Functional domains as correlates of suicidality among psychiatric inpatients

Background Suicide remains poorly understood and unpredictable. Addressing this challenge, this study examined the independent contributions of several research domain criteria (RDoC) constructs in relation to suicidality in patients hospitalized for acute suicide risk. Specifically, we examined anhedonia, anxiety/entrapment, and attachment disturbances, reflecting disturbances in reward processes, negative valence systems, and social processes, respectively. Methods Anhedonia, anxiety, entrapment, and fearful attachment, were assessed quantitatively in 135 adults hospitalized for suicidality. Current suicidality and suicidal history were assessed with the Columbia Suicide Severity Rating Scale. Bivariate analyses (with significance threshold of p<.01 to account for multiple comparisons) and multivariate models examined relationships between symptom dimensions and severity of suicidal ideation (SI). We also assessed differences between patients with a history of suicide attempt and those who exhibited only suicidal ideations. Results Using bivariate analyses all symptoms except for fearful attachment correlated robustly with SI (r =.37-0.50, p<.001). However, when using multivariate analyses, only anhedonia (β=.28, p=.01) and entrapment (β=.19, p=.03) were independently associated with SI across the entire sample. No functional domain measures differed between patients with history of suicide attempt versus ideation only. Limitations The reliance on self-report data and a cross-sectional design. Conclusions Disturbances in reward and threat processing may represent independent factors in the development of suicidal ideation in this high suicide risk cohort. Future studies should assess their role as risk factors.