about death were associated with desire and plans and preparations for suicide. There were no significant differences in suicide risk correlates between ideators and attempters. The primary limitations of the current study relate to the cross-sectional design and the nature of the sample, which do not allow for inference of causal relations, or generalizability to outpatient and community samples or to individuals who die by suicide. Psychological pain and fearlessness about death may function as transitional factors that are associated with the transition from desire to suicidal intent in psychiatric inpatients. Findings have important implications for clinical practice. Treatment interventions should reduce psychological pain, increase safety, and reduce access to means.