Interpersonal life stressors as proximal risk factors for suicide ideation and behavior

Life stress is a well-established risk factor for suicide ideation (SI) and behavior (SB), but the specific types of stressors that are most strongly associated with suicide-related outcomes, and on what time scale they impact these outcomes, remain poorly understood. Social rejection, especially targeted rejection, may be markedly potent for generating acute increases in SI and SB because of its threat to social bonds. Using a combination of gold-standard interviews including a contextual threat interview for assessing stress exposure and timeline followback procedures to assess suicide-related outcomes, we examined how fluctuations in severity of different types of life stressors are temporally associated with same-day and next-day likelihood of SI and SB over the course of 16 months in 143 young adults (Mage = 25.27, SD = 4.65) with recent SI or SB. Results demonstrated that daily within-person increases in interpersonal stressors, relative to an individual’s average levels, predicted higher odds of same-day and next-day SI and SB, even after controlling for daily non-interpersonal stressors, drug and alcohol use, and non-suicidal self-injury. Additionally, we observed stronger effects of social rejection and targeted rejection stressors on the proximal likelihood of SI, but no significant differences in the magnitude of effects of different types of stressors on SB. Results suggest that interpersonal stressors, particularly social rejection, are proximal risk factors for SI and SB. Findings suggest that clinicians should assess recent social rejection when assessing for acute risk, and suicide prevention strategies should target responses to interpersonal stress and stabilizing social relationships.