Network analysis of the link between depressive symptoms and risk of suicidal behavior at three years: A national prospective study.

Authors

Valentin Scheer, Julie Nejar, Marina Sánchez-Rico, Carlos Blanco, Mark Olfson, Mahdi Fayad, Frédéric Limosin, Nicolas Hoertel

Published in

Journal of affective disorders. Pages 122423. Aug 26, 2026. Epub Aug 26, 2026.

Abstract

Depressive symptoms predict suicidal behavior, but the specific pathways linking individual symptoms to suicide attempts remain incompletely characterized. Network analysis combined with cross-lagged panel models (CLPM) offers a framework to identify bridge symptoms and disentangle their temporal directionality.
Using Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions, we examined longitudinal associations between depressive symptoms during a past-12-month major depressive episode (MDE) at baseline (N = 3485) and suicide attempts three years later (n = 102). We estimated an Ising network, computed bridge centrality, and fitted five a priori CLPMs using the WLSMV estimator. Two sensitivity analyses excluded participants with a lifetime manic episode or with past-12-month alcohol or non-nicotine substance use disorders.
Suicidal ideation at follow-up emerged as the strongest bridge symptom to suicide attempt (bridge expected influence = 0.282), followed by baseline suicidal ideation and thoughts of death. In CLPMs, worthlessness at follow-up predicted concurrent suicidal ideation (β = 0.509, 95% CI [0.477; 0.541]) and thoughts of death (β = 0.508, [0.477; 0.540]), whereas baseline guilt predicted the same outcomes with substantially smaller coefficients (β = 0.067; β = 0.066) - a 7- to 8-fold differential. Follow-up suicidal ideation predicted suicide attempt (β = 0.515, p < 0.001). The worthlessness-guilt hierarchy replicated in both sensitivity analyses.
Suicide attempts occurred in a small sub-sample (n = 102), and binary symptom measures limit granularity.
Interventions targeting the schematic self-devaluation captured by worthlessness, rather than guilt-focused strategies, may offer greater clinical leverage in preventing the transition from depressive symptomatology to suicidal cognitions.

PMID:
42648553
Bibliographic data and abstract were imported from PubMed on 27 Aug 2026.

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