Using intensive time sampling methods to capture daily suicidal ideation: A systematic review

INTRODUCTION

There has been an increased emphasis on understanding suicidal thoughts and behaviors as they occur in real-time, resulting in a proliferation of studies utilizing intensive time sampling methods. Given the continued growth in this area, there is a need to synthesize the feasibility of these methods in capturing suicidal ideation at the daily level, in addition to an examination of study factors that may impact suicidal ideation detection, to guide future research.

METHOD

Online databases (i.e., PsychINFO, ERIC, PubMed, MEDLINE) were systematically searched for articles published through December 2020 that assessed suicidal ideation at the daily level.

RESULTS

Twenty-six articles presenting data from sixteen independent datasets met inclusion criteria. Across included articles, suicidal ideation detection ranged from approximately 1-92% of participant-completed surveys, with 18-100% of unique study participants reporting suicidal ideation during the study period. Assessment-based factors (i.e., number of daily assessments, duration of daily assessment period) did not appear to be meaningfully associated with suicidal ideation detection rates. Rather, participant characteristics (i.e., baseline suicide risk history, inclusion criteria) were better indicators of a study's ability to capture suicidal ideation at the daily level.

CONCLUSIONS

Findings highlights the impact of targeting participants with elevated suicide risk at study enrollment.

Use of Ecological Momentary Assessment to Study Suicidal Thoughts and Behavior: a Systematic Review

PURPOSE OF REVIEW

Ecological momentary assessment (EMA) is a recently introduced approach to patient evaluation that consists of asking patients questions in real time and in their usual habitat. This method seeks to contribute to suicide prevention by providing psychiatrists with detailed information about suicidal thoughts and behavior, how these fluctuate over short periods of time, and the short-term risk factors presented by patients. We conducted a systematic review of published research using EMA to study suicidal thoughts and behavior.

RECENT FINDINGS

Several systematic reviews of EMA in mental health have been conducted to date, and the literature contains numerous theoretical papers and compilations on EMA and suicide phenomena. To date, however, no systematic reviews have explored the use of this tool to study suicidal thoughts and behavior. We performed a systematic review of five databases (i.e., PubMed, Embase, Scopus, Web of Science, and PsycINFO) to identify studies on EMA and suicidal thoughts and behavior. An initial search revealed 544 articles. Following the study selection process, 35 studies were included in the review. Almost three-quarters of the studies were published in the last 4 years. The studies reviewed concluded that EMA was generally feasible and well accepted. EMA findings correlated well with the results of a retrospective assessment, though tended to over-represent symptom severity. Our review points to important aspects of suicidal thoughts and behavior, such as its wide fluctuation over short periods of time. Negative affect and disturbed sleep, among others, emerged as short-term predictors of suicidal thoughts and behavior. Therefore, EMA is a potentially useful tool in clinical practice, although not without drawbacks, such as participant fatigue with questionnaires and ethical concerns.

Ecological momentary assessment (EMA) of mental health outcomes in veterans and servicemembers: A scoping review

This PRISMA scoping review explores existing research conducted with United States military samples utilizing ecological momentary assessment (EMA) to evaluate mental health outcomes. EMA facilitates understanding of temporal changes of dynamic variables subject to change difficult to capture in standard laboratory assessment. It also elucidates understanding of complex etiology of mental illness in military and veteran samples and treatment approaches. Thirty-two articles published between 1995 and 2019 met inclusion criteria. Most (68.7%) included studies examined mental health symptoms and their temporal relationship to other outcomes among servicemembers and/or veterans, particularly posttraumatic stress disorder and substance use disorders. EMA was frequently employed to better understand underlying mechanisms of mental illness, predict symptom changes, assess feasibility among special populations, and assess treatment outcomes. Considerable variability existed in assessment period duration, number of daily assessments, and EMA modalities utilized. Several research gaps were identified, including underutilization of EMA to study suicide risk in veterans/servicemembers. EMA has great potential for increasing understanding of an array of complex mental health problems; however, this highly promising approach has been largely underutilized to study mental health issues among veteran and military populations to date, perhaps due to institutional delays in its adoption secondary to privacy/data security concerns.