Feasibility and validity of ecological momentary assessment in the investigation of suicide risk
Abstract
Ecological Momentary Assessment has been used to investigate a wide range of behaviors and psychiatric conditions. Previous investigations have consistently obtained promising results with high acceptance and compliance rates, and with only minor reactive effects for specific variables. Despite the promise of this methodology for the study of severe psychiatric populations, little is known about its feasibility in samples at risk for suicide. In the present study, four samples at varying risk for suicide completed an Ecological Momentary Assessment study by responding to five electronic assessments per day over a one-week period. Samples included healthy controls (n=13), affective controls (n=21), past suicide attempters (n=20), and recent suicide attempters (n=42). The results demonstrate satisfactory participation rates and high compliance with daily life repeated assessments across all groups. Importantly, negative thoughts or suicidal ideation were not reactive to the duration of the study, indicating that the repeated assessment of such cognitions in daily life have little or no effect on their frequency. The findings provide support for the use of Ecological Momentary Assessment in the study of suicidal ideation and suggest that mobile technologies represent new opportunities for the assessment of high-risk cognitive states experienced by patients in daily life.
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Fixed schedules were almost exclusively used in studies with once-daily prompts, whereas pseudo-random schedules were typically used for repeated within-day assessments.
“Fixed schedules were almost exclusively used in studies with once-daily prompts (as well as three older studies with PDAs (45, 81, 82)), whereas pseudo-random schedules were typically used for repeated within-day assessments.”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [81]
Studies frequently (57%, n = 13) reported that participants could provide input about their daily schedules, allowing EMA prompt windows to be adjusted for each participant.
“Studies frequently (57%, n = 13; (47, 51, 58, 60, 61, 69, 71, 79–81, 85, 86)) reported that participants could provide input about their daily schedules (incl. sleep and wake times), allowing EMA prompt windows to be adjusted for each participant”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [81]
Baseline depression severity (HAMD) predicted EMA-assessed sad mood and negative thoughts, including suicidal ideation.
“Baseline depression severity [Hamilton Depression Rating Scale, HAMD (92)] predicted EMA-assessed sad mood and negative thoughts (incl. suicidal ideation) (81).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [81]
Practice effects were observed by participant response times decreasing over time.
“Practice effects were also observed by participant's response times decreasing over time (81).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [81]
Acceptance was highest among outpatients with a recent history of a suicide attempt (88%), compared to clinical controls (68%) and healthy controls (77%).
“Comparing three subgroups, acceptance was highest among outpatients with a recent history of a suicide attempt (88%), as compared to clinical controls (i.e., 68% outpatients without a history of suicide attempts), and healthy controls [77%; (81)].”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [81]
The decline in compliance over time was not replicated by all studies: one study reported no decrease over time, another reported fluctuation before stabilizing after about 2 weeks, and another reported increased compliance over time during a 1-week EMA study.
“However, this effect was not replicated by all: rather than declining in a linear manner, one study reported that compliance rates did not decrease over time (66), fluctuated before stabilizing after ~2 weeks (83), or that compliance increased over time during a 1-week EMA study (81).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [81]
There was a decrease in positive affect among recent and past suicide attempters, and a decrease in hopelessness among recent suicide attempters with increasing study duration across seven days.
“However, there was a decrease in positive affect among recent and past suicide attempters, and a decrease in hopelessness among recent suicide attempters with increasing study duration (across seven days) (81).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [81]
Compliance in clinical subgroups (range 74-82%) was lower than that in a non-clinical control group (86%).
“Compliance in clinical subgroups (range 74–82%) was lower than that in a non-clinical control group (86%) (81).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [81]
A feasibility study in adult suicide attempters, clinical controls, and healthy controls found no effects of study duration on the intensity of negative affect or frequency of suicidal ideation, indicating no symptom worsening with repeated prompts.
“A feasibility study in adult suicide attempters (recent or past attempt history), clinical controls (i.e., depressed patients without suicide attempt history), and healthy controls, found no effects of study duration on the intensity of negative affect or frequency of suicidal ideation, indicating no symptom worsening with repeated prompts (81).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [81]
The review did not uncover systematic negative mood reactivity to EMA, and importantly, there was no evidence of reactivity on suicidal thoughts and behaviors specifically.
“Our review did not uncover systematic (negative) mood reactivity to EMA, and importantly, there was no evidence of reactivity on STBs specifically (81, 82).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [81]
These findings are in line with reports of no symptom reactivity in other patient populations, such as those with chronic pain and mood disorders.
“These findings are in line with reports of no symptom reactivity in other patient populations, such as those with chronic pain (114) and mood disorders (81).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [81]
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Self-citation
- Authors
- Husky, M., Olié, E., Guillaume, S., Genty, C., Swendsen, J., & Courtet, P.
- Affiliations
- Institut Universitaire de France (FR)
- Inserm (FR)
- Centre National de la Recherche Scientifique (FR)
- Corresponding author
- Husky, Mathilde
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 220
- Issue
- 1-2
- Pages
- 564-570
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2095267443
- Cited by
- 124
- References
- 33
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 8 · 2023: 7 · 2022: 8 · 2021: 19 · 2020: 14 · 2019: 13 · 2018: 13 · 2017: 12 · 2016: 9 · 2015: 5 · 2014: 1
- FWCI
- 12.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- ecological momentary assessment, suicide risk, suicidal ideation, suicide attempters, mobile technology, reactivity effects, participant compliance
- MeSH terms
- Adult, Mental Disorders, Female, Humans, Male, Middle Aged, Suicide, Attempted, Risk Assessment, Suicidal Ideation
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