title: Trajectories of Suicidal Ideation in People Seeking Web-Based Help for Suicidality: Secondary Analysis of a Dutch Randomized Controlled Trial.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Copenhagen Mental Health Center, Copenhagen University Hospital, Hellerup, Denmark. trine.madsen@regionh.dk.
authors.forename: Trine
authors.identifier: 0000-0003-4918-5862
authors.initials: T
authors.lastname: Madsen
authors.forename: Bregje
authors.identifier: 0000-0002-8124-2559
authors.initials: B
authors.lastname: van Spijker
authors.forename: Karen-Inge
authors.identifier: 0000-0001-9234-9784
authors.initials: KI
authors.lastname: Karstoft
authors.forename: Merete
authors.identifier: 0000-0003-4895-7023
authors.initials: M
authors.lastname: Nordentoft
authors.forename: Ad Jfm
authors.identifier: 0000-0003-1701-5332
authors.initials: AJ
authors.lastname: Kerkhof
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000523:psychology* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D059020:Suicidal Ideation; D013405:Suicide; D013406:Suicide, Attempted; D013997:Time Factors
keywords: latent growth mixture modeling; online self-help; suicidal ideation; trajectories