Trajectories of suicidal ideation in people seeking web-based help for suicidality: Secondary analysis of a Dutch randomized controlled trial

Background: suicidal ideation (si) is a common mental health problem. variability in intensity of si over time has been linked to suicidal behavior,yet little is known about the temporal course of si. objective: the primary aim was to identify prototypical trajectories of si in the general population and,secondarily,to examine whether receiving web-based self-help for si,psychiatric symptoms,or sociodemographics predicted membership in the identified si trajectories. methods: we enrolled 236 people,from the general dutch population seeking web-based help for si,in a randomized controlled trial comparing a web-based self-help for si group with a control group. we assessed participants at inclusion and at 2,4,and 6 weeks. the beck scale for suicide ideation was applied at all assessments and was included in latent growth mixture modeling analysis to empirically identify trajectories. results: we identified 4 si trajectories. the high stable trajectory represented 51.7% (122/236) of participants and was characterized by constant high level of si. the high decreasing trajectory (50/236,21.2%) consisted of people with a high baseline si score followed by a gradual decrease to a very low score. the third trajectory,high increasing (12/236,5.1%),also had high initial si score,followed by an increase to the highest level of si at 6 weeks. the fourth trajectory,low stable (52/236,22.0%) had a constant low level of si. previous attempted suicide and having received web-based self-help for si predicted membership in the high decreasing trajectory. conclusions: many adults experience high persisting levels of si,though results encouragingly indicate that receiving web-based self-help for si increased membership in a decreasing trajectory of si.