The frequency of negative automatic thoughts may predict near-term suicide attempt in high-risk patients

Negative automatic thoughts feature centrally in psychiatric disorder but are rarely studied in the prediction of suicide attempts. This study tested whether negative automatic thoughts could prospectively predict suicide attempt or other suicide event (aborted or self-interrupted attempt, preparatory behavior or suicidal ideation resulting in hospitalization) within a 90-day window among high suicide risk patients. Sixty Veterans at high risk of suicide completed assessments of negative automatic thoughts at multiple timepoints over a 1-year period. Each assessment session was then coded according to whether the participant made a suicide attempt or had an other suicide event in the following 90 days. Generalized Estimating Equations (GEE) were used to evaluate the incremental utility of (1) negative automatic thoughts and (2) acquired capability for suicide on predicting 90-day suicide attempt or other suicide event over established suicide risk factors, including lifetime number of suicide attempts, concurrent suicidal ideation, depressive symptom severity and hopelessness. The odds of a 90-day suicide attempt were significantly greater with more frequent negative automatic thoughts (OR = 1.06 [95% CI 1.03-1.09], p < .001); however, negative automatic thoughts did not significantly predict a near-term other suicide event (excluding an actual attempt). Acquired capability did not add to the near-term prediction of either suicide attempt or other suicide event. The study was a secondary analysis of data collected from a small sample, and thus, findings require replication. Near-term suicide attempts were rare even in this high-risk sample. Nevertheless, findings provide preliminary evidence for depressionogenic thought content in suicide attempt risk, and suggest a more direct link between negative automatic thoughts and suicide attempt than posited in contemporary theories.