Multidimensional variability in ecological assessments predicts two clusters of suicidal patients.
Open accessAbstract
The variability of suicidal thoughts and other clinical factors during follow-up has emerged as a promising phenotype to identify vulnerable patients through Ecological Momentary Assessment (EMA). In this study, we aimed to (1) identify clusters of clinical variability, and (2) examine the features associated with high variability. We studied a set of 275 adult patients treated for a suicidal crisis in the outpatient and emergency psychiatric departments of five clinical centers across Spain and France. Data included a total of 48,489 answers to 32 EMA questions, as well as baseline and follow-up validated data from clinical assessments. A Gaussian Mixture Model (GMM) was used to cluster the patients according to EMA variability during follow-up along six clinical domains. We then used a random forest algorithm to identify the clinical features that can be used to predict the level of variability. The GMM confirmed that suicidal patients are best clustered in two groups with EMA data: low- and high-variability. The high-variability group showed more instability in all dimensions, particularly in social withdrawal, sleep measures, wish to live, and social support. Both clusters were separated by ten clinical features (AUC = 0.74), including depressive symptoms, cognitive instability, the intensity and frequency of passive suicidal ideation, and the occurrence of clinical events, such as suicide attempts or emergency visits during follow-up. Initiatives to follow up suicidal patients with ecological measures should take into account the existence of a high variability cluster, which could be identified before the follow-up begins.
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The fluctuating nature of suicidality may hamper assessment of the consistency of the death wish.
“Moreover, suicidality might complicate MAID assessment: the fluctuating nature of suicidality13 may hamper assessment of the consistency of the death wish,14 and acute suicidality might interfere with decision-making.15”
From Requests for Medical Assistance in Dying by Young Dutch People With Psychiatric Disorders (2025) · cites this paper as [13]
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- Authors
- Bonilla-Escribano, P., Ramírez, D., Baca-García, E., Courtet, P., Artés-Rodríguez, A., & López-Castromán, J.
- Affiliations
- Instituto de Investigación Sanitaria Gregorio Marañón (ES)
- Centre National de la Recherche Scientifique (FR)
- Corresponding author
- Bonilla-Escribano, Pablo
- Venue
- Scientific Reports
- Published
- 2023-03-02
- Volume
- 13
- Issue
- 1
- Pages
- 3546-3546
- ISSN
- 2045-2322 (ISSN-L)
- PMC
- PMC9981613
- OpenAlex
- W4322768294
- Cited by
- 17
- References
- 72
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 3
- FWCI
- 4.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
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- Scientific Reports (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
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- HAL (submittedVersion, cc-by)
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- e-Archivo (Carlos III University of Madrid) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Ministerio de Ciencia, Innovación y Universidades, jointly with the European Commission (grants RTI2018-099655-BI00 (CLARA), PID2021-123182OB-I00 (EPiCENTER), TED2021-131823B-I00 (SCAR))
- Comunidad de Madrid (Y2018/TCS-4705 (PRACTICO-CM), S2017/BMD-3740 (AGES-CM 2-CM))
- Instituto de Salud Carlos III (ISCIII PI20/01555)
- American Foundation for Suicide Prevention (LSRG-1-005-16)
- GCS MERRI Montpellier-Nîmes (AOI 2016)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Social Psychology › Mental Health via Writing
- Keywords
- suicidal ideation, suicidal crisis, ecological momentary assessment, clinical heterogeneity, patient clustering, vulnerable patients, social withdrawal, sleep, social support, depressive symptoms, passive suicidal ideation, suicide attempts, emergency department visits, cognitive instability, suicide prevention
- MeSH terms
- Ecological Momentary Assessment, Emergency Service, Hospital, France, Suicide, Attempted, Suicidal Ideation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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