From ideation to action: differentiating between those who think about suicide and those who attempt suicide in a national study of young adults

Background: Although many suicide risk factors have been identified, there is still relatively little known about the factors that differentiate those who think about suicide from those who make a suicide attempt. Aims: Using the integrated motivational-volitional model (IMV) of suicidal behaviour as a framework, this study hypothesised that (i) motivational and volitional phase factors would differentiate non-suicidal controls from those who had a history of suicidal ideation or suicide attempts, and (ii) within a multivariable model only volitional phase factors would differentiate between those who had a history of suicidal ideation and those who had attempted suicide. Method: The Scottish Wellbeing Study (n = 3508) is a nationally representative study of young people (18–34 years) recruited throughout Scotland. Using multinomial regression analysis, three groups (non-suicidal control (n = 2534), lifetime suicide ideation (n = 498) and lifetime suicide attempt (n = 403) groups) were compared on motivational and volitional phase variables. Results: Consistent with the IMV model, motivational and volitional phase variables differentiated the control group from both the ideation and attempt groups. Only volitional phase variables differentiated between the suicide attempt group and the suicidal ideation group in the multivariable model; with those reporting a suicide attempt being higher on acquired capability, mental imagery about death, impulsivity, and being more likely to know a friend who had made a suicide attempt. Having a family member or friend die by suicide or a family member attempt suicide did not differentiate between the groups. Limitations: The findings were based on cross-sectional data derived from self-report measures. Conclusions: These findings provide further support for the IMV model, and highlight potential targets for clinical intervention