4 - (SYM 91) Negative Interpersonal Life Events and Proximal Associations with Passive and Active Suicidal Ideation in Psychiatrically Acute Adolescents: A 28-day Ecological Momentary Assessment Study

Background: In addition to being an antecedent to suicidal behavior, suicidal ideation (SI) is a clinically important outcome in its own right. SI includes both passive ideation (a desire to be dead) and active ideation (the desire to kill oneself). Relative to active SI, passive SI has been understudied in the literature, in part because of the implicit view that active SI is more related to risk for suicidal behavior. Recent meta-analytical work, however, challenges this common assumption. Additional work is therefore needed to characterize risk for passive SI and comparisons with active SI in terms of risk factors.

One risk factor of particular relevance to SI is negative life events (NLEs). The association with SI appears to be especially strong for interpersonal stressors. Most research has focused on assessments of NLEs over long periods of time, leaving unclear how these events may relate to SI on finer temporal scales, an important consideration given evidence that SI may fluctuate significantly over these briefer temporal scales and evidence that acute suicidal risk often manifests as very temporally delimited periods of arousal.

The current study evaluates prospective associations between NLEs, particularly interpersonal events, with next-day passive and active suicidal SI over a 28-day period using ecological momentary assessment (EMA). It was hypothesized that NLEs, particularly interpersonal ones, would be positive associated with next-day passive and active SI.

Methods: Adolescents (n = 19; 68.42% assigned female at birth; mean age = 15.05, SD = 1.65; 78.95% White, 31.58% Hispanic) admitted to a psychiatric inpatient facility were followed prospectively over 28 days post-discharge, during which they completed an EMA protocol consisting of five daily surveys about current passive and active SI, as well as a morning survey asking about experiences with NLEs over the past day.

Results: Total NLEs were associated with next-day passive (b = .09, p = .04) and active SI (b = .11, p < .01). These associations held when restricted to interpersonal life events (passive SI: b = .11, p = .04; active SI b = .10, p = .01).

Conclusion: NLEs (and interpersonal events) had similar associations with passive as with active SI. This is consistent with the broader literature showing modest differences between passive and active SI with respect to underlying risk factors. This pattern of findings supports the potential role of interpersonal NLEs as precipitants of passive and active SI, and more research on passive SI is warranted.