Suicidal ideation can be a strong predictor of suicidal attempts, and the intensity of suicidal ideation at its highest point presents an important variable, according to research published in Psychiatry Research.

Researchers found a strong indirect association between worst point ideation and eventual suicide attempts. The data suggest that painful and provocative events play a primary role in the relationship between suicidal ideation and suicidal attempts independent from fearlessness about death. The researchers highlight that “these results speak to the continued need to refine the definition and assessment of the capability for suicide.”

The study used a sample of 229 adults with a lifetime history of suicidal ideation (mage=35.15, standard deviation=10.20) drawn from Amazon’s Mechanical Turk program. A total of 53.7% reported at least 1 prior suicide attempt. The Acquired Capability for Suicide Scale, which consists of 7 items assessing fearlessness about death and bodily harm was used to measure suicidal capability, and lifetime exposure to painful or provocative events was measured using the Painful and Provocative Events Scale, a 25-item self-reported measure of a range of painful and/or provocative experiences. The study found that suicidal ideation at the worst point was a significant differentiator between ideators and attempters and correctly identified 73.4% of cases (x2(10)=72.14, P <.001; Nagelkerke R2=0.361). Of the variables studied, the intensity of worst point ideation was the only one that differentiated between ideators and attempters significantly (B=1.28, standard error=0.23; odds ratio=3.62, 95% CI=2.292-5.720), indicating that every unit increase in the severity of suicidal ideation at the worst point increases the likelihood of a suicide attempt by 362%.

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Researchers noted that using single items to measure suicidal ideation is not ideal; however, past research has failed to find one type of measurement scale that outperforms another. Additionally, they mention the possibility of criterion contamination in attempting to create multiple items on a single component of suicidal ideation and the nonclinical nature of the study, yet they maintain the study’s scientific and clinical value.

These findings point to the need to continue and expand clinical understanding of the variables contributing to suicidal behavior and the role of suicidal ideation.


Law K, Jin HM, Anestis MD. The intensity of suicidal ideation at the worst point and its association with suicide attempts. Psychiatry Res. 2018;269:524-528.

This article originally appeared on Psychiatry Advisor