(PS11-62) How Mood States Predict Next Day Suicidal Ideation in Treatment-seeking Adults: The Moderating Role of Dialectical Behavioral Therapy Skill Use

Background: Mood states have been found to be associated with suicidal ideation (SI). Little is understood about which specific mood states may act as an acute risk factor for next day SI, and whether interventions aimed at reducing SI effectively buffer against negative mood states to reduce the risk of next day SI. Dialectical behavioral therapy (DBT) is an evidence-based psychotherapy in which greater DBT skill use is associated with reduced SI. However, no studies have analyzed whether DBT skill use moderates the relationship between mood states and next day SI.

Methods: Over 2,400 assessments of daily diary card data from 83 adults (M_age = 29.5; 67% female; 61% White) seeking treatment at an 8-week DBT intensive outpatient program were analyzed. Sadness, anger, anxiety, guilt, and shame were independently evaluated as predictors of next day presence of SI. Daily total DBT skill use was evaluated as a moderator of the relationship between the mood states and next day presence of SI.

Results: Multilevel logistic regression models revealed that at the between person level, increased levels of sadness (B = 2.03, p < .001), guilt (B = 1.80, p < .001), shame (B = 1.69, p < .001), and anxiety (B = 0.84, p = .01) all significantly predicted next day SI, while anger (B = 0.58, p = .12), was a non-significant predictor. DBT skill use was found to be a non-significant predictor of next day SI across all models. The interaction between guilt and DBT skill use (B = 0.11, p = .01) was significant such that increased DBT skill use strengthened the relationship between guilt and next day SI. At the within person level, increased levels of sadness (OR = 1.36, 95%CI [1.23, 1.51], p < .001), guilt (OR = 1.24, 95%CI [1.05, 1.45], p = .01), and shame (OR = 1.20, 95%CI [1.06, 1.35], p = .003) were significantly predictive of next day SI, while anger was marginally significant (OR = 1.18, 95%CI [0.98, 1.43], p = .08), and anxiety was nonsignificant (OR = 0.99, 95%CI [0.86, 1.14], p = .85). DBT skill use was found to be a non-significant predictor of next day SI across all models. The interaction between sadness and DBT skill use (OR = 1.03, 95%CI [1.01, 1.05], p = .001) was significant such that increased skill use strengthened the relationship between sadness and next day SI.

Discussion: Across mood states, increased levels of sadness, guilt, and shame may be salient acute risk factors for next day suicidal thoughts. Further, the present study only assessed for the total number of DBT skills used and did not assess for client perception of successful or unsuccessful skill use. Thus, although greater DBT skill use was non predictive of next day SI, a more nuanced assessment of if DBT skill use was successful in alleviating symptoms may be needed to understand this relationship.