Longterm Temporal Dynamics of Suicidal Ideation: A Dynamic Time Warping Analysis of Depression, Anxiety, Worry, and Mastery

BackgroundSuicidal ideation (SI) fluctuates over time, yet traditional static risk factors poorly align with its dynamics over time. Understanding dynamic symptom patterns may advance knowledge of the temporal interplay between SI and co-occurring symptoms in adults with depressive and anxiety disorders. Materials and methodsWe analyzed six waves (at baseline, and after 2, 4, 6, 9, and 13 years of follow-up) of the Netherlands Study of Depression and Anxiety (NESDA; n = 305, mean age 40.8 years, 62% female) in participants with any SI fluctuation over time. Variables included depressive, anxiety, mastery, and worry symptoms. Dynamic Time Warping (DTW) quantified within-person temporal alignment between SI and other symptoms, and an undirected network and forestplot visualized co-fluctuations. Analyses were stratified by age-groups and sex. ResultsOver the years, SI co-fluctuated most strongly with affective and anhedonic depressive symptoms, including sad mood, low capacity for pleasure, low general interest, pessimism, quality of mood, and decreased appetite. Select anxiety (terrified/afraid) and worry (overwhelming worries) items also aligned with SI, whereas mastery items did not. Patterns were broadly consistent across age and gender subgroups. Networks indicated that SI is part of a cluster of depressogenic symptoms but bridges to acute fear and persistent worry. ConclusionsSI is a dynamic phenomenon closely linked to specific depressive, anxiety, and worry symptoms. Interventions targeting mood instability, anhedonia, and uncontrollable worry, combined with real-time monitoring, may improve personalized suicide prevention. DTW provides a framework to identify long-term temporally proximal symptom patterns.