(PS13-60) Uncontrollability of Suicidal Thoughts as a Predictor of Suicidal Ideation and Behavior

Suicidal thoughts and behaviors (STBs) represent a major public health concern but remain challenging to predict and prevent. Research has investigated risk factors associated with STBs, but most studies have focused on a narrow range of risk factors (Franklin et al., 2017). One understudied potential risk factor is perceived uncontrollability of suicidal thoughts, which has been linked to suicidal ideation in community-based (Rogers et al., 2021) and Veteran samples (Udapa et al. 2023). The perception that one’s suicidal thoughts are uncontrollable may lead to future suicidal ideation (SI) and behavior (SB) by increasing hopelessness, which contributes to STBs according to the prominent Three-Step Theory (Klonsky et al., 2021). The present study aimed to longitudinally evaluate perceived uncontrollability of suicidal thoughts as a prospective predictor of SI and SB in an inpatient population at high risk for suicide.

Participants were 88 adult psychiatric inpatients hospitalized for SI or a suicide attempt in the past month. Hierarchical multiple regression analyses were conducted to determine whether past-month uncontrollability, as measured by the C-SSRS during baseline assessment, predicted the severity of past-month SI (C1-C5 maximum score) assessed at two-month and six-month follow-up, controlling for baseline measures of past-month severity of SI. Additional hierarchical multiple regression analyses were conducted to determine whether past-month uncontrollability at baseline predicted the presence of SB (presence of at least one of the following: actual, interrupted, or aborted attempt, or preparatory behavior) since last assessment at two-month and six-month follow-up, controlling for history of SB at baseline.

Baseline uncontrollability did not predict severity of SI or SB at two-month follow-up; however, baseline uncontrollability significantly predicted SI severity at six-month follow-up, t(87) = 3.32, p = .001, and accounted for 10% of the variance in SI severity. Similarly, baseline uncontrollability significantly predicted SB at six-month follow-up, t(87) = 2.12, p = .037, and accounted for 4% of the variance in SB. 

Findings suggest that uncontrollability of SI predicts SI severity and SB six months after baseline above and beyond severity of SI and history of SB at baseline, meaning uncontrollability explains unique variance in severity of SI and SB after accounting for historical severity of SI and SB; this points to uncontrollability as a useful risk indicator. Our findings also suggest that uncontrollability of SI may be a relevant long-term but not short-term risk factor for suicide. Given these findings, individuals with more uncontrollable SI before hospitalization may benefit from additional support after discharge to manage long-term risk of SI and SB. Future research may examine how uncontrollability predicts SI and SB across time to better understand the timescale in which uncontrollability functions as a risk factor for increased SI and SB.