A within-person approach to risk for suicidal ideation and suicidal behavior: Examining the roles of depression, stress, and abuse exposure

Adam Bryant Miller*, Tory Eisenlohr-Moul, M. Giletta, Paul D. Hastings, Karen D. Rudolph, Matthew K. Nock, Mitchell J. Prinstein

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Objective:

This study tests a novel, within-person model that reexamines depression and stress as risk factors for suicidal ideation and behavior among adolescent girls with and without sexual/physical abuse histories.

Method:

This longitudinal study includes data from 220 adolescent girls between 12 and 16 years of age (M = 14.69 years, SD = 1.37; 61% White). At baseline, adolescents reported the presence or absence of prior abuse as part of a clinical interview. At baseline and every 3 months for 18 months, adolescents completed measures of suicidal ideation and behavior, depressive symptoms, and stress.

Results:

Multilevel models examined within-person mean, deviations from within-person mean, depression, and stress and their interactions with abuse as predictors of suicidal ideation and behavior. In addition to within-person mean depression, higher-than-usual depression (odds ratio [ OR] = 1.99) and higher-than-usual stress (OR = 1.53) predicted greater risk of suicidal ideation at each follow-up assessment. Periods of higher-than-usual stress (1 SD increase) and periods of higher-than-usual depression (1 SD increase) were associated with an 82% and 57% increase in the odds of suicidal behavior, respectively, but only among those with abuse histories.

Conclusion:

Depression, stress, and abuse are well-known risk factors for suicidal ideation and behavior; however, it has been unclear for whom, and when, these factors have their greatest impact. These results show that depression and stress are potent risk factors among those with a history of abuse and that within-person elevations in these risk factors signal increased short-term risk of suicidal ideation and behavior.

What is the public health significance of this article?

This study's results demonstrate that worsening depression and increasing stress compared with a youth's typical level of depression and stress may signal potential time frames of increased risk for suicidal behavior among those with childhood abuse histories. This study highlights the importance of considering within-person changes in known risk factors for suicidal ideation and behavior. Clinically, results underscore the importance of routine outcome monitoring to track clinical progress and increased vigilance for potentially risky times for suicidal ideation and behavior.

Original languageEnglish
Pages (from-to)712-722
JournalJournal of Consulting and Clinical Psychology
Volume85
Issue number7
DOIs
Publication statusPublished - Jul 2017

Keywords

  • suicidal ideation
  • suicide attempts
  • child adversity
  • depression
  • stress
  • CHILDHOOD ADVERSITY
  • LIFE EVENTS
  • SELF-HARM
  • ADOLESCENT DEPRESSION
  • EARLY ADULTHOOD
  • MALTREATMENT
  • SENSITIZATION
  • TRAJECTORIES
  • PREDICTORS
  • CHILDREN

Cite this

Miller, Adam Bryant ; Eisenlohr-Moul, Tory ; Giletta, M. ; Hastings, Paul D. ; Rudolph, Karen D. ; Nock, Matthew K. ; Prinstein, Mitchell J. / A within-person approach to risk for suicidal ideation and suicidal behavior : Examining the roles of depression, stress, and abuse exposure. In: Journal of Consulting and Clinical Psychology. 2017 ; Vol. 85, No. 7. pp. 712-722.
@article{1e26d9f089704676874b8181ff3a98d4,
title = "A within-person approach to risk for suicidal ideation and suicidal behavior: Examining the roles of depression, stress, and abuse exposure",
abstract = "Objective: This study tests a novel, within-person model that reexamines depression and stress as risk factors for suicidal ideation and behavior among adolescent girls with and without sexual/physical abuse histories. Method: This longitudinal study includes data from 220 adolescent girls between 12 and 16 years of age (M = 14.69 years, SD = 1.37; 61{\%} White). At baseline, adolescents reported the presence or absence of prior abuse as part of a clinical interview. At baseline and every 3 months for 18 months, adolescents completed measures of suicidal ideation and behavior, depressive symptoms, and stress. Results: Multilevel models examined within-person mean, deviations from within-person mean, depression, and stress and their interactions with abuse as predictors of suicidal ideation and behavior. In addition to within-person mean depression, higher-than-usual depression (odds ratio [ OR] = 1.99) and higher-than-usual stress (OR = 1.53) predicted greater risk of suicidal ideation at each follow-up assessment. Periods of higher-than-usual stress (1 SD increase) and periods of higher-than-usual depression (1 SD increase) were associated with an 82{\%} and 57{\%} increase in the odds of suicidal behavior, respectively, but only among those with abuse histories. Conclusion: Depression, stress, and abuse are well-known risk factors for suicidal ideation and behavior; however, it has been unclear for whom, and when, these factors have their greatest impact. These results show that depression and stress are potent risk factors among those with a history of abuse and that within-person elevations in these risk factors signal increased short-term risk of suicidal ideation and behavior.What is the public health significance of this article?This study's results demonstrate that worsening depression and increasing stress compared with a youth's typical level of depression and stress may signal potential time frames of increased risk for suicidal behavior among those with childhood abuse histories. This study highlights the importance of considering within-person changes in known risk factors for suicidal ideation and behavior. Clinically, results underscore the importance of routine outcome monitoring to track clinical progress and increased vigilance for potentially risky times for suicidal ideation and behavior.",
keywords = "suicidal ideation, suicide attempts, child adversity, depression, stress, CHILDHOOD ADVERSITY, LIFE EVENTS, SELF-HARM, ADOLESCENT DEPRESSION, EARLY ADULTHOOD, MALTREATMENT, SENSITIZATION, TRAJECTORIES, PREDICTORS, CHILDREN",
author = "Miller, {Adam Bryant} and Tory Eisenlohr-Moul and M. Giletta and Hastings, {Paul D.} and Rudolph, {Karen D.} and Nock, {Matthew K.} and Prinstein, {Mitchell J.}",
year = "2017",
month = "7",
doi = "10.1037/ccp0000210",
language = "English",
volume = "85",
pages = "712--722",
journal = "Journal of Consulting and Clinical Psychology",
issn = "0022-006X",
publisher = "AMER PSYCHOLOGICAL ASSOC",
number = "7",

}

A within-person approach to risk for suicidal ideation and suicidal behavior : Examining the roles of depression, stress, and abuse exposure. / Miller, Adam Bryant; Eisenlohr-Moul, Tory; Giletta, M.; Hastings, Paul D.; Rudolph, Karen D.; Nock, Matthew K.; Prinstein, Mitchell J.

In: Journal of Consulting and Clinical Psychology, Vol. 85, No. 7, 07.2017, p. 712-722.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - A within-person approach to risk for suicidal ideation and suicidal behavior

T2 - Examining the roles of depression, stress, and abuse exposure

AU - Miller, Adam Bryant

AU - Eisenlohr-Moul, Tory

AU - Giletta, M.

AU - Hastings, Paul D.

AU - Rudolph, Karen D.

AU - Nock, Matthew K.

AU - Prinstein, Mitchell J.

PY - 2017/7

Y1 - 2017/7

N2 - Objective: This study tests a novel, within-person model that reexamines depression and stress as risk factors for suicidal ideation and behavior among adolescent girls with and without sexual/physical abuse histories. Method: This longitudinal study includes data from 220 adolescent girls between 12 and 16 years of age (M = 14.69 years, SD = 1.37; 61% White). At baseline, adolescents reported the presence or absence of prior abuse as part of a clinical interview. At baseline and every 3 months for 18 months, adolescents completed measures of suicidal ideation and behavior, depressive symptoms, and stress. Results: Multilevel models examined within-person mean, deviations from within-person mean, depression, and stress and their interactions with abuse as predictors of suicidal ideation and behavior. In addition to within-person mean depression, higher-than-usual depression (odds ratio [ OR] = 1.99) and higher-than-usual stress (OR = 1.53) predicted greater risk of suicidal ideation at each follow-up assessment. Periods of higher-than-usual stress (1 SD increase) and periods of higher-than-usual depression (1 SD increase) were associated with an 82% and 57% increase in the odds of suicidal behavior, respectively, but only among those with abuse histories. Conclusion: Depression, stress, and abuse are well-known risk factors for suicidal ideation and behavior; however, it has been unclear for whom, and when, these factors have their greatest impact. These results show that depression and stress are potent risk factors among those with a history of abuse and that within-person elevations in these risk factors signal increased short-term risk of suicidal ideation and behavior.What is the public health significance of this article?This study's results demonstrate that worsening depression and increasing stress compared with a youth's typical level of depression and stress may signal potential time frames of increased risk for suicidal behavior among those with childhood abuse histories. This study highlights the importance of considering within-person changes in known risk factors for suicidal ideation and behavior. Clinically, results underscore the importance of routine outcome monitoring to track clinical progress and increased vigilance for potentially risky times for suicidal ideation and behavior.

AB - Objective: This study tests a novel, within-person model that reexamines depression and stress as risk factors for suicidal ideation and behavior among adolescent girls with and without sexual/physical abuse histories. Method: This longitudinal study includes data from 220 adolescent girls between 12 and 16 years of age (M = 14.69 years, SD = 1.37; 61% White). At baseline, adolescents reported the presence or absence of prior abuse as part of a clinical interview. At baseline and every 3 months for 18 months, adolescents completed measures of suicidal ideation and behavior, depressive symptoms, and stress. Results: Multilevel models examined within-person mean, deviations from within-person mean, depression, and stress and their interactions with abuse as predictors of suicidal ideation and behavior. In addition to within-person mean depression, higher-than-usual depression (odds ratio [ OR] = 1.99) and higher-than-usual stress (OR = 1.53) predicted greater risk of suicidal ideation at each follow-up assessment. Periods of higher-than-usual stress (1 SD increase) and periods of higher-than-usual depression (1 SD increase) were associated with an 82% and 57% increase in the odds of suicidal behavior, respectively, but only among those with abuse histories. Conclusion: Depression, stress, and abuse are well-known risk factors for suicidal ideation and behavior; however, it has been unclear for whom, and when, these factors have their greatest impact. These results show that depression and stress are potent risk factors among those with a history of abuse and that within-person elevations in these risk factors signal increased short-term risk of suicidal ideation and behavior.What is the public health significance of this article?This study's results demonstrate that worsening depression and increasing stress compared with a youth's typical level of depression and stress may signal potential time frames of increased risk for suicidal behavior among those with childhood abuse histories. This study highlights the importance of considering within-person changes in known risk factors for suicidal ideation and behavior. Clinically, results underscore the importance of routine outcome monitoring to track clinical progress and increased vigilance for potentially risky times for suicidal ideation and behavior.

KW - suicidal ideation

KW - suicide attempts

KW - child adversity

KW - depression

KW - stress

KW - CHILDHOOD ADVERSITY

KW - LIFE EVENTS

KW - SELF-HARM

KW - ADOLESCENT DEPRESSION

KW - EARLY ADULTHOOD

KW - MALTREATMENT

KW - SENSITIZATION

KW - TRAJECTORIES

KW - PREDICTORS

KW - CHILDREN

U2 - 10.1037/ccp0000210

DO - 10.1037/ccp0000210

M3 - Article

VL - 85

SP - 712

EP - 722

JO - Journal of Consulting and Clinical Psychology

JF - Journal of Consulting and Clinical Psychology

SN - 0022-006X

IS - 7

ER -