Year: 2023 Source: Research Square. (2023). 1-22. DOI: SIEC No: 20231866
Imminent suicide is difficult to predict. Suicide usually occurs on the first attempt. Suicide may consist of suicidal crises, with fluctuating and unpredictable risk, superimposed on long-term latent susceptibility. Risk characteristics are consistent with interacting long-term (sensitization) and short-term (impulsivity) mechanisms: sensitization to stress/trauma perceived as inescapable, or to addiction, can increase latent action-impulsivity, disinhibiting high-risk behavior including suicidal ideation and aggression. Survived medically severe suicide attempts are associated with severe morbidity and premature death. Therefore, it is necessary to identify characteristics that may predict a first attempt. We used Bayesian logistic regression and path analysis to identify direct and indirect (via suicidal ideation-worst (SSI-W)) predictors of MSSA in 28 adult survivors of MSSA and 23 symptomatically and demographically similar non-attempters (NA). SSI-W increased odds ratio (OR) for MSSA; Cumulative Adversity and action-impulsivity increased OR for MSSA independent of SSI-W. SSI-W mediated increased MSSA by aggression, alcohol use, and depression. Childhood Trauma Minimization/Denial increased MSSA directly but correlated negatively with SSI-W. MSSA required latent aggression or impulsivity combined with stress-sensitization and increased action-impulsivity. These interacting characteristics are potential targets for identification and preventive treatment of risk for suicide regardless of attempt history.