Saturday, 15 January 2005 - 4:00 PM

This presentation is part of: Suicide in Young Adults

A Sudden Decision: Variability in suicidality in multiple, single and non- suicide attempters

Purpose: There has been no study of the daily variability of suicidality, in spite of findings suicidality predicts suicide attempts (Joiner, 2002) and that suicide itself often comes as a surprise to workers (Saarinen, Hintikka & Lehtonen, 1998). This study tests two hypotheses, first, that mean daily variability in suicidality is statistically significantly different from zero regardless of history of suicide attempts, and second, that individuals with a history of multiple suicide attempts will show increased variability in suicidality. This second hypothesis would be expected to hold if Beck’s (1996) theory that multiple suicide attempts can make suicide-related cognitions more available were correct.

Methodology: Sixty-eight university undergraduates kept daily suicidality ratings on the Suicide Probability Scale (SPS) a 36-item, self-report measure of attitudes and behaviors related to suicide risk for periods of five or six weeks. Logarithms of the Mean Squared Successive Differences (MSSD) of the daily scores were used as a measure of the variability of each participant’s suicidality. MSSD is a standard measure of time series variability in which the sum of squared first lag differences is divided by the number of points in the time series minus one (Woyshville, Lackamp, Eisengart & Gilliland, 1999). Participants also kept daily ratings of their hopelessness on the Beck Hopelessness Scale (BHS), depression on the Beck Depression Inventory (BDI) and reported previous attempt status in a questionnaire administered at the beginning of the study. The difference of logged SPS MSSD scores from zero was analyzed using a 95% confidence level, while the ability of previous attempt status to predict logged mean SPS MSSD was analyzed using multiple regression.

Results: The mean logarithm of SPS MSSD was statistically significantly greater than zero regardless of a previous history of zero, one or multiple suicide attempts (CI = 2.57 ± .48, 2.96 ± .66 and 4.34 ± .71, respectively). Regression analysis indicated that previous attempt status was a statistically significant predictor of the logarithm of SPS MSSD (t = 3.107, p < .01) while controlling for the number of days spent in the study, mean BHS during the study and mean BDI during the study.

Implications: This study highlights both the presence of daily variability in suicidality and its positive association with multiple suicide attempts. This suggests that it may be of value for social workers to assess this variability in addition to assessing the current level of suicidality in clients.

References Beck, A.T. (1996). Beyond belief: A theory of modes, personality, and psychopathology. Frontiers of Cognitive Therapy. In P.M. Salkovkis (Ed.), Frontiers of Cognitive Therapy (pp. 1-25). New York: Guilford. Joiner, T.E. (2002). The trajectory of suicidal behavior over time. Suicide and Life- Threatening Behavior, 32, 33-41. Saarinen, P., Hintikka, J. & Lehtonen, J. (1998). Somatic symptoms and risk of suicide. Nordic Journal of Psychiatry, 52(4), 311-317. Woyshville, M.J., Lackamp, J.M., Eisengart, J.A., Gilliland, J.A.M. (1999). On the Meaning and Measurement of Affective Instability: Clues from Chaos Theory. Society of Biological Psychiatry, 45, 261-269.

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