Conference Agenda

Persistent suicidal ideation (PSI) represents a clinically significant but insufficiently researched phenomenon. A proposed working definition characterizes PSI as suicidal thoughts occurring on most days over a period of at least twelve months. To advance understanding of the dynamics, functionality, and everyday context of PSI, a pilot study including a participatory approach to refine an Ecological Momentary Assessment (EMA) design is conducted. The study aims to evaluate the feasibility of intensive EMA among individuals with PSI and to identify methodological and ethical considerations relevant for future research.

The study consists of a pre-assessment including a clinical interview, a 7-day EMA period with nine prompts per day, and a comprehensive post-assessment involving semi-structured interviews. The EMA includes questions on PSI, general affect, emotion regulation, metacognitions, trigger events for PSI, functionality of PSI, and social context. The post-assessment interviews focus on participants’ experiences during the EMA phase, feedback on item clarity and relevance, perceived burden, and ethical considerations, as well as suggestions for improving the study design. The participatory elements will provide essential information for optimizing the EMA protocol and aligning it with the needs and perspectives of individuals with PSI.

Only participants fulfilling the inclusion criteria of PSI are recruited (current n = 9, target n = 10-15). The data collection will be finished in spring and results will be presented in the talk.

This pilot study provides important insights into the methodological and ethical foundations of EMA research on PSI and offers guidance for developing future studies including participant-centered and ethically sound EMA designs.

Theoretical background: Ecological Momentary Assessment (EMA) allows for the real-time evaluation of suicidal ideation and their fluctuations in people's daily lives. While EMA provides unique temporal precision, sustained participant engagement is essential for its effectiveness, particularly in high-risk populations where distress, burden and symptom variability may reduce compliance.

Research question: This study examined the feasibility of, and engagement patterns within, a 28-day EMA protocol for individuals with persistent suicidal thoughts. Specifically, we investigated whether participants were able to maintain stable participation in the EMA protocol over several weeks and which individual characteristics were associated with higher or lower engagement.

Method: Data were collected within an ongoing, randomised controlled, longitudinal trial involving 68 participants (mean age = 41.0 years, range 18–69). EMA Engagement: Participants received four EMA prompts per day for 28 days, assessing momentary suicidal ideation, affect, interpersonal stress and coping. Engagement was quantified through prompt-level completion rates, and temporal trajectories and individual differences were analysed using mixed-effects models.

Results: Overall, the study was feasible, with participants completing a substantial proportion of prompts throughout the entire period. Neither age nor baseline symptom severity appeared to meaningfully reduce engagement. Preliminary results suggest that individuals with persistent suicidal ideation can reliably participate in high-frequency EMA protocols, experiencing only a modest decline in completion rates over time. Qualitative feedback suggests that many participants found EMA helpful for recognizing emotional patterns.

Conclusion: The findings support the feasibility of multi-week EMA participation in a high-risk clinical sample. Stable engagement over 28 days suggests that EMA could be successfully integrated into intervention studies to monitor therapeutic change processes.

Background: Ecological Momentary Assessment (EMA) provides unique insight into short-term fluctuations in suicidal thoughts and related risk factors. Yet, sustaining participation in intensive EMA designs can be challenging, especially among individuals recently discharged from inpatient psychiatric care. Understanding compliance patterns is therefore essential to ensure data quality and interpretability in suicide risk research.

Objectives: This study investigates engagement with a long-term EMA protocol in the APOS project, a multicenter study on post-discharge suicide risk. We aim to (1) describe overall compliance and its change over time, (2) identify participant characteristics associated with higher or lower compliance, and (3) examine whether contextual factors influence the likelihood of responding to individual prompts.

Methods: Psychiatric inpatients (N = 184) admitted for a recent suicidal crisis or attempt were enrolled during hospitalization and monitored after discharge. EMA consisted of two phases: a more intensive 3-week period (four daily prompts) followed by up to 26 weeks of reduced monitoring (two days per week, four prompts per day). Each brief smartphone survey assessed current affect, cognitions, social context, and suicidal ideation. Compliance was defined as completing the survey within 20 minutes of a prompt.

We will combine descriptive analyses with multilevel modeling to distinguish between-person predictors of overall compliance (e.g., demographics, clinical history, baseline severity) and within-person influences on prompt-level responding (e.g., time of day, weekday vs. weekend, study phase). Additional sensitivity analyses will address protocol-specific influences and dropout patterns.

Expected Contributions: By characterizing how and when compliance decreases, and for whom, this project will help refine EMA design for vulnerable clinical groups. Insights into person- and context-level predictors of response behavior will support more feasible monitoring strategies and improve the validity of intensive longitudinal data used to study near-term suicide risk.

Background: Ecological momentary assessment (EMA) has become a central tool in suicide research, offering real-time insights into suicidal thoughts and behaviors (STBs). Yet, little is known about how individuals with recent suicidal crises experience frequent and long-term digital assessments. This study explores the feasibility and potential reactivity of EMA among patients recently discharged from inpatient psychiatric care.

Methods: Participants completed an intensive 21–24 day EMA phase (EMA 1; four semi-random prompts per day), followed by a 26-week reduced-frequency EMA phase (EMA 2; four prompts per day on two random consecutive days per week). Debriefings were conducted via telephone interviews after EMA 1 (n = 68) and after EMA 2 (n = 51) using quantitative ratings and open-ended questions. In addition, 16 participants reflecting varying levels of STBs and compliance were interviewed in depth regarding feasibility and reactivity. Qualitative content analysis was conducted using an inductive–deductive approach with consensual coding.

Results: Across both phases, many participants reported changes in mood or behavior due to EMA engagement (62% after EMA 1; 66% after EMA 2). Reported effects varied widely: some experienced EMA as helpful—enhancing self-insight or providing a sense of support—while others reported burden, exhaustion, or annoyance. Reactivity effects were noted by a subset of participants, including temporary intensification of suicidal thoughts or increased brooding. Importantly, no participants reported that EMA triggered suicidal actions. Overall, EMA was perceived as feasible and beneficial, though burden tended to increase over time, and feasibility during acute suicidal crises was questioned due to decreased ability or willingness to respond.

Conclusions: Findings highlight both the promise and the challenges of long-term EMA among individuals at elevated suicide risk. They underscore the need for personalized monitoring durations, participatory protocol design, and mixed-methods approaches to better understand and interpret EMA data in high-risk populations.