A proof of concept study on individual trends in suicidal ideation: an ecological momentary assessment study of 5 patients over three months.
Open accessAbstract
Background: Suicidal ideation (SI) is a significant and long-lasting mental health problem, with a third of individuals still experiencing SI after two years. To date, most Ecological Momentary Assessment (EMA) studies of SI have assessed its day-to-day course over one to four consecutive weeks and found no consistent trends in average SI severity over time. Aim: The current proof of concept study assessed daily fluctuations of SI over a time span of 3 to 6 months to explore whether individual trends in SI severity could be detected, and if so, if the trajectory of changes were gradual or sudden. The secondary aim was to explore whether changes in SI severity could be detected at an early stage. Method: Five adult outpatients with depression and SI used an EMA app on their smartphone in addition to their regular treatment for 3 to 6 months, where SI was assessed 3 times a day. To detect trends in SI for each patient, three models were tested: a null model, a gradual change model and a sudden change model. To detect changes in SI before a new plateau was reached, Early Warning Signals and Exponentially Weighted Moving Average control charts were used. Results: In each patient, average SI severity had a unique trajectory of sudden and/or gradual changes. Additionally, in some patients, increases in both sudden and gradual SI could be detected at an early stage. Conclusions: The study presents a first indication of unique individual trends in SI severity over a 3 to 6 months period. Though replication in a larger sample is needed to test how well results generalize, a first proof-of-concept is provided that both sudden and gradual changes in SI severity may be detectable at an early stage using the dynamics of time-series data.
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Acute suicidal behaviors typically fluctuate.
“While acute suicidal behaviors typically fluctuate,31,32 patients need to prove a well-considered and recurrent death wish to be eligible for MAID.”
From Requests for Medical Assistance in Dying by Young Dutch People With Psychiatric Disorders (2025) · cites this paper as [31]
The Discussion reports that suicidal ideation severity fluctuated in five outpatients, and the Introduction cites prior studies finding fluctuations over hours. The cited paper addresses suicidal thoughts, not acute suicidal behaviors, so it does not fully support the broader claim. (LLM, conf=0.85)
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- Authors
- Nuij, C., Van Ballegooijen, W., Smit, A. C., De Beurs, D., De Winter, R. F. P., O’Connor, R. C., Kerkhof, A., Smit, J. H., & Riper, H.
- Affiliations
- Amsterdam Public Health (NL)
- University of Glasgow (GB)
- Corresponding author
- Nuij, Chani
- Venue
- Journal for Person-Oriented Research
- Publisher
- Journal for Person-Oriented Research
- Published
- 2023-06-17
- Volume
- 9
- Issue
- 1
- Pages
- 42-50
- ISSN
- 2002-0244 (ISSN-L)
- 2003-0177
- PMC
- PMC10302657
- OpenAlex
- W4381248909
- Cited by
- 6
- References
- 30
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Journal for Person-Oriented Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- UvA-DARE (University of Amsterdam) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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 › Social Psychology › Mental Health via Writing
- Keywords
- suicidal ideation, individual trajectories, gradual change, abrupt change, early warning indicators, EWMA control chart, time series dynamics, depression, smartphone-based ecological momentary assessment, suicide risk identification
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