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Cited by 130Suicide and Self-Harm StudiesMental Health Research TopicsMental Health via Writing

Short-term change and prediction of suicidal ideation among adolescents: a daily diary study following psychiatric hospitalization

Open access
Czyz, Ewa K., Horwitz, Adam G., Arango, Alejandra, King, Cheryl A·2019·Journal of Child Psychology and Psychiatry
DOI 10.1111/jcpp.12974PMC PMC6726492
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Abstract

Background: Our understanding of suicidal ideation ( SI ) and its risk precursors is largely informed by studies spanning over wide time intervals (weeks, months, years). Little is known about SI as it occurs in daily lives of individuals at risk for suicide, the extent to which suicidal thoughts are dynamic over short periods of time, and the degree to which theoretically informed risk factors predict near‐term SI . Methods: Thirty‐four adolescents hospitalized due to last‐month suicide attempt and/or last‐week SI (76% female; ages 13–17) responded to daily surveys sent to their cell phones for four consecutive weeks after discharge ( n = 652 observations). Results: There was notable variability in day‐to‐day SI , with half of ideation ratings changing at least one within‐person standard deviation from one day to the next. Results of mixed effects models revealed concurrent (same‐day), but not short‐term prospective (next‐day), associations between SI (frequency, duration, urge) and well‐established predictors (connectedness, burdensomeness, hopelessness). However, synergistic effects of low connectedness with either high burdensomeness or high hopelessness were reliably associated with more severe same‐ and next‐day suicidal ideation. Conclusions: This study adds to emerging literature indicating that suicidal thoughts fluctuate considerably among individuals at risk for suicide, further extending it by focusing on adolescents in the critical posthospitalization period. Fostering high‐risk adolescents’ sense of connectedness to others may be an especially promising intervention target. Frequent assessment of SI and its predictors, independently and in combination, could help identify promising predictors of short‐term risk and meaningful intervention targets in high‐risk teens.

AI snapshot

Written from the paper’s full text.

TL;DR

In 34 recently psychiatrically hospitalized adolescents followed with daily surveys for 28 days, suicidal ideation fluctuated substantially day to day, with 43–47% of variance in frequency, duration, and urge due to within-person variability. Connectedness, burdensomeness, and hopelessness showed concurrent but not independent next-day associations with ideation; however, low connectedness combined with high burdensomeness or high hopelessness predicted more severe same- and next-day ideation.

Key findings

  • Any suicidal ideation was reported on 24.4% of daily responses (159 events), and 24 of 34 participants (70.6%) endorsed ideation at least once. About half of ideation ratings changed by at least one within-person standard deviation from one day to the next: 54.7% for frequency, 44% for duration, and 43.3% for urge.
  • Within-person variability accounted for 43%, 46%, and 47% of the variance in suicidal ideation frequency, duration, and urge, respectively. Predictors also varied day to day: connectedness 37%, burdensomeness 31%, and hopelessness 33%.
  • In mixed effects models, lower connectedness, greater burdensomeness, and higher hopelessness had significant same-day, but not next-day, independent associations with suicidal ideation; only previous-day suicidal ideation independently predicted next-day ideation.
  • Synergistic effects were found: low connectedness with either high burdensomeness or high hopelessness was associated with more severe same- and next-day suicidal ideation. Prospectively, connectedness × burdensomeness predicted next-day frequency, duration, and urge, while connectedness × hopelessness predicted next-day frequency and duration.

Methods

  • Design and sample: ecological momentary assessment/daily diary study of 34 adolescents ages 13–17 hospitalized for last-month suicide attempt and/or last-week suicidal ideation (76% female; mean age 15.5 years, SD=1.35), followed for 28 consecutive days after discharge; abstract reports n=652 observations.
  • Procedures: daily surveys sent by text between 5pm and 7pm via Qualtrics/TelEMA; measures included daily suicidal ideation frequency, duration, and urge, plus connectedness, burdensomeness, and hopelessness; baseline suicidal ideation severity used the C-SSRS.
  • Analysis: descriptive ICC/within-person variability; linear mixed effects models with random intercept and slope, controlling for pilot intervention group and previous-day suicidal ideation in next-day models; Benjamini-Hochberg correction for multiple comparisons.

Limitations

  • Stated: the primarily female and Caucasian sample limits generalizability; survey adherence was 69% and may have been influenced by mood or other factors; single-item EMA measures need further validation; daily surveys have greater recall bias than multiple daily assessments; the study was not powered for between-person moderators; possible underreporting of suicidal thoughts, though daily diaries yielded more disclosure than an end-of-study assessment; and the measure did not assess suicidal intent, plans, or content variability.
  • Evident: the small pilot sample (34 adolescents) and short 28-day follow-up limit precision and generalizability; findings may not extend to other high-risk adolescent populations or settings.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/jcpp.12974

Cites

57 of 57 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 43 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Synergistic effects of low connectedness with either high burdensomeness or high hopelessness were reliably associated with more severe same- and next-day suicidal ideation.

    “However, synergistic effects of low connectedness with either high burdensomeness or high hopelessness were reliably associated with more severe same- and next-day suicidal ideation.”
    Quote in the paperSubstantial claim
  • Findingown data

    All participants had at least one instance of suicidal ideation change by at least one within-person standard deviation from one day to the next.

    “with all participants having at least one instance of suicidal ideation change by at least one within-person standard deviation from one day to the next day.”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was notable variability in day-to-day suicidal ideation, with about half of ideation ratings changing at least one within-person standard deviation from one day to the next.

    “There was notable variability in day-to-day suicidal ideation, with half of ideation ratings changing at least one within-person standard deviation from one day to the next.”
    Quote in the paperNot a substantial claim
  • Findingown data

    A total of 24 (70.6%) individual participants endorsed suicidal ideation at least once across the 159 events.

    “a total of 24 (70.6%) individual participants endorsed ideation at least once across these 159 events”
    Quote in the paperNot a substantial claim
  • Findingown data

    The proportion of any suicidal ideation disclosures was fairly consistent across the four weeks: 24.6% in week 1, 22.1% in week 2, 24% in week 3, and 27.3% in week 4.

    “The proportion of disclosures of any suicidal ideation was fairly consistent across the four weeks: 24.6% in week 1 (n=46 events), 22.1% (n=38 events) in week 2, 24% (n=36 events) in week 3, and 27.3% (n=39 events) in week 4.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 26
  • Classified as probably not a substantial claim. 23

  • May combine two claims.

    Findingown data

    Approximately a third of connectedness, burdensomeness, and hopelessness ratings differed from one day to the next by at least one within-person standard deviation: 33.9% for connectedness, 34.5% for burdensomeness, and 32.4% for hopelessness.

    “Approximately a third of connectedness, burdensomeness, and hopelessness ratings differed from one day to the next by at least one within-person standard deviation: 33.9% (173/510) for connectedness, 34.5% (176/510) for burdensomeness, and 32.4% (166/512) for hopelessness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For suicidal ideation frequency, duration, and urge, 54.7%, 44%, and 43.3% of daily ideation ratings, respectively, changed from one day to the next by at least one within-person standard deviation from participants' individual mean.

    “Specifically, for suicidal ideation frequency, duration, and urge, 54.7% (n=235/519), 44% (n=229/520), and 43.3% (n=225/520) of daily ideation ratings, respectively, changed from one day to the next day by at least one standard deviation from participants’ individual mean.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Within-person variability for connectedness, burdensomeness, and hopelessness was 37%, 31%, and 33%, respectively.

    “The within-person or day-to-day variability for connectedness, burdensomeness, and hopelessness ranged, respectively, from 37% to 31% to 33%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants' levels of connectedness, burdensomeness, and hopelessness changed from one day to the next, but less so than suicidal ideation.

    “Participants’ levels of connectedness, burdensomeness, and hopelessness also changed from one day to the next consecutive day, however less so than for suicidal ideation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Nearly all participants had at least one instance of day-to-day change in connectedness (100%), burdensomeness (94.1%), and hopelessness (97.1%) by at least one within-person standard deviation.

    “Nearly all participants had at least one instance of day-to-day change in these variables (100% for connectedness; 94.1% for burdensomeness; 97.1% for hopelessness) by at least one within-person standard deviation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The sample was 76.5% female, with a mean age of 15.5 years (SD=1.35).

    “The sample’s sex distribution included 76.5% (n=26) female adolescents, with a mean age of 15.5 years (SD=1.35).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The average baseline suicidal ideation severity (range 0-5) was 4.06 (SD=0.92).

    “The average baseline suicidal ideation severity (range 0–5) was 4.06 (SD=0.92).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When either burdensomeness or hopelessness were high, higher levels of connectedness were associated with decreasing same-day suicidal ideation, and the same pattern emerged for next-day suicidal ideation.

    “As shown in Figure 3 (online supplemental materials), when either burdensomeness or hopelessness were high, presence of higher levels of connectedness was associated with decreasing same-day suicidal ideation; the same pattern emerged when interactions were plotted for next-day suicidal ideation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At baseline, 52.9% of teens had a previous suicide attempt; 32.4% attempted within a month of hospitalization.

    “At baseline, 52.9% (n=18) of the teens had a previous suicide attempt; 32.4% (n=11) attempted within a month of hospitalization.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In mixed effects models, lower connectedness, greater burdensomeness, and higher hopelessness had statistically significant concurrent associations with suicidal ideation outcomes, but not short-term prospective associations.

    “Results from mixed effects models (Table 2) indicate statistically significant concurrent, but not short-term prospective, relationships between suicidal ideation outcomes and lower connectedness, greater burdensomeness, and higher hopelessness.”
    • Also stated in: § Discussion · plain
      “Additional findings that warrant discussion include the fact that, despite significant concurrent associations, connectedness, burdensomeness, and hopelessness were not significant predictors of next-day suicidal ideation indicators when accounting for previous-day suicidal ideation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Approximately a third (32.4%; n=11) of the sample had at least one previous psychiatric hospitalization.

    “Approximately a third (32.4%; n=11) of the sample had at least one previous psychiatric hospitalization.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the authors' previous study of adolescents followed daily for a month following psychiatric hospitalization, daily assessments of suicidal ideation in the post-discharge period were feasible, acceptable to adolescents, and resulted in more teens reporting thoughts of suicide compared to an end-of-study assessment.

    “In our previous study of adolescents who were followed daily for a month following psychiatric hospitalization, we learned that daily assessments of suicidal ideation in the critical post-discharge period were feasible, acceptable to adolescents, and resulted in more teens reporting thoughts of suicide compared to an end-of-study assessment (Czyz, King, Nahum-Shani, 2018b).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Czyz, King, Nahum-Shani, 2018b

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The Brief Hopelessness Scale item used has sound psychometrics and is comparable to the full measure of hopelessness.

    “This item was from the 6-item Brief Hopelessness Scale (Bolland, McCallum, Lian, Bailey, & Rowan, 2001), adapted from the Hopelessness Scale for Children (Kazdin, Rodgers, & Colbus, 1986). The measure has sound psychometrics and is comparable to the full measure of hopelessness.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Bolland, McCallum, Lian, Bailey, & Rowan, 2001

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    • cites Kazdin, Rodgers, & Colbus, 1986

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  • May combine two claims.

    Premisecitation

    IPTS proposes that the combination of low connectedness and high burdensomeness leads to suicidal desire, which has been supported by previous research among adults and teens.

    “IPTS proposes that the combination of these two factors leads to suicidal desire, which has been supported by previous research among adults and teens (Chu et al., 2017; Opperman, Czyz, Gipson, & King, 2015; Stewart, Eaddy, Horton, Hughes, & Kennard, 2017).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Chu et al., 2017

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    • cites Opperman, Czyz, Gipson, & King, 2015

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    • cites Stewart, Eaddy, Horton, Hughes, & Kennard, 2017

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  • May combine two claims.

    Interpretationown data

    This study adds to emerging literature indicating that suicidal thoughts fluctuate considerably among individuals at risk for suicide, and extends it by focusing on adolescents in the critical post-hospitalization period.

    “This study adds to emerging literature indicating that suicidal thoughts fluctuate considerably among individuals at risk for suicide, further extending it by focusing on adolescents in the critical post-hospitalization period.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    EMA data collection is feasible for repeated assessment of suicide risk-related constructs.

    “Existing studies involving repeated assessment of suicide risk-related constructs have demonstrated that EMA data collection is feasible (Davidson, Anestis, & Gutierrez, 2017)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Davidson, Anestis, & Gutierrez, 2017

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Only one EMA study (Nock et al., 2009) has assessed suicidal ideation in adolescents (ages 12-19), but participants were recruited from the community and reported relatively infrequent suicidal ideation over the two-week follow-up period.

    “To our knowledge, only one EMA study (Nock et al., 2009) has assessed suicidal ideation in adolescents (ages 12–19), however participants were recruited from the community and reported relatively infrequent suicidal ideation over the two-week follow-up period.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Nock et al., 2009

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    In two adult samples of previous suicide attempters and psychiatric inpatients, hopelessness, burdensomeness, and loneliness had strong associations with concurrent suicidal ideation, but these risk factors were not associated with next-assessment suicidal ideation when controlling for suicidal ideation at the previous assessment.

    “Similarly, in two adult samples of previous suicide attempters and psychiatric inpatients, Kleiman et al. (2017) found that while hopelessness, burdensomeness, and loneliness had strong associations with concurrent suicidal ideation, these risk factors were not associated with next-assessment suicidal ideation when controlling for suicidal ideation at the previous assessment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kleiman et al. (2017)

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  • Classified as probably not a substantial claim.

    Premisecitation

    Hopelessness is conceptualized as both central and proximal to the emergence of suicidal ideation in a cognitive framework.

    “Our focus on hopelessness, defined as negative expectations about the future, is guided by a cognitive framework (Wenzel & Beck, 2008) wherein hopelessness is conceptualized as both central and proximal to the emergence of suicidal ideation.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Wenzel & Beck, 2008

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  • May combine two claims.

    Premisecitation

    The post-discharge period for psychiatrically hospitalized teens is often characterized by ongoing suicide risk-related crises and fluctuating risk patterns.

    “The need to fill these knowledge gaps is especially critical for psychiatrically hospitalized teens, as the post-discharge period is often characterized by ongoing suicide risk-related crises (Brent et al., 2013; Czyz, Berona, & King, 2016; Goldston et al., 1999; Yen et al., 2013) and fluctuating risk patterns (Czyz & King, 2015; Prinstein et al., 2008).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Brent et al., 2013

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    • cites Czyz, Berona, & King, 2016

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    • cites Goldston et al., 1999

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  • Classified as probably not a substantial claim.

    Premisecitation

    The interpersonal-psychological theory of suicidal behavior (IPTS) conceptualizes suicidal desire as arising from low levels of social connectedness (thwarted belongingness) and perception that one is a burden on others (burdensomeness).

    “Our focus on connectedness and burdensomeness is informed by the interpersonal-psychological theory of suicidal behavior (IPTS) (Joiner, 2015; Van Orden et al., 2010), wherein suicidal desire is conceptualized as arising from low levels of social connectedness (i.e. thwarted belongingness) and perception that one is a burden on others (burdensomeness).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Joiner, 2015

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    • cites Van Orden et al., 2010

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Repeated assessment of suicidal thoughts was not associated with any iatrogenic increase in suicidal thinking.

    “and that repeated assessment of suicidal thoughts was not associated with any iatrogenic increase in suicidal thinking (Husky et al., 2014; Law et al., 2015).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Husky et al., 2014

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    • cites Law et al., 2015

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Interpersonal Needs Questionnaire (INQ) has strong psychometric properties in adult and adolescent samples.

    “These two questions were derived from the 15-item Interpersonal Needs Questionnaire (INQ) (Van Orden, Cukrowicz, Witte, & Joiner, 2012) measuring thwarted belongingness and perceived burdensomeness. The INQ has strong psychometric properties in adult and adolescent samples (Hill et al., 2015; Van Orden et al., 2012).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hill et al., 2015

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    • cites Van Orden et al., 2012

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Additional EMA studies with adults have indicated that suicidal thoughts are dynamic over short periods of time, sometimes fluctuating over an interval of only a few hours.

    “Additional EMA studies with adults have indicated that suicidal thoughts are dynamic over short periods of time, sometimes fluctuating over an interval of only a few hours (Hallensleben et al., 2018; Kleiman et al., 2017).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hallensleben et al., 2018

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    • cites Kleiman et al., 2017

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Columbia-Suicide Severity Rating Scale (C-SSRS) has shown strong reliability and validity, including predictive validity for suicide attempts.

    “The C-SSRS assesses a range of suicidal thoughts and behaviors, and it has shown strong reliability and validity (Posner et al., 2011), including predictive validity for suicide attempts (Gipson, Agarwala, Opperman, Horwitz, & King, 2015; Horwitz, Czyz, & King, 2015).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Posner et al., 2011

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    • cites Gipson, Agarwala, Opperman, Horwitz, & King, 2015

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    • cites Horwitz, Czyz, & King, 2015

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  • May combine two claims.

    Interpretationown data

    Low connectedness together with high hopelessness was also associated with next-day suicidal ideation, pointing to multiple proximal pathways to suicidal ideation.

    “Moving beyond IPTS, however, it is noteworthy that low connectedness together with high hopelessness was also associated with next-day suicidal ideation, pointing to multiple proximal pathways to suicidal ideation.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: A sense of burdensomeness may contribute to hopelessness, and hopelessness is a broader construct that may reflect struggles in interpersonal and/or non-interpersonal domains.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Kleiman and colleagues (2017), in two samples of adults responding to four surveys per day, reported that 33% and 47% of variance was accounted for by within-person variability.

    “This is consistent with previous work conducted by Kleiman and colleagues (2017) who, in two samples of adults responding to four surveys per day, reported that 33% and 47% of variance was accounted for by within-person variability.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kleiman and colleagues (2017)

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  • May combine two claims.

    Interpretationown data

    Low connectedness, together with elevated sense of burdensomeness or hopelessness, appears to represent an especially risky state for both the emergence of suicidal ideation and its persistence into the next day.

    “With implications for our understanding of suicide risk, low connectedness, together with elevated sense of burdensomeness or hopelessness, appears to represent an especially risky state for not only the emergence of suicidal ideation but also its persistence into the next day.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The time-dependent relationship between suicidal thoughts and individual risk factors examined in this study points to the possibility that the dynamic nature of these constructs may require even more fine-grained assessment to improve short-term prediction.

    “Finally, the time-dependent relationship between suicidal thoughts and individual risk factors examined in this study points to the possibility that the dynamic nature of these constructs may require even more fine-grained assessment in order to improve short-term prediction.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    IPTS theory conceptualizes connectedness, burdensomeness, and hopelessness as dynamic.

    “In line with IPTS theory, which conceptualizes these as dynamic (Van Orden et al., 2010), it is notable that the precursors to suicidal ideation examined in this study also varied considerably, with approximately a third of connectedness, burdensomeness, and hopelessness ratings changing day-to-day by at least one within-person standard deviation.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Van Orden et al., 2010

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    All mixed effects models included a random intercept and slope and controlled for any group effects because the data came from a pilot intervention study.

    “All models included a random intercept and slope and, because the data came from a pilot intervention study, also controlled for any group effects1.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Kleiman and colleagues' study (2017) found that only suicidal ideation (but not hopelessness, loneliness, or burdensomeness) predicted short-term changes in suicidal ideation assessed multiple times per day.

    “This is consistent with Ben-Zeev et al. (2012) who found no relationship between hopelessness and near-term ideation as well as with Kleiman and colleagues’ study (2017) where only suicidal ideation (but not hopelessness, loneliness, or burdensomeness) predicted short-term changes in suicidal ideation assessed multiple times per day.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kleiman and colleagues’ study (2017)

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  • Classified as probably not a substantial claim.

    Interpretationown data

    The dynamic nature of suicidal ideation observed in this study converges with clinical recommendations to closely monitor ideation in the post-discharge period.

    “The dynamic nature of suicidal ideation observed in this study also converges with clinical recommendations to closely monitor ideation in the post-discharge period, although much more work is needed to address critical issues related to the feasibility of clinical implementation of more frequent monitoring.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    This study adds to the growing literature suggesting that suicidal thoughts fluctuate considerably, highlighting the value of EMA methods.

    “Taken together, this study adds to the growing literature suggesting that suicidal thoughts fluctuate considerably, thus highlighting the value of EMA methods in providing a more nuanced understanding of when these thoughts occur as well as the associated contextual factors.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Next-day models controlled for previous-day suicidal ideation corresponding to the outcome.

    “All models included the three predictors, and next-day models also controlled for previous-day suicidal ideation corresponding to the outcome (e.g., for next-day duration, previous-day duration was controlled for).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The measure of suicidal thoughts used in this study did not assess suicidal intent or plans, or variability in the content of suicidal thoughts.

    “Finally, the measure of suicidal thoughts used in this study did not assess suicidal intent or plans, or, more generally, variability in the content of suicidal thoughts, which could be important to our understanding of transitions in suicidal thinking and precursors to suicidal behavior.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The study adjusted for multiple comparisons using the Benjamini-Hochberg procedure with a 0.05 false positive discovery rate.

    “To adjust for multiple comparisons, we applied the Benjamini-Hochberg procedure (Benjamini & Hochberg, 1995) with a 0.05 false positive discovery rate.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Benjamini & Hochberg, 1995

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Survey adherence (69%) may be a limitation, as it is not possible to rule out that adherence may have been influenced by relevant mood states or factors.

    “Although comparable to EMA studies of similar length (e.g., 62.0% reported by Kleiman et al., 2017; 77.8% reported by Torous et al., 2015), survey adherence (69%) may be another limitation, as it is not possible to rule out that adherence may have been influenced by relevant mood states or factors.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kleiman et al., 2017

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    • cites Torous et al., 2015

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  • May combine two claims.

    Interpretationown data

    The time-dependent relationships may reflect the dynamic, state-like nature of these constructs, and hopelessness, burdensomeness, and connectedness may be limited in predicting short-term suicidal ideation.

    “These time-dependent relationships may be reflective of the dynamic, or state-like, nature of these constructs and, while contrary to what might be expected based on theory and evidence found in existing literature, it may be that hopelessness, burdensomeness, and connectedness are limited in predicting short-term suicidal ideation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Survey adherence: participants responded to 654 (69.4%) and completed 650 (68.9%) surveys during the 28-day period; on average, participants completed 19.12 (SD=7.07) surveys.

    “With regard to survey adherence, participants responded to 654 (69.4%) and completed 650 (68.9%) surveys during the 28-day period. On average, participants completed 19.12 (SD=7.07) surveys.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Daily surveys employed in this study are subject to greater recall bias relative to multiple daily assessments.

    “Daily surveys employed in this study are subject to greater recall bias relative to multiple daily assessments, which would have the advantage of providing even more fine-grained information about teens’ experiences.”
    Quote in the paperNot a substantial claim
41 of 41

  • The paper relies on this without support.

    There is limited information about the extent to which suicidal ideation and its precursors change over short periods of time among adolescents in the post-discharge period.

    “Given limited information about the extent to which suicidal ideation and its precursors change over short periods of time among adolescents in the post-discharge period, we also examined day-to-day variability in suicidal ideation as well as connectedness, burdensomeness, and hopelessness.”

  • The paper relies on this without support.

    Most studies ask about severity of suicidal ideation as well as risk indicators over longer time intervals that may not capture short-term changes or states.

    “This pattern of variability is worth noting because most studies ask about severity of suicidal ideation as well as risk indicators over longer time intervals that may not capture these changes or states, which, in turn, could be critical to improving risk detection.”

  • The authors state this as an assumption.

    This is the first study employing fine-grained (i.e. daily) assessments among discharged adolescents to understand the dynamic nature of these phenomena and short-term prediction of suicidal ideation.

    “To our knowledge, this is the first study employing fine-grained (i.e. daily) assessments among discharged adolescents to understand the dynamic nature of these phenomena and short-term prediction of suicidal ideation.”

  • The authors state this as an assumption.

    This study is the first to provide evidence supporting the importance of these two theory components to our understanding of suicidal ideation or desire using a short-term prospective design.

    “However, to our knowledge, this study is the first to provide evidence supporting the importance of these two theory components to our understanding of suicidal ideation or desire using a short-term prospective design.”

  • The paper relies on this without support.

    A sense of burdensomeness may contribute to hopelessness, and hopelessness is a broader construct that may reflect struggles in interpersonal and/or non-interpersonal domains.

    “Although a sense of burdensomeness may contribute to hopelessness, hopelessness is a broader construct that may reflect struggles in interpersonal and/or non-interpersonal domains.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Most individuals in the reviewed studies experienced substantial variability in suicidal ideation both between days and within days.

    “Most individuals experienced substantial variability in suicidal ideation both between- (55) and within-days (47, 56, 58).”

    From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [55]

  • Risk factors (negative affect, hopelessness, loneliness, burdensomeness, connectedness, thwarted belongingness) occurred with similar variability and were concurrently associated with suicidal ideation.

    “Risk factors (negative affect, hopelessness, loneliness, burdensomeness, connectedness, thwarted belongingness) occurred with similar variability, and were concurrently associated with suicidal ideation (47, 55, 56, 68, 78).”

    From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [55]

  • Most reports failed to establish independent temporal predictors of suicidal ideation severity: of twelve articles fitting temporal prediction models, four failed to establish significant predictors after accounting for ideation at the previous time point, and five did not control for prior ideation.

    “Most reports failed to establish independent temporal predictors of suicidal ideation severity: of twelve articles fitting temporal prediction models (47, 51, 52, 55–57, 60, 73, 74, 76, 77), four failed to establish significant predictors after accounting for ideation at the previous time point (47, 52, 55), and five did not control for prior ideation (51, 60, 73, 74, 76).”

    From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [55]

  • Studies examining day-to-day rather than within-day changes in suicidal ideation were less likely to report positive findings.

    “Studies examining day-to-day rather than within-day changes in suicidal ideation were less likely to report positive findings (55, 80).”

    From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [55]

  • In three studies following adolescents recently discharged from inpatient treatment after a suicide attempt or severe ideation, the incidence of suicide attempts over 28 days was 6%, 8%, and 9%.

    “Three studies followed adolescents who were recently discharged from inpatient treatment after a suicide attempt or severe ideation. In 28 days, the incidence of suicide attempts was 6% (55), 8% (72), and 9% (85).”

    From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [55]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Not every participant could have had a change in suicidal ideation

    Minor

    Only 24 of the 34 participants endorsed ideation at least once. Participants who never endorsed ideation could not have had a day-to-day change in its reported frequency, duration, or urge, contrary to the claim about all participants.

  • Ideation-frequency change percentage does not match its count

    Minor

    The stated 235 of 519 ratings is 45.3%, not 54.7%.

    Reported 54.7 · recomputed 45.279383

2 of 2

Cites

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Related

Authors
Czyz, E. K., Horwitz, A. G., Arango, A., & King, C. A.
Affiliations
  • University of Michigan (US)
  • Rush University Medical Center (US)
Corresponding author
Czyz, Ewa K.
ORCID
Venue
Journal of Child Psychology and Psychiatry
Publisher
Wiley
Published
2018-09-24
Volume
60
Issue
7
Pages
732-741
ISSN
  • 0021-9630 (ISSN-L)
  • 1469-7610
DOI
10.1111/jcpp.12974
PMC
PMC6726492
OpenAlex
W2894519176
Semantic Scholar
aba196e596a3d9a097fc027553960d4b5f0e97ba
Cited by
130
References
56
Citations by year
2026: 13 · 2025: 19 · 2024: 25 · 2023: 16 · 2022: 18 · 2021: 21 · 2020: 10 · 2019: 7 · 2018: 1
FWCI
11.46
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of Child Psychology and Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Funders
Michigan Institute for Clinical and Health Research
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, adolescents, suicide attempts, psychiatric hospitalization, daily fluctuations, connectedness, perceived burdensomeness, hopelessness, risk prediction, post-discharge period, suicide prevention
MeSH terms
Adolescent, Female, Hospitals, Psychiatric, Humans, Male, Patient Discharge, Prognosis, Surveys and Questionnaires, Suicide, Attempted, Time Factors, 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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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.

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