Suicidal ideation and suicidal beliefs as prospective indicators of suicidal behavior among primary care patients

Multiple studies have found that suicidal beliefs, measured with items from the Suicide Cognitions Scale (SCS), are significant predictors of future suicidal behavior and outperform suicidal ideation. These studies have not considered suicidal behavior and suicidal ideation as discrete outcomes, however, clouding interpretability. In this study, 2744 primary care patients completed self-report assessments during routine clinic visits. Incidence of suicidal ideation and suicidal behavior during the 12-month follow-up was assessed via phone interview. Multinomial logistic regression models were used to determine if suicidal beliefs and suicidal ideation significantly differentiated three groups: patients with follow-up suicidal behavior (SB), patients with follow-up suicidal ideation but no suicidal behaviors (SI), and patients with neither (no SI/SB). Suicidal beliefs and suicidal ideation significantly differentiated SB and SI from no SI/SB, but only suicidal beliefs significantly differentiated SB from SI. Results support the clinical utility of assessing suicidal beliefs with SCS items, confirm the superiority of suicidal beliefs over suicidal ideation as indicators of future suicidal behavior, and suggest suicidal ideation is a risk factor for future suicidal ideation but not future suicidal behavior.