Ambivalence About Living and the Risk for Future Suicide Attempts
Bibliographic record
Abstract
OBJECTIVE: While suicidal ideation is a recognized risk factor for future suicidal behavior, clinicians often subtype ideation in an effort to further clarify risk. This study referred to the SAFE (Suicide Assessment Form in Emergency Psychiatry) database to examine individuals who were assessed for suicidal ideation in the emergency department (ED) to determine whether ideation subtypes (active desire for death versus ambivalence about living) differentially predicted future suicide attempt. METHODS: Participants were individuals presenting to psychiatric services in the ED between January 1, 2009, and December 31, 2013, at 2 hospitals in Manitoba, Canada. People presenting with suicidal ideation were subtyped as having either ambivalence about living or active suicidal ideation. These presentations were examined as predictors of suicide attempt (defined by the Columbia Classification Algorithm for Suicide Assessment scale) within 6 months in regression models that adjusted for confounders. RESULTS: Of the 5,655 individuals presenting to the ED during the study, 158 (3.1%) presented again within 6 months with a suicide attempt. Individuals presenting with ambivalence about living showed more than a doubling in risk for future suicide attempts (odds ratio [OR] = 2.57, 95% CI = 1.64-4.02, P < .001). Active suicidal ideation also predicted attempts (defined by the within 6 months, with more than a tripling of risk compared to people who were not suicidal at baseline (OR = 3.75, 95% CI = 2.61-5.34, P < .001). CONCLUSIONS: Psychiatric presentations to the ED often include suicidal ideation. Both active suicidal ideation and ambivalence about living are concerning presentations associated with risk of attempt within 6 months. Clinicians should be mindful that differentiating between active suicidal ideation and ambivalence about living may downplay the severity of the latter presentation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".