Separating presence from severity in suicidal ideation: Evidence from multilevel hurdle models

Area of Science:

• Psychiatry and Mental Health
• Adolescent Psychology
• Quantitative Psychology

Background:

• Suicidal ideation is often treated as a continuous process, potentially masking distinct mechanisms for its occurrence versus severity.
• Existing analytical methods may not adequately capture the episodic nature of suicidal ideation, particularly in acute psychiatric samples.
• Understanding the differential impact of affective states on suicidal ideation is crucial for targeted interventions.

Purpose of the Study:

• To investigate whether affective states differentially predict the occurrence and severity of suicidal ideation in psychiatrically acute adolescents.
• To explore the distinct roles of within-person (momentary) and between-person (average) affective states.
• To apply multilevel hurdle models to capture the episodic structure of suicidal ideation.

Main Methods:

• Utilized ecological momentary assessment (EMA) data from 244 psychiatrically acute adolescents with recent suicidal thoughts.
• Applied multilevel hurdle models to separate suicidal ideation into presence (binary) and severity (continuous, conditional on presence).
• Analyzed concurrent and lagged associations of negative and positive affect (within- and between-person components) while controlling for temporal persistence.

Main Results:

• Person-level average negative affect strongly predicted the occurrence of suicidal ideation.
• Momentary negative affect fluctuations weakly predicted the presence of suicidal ideation but significantly predicted increased severity.
• Positive affect showed modest concurrent associations with lower ideation presence and severity but did not reliably predict future ideation.

Conclusions:

• Affective states, particularly negative affect, may act more as amplifiers of suicidal ideation severity than as acute triggers for its presence.
• Multilevel hurdle models provide a valuable framework for analyzing the episodic nature of suicidal ideation.
• Findings suggest potential for real-time prevention strategies targeting affective states to manage ideation severity.