24-hour warning signs for adolescent suicide attempts
Open accessAbstract
BACKGROUND: youth may be at greatest risk for attempting suicide, which is critically important information for the parents, caregivers, and professionals who care for youth at risk. This study used adolescent and parent reports, and a case-crossover, within-subject design to identify 24-hour warning signs (WS) for suicide attempts. METHODS: = 1094, ages 13 to 18) with one or more suicide risk factors were enrolled and invited to complete bi-weekly, 8-10 item text message surveys for 18 months. Adolescents who reported a suicide attempt (survey item) were invited to participate in an interview regarding their thoughts, feelings/emotions, and behaviors/events during the 24-hours prior to their attempt (case period) and a prior 24-hour period (control period). Their parents participated in an interview regarding the adolescents' behaviors/events during these same periods. Adolescent or adolescent and parent interviews were completed for 105 adolescents (81.9% female; 66.7% White, 19.0% Black, 14.3% other). RESULTS: Both parent and adolescent reports of suicidal communications and withdrawal from social and other activities differentiated case and control periods. Adolescent reports also identified feelings (self-hate, emotional pain, rush of feelings, lower levels of rage toward others), cognitions (suicidal rumination, perceived burdensomeness, anger/hostility), and serious conflict with parents as WS in multi-variable models. CONCLUSIONS: This study identified 24-hour WS in the domains of cognitions, feelings, and behaviors/events, providing an evidence base for the dissemination of information about signs of proximal risk for adolescent suicide attempts.
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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 King et al., 2023
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Flagged first, then by citations
Research works printed but not linked: 2
- Bagge, C. L., Conner, K. R., & Littlefield, A. (2019, April). Validity of the Warning SIgns for Suicide Attempts Assessment -Adult Version. In C. King (Chair), Understanding proximal risk for suicide attempts. Paper presented at the American Association of Suicidology Annual Symposium, Denver, CO.
- Cheryl A. King et al. https://doi.org/10.1017/S0033291723003112 Published online by Cambridge University Press
Cited by
Sorted by citations
Clinical indicators of the suicide crisis and response to ketamine
Ballard, E. D., Neely, L., Waldman, L., Greenstein, D., & Zarate, C. A. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.11.080 · Cited by 5 · see citing works
- Authors
- King, C. A., Gipson Allen, P. Y., Ahamed, S. I., Webb, M., Casper, T. C., Brent, D., Grupp-Phelan, J., Rogers, T. A., Arango, A., Al-Dajani, N., McGuire, T. C., & Bagge, C. L.
- Affiliations
- University of Michigan (US)
- Marquette University (US)
- University of Utah (US)
- University of Pittsburgh (US)
- Corresponding author
- King, Cheryl A.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2023-11-10
- Volume
- 54
- Issue
- 7
- Pages
- 1272-1283
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W4388568174
- Cited by
- 22
- References
- 50
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 5
- FWCI
- 6.39
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- American Foundation for Suicide Prevention
- University of Michigan
- Once Upon A Time Foundation
- National Institutes of Health
- National Institute of Mental Health (R01MH113582)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Social Psychology › Mental Health via Writing
- Keywords
- adolescent suicide attempts, suicide warning signs, social withdrawal, perceived burdensomeness, parent-adolescent conflict, self-hatred, emotional pain, anger, youth suicide prevention
- MeSH terms
- Adolescent, Adolescent Behavior, Emotions, Female, Humans, Male, Surveys and Questionnaires, Risk Factors, Suicide, Attempted, Suicidal Ideation
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