Describing and measuring the pathway to suicide attempts: A preliminary study
Abstract
To die by suicide, one must think about suicide, make a plan, and then carry it out. Prior research has examined the presence and predictors of these outcomes; however, virtually no studies have characterized how these steps unfold along the pathway to suicide. A novel instrument was administered to 30 recent suicide attempters. Results revealed that although the median onset for suicidal ideation occurs 1 to 5 years prior to attempting, the median for 6 of the 10 steps measured was within 6 hours of attempting. Overall, 86.5% of proximal planning steps took place within 1 week of attempting and 66.6% occurred within 12 hours.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In general, the transition phase seems to be rather brief: up to 48% of suicide attempters reported a period of less than 10 minutes between the decision to die by suicide and the suicidal act.
“In general, the transition phase seems to be rather brief: When asked about the time that passed between the decision to die by suicide and the suicidal act, up to 48% of suicide attempters reported a period of less than 10 minutes (5, 70, see also 71).”
From Ambivalence model of suicidality [ABS-model]: an orientation model for the treatment of suicidal individuals (2024) · cites this paper as [71]
Suicide attempts are preceded by large, rapid changes in suicidal thinking.
“prior retrospective work suggests that suicide attempts are preceded by large, rapid changes in suicidal thinking.11,12”
From A pilot study using frequent inpatient assessments of suicidal thinking to predict short-term postdischarge suicidal behavior (2021) · cites this paper as [11]
Cites
Matplotlib: a 2D graphics environment
Hunter, J. D. (2007) · Computing in Science & Engineering · doi:10.1109/mcse.2007.55 · Cited by 39,249 · see citing works
Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., Abraham, J., Adair, T., Aggarwal, R., Ahn, S. Y., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61728-0 · Cited by 14,070 · see citing works
Data Structures for Statistical Computing in Python
McKinney, W. (2010) · Proceedings of the Python in Science Conferences · doi:10.25080/majora-92bf1922-00a · Cited by 11,511 · see citing works
The NumPy Array: A Structure for Efficient Numerical Computation
van der Walt, S., Colbert, S. C., & Varoquaux, G. P. (2011) · Computing in Science & Engineering · doi:10.1109/mcse.2011.37 · Cited by 10,445 · see citing works
Bayesian model selection in social research
Raftery, A. E. (1995) · Sociological Methodology · doi:10.2307/271063 · Cited by 6,823 · see citing works
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., et al. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2011.10111704 · Cited by 5,157 · see citing works
On aims and methods of ethology
Tinbergen, N. (1963) · Zeitschrift für Tierpsychologie · doi:10.1111/j.1439-0310.1963.tb01161.x · Cited by 4,551 · see citing works
Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008) · Epidemiologic Reviews · doi:10.1093/epirev/mxn002 · Cited by 2,897 · see citing works
Self-citationCross-national prevalence and risk factors for suicidal ideation, plans and attempts
Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., Bruffaerts, R., Chiu, W. T., de Girolamo, G., Gluzman, S., et al. (2008) · British Journal of Psychiatry · doi:10.1192/bjp.bp.107.040113 · Cited by 2,654 · see citing works
Self-citationPrevalence of and Risk Factors for Lifetime Suicide Attempts in the National Comorbidity Survey
Kessler, R. C., Borges, G., & Walters, E. E. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.7.617 · Cited by 2,514 · see citing works
Vrieze, S. I. (2012) · Psychological Methods · doi:10.1037/a0027127 · Cited by 1,948 · see citing works
On optimal and data-based histograms
Scott, D. W. (1979) · Biometrika · doi:10.1093/biomet/66.3.605 · Cited by 1,732 · see citing works
LMFIT: Non-Linear Least-Square Minimization and Curve-Fitting for Python
Newville, M. G., Stensitzki, T., Allen, D. B., et al. (2014) · Zenodo (CERN European Organization for Nuclear Research) · doi:10.5281/zenodo.11813 · Cited by 1,339 · see citing works
Safety planning intervention: a brief intervention to mitigate suicide risk.
Stanley, B., & Brown, G. K. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2011.01.001 · Cited by 1,267 · see citing works
The seven sins of memory: Insights from psychology and cognitive neuroscience.
Schacter, D. L. (1999) · American Psychologist · doi:10.1037/0003-066x.54.3.182 · Cited by 1,133 · see citing works
Silverman, M. M., Berman, A. L., Sanddal, N. D., O'Carroll, P. W., & Joiner, T. E. (2007) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2007.37.3.264 · Cited by 991 · see citing works
Beyond the tower of Babel: A nomenclature for suicidology
O'Carroll, P. W., Berman, A. L., Maris, R. W., Moscicki, E. K., Tanney, B. L., & Silverman, M. M. (1996) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.1996.tb00609.x · Cited by 982 · see citing works
Nock, M. K., Hwang, I., Sampson, N., Kessler, R. C., Angermeyer, M., Beautrais, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., et al. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000123 · Cited by 912 · see citing works
Self-citationDevelopment of suicidal intent scales.
Beck, A. T., Schuyler, D., & Herman, I. (1974) · Cited by 663 · see citing works
Memory for the time of past events.
Friedman, W. J. (1993) · Psychological Bulletin · doi:10.1037/0033-2909.113.1.44 · Cited by 639 · see citing works
Measuring the Suicidal Mind: Implicit Cognition Predicts Suicidal Behavior
Nock, M. K., Park, J. M., Finn, C. T., Deliberto, T. L., Dour, H. J., & Banaji, M. R. (2010) · Psychological Science · doi:10.1177/0956797610364762 · Cited by 624 · see citing works
Self-citationCharacteristics of Impulsive Suicide Attempts and Attempters
Simon, T. R., Swann, A. C., Powell, K. E., Potter, L. B., Kresnow, M., & O'Carroll, P. W. (2002) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.32.1.5.49.24212 · Cited by 548 · see citing works
Single-item measurement of suicidal behaviors: Validity and consequences of misclassification
Millner, A. J., Lee, M. D., & Nock, M. K. (2015) · PLOS ONE · doi:10.1371/journal.pone.0141606 · Cited by 361 · see citing works
Self-citationReconsidering the link between impulsivity and suicidal behavior
Anestis, M. D., Soberay, K. A., Gutierrez, P. M., Hernández, T. D., & Joiner, T. E. (2014) · Personality and Social Psychology Review · doi:10.1177/1088868314535988 · Cited by 307 · see citing works
On the retention function for autobiographical memory
Rubin, D. C. (1982) · Journal of Verbal Learning and Verbal Behavior · doi:10.1016/s0022-5371(82)90423-6 · Cited by 280 · see citing works
Data-Based Choice of Histogram Bin Width
WAND, M. P. (1997) · The American Statistician · doi:10.1080/00031305.1997.10473591 · Cited by 275 · see citing works
A risk index for 12-month suicide attempts in the National Comorbidity Survey Replication (NCS-R)
BORGES, G., ANGST, J., NOCK, M. K., RUSCIO, A. M., WALTERS, E. E., & KESSLER, R. C. (2006) · Psychological Medicine · doi:10.1017/s0033291706008786 · Cited by 246 · see citing works
Self-citationReports of elapsed time: Bounding and rounding processes in estimation.
Huttenlocher, J., Hedges, L. V., & Bradburn, N. M. (1990) · Journal of Experimental Psychology Learning Memory and Cognition · doi:10.1037//0278-7393.16.2.196 · Cited by 222 · see citing works
Suicide attempts and impulsivity
Baca‐García, E., Díaz-Sastre, C., Garcı́a-Resa, E., Blasco, H., Conesa, D. B., Oquendo, M. A., Sáiz, P. A., & de León, J. (2004) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-004-0549-3 · Cited by 214 · see citing works
Quantifying the impact of recent negative life events on suicide attempts
Bagge, C. L., Glenn, C. R., & Lee, H.-J. (2013) · Journal of Abnormal Psychology · doi:10.1037/a0030371 · Cited by 201 · see citing works
Dombrovski, A. Y., Szanto, K., Siegle, G. J., Wallace, M. L., Forman, S. D., Sahakian, B., Reynolds, C. F., & Clark, L. (2011) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.12.025 · Cited by 198 · see citing works
Telescoping is not time compression: A model
Rubin, D. C., & Baddeley, A. (1989) · Memory & Cognition · doi:10.3758/bf03202626 · Cited by 180 · see citing works
Reports of elapsed time: Bounding and rounding processes in estimation.
Huttenlocher, J., Hedges, L. V., & Bradburn, N. M. (1990) · Journal of Experimental Psychology Learning Memory and Cognition · doi:10.1037/0278-7393.16.2.196 · Cited by 133 · see citing works
Behind impulsive suicide attempts: Indications from a community study
Wyder, M., & De Leo, D. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.02.015 · Cited by 132 · see citing works
Conner, K. R., Phillips, M. R., Meldrum, S. C., Knox, K. L., ZHANG, Y., & Yang, G. (2005) · Psychological Medicine · doi:10.1017/s003329170500454x · Cited by 130 · see citing works
Memory for unique personal events: The roommate study
Thompson, C. P. (1982) · Memory & Cognition · doi:10.3758/bf03202424 · Cited by 129 · see citing works
The Final Months: A Study of the Lives of 134 Persons Who Committed Suicide
Hankoff, L. D. (1982) · JAMA · doi:10.1001/jama.1982.03320370067045 · Cited by 128 · see citing works
“The Walls Were Closing in, and We Were Trapped”
Kidd, S. A. (2004) · Youth & Society · doi:10.1177/0044118x03261435 · Cited by 121 · see citing works
The final months : a study of the lives of 134 persons who committed suicide
Robins, E. (1981) · DigitalGeorgetown (Georgetown University Library) · Cited by 112 · see citing works
Data-Based Choice of Histogram Bin Width
WAND, M. P. (1997) · The American Statistician · doi:10.2307/2684697 · Cited by 107 · see citing works
Classification of Suicidal Behaviors
Beck, A. T. (1976) · Archives of General Psychiatry · doi:10.1001/archpsyc.1976.01770070065006 · Cited by 101 · see citing works
Alcohol as an Acute Risk Factor for Recent Suicide Attempts: A Case-Crossover Analysis
Bagge, C. L., Lee, H., Schumacher, J. A., Gratz, K. L., Krull, J. L., & Holloman, G. (2013) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2013.74.552 · Cited by 88 · see citing works
Kagan, J. (2007) · Perspectives on Psychological Science · doi:10.1111/j.1745-6916.2007.00049.x · Cited by 84 · see citing works
Stressful Life Events and Impulsiveness in Failed Suicide
Weyrauch, K. F., Roy‐Byrne, P., Katon, W. J., & Wilson, L. (2001) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.31.3.311.24240 · Cited by 78 · see citing works
Bagge, C. L., Littlefield, A. K., Conner, K. R., Schumacher, J. A., & Lee, H. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.04.010 · Cited by 76 · see citing works
Characteristics of individuals who make impulsive suicide attempts
Spokas, M. E., Wenzel, A. E., Brown, G. K., & Beck, A. T. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.10.034 · Cited by 75 · see citing works
Precontemplated and impulsive suicide attempts among individuals with alcohol dependence.
Conner, K. R., HESSELBROCK, V. M., Schuckit, M. A., Hirsch, J. K., Knox, K. L., Meldrum, S. C., Bucholz, K. K., Kramer, J., Samuel Kuperman, C., Preuss, U. W., et al. (2006) · Journal of Studies on Alcohol · doi:10.15288/jsa.2006.67.95 · Cited by 67 · see citing works
Self-events and other-events: Temporal dating and event memory
Betz, A. L., & Skowronski, J. J. (1997) · Memory & Cognition · doi:10.3758/bf03211313 · Cited by 56 · see citing works
Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients
Wojnar, M., Ilgen, M. A., Jakubczyk, A., Wnorowska, A., Klimkiewicz, A., & Brower, K. J. (2008) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2008.04.006 · Cited by 55 · see citing works
A Cluster Analysis of the Circumstances of Death in Suicides in Hong Kong
Chen, E. Y. H., Chan, W. S. C., Chan, S. S. M., Liu, K., Chan, C., Wong, P. W. C., Law, Y. W., & Yip, P. S. F. (2007) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2007.37.5.576 · Cited by 46 · see citing works
“Impulsive” suicide attempts: What do we really mean?
May, A. M., & Klonsky, E. D. (2015) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000160 · Cited by 45 · see citing works
Correlates of proximal premeditation among recently hospitalized suicide attempters
Bagge, C. L., Littlefield, A. K., & Lee, H. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.02.004 · Cited by 43 · see citing works
A Cross‐Cultural Study of Suicide Intent in Parasuicide Patients
Hjelmeland, H., Nordvik, H., Bille‐Brahe, U., et al. (2000) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2000.tb01096.x · Cited by 39 · see citing works
Planning of suicide attempts among depressed inpatients ages 50 and over
Conner, K. R., Duberstein, P. R., Beckman, A. M., Heisel, M. J., Hirsch, J. K., Gamble, S., & Conwell, Y. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.06.003 · Cited by 30 · see citing works
Time, Language, and Autobiographical Memory
Burt, C. D. B. (2008) · Language Learning · doi:10.1111/j.1467-9922.2008.00466.x · Cited by 25 · see citing works
Messer, S. B., & Meinster, M. O. (1980) · Journal of Clinical Psychology · doi:10.1002/1097-4679(198001)36:1 · Cited by 16 · see citing works
Impulsivity and Suicidal Behavior: How You Define It Matters
Chalker, S. A., Comtois, K. A., & Kerbrat, A. H. (2015) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2015.8.2.172 · Cited by 10 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Annual Research Review: Suicide among youth – epidemiology, (potential) etiology, and treatment
Cha, C. B., Franz, P. J., M. Guzmán, E., Glenn, C. R., Kleiman, E. M., & Nock, M. K. (2018) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12831 · Cited by 602 · see citing works
Self-citationDigital phenotyping of suicidal thoughts
Kleiman, E. M., Turner, B. J., Fedor, S., Beale, E. E., Picard, R. W., Huffman, J. C., & Nock, M. K. (2018) · Depression and Anxiety · doi:10.1002/da.22730 · Cited by 210 · see citing works
Self-citationBryan, C. J., Butner, J. E., May, A. M., Rugo, K. F., Harris, J. A., Oakey, D. N., Rozek, D. C., & Bryan, A. O. (2020) · New Ideas in Psychology · doi:10.1016/j.newideapsych.2019.100758 · Cited by 169 · see citing works
Allen, N. B., Nelson, B. W., Brent, D., & Auerbach, R. P. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.03.044 · Cited by 115 · see citing works
Wang, S. B., Coppersmith, D. D. L., Kleiman, E. M., Bentley, K. H., Millner, A. J., Fortgang, R., Mair, P., Dempsey, W., Huffman, J. C., & Nock, M. K. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.0591 · Cited by 98 · see citing works
Self-citationCognition and self-injurious thoughts and behaviors: a systematic review of longitudinal studies
Cha, C. B., Wilson, K. M., Tezanos, K. M., DiVasto, K. A., & Tolchin, G. K. (2019) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.07.002 · Cited by 94 · see citing works
Wastler, H. M., Bryan, A. O., & Bryan, C. J. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23268 · Cited by 91 · see citing works
Bryan, C. J., Rozek, D. C., Butner, J., & Rudd, M. D. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.04.001 · Cited by 71 · see citing works
Bloch-Elkouby, S., Barzilay, S., Gorman, B. S., Lawrence, O. C., Rogers, M. L., Richards, J., Cohen, L. J., Johnson, B. N., & Galynker, I. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.08.048 · Cited by 72 · see citing works
Value-Based Choice, Contingency Learning, and Suicidal Behavior in Mid- and Late-Life Depression
Dombrovski, A. Y., Hallquist, M. N., Brown, V. M., Wilson, J., & Szanto, K. (2019) · Biological Psychiatry · doi:10.1016/j.biopsych.2018.10.006 · Cited by 65 · see citing works
Paashaus, L., Forkmann, T., Glaesmer, H., Juckel, G., Rath, D., Schönfelder, A., & Teismann, T. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2580 · Cited by 46 · see citing works
A controlled examination of acute warning signs for suicide attempts among hospitalized patients
Bagge, C. L., Littlefield, A. K., Wiegand, T. J., Hawkins, E., Trim, R. S., Schumacher, J. A., Simons, K., & Conner, K. R. (2023) · Psychological Medicine · doi:10.1017/s0033291721004712 · Cited by 52 · see citing works
24-hour warning signs for adolescent suicide attempts
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., et al. (2024) · Psychological Medicine · doi:10.1017/s0033291723003112 · Cited by 22 · see citing works
Rethinking suicides as mental accidents: towards a new paradigm
Ajdacic-Gross, V., Hepp, U., Seifritz, E., & Bopp, M. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.04.022 · Cited by 13 · see citing works
The temporal dynamics of the wish to live and the wish to die among suicidal individuals
Bryan, C. J. (2020) · Alternatives to Suicide · doi:10.1016/b978-0-12-814297-4.00004-2 · Cited by 13 · see citing works
Teismann, T., Britton, P. C., & Forkmann, T. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1449565 · Cited by 9 · see citing works
- Authors
- Millner, A. J., Lee, M. D., & Nock, M. K.
- Affiliations
- Harvard University (US)
- The University of Texas at Austin (US)
- Corresponding author
- Millner, Alexander J.
- Venue
- Suicide and Life-Threatening Behavior
- Publisher
- Wiley
- Published
- 2016-08
- Volume
- 47
- Issue
- 3
- Pages
- 353-369
- ISSN
- 0363-0234 (ISSN-L)
- 1943-278X
- OpenAlex
- W2480170080
- Cited by
- 161
- References
- 57
- Citations by year
- 2026: 19 · 2025: 11 · 2024: 25 · 2023: 21 · 2022: 19 · 2021: 21 · 2020: 17 · 2019: 10 · 2018: 11 · 2017: 6
- FWCI
- 12.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Suicide and Life-Threatening Behavior (publishedVersion)
- PubMed (publishedVersion)
- OSF Preprints (OSF Preprints) (submittedVersion)
- 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 › Clinical Psychology › Grief, Bereavement, and Mental Health
- Keywords
- suicide attempts, suicidal ideation, suicide planning, suicide attempters, measurement instruments
- MeSH terms
- Adolescent, Adult, Female, Humans, Male, Suicide, Suicide, Attempted, Intention, Young Adult, Suicidal Ideation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
