Suicide attempts among adults denying active suicidal ideation: An examination of the relationship between suicidal thought content and suicidal behavior

OBJECTIVES: The purpose of the current study was to examine the possibility that there are multiple pathways to suicidal behavior by conducting a fine-grained investigation of the relationship between suicidal thought content and suicidal behavior. METHODS: Six thousand two hundred US adults completed self-report measures of suicidal thoughts and behaviors. Descriptive statistics and logistic regression were used to examine the relationship between suicidal thoughts and behaviors. RESULTS: About 36.0% of participants with a lifetime suicide attempt denied ever experiencing any active suicidal thoughts and 11.0% denied ever experiencing any suicidal thoughts; 53.8% of recent attempters denied recent active suicidal thoughts and 22.6% denied any recent suicidal thoughts. Additionally, the sole presence of passive suicidal ideation was associated with increased odds of lifetime and past-month suicide attempts. CONCLUSIONS: These findings suggest that there are likely multiple pathways to suicide, some of which do not involve progressively worsening suicidal thoughts.