Suicidal Ideation Trajectories for Clients in Outpatient Treatment

Thursday, February 9

In recent years suicide has emerged as a national public health crisis. Nearly 50,000 people annually commit suicide (American Foundation for Suicide Prevention, 2022). Tracking changes in suicidal ideation among those in outpatient treatment has been identified as a practice that could prevent suicidal behaviors. On average, individuals in treatment tend to report a decrease in suicidal ideation (Wu et al., 2022; Zalsman et al., 2016; Kaminer, 2006). For example, Snippe et al. (2021) examined the rate at which a wide range of depressive symptoms improved in response to treatment. Findings showed that suicidal ideation was one of the first symptoms to improve as early as after individuals committed to seeking services. However, less is known about changes in suicide ideation in private practice settings. 

In the present study, 2268 clients diagnosed with depression were assessed through the SonderMind platform. These clients were administered PHQ-9, a nine item self-report scale designed to measure depressive symptoms, prior to each session. Among these depressive symptoms, the PHQ-9 also assesses suicide ideation. At baseline, 65.3% (n = 1480) indicated no suicide ideation in the previous two weeks, 24.7% (n = 561) indicated that they thought our suicide on several days, 6.4% (n = 145) and 3.6% (n = 82) indicated that they thought about suicide more than half the days and nearly every day, respectively. At the end of treatment, 78.4% (n = 1779) of clients reported no suicide ideation. There was a 35% decrease in the number of clients who reported experiencing suicide ideation on several days over the previous two weeks. Additionally, there was a 47% reduction in the number of clients reporting suicide ideation more than half the days over the previous two weeks. Lastly, there was a 44% reduction in the number of clients reporting suicide ideation nearly every day. These promising statistics suggest that the services provided on SonderMind led to significant reductions in suicidal ideation among clients who reported them at intake. 

American Foundation for Suicide Prevention. (2022, November 4). Suicide Statistics.

Kaminer, Y., Burleson, J. A., Goldston, D. B., & Burke, R. H. (2006). Suicidal Ideation among Adolescents with Alcohol Use Disorders during Treatment and Aftercare. American Journal on Addictions, 15, 43-s49.

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613.

Snippe, E., Doornbos, B., Schoevers, R. A., Wardenaar, K. J., & Wichers, M. (2021). Individual and common patterns in the order of symptom improvement during outpatient treatment for major depression. Journal of Affective Disorders, 290, 81–88.

Wu, H., Lu, L., Qian, Y., Jin, X.-H., Yu, H.-R., Du, L., Fu, X.-L., Zhu, B., & Chen, H.-L. (2022). The significance of cognitive-behavioral therapy on suicide: An umbrella review. Journal of Affective Disorders, 317, 142–148.

Zalsman, G., Hawton, K., Wasserman, D., van Heeringen, K., Arensman, E., Sarchiapone, M., Carli, V., Höschl, C., Barzilay, R., Balazs, J., Purebl, G., Kahn, J. P., Sáiz, P. A., Lipsicas, C. B., Bobes, J., Cozman, D., Hegerl, U., & Zohar, J. (2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry, 3(7), 646–659.

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