Real-Time Prediction of Active and Passive Suicidal Ideation and the Moderating Role of Suicide Attempts

Active suicidal ideation and passive suicidal ideation are distinct but related constructs, each carrying significant clinical implications. However, their real-time predictors remain underexplored in intensive longitudinal studies. This ecological momentary assessment (EMA) study investigated the associations of thwarted belongingness (TB), perceived burdensomeness (PB), and hopelessness with changes in both types of ideation at 2-4 h intervals, and whether a history of suicide attempts moderates these relationships.

Thirty-one college students (23 females; mean age = 19.83 ± 1.86 years) with current suicidal ideation participated, 17 of whom (54.84%) had a history of suicide attempts. Participants completed EMA assessments five times daily for one week. Data were analyzed using mixed linear models.

TB (β = 0.05, p = 0.007) and hopelessness (β = 0.09, p = 0.006) predicted next-moment active ideation, but these associations became insignificant after all covariates were considered. PB was a robust predictor (β = 0.04, p = 0.032) of subsequent passive ideation, even after accounting for TB, hopelessness, and prior ideation. Notably, hopelessness predicted subsequent active ideation (β = 0.12, p = 0.034) only in participants with a history of suicide attempts.

These findings underscore the distinct predictive roles of PB, TB, and hopelessness, highlighting the importance of considering suicide attempt history in risk assessment for suicidal ideation.