Differential time varying associations among affective states and suicidal ideation among adolescents following hospital discharge

Abstract

Suicide is a major public health problem among adolescents. Identifying factors that confer increased risk for suicidal ideation, particularly during the high-risk period following psychiatric hospitalization, is essential for preventing suicide in this population. Negative and positive affect are two such important modifiable risk factors. This study examined relationships between specific affective states and suicidal ideation, collected via daily diary, as continuous functions of time among discharged adolescents. Adolescents hospitalized for suicidal ideation and/or behavior responded to daily surveys for four weeks after discharge (N\xa0=\xa034; 952 observations). Time-varying effects models (TVEM) were used to predict same- and next-day suicidal ideation. Examining between-persons effects, adolescents reporting greater misery and less happiness compared to others had a significantly increased likelihood of same-day suicidal ideation; between-person anger was not significantly associated with suicidal ideation. Within-persons effects suggested that elevated same-day, but not previous-day, misery and anger were associated with suicidal ideation. Elevated within-person happiness was protective for same-day suicidal ideation, but was also associated with next-day suicidal ideation. These findings begin to clarify not only which, but when, specific affective processes influence suicidal ideation for discharged adolescents. These dynamic risk factors represent modifiable treatment targets relevant for real-time interventions.