A controlled examination of acute warning signs for suicide attempts among hospitalizations patients

This study examined warning signs for suicidal behavior in people recently admitted to a psychiatric hospital following a suicide attempt. Participants were 349 adult civilians and Veterans across five medical centers who were interviewed about the 48 hours prior to their attempt. Participants were asked about the six hours prior to their suicide attempted and the six hours from the day before their suicide attempt. Participants were asked about negative life events (e.g., relationship break up, fired from job, charged with a law violation, evicted from housing), substance use, reckless or risky behaviors, suicide-related communication (e.g., telling someone they were going to kill themselves), and preparation of personal affairs (e.g., writing a will). Participants were also asked about an hour by hour recount of the six hours prior to the attempt and the six hours the day before and asked to rate the intensity of their thoughts and emotions in order to compare and identify warning signs for suicidal behavior.

Nine warning signs were identified that correctly differentiated the day of the suicide attempt from the previous day including:
Four behavioral/events
1. Any suicide-related communications
2. Any preparation of personal affairs
3. Alcohol use
4. An interpersonal negative life event (e.g., break up, conflict with another person)

Three affective (emotional) responses
5. Empty
6. Hostile
7. Scared
Two cognitions (thought) patterns
8. Burdensomeness
9. No reason for living

The results for these warning signs did not differ when examining differences in gender or Veteran vs. non-Veteran status. These results are in line with previous literature related to warning signs and are important to consider as these warning signs will likely enhance suicide risk assessment and safety planning, as well as help clinicians and loved one identify when someone at risk of suicide is entering into a state of acute risk. This was a retrospective study, and as such, future, ethically appropriate predictive research would be beneficial to understand warning signs for suicide attempts prior to them occurring.

Bagge, C., Littlefield, A., Wiegand, T., Hawkins, E., Trim, R., Schumacher, J., . . . Conner, K. (2022). A controlled examination of acute warning signs for suicide attempts among hospitalized patients. Psychological Medicine, 1-9. doi:10.1017/S0033291721004712

Bagge, C. L., Glenn, C. R., & Lee, H.-J. (2013a). Quantifying the impact of recent negative life events on suicide attempts. Journal of Abnormal Psychology, 122(2), 359–368. doi: 10.1037/a0030371