Suicidal ideation trajectories among adults following psychiatric hospitalization

Although suicidal behaviors following psychiatric hospitalization have been well characterized, there is a paucity of literature on trajectories of suicidal ideation (SI) among civilian adults during this period. This study examined SI trajectories following psychiatric hospitalization among adults enrolled in a randomized controlled trial of a peer support intervention. Participants were individuals hospitalized following a recent suicide attempt and/or with SI (N = 455; mean age = 32.0, SD = 13.7; 60.0% female) who completed assessments at baseline, 3 months, and 6 months. Growth mixture modeling identified SI trajectories, which were compared across baseline risk factors and used to predict non-fatal suicide attempts throughout the study. Results revealed three trajectories: High Chronic (N = 57; 12.5%), Moderate Steadily Declining (N = 82; 18.0%), and Moderate Rapidly Declining (N = 316; 69.5%). Study arm was not associated with trajectory. The High Chronic and Moderate Steadily Declining trajectories had higher hopelessness, perceived burdensomeness, thwarted belongingness, and loneliness relative to the Moderate Rapidly Declining trajectory, with the High Chronic trajectory also having higher depression relative to the Moderate Rapidly Declining trajectory. The only difference between the High Chronic and Moderate Steadily Declining trajectories was that High Chronic trajectory was more likely to have had prior suicidal behavior. The likelihood of having a non-fatal suicide attempt during follow-up was higher in the High Chronic trajectory than the other trajectories. Findings suggest that distinct SI trajectories are present following psychiatric hospitalization. Risk factors differentiated individuals with declining SI from those with continued SI; however, more work is needed to elucidate predictors of the highest-risk trajectory.