Social support predicts longitudinal reductions in suicidal ideation among patients on a waitlist for psychiatric treatment

Abstract

Social support is a protective factor for suicide and suicidal ideation (SI). However, inconsistencies exist regarding which aspects of social support are most protective for SI, potentially due to overlap amongst social support subscales. This study used bifactor modeling to test the cross-sectional and longitudinal relations between social support and SI, as bifactor modeling allows for the examination of subscale-specific relations after accounting for shared variance across all social support items (i.e., a general social support factor). Participants were 2445 adults on a waitlist for outpatient psychiatric treatment (M age = 37.74; SD = 14.75; 72.11% female) enrolled in a clinical trial assessing mobile app interventions. Participants completed a baseline measure of social support to assess appraisal support, belonging support, and tangible support, and an SI measure at baseline and 6-week follow-up. Confirmatory factor analysis compared correlated-factor and bifactor models of social support and examined associations with SI. A bifactor model of social support fit the data best. The general Social Support factor was negatively associated with SI at baseline and at 6-week follow-up. The specific social support factors explained minimal variation in SI after controlling for the general social support factor. Findings suggest that general social support, rather than lower-order dimensions, may be most relevant to assess when evaluating predictors of SI. Findings are consistent with theoretical accounts that suggest social support protects against escalating SI. Interventions targeting social support hold promise for ameliorating SI among individuals on waitlists for psychiatric treatment.