A controlled examination of acute warning signs for suicide attempts among hospitalized patients
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Abstract Background Near-term risk factors for suicidal behavior, referred to as ‘warning signs’ (WS), distinguish periods of acute heightened risk from periods of lower risk within an individual. No prior published study has examined, using a controlled study design, a broad set of hypothesized WS for suicide attempt. This study addressed this gap through examination of hypothesized behavioral/experiential, cognitive, and affective WS among patients recently hospitalized following a suicide attempt. Methods Participants were recruited during hospitalization from five medical centers across the USA including two civilian hospitals and three Veterans Health Administration facilities ( n = 349). A within-person case-crossover study design was used, where each patient served as her/his own control. WS were measured by the Timeline Follow-back for Suicide Attempts Interview and were operationalized as factors that were present ( v. absent) or that increased in frequency/intensity within an individual during the 6 h preceding the suicide attempt (case period) compared to the corresponding 6 h on the day before (control period). Results Select WS were associated with near-term risk for suicide attempt including suicide-related communications, preparing personal affairs, drinking alcohol, experiencing a negative interpersonal event, and increases in key affective (e.g. emptiness) and cognitive (e.g. burdensomeness) responses. Conclusions The identification of WS for suicidal behavior can enhance risk recognition efforts by medical providers, patients, their families, and other stakeholders that can serve to inform acute risk management decisions.
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Timeline follow-back interviews have identified other affective symptoms heightened during the crisis state, such as hostility, fearfulness, emptiness, self-hatred, and anger.
“Timeline follow-back interviews—in which individuals are retrospectively asked to give detailed accounts of the time just before a suicide attempt as compared to a control condition—have also identified other affective symptoms that are heightened during this crisis state, such as hostility, fearfulness, emptiness, self-hatred, and anger (Bagge et al., 2023; King et al., 2023).”
From Clinical indicators of the suicide crisis and response to ketamine (2025) · cites this paper as Bagge et al., 2023
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- Authors
- Bagge, C. L., Littlefield, A. K., Wiegand, T. J., Hawkins, E., Trim, R. S., Schumacher, J. A., Simons, K., & Conner, K. R.
- Affiliations
- University of Michigan (US)
- Texas Tech University (US)
- University of Rochester Medicine (US)
- University of Washington (US)
- University of California San Diego (US)
- University of Mississippi Medical Center (US)
- Corresponding author
- Bagge, Courtney L.
- ORCID
- Bagge, Courtney L.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2022-01-25
- Volume
- 53
- Issue
- 7
- Pages
- 2768-2776
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC10235647
- OpenAlex
- W4206986260
- Cited by
- 52
- References
- 30
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 14 · 2023: 8 · 2022: 4
- FWCI
- 9.83
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychological Medicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- suicide attempts, warning signs, hospitalized patients, alcohol consumption, emptiness, perceived burdensomeness, risk identification, suicide risk management
- MeSH terms
- Female, Humans, Risk Factors, Suicide, Attempted, Cross-Over Studies, Suicidal Ideation
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