Expecting a Future Suicide Attempt Predicts Suicidal Behavior Among High-Risk Veterans

Expectations about the future are central to theories of suicide. However, the clinical relevance of an individual's direct expectation of a future suicide attempt is not well understood. This study examined the correlates and prospective significance of expecting a future suicide attempt in a high-risk cohort.

Veterans at high risk of suicide (N = 126) were tracked for 365 days during a randomized clinical trial. Chi-square tests and Wilcoxon rank-sum tests were used for cross-sectional comparisons and Cox proportional hazards regression was used for prospective prediction of suicidal behavior.

Veterans who expected a future suicide attempt had higher rates of preparation for suicide, recent suicidal behavior, and perceived access to a method and opportunity for suicide than those who did not expect one. Groups did not differ in hopelessness, positive and negative expectations toward the future, and perceived suicide-related coping. Veterans who expected a suicide attempt had elevated risk of suicidal behavior.

Risk factors differentiated Veterans who did and did not expect a future suicide attempt, yet this expectation predicted suicidal behavior independent of these factors. Research on how individuals anticipate their own suicidal behavior may clarify the transition from suicidal thoughts to behavior and facilitate suicide prevention.