3 - SYM (105) Suicide Ambivalence: Resolved Wish to Die as a Clinical Marker of High Risk

Background: Suicide ambivalence, typically defined as fluctuations in an individual’s wish to live (WTL) and wish to die (WTD), is a developing theory of suicide risk that incorporates a more dynamic approach to understanding suicide ideation, intent, and motivation to die. Suicide ambivalence is typically operationalized as the difference between WTL and WTD, as measured from the Beck Scale for Suicide Ideation (BSS: Beck et al., 1988) self-report measure. This measure (BSS) and definition of suicide ambivalence has been used in previous research (Mitchell et al., in press), with variable findings with regard to suicide ideation latent classes. Previous research has also found evidence to suggest that suicide ambivalence is predictive of suicidal desire, primarily driven by changes in WTD (Oakey-Frost, 2023). Given previous research, we investigated typologies in WTD and WTL characterized by ambivalent (differences in WTL and WTD) and non-ambivalent (resolved WTL and resolved WTD) suicidality to identify individuals at higher risk of suicide.

Methods: 200 individuals admitted for suicidality at an inpatient facility reported WTL and WTD scores at intake and throughout 6 months. Suicide ambivalence was translated to a categorical variable from a continuous measure (0-8) comprised of two items with single ratings of WTL and WTD, with scores of 0-3 indicating low levels of WTL or WTD and scores of 5-8 indicating high levels of WTL or WTD. Exploratory analyses on the construct of resolved wish to die (non-ambivalence regarding high WTD and low WTL) were conducted.

Results: Resolved wish to die was effective at differentiating those making multiple suicide attempts, those with more severe symptom profiles, inpatient readmissions, and evidenced promising levels of specificity (92.1%) and positive predictive value (50%) for suicide attempts relative to other variables.

Conclusion: Identifying resolved wish to die in clinical settings can be accomplished with two simple questions and used as part of a broader suicide risk evaluation strategy. In totality, the most compelling evidence of utility of the construct of suicide ambivalence is that individuals identified with resolved wish to die, compared to all other categories that have some level of ambivalence, predict the presence or absence of inpatient readmissions and suicide attempts at follow-up. WTL and WTD are important constructs, and we posit that these commonly used measures can be used to assess suicide ambivalence in a clinically meaningful way by further evaluating resolved ambivalence.