Suicidal ideation and affect lability in single and multiple suicidal attempters with Major Depressive Disorder: An exploratory network analysis

•Affect lability and anxiety as trait were the most central psychopathological aspects in suicidal attempters with a primary diagnosis of Major Depressive Disorder.•Suicidal ideation was specifically connected with anxiety as trait and hopelessness.•There were some differences between the symptomatic profiles of repeaters and non-repeaters and also between high and low suicidal ideation.•Emotional regulation difficulties might be suitable targets for early detecting and treating suicidal patients. Introduction: A better understanding of the specific contribution of risk factors to suicidal behavior could arise from analyzing suicidal ideation (SI) in clinical samples, and comparing single versus multiple suicide attempters through contemporary methods allowing complex and dynamical analyses of multiple and simultaneously interacting suicide risk factors. Method: We explored associations among suicidal ideation (SI), affect lability and other suicide risk factors in 323 suicidal attempters diagnosed with major depressive disorder (MDD). We analyzed the network structure and centrality of the total sample, and compared single versus multiple attempters and subjects with low and high suicidal ideation. Results: SI was connected with anxiety (trait) and hopelessness. Central nodes for global and specific groups were affect lability (from anxiety to depression), anxiety as a trait, and harm avoidance. We observed some specific differences between clinical profiles of repeaters and non-repeaters and significant network density between high and low SI. Limitations: Because our cross-sectional design, we cannot establish casual relationships among variables. We only examined associations at group level but not at single subject level. Conclusions: Affect lability (mainly the shifts from anxiety to depression) and trait anxiety were central in each estimated network. These symptoms might be suitable targets for early detecting and treating suicidal patients.