Persistent suicidality: a concept analysis using Rodgers' evolutionary approach

Suicidality is often understood as an acute crisis, yet it can also present as a persistent condition. Chronic or persistent suicidality (PS) remains conceptually underdefined, and existing literature provides varied operationalisations, underscoring the need for conceptual clarity. To clarify the concept of PS, an evolutionary concept analysis of the available literature was conducted. Following a systematic search across six databases, surrogate and related terms, antecedents, attributes, and consequences were identified in 45 included sources (1974-2025) and narratively synthesised according to Rodgers' evolutionary framework. The literature characterises PS as an ego-syntonic, fluctuating phenomenon. Its core attributes include serving as a functional tool for psychological regulation. While frequently associated with personality pathology, the analysis reveals that PS manifests across various psychiatric diagnoses. The identified consequences include a discrepancy between acute risk protocols and clinical care tailored to the nature of PS, aiming to avoid potential iatrogenic risks. This study establishes the conceptual groundwork for viewing PS as a transdiagnostic phenomenon, providing a step toward a shared understanding. The findings support a shift from rigid diagnostic categories toward a dimensional perspective that captures the fluctuating severity and persistence of the patient's experiences.