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

Maria A Oquendo, Hanga C Galfalvy, Tse-Hwei Choo, Raksha Kandlur, Ainsley K Burke, M Elizabeth Sublette, Jeffrey M Miller, J John Mann, Barbara H Stanley, Maria A Oquendo, Hanga C Galfalvy, Tse-Hwei Choo, Raksha Kandlur, Ainsley K Burke, M Elizabeth Sublette, Jeffrey M Miller, J John Mann, Barbara H Stanley

Abstract

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.

Conflict of interest statement

Conflict of Interest Statements: Drs. Burke, Mann, Oquendo and Stanley receive royalties for the commercial use of the Columbia Suicide Severity Rating Scale from the Research Foundation for Mental Hygiene. Dr. Oquendo owns shares in Mantra, Inc. and her family owns stock in Bristol Myers Squibb. The rest of the authors report no conflicts of interest.

© 2020. The Author(s), under exclusive licence to Springer Nature Limited.

Figures

Figure 1.
Figure 1.
Spaghetti Plot of Trajectories of Suicidal Ideation over a 2 year period divided by median split of RMSSD

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Source: PubMed

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