Pathways to suicidal ideation for young people engaged in mental health care

Background: Suicidal thoughts and behaviours (STBs) have a profound impact on individuals, communities, and healthcare systems. A wide range of factors have been shown to be associated with STBs. Within prior research it is also common to distinguish between proximal and distal factors, usually by distinction of short compared to long-term prediction. Objective: We aimed to learn the proximal and distal factors of suicidal ideation for young people engaged in mental health care using the inferred structure of probabilistic graphical models (PGMs). Methods and materials: We used cross-sectional data from a sample of 1020 help-seeking individuals aged 12-25 years from Australia that while engaged in mental health care, contributed data to a digital platform. The posterior distribution of the dependency structure assuming both undirected PGMs and Bayesian networks (BNs) was inferred. Causal effects were then estimated using a counterfactual query of the Bayesian networks. Results: Depressed mood, functional impairment, poor social connection, and psychosis-like experiences were proximal factors. Whereas experiencing a traumatic event, anxiety, insomnia, and unrefreshed sleep were distal factors. Proximal factors had the greatest effect on suicidal ideation, while anxiety symptoms and experiencing a traumatic event were the most influential distal factors. Conclusions: These relative timings of events and their effects on suicidal ideation could be used to understand the future likelihood of suicidal ideation, and aid planning of targeted interventions.