2 - (SYM 87) One of Us Is Not Like the Other: Extreme Individual Differences in Risk Factors for Suicidal Ideation in at Risk Service Members and Veterans

Background: Suicidal ideation (SI) and behaviors are elevated among active-duty service members (ADSM) and Veterans. Hence, it is a priority to examine maintenance factors underlying SI among ADSM and Veterans to develop effective, targeted interventions. In particular, interpersonal risk factors, hopelessness, and overarousal are robustly connected to SI within these groups.

Methods: To identify the most relevant SI risk factors, we employed network analysis to examine between-subjects (cross-sectional), contemporaneous (within seconds), and temporal (across four hours) group- and individual-level networks of SI and related risk factors in a sample of ADSM and Veterans (participant n=92, observations n=10,650). To be eligible, participants (Mage = 32.16 [8.6]; male [75.8%]; white [81.8%], active duty Army [58.66]) had to report SI and/or a suicide attempt. Participants completed ecological momentary assessment (EMA) surveys 4x/day for 30 days where they answered questions related to SI and SI risk factors.

Results: Eight items assessing SI (active and passive), not feeling close to others, feeling ineffective, disgust/shame, hopelessness, irritability, and sleep problems were included in the networks. The between-subjects and contemporaneous networks identified agitation, not feeling close to others, and ineffectiveness as the most central symptoms. The temporal network revealed that feeling ineffective was most likely to influence other symptoms over time. For the individual networks, there was significant variability in the most central symptoms for each participant, where every symptom emerged as a top symptom in at least one participant’s temporal and contemporaneous networks. In individual contemporaneous networks, hopelessness was the most common symptoms with the highest expected influence. In individual temporal networks, hopelessness and active SI were the most common symptoms with the highest OutExpectedInfluence.

Conclusion: Group level findings suggest that ineffectiveness, low belongingness, and agitation are important drivers of moment-to-moment and longitudinal relations between risk factors for SI in ADSM and Veterans. Individual level analyses indicated extreme variability in the most central symptoms for each participant. This means there may be multiple, unique routes to experiencing SI. This individual variability may explain why many of our treatments developed based on “on-average” targets may not always work suggests consideration of data-driven personalized medicine approaches.