Weekly Links among Irritability and Suicidal Thoughts and Behaviors in High-Risk Youth

Previous studies demonstrate a link between irritability and suicidal thoughts and behaviors (STBs) in youth samples. However, they have mostly assessed irritability in community samples and as a largely dispositional (i.e., trait-like) construct. Thus, it remains unclear to what extent links between irritability and STBs reflect within-person processes of elevated risk in clinically meaningful time periods. The present study used clinical data from 689 adolescents aged 12 to 19 years attending a total of 6128 visits at a specialty Intensive Outpatient Program for depressed and suicidal youth to examine patterns in weekly assessments of irritability and STBs throughout treatment, including associations among trends and fluctuations departing from these trends. Youth completed validated self-report measures of irritability, depression and STBs weekly as part of standard IOP clinical care. Overall, two-thirds of variance in weekly irritable mood was accounted for by stable between-person differences, and the remaining portion to weekly fluctuations. After controlling for depression, during weeks when youth were more irritable they experienced increased STBs. At the same time, youth who were generally more irritable also tended to experience more STBs. Rates of change in irritability and STBs tended to track together at early stages of treatment, but these effects were generally accounted for by depression severity. Our results suggest that although changes in STBs are best accounted for by depression, irritability can be understood as a specific, proximal risk factor for youth STBs that exacerbates youth STBs in clinically informative timeframes above and beyond depression.