• Bibtex: @bagge2023
  • Bibliography: Bagge, C. L., Littlefield, A. K., Wiegand, T. J., Hawkins, E., Trim, R. S., Schumacher, J. A., Simons, K., & Conner, K. R. (2023). A controlled examination of acute warning signs for suicide attempts among hospitalized patients. Psychological Medicine, 53(7), 2768–2776. https://doi.org/10.1017/S0033291721004712

Example citation

Preparation of personal affairs was the single strongest predictor of a suicide attempt in retrospective interviews

My notes

  • They use something called Timeline Follow-back which is a pretty extensive interview developed by Bagge.
    • Negative life events: interpersonal, work, legal, financial.
  • They did stepwise logistic regression models, first within-category and then a final multivariate model. So not really within-individual.
    • Comparing the day of suicide attempt to the day prior
  • Retrospective interviews within 48h of suicide attempts

Most notably, ‘any preparation of personal affairs’ was associated with very high proximal risk, OR = 36.24, p = 0.0019, 10-fold higher risk compared to the point estimates of other WS examined herein.

ROC curve analysis indicated an AUC of 0.80, suggesting that our final model provided an 80% accuracy of determining an acute risk period (day when a patient attempted) compared to a non-acute risk period (a day when a patient did not attempt suicide).

(Paying off bills or giving away things, writing or revising a will, arranging for other to take care of loved ones or affairs)

The TLFB-SA was used to gather retrospective information on behaviors and events, affective responses, and cognitions during the 48 h prior to the suicide attempt.


Background Near-term risk factors for suicidal behavior, referred to as ‘warning signs’ (WS), distinguish periods of acute heightened risk from periods of lower risk within an individual. No prior published study has examined, using a controlled study design, a broad set of hypothesized WS for suicide attempt. This study addressed this gap through examination of hypothesized behavioral/experiential, cognitive, and affective WS among patients recently hospitalized following a suicide attempt.

Methods Participants were recruited during hospitalization from five medical centers across the USA including two civilian hospitals and three Veterans Health Administration facilities (n = 349). A within-person case-crossover study design was used, where each patient served as her/his own control. WS were measured by the Timeline Follow-back for Suicide Attempts Interview and were operationalized as factors that were present (v. absent) or that increased in frequency/intensity within an individual during the 6 h preceding the suicide attempt (case period) compared to the corresponding 6 h on the day before (control period).

Results Select WS were associated with near-term risk for suicide attempt including suicide-related communications, preparing personal affairs, drinking alcohol, experiencing a negative interpersonal event, and increases in key affective (e.g. emptiness) and cognitive (e.g. burdensomeness) responses.

Conclusions The identification of WS for suicidal behavior can enhance risk recognition efforts by medical providers, patients, their families, and other stakeholders that can serve to inform acute risk management decisions. PDF: bagge_2023_a_controlled_examination_of_acute_warning_signs_for_suicide_attempts_among.pdf