A Real-Time Evaluation of Within-Person and Between-Person Risk for Suicidal Behaviors

Intensive longitudinal designs have been increasingly leveraged to examine short-term risk factors for suicidal ideation and intent. Less understood, however, are factors that may increase risk for momentary engagement in suicidal behaviors (i.e., plans, preparations, and attempts). The present study examines commonly cited transdiagnostic suicide risk factors as predictors of suicidal behaviors at the prompt-, day-, and participant-levels using ecological momentary assessment (EMA). A sample of 237 community-based adults at high risk for suicide (Mage = 27.12 years, 61.6% cisgender women) completed six EMA prompts per day for two weeks. Three-level multilevel models, nesting prompts (Level 1) within days (Level 2) within participants (Level 3), were used to examine concurrent and prospective predictors of suicidal behaviors. Several factors, including general rumination (OR = 2.03, p = .049), suicide-specific rumination (OR = 13.88, p < .001), physical distance to suicide methods (OR = 3.09, p = .002), psychological distance to suicide methods (OR = 2.34, p = .042), and life event stress (OR = 1.96, p < .001), were significant prompt-level predictors of concurrent suicidal behaviors. However, no significant day-level or participant-level predictors of concurrent suicidal behaviors emerged. Furthermore, prospectively, there were no significant predictors of subsequent time-point suicidal behaviors at any level. Overall, this study provides preliminary evidence for the roles of perseverative thinking, lethal means accessibility, and stressful life events as correlates of suicidal behaviors. Notably, however, these findings also highlight the difficulties in predicting future suicidal behaviors.