Kivelä L M M, van der Does A J W, Gilissen R, Antypa Niki
Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.
Leiden University Treatment and Expertise Center (LUBEC), Leiden, The Netherlands.
Acta Psychiatr Scand. 2025 Mar;151(3):375-387. doi: 10.1111/acps.13750. Epub 2024 Aug 26.
Suicidal ideation variability refers to within-day fluctuations in suicidal ideation, and has recently been proposed as an indicator of suicide risk. However, not much is known yet about its correlates and clinical relevance.
We examined characteristics of real-time suicidal ideation using Ecological Momentary Assessment in 82 individuals with current active suicidal ideation. Data were collected four times daily over 21 days. Latent profile analysis was used to identify subtypes of suicidal ideation. We further examined sociodemographic and clinical correlates of the profiles, and their association with the occurrence of suicide attempts during a 1-year follow-up.
We identified three "digital" phenotypes of suicidal ideation that differed on the frequency, intensity and variability of ideation. The profiles were: high frequency, high intensity, moderate variability (Phenotype 1), moderate/high frequency, moderate intensity, high variability (Phenotype 2), and moderate frequency, low intensity, low variability (Phenotype 3). Phenotypes 1 and 2 were associated with a worse clinical profile at baseline (higher suicidal ideation and depressive symptom severity), and increased odds of suicide attempt during follow-up, compared to Phenotype 3. Phenotype 1 was further characterized by repeated suicidal behavior.
Two phenotypes of real-time suicidal ideation were identified that appear to confer a higher risk of suicidal behavior in the near future (12 months). These phenotypes were characterized by higher variability of suicidal ideation-and also higher intensity and frequency of ideation. Considering the small sample size, the clinical usefulness of the profiles remains to be demonstrated.
自杀意念变异性是指自杀意念在一天内的波动，最近被提出作为自杀风险的一个指标。然而，关于其相关因素和临床相关性，目前所知甚少。
我们使用生态瞬时评估法对82名当前有活跃自杀意念的个体的实时自杀意念特征进行了研究。在21天内每天收集4次数据。采用潜在剖面分析来识别自杀意念的亚型。我们进一步研究了这些剖面的社会人口学和临床相关因素，以及它们与1年随访期间自杀未遂发生情况的关联。
我们识别出了三种自杀意念的“数字”表型，它们在自杀意念的频率、强度和变异性方面存在差异。这些剖面分别是：高频率、高强度、中等变异性（表型1），中等/高频率、中等强度、高变异性（表型2），以及中等频率、低强度、低变异性（表型3）。与表型3相比，表型1和表型2在基线时具有更差的临床特征（更高的自杀意念和抑郁症状严重程度），并且在随访期间自杀未遂的几率增加。表型1的进一步特征是反复出现自杀行为。
识别出了两种实时自杀意念表型，它们似乎在不久的将来（12个月）会带来更高的自杀行为风险。这些表型的特征是自杀意念变异性更高，同时自杀意念的强度和频率也更高。考虑到样本量较小，这些剖面的临床实用性仍有待证明。
