A Daily Diary Study of How Affective States Are Associated with and Predict Suicidal Ideation in Adults Seeking Intensive Outpatient Treatment.

Abstract

Objective: Negative affective states are known risk factors for suicidal ideation (SI). However, most research to date has used cross-sectional or longitudinal designs with long follow-up periods to understand these relationships. Thus, the current study aimed to understand how specific negative affective states may act as acute risk factors for same day SI and predict next day SI.

Methods: Daily diary cards from 83 adults (4,648 observations; M_age = 29.5; 67% female; 61% White) seeking treatment at an 8-week dialectical behavioral therapy (DBT) intensive outpatient program were analyzed. Sadness, anger, anxiety, guilt, and shame were independently evaluated to understand their association with same day SI intensity and examine how they predicted next day SI intensity.

Results: Multilevel regression revealed at the within person level that increases in all five affective states was associated with same day SI. However, only increased sadness and guilt, and decreased anxiety, predicted next day SI, covarying for same day SI.

Conclusion: Sadness and guilt may be salient acute risk factors for next day SI. Clinicians who implement treatments that use daily diary cards, such as DBT, may want to attend to these specific affective states when monitoring client diary cards and during suicide risk assessment.