(PS13-14) Patterns of Adolescent Suicidal Ideation Associated with Internal and External Precipitants

Introduction: While suicide ideation (SI) is common in adolescents, there is a limited understanding of acute precipitants of adolescent SI. We sought to examine youth who presented with SI in response to an external precipitant (e.g., interpersonal conflict, failure) or an internal precipitant (e.g., thoughts, feelings), and whether they exhibit any differences in their pattern of ideation and whether their SI resulted in a suicide attempt (SA).

Methods: 170 adolescents, ages 12-17 years old (M = 14.5, SD = 1.66) were recruited after presenting to public New York City hospitals for suicidal ideation (n = 107) or a suicide attempt (n = 63) within the preceding 2 weeks. 82% of participants were born female, 25% identified as a gender minority, 72% as a racial minority, and 64% as Hispanic/Latine. Participants completed the Adolescent Suicide Ideation Interview (Miranda et al., 2021) where they were asked questions about the precipitants, form, and content of the SI that prompted their presentation to the hospital. Participants were then grouped into one of three subtypes: brief SI (n = 57), consisting of SI lasting less than 2 weeks, intermittent SI (n = 69), consisting of SI occurring on and off for two or more weeks, or persistent SI (n = 44), consisting of daily SI for two or more weeks.

Results: 44% adolescents reported that their SI was in response to an external precipitant, while 54% reported responding to an internal precipitant. The proportion of adolescents who reported an internal precipitant significantly differed by SI subtype, χ2(2) = 13.47, p = .001. An even distribution of those with brief (50%) and intermittent SI (45) reported an internal precipitant, while the majority of those with persistent SI reported an internal precipitant (79%; z = 3.6). Type of SI precipitant was not significantly associated with whether that SI was followed by a suicide attempt, χ2(1) = 2.502, p = .114.

Conclusions: These findings suggest that persistent SI tends to arise in response to an internal precipitant, while brief SI is equally likely to arise in response to internal or external precipitants. Therefore, treatment for persistent SI may require addressing internal precipitants, such as mood and cognitions, while treatment following brief SI may focus on addressing responses to external events.