Who is getting better in treatment? Dynamics in risk processes as a signature of short-term suicide treatment response

Background Although efficacious treatments that reduce suicide attempt risk have been developed, signatures that indicate that a patient's suicide risk may be stabilizing over the course of treatment for suicide are not well understood. This study examined whether dynamics in suicide risk and resilience processes over the course of treatment differentiated individuals who did versus did not attempt suicide while in treatment.Method Participants were adults who completed up to 12 sessions of suicide-focused therapy as part of a randomized clinical trial. Weekly surveys assessed suicide risk and resilience variables and suicide attempts since the last therapy session. Analyses examined progression of single risk indicators over the course of treatment (n = 70). Dynamical systems models were used to compare symptom dynamics for attempt while in treatment (n = 12) and non-attempt while in treatment (n = 45) groups in the first and last 30 days of treatment using singular value decomposition and vector autoregressive multilevel models.Results Participants in the non-attempters group showed increasing stability in suicidal mode dynamics over the course of treatment. Interestingly, there were no significant changes in stability observed for the suicide attempters group. Moreover, differences in the dynamics of these groups emerged in the first 30 days of treatment, potentially indicative of an early signature of treatment response.Discussion These results are consistent with extant theory about how suicide risk networks should change over the course of therapy and have important implications for research to identify indicators of suicide risk stabilization.