(PS9-A20) Within-person Change in Distress Intolerance Predicts Near-term Suicidal Ideation in a High-risk Sample of Community Adults

According to the World Health Organization (2018), suicide is the 4^th leading cause of death worldwide, with about 800,000 lives lost to suicide each year. Suicidal ideation (SI) is a strong predictor of suicide (Large et al., 2021). Therefore it is essential to understand the risk and protective factors associated with SI in order to advance suicide prevention efforts. Cross-sectional research has found that SI is positively correlated with distress intolerance (i.e., difficulties focusing on goals and values in the face of discomfort) on a between-person level (Anestis et al., 2011; Anestis et al., 2013; Kratovic et al., 2012). The present study advances this literature by examining the relationship between distress intolerance and SI on a within-person level using ecological momentary assessment (EMA).

We hypothesized that higher levels of distress intolerance at one time would predict an increase in SI over the next 3 hours. To test this hypothesis, participants who endorsed a history of self-harm and/or suicidal ideation were recruited from the Bronx, NY. The final sample included 61 adults (56% female, 85% people of color, M_age=36.2 years) who completed a 10-day EMA study with 4 assessments per day separated by approximately 3 hours. Distress intolerance (e.g., “right now, my emotions are getting in the way”) and SI (e.g., “life was not worth living”) were assessed at each EMA prompt. 

We used multilevel modeling to examine how subjective reports of distress intolerance at a given assessment point were associated with reports of SI over the next three hours . Our results revealed at the within-person level distress intolerance positively and significantly predicted SI at the next time point (β = .12, p  = < .001). At the between-person level (i.e., aggregating across all EMA prompts), the association was much stronger (β = .48, p < 0.001). About half of the total variance in SI was due to between-person differences (ICC = .53), while about one third of variance in distress intolerance was due to between-person differences (ICC = .31). 

Overall, the between-person results indicate that individual differences in distress intolerance were strongly associated with individual differences in intensity of SI over the 10-day study period, corroborating findings from previous cross-sectional research. The within-person results indicate that when people were more intolerant of distress than usual, their SI over the next three hours was more intense than usual, although this association was smaller. That over half the variability in distress intolerance was due to within-person differences illustrates that an individual’s distress intolerance can vary widely from occasion to occasion. This result is consistent with the idea that distress tolerance skills are a useful target in treatments for suicide, including for people of color, such that increasing these skills can help individuals withstand intense emotions during short-term crisis situations.