Risk factors of transition from suicidal ideation to suicide attempt: A one-year longitudinal study among hospital-based in- and outpatients

Identifying risk factors for transitioning from suicidal ideation to suicide attempts is crucial for improving suicide prevention strategies. Many existing risk factors fail to differentiate between those who attempt suicide and those who only experience suicidal thoughts. This study aimed to prospectively examine risk factors for suicide attempt over a one-year follow-up period in patients with mood disorders and current suicidal ideation, stratified by their history of lifetime suicide attempt. A cohort of 679 hospital-based patients with mood disorders and current suicidal ideation was assessed. Sociodemographic and clinical data, including depression severity, psychological pain, and suicidal ideation, were collected. Multivariate analyses and Cox proportional hazard models identified risk factors for suicide attempts. Among patients with a history of suicide attempt (n = 440), 20.2 % attempted suicide during follow-up. Significant risk factors included comorbid anxiety disorders (OR = 2.11; 95 % CI = [1.24, 3.70]) and higher levels of maximum suicidal ideation (OR = 1.19; 95 % CI = [1.04, 1.40]). Among those without a prior attempt (n = 239), 9.6 % attempted suicide, with younger age (OR = 0.93; 95 % CI = [0.87, 0.97]) and an interaction between psychological pain and suicidal ideation (OR = 2.08; 95 % CI = [1.31, 3.58]) as key predictors. High suicidal ideation levels were a common risk factor, regardless of attempt history. Suicidal ideation and associated risk factors, particularly anxiety and psychological pain, should be addressed through evidence-based and person-centered pharmacological, psychotherapeutic, and psychosocial strategies to help prevent suicidal behavior.