Trajectories of Affective Response as Warning Signs for Suicide Attempts: An Examination of the 48 Hours Prior to a Recent Suicide Attempt

Change in affect is widely considered a warning sign for suicidal behavior. However, no study to date has directly examined such within-person changes during the hours preceding a suicide attempt. This study aimed to identify subgroups differentiated by affective patterns leading up to their suicide attempt, determine whether types of affect can be considered warning signs among these subgroups, and identify subgroup clinical correlates. Participants included 216 suicide attempters presenting to the hospital within 24 hours of their attempt. A timeline follow-back methodology was used to assess near-term behaviors and affect prior to the attempt, and a battery of measures assessed distal clinical correlates and attempt characteristics. Four affective subgroups were identified and were distinguished by specific affective warning signs and clinical correlates. Findings indicate that affective changes are warning signs for some, but not all, suicide attempters and highlight the exceptional challenge of predicting imminent risk for suicide.