Objective:To extend evidence on the short-term variability of passive and active suicidal ideation (SI) and the association with suggested proximal risk factors such as interpersonal variables (perceived burdensomeness [PB], thwarted belongingness [TB], hopelessness, and depression) in real-time.Methods:This is an observational study using a prospective design applying ecological momentary assessments (EMA). Eligible for study inclusion were inpatients with unipolar depression, current or lifetime suicidal ideation, and fluent German. Over six days, 74 participants rated their momentary level of passive and active SI, PB, TB, depressiveness, and hopelessness up to 10 times per day on smartphones. Data was collected from August 2015 to July 2017. Compliance was excellent (89.7%).Results:Mean squared successive differences supported temporal instability for all variables. According intra-class correlations, between 25% and 47% of variance was accounted for by within-person variability. Multilevel analysis demonstrated significant positive associations between hopelessness, depressiveness, PB, and TB with passive SI. Prospectively, hopelessness and PB remained predictors of passive SI. For active SI, hopelessness, depression, PB, and TB were significantly associated cross-sectionally. Prospectively, hopelessness, PB, and the interaction PBxTB predicted active SI. All models were controlled for previous level of SI.Conclusions:This study provides further evidence on the short-term variability of SI in very short time frames implying the need of assessing SI repeatedly in clinical and research settings. The associations between interpersonal variables and passive and active SI were only partial in line with assumptions of the Interpersonal Theory of Suicide. Overall, the effects were small warranting further investigation.

Suicidal ideation is a major risk factor for suicidal behavior and has recently been shown to be fluctuating in studies applying ecological momentary assessments (EMAs). The aims of this study are to introduce a reliable and valid item set for assessing suicidal ideation and relevant proximal risk factors that can be used in future EMA studies within suicidology. Additionally, we provide data on the ability of the items to capture moment-to-moment variability and discuss feasibility aspects of EMA studies on suicidal ideation in a clinical sample. Psychiatric inpatients diagnosed with a depressive disorder (N = 74) rated a set of 28 items measuring suicidal ideation, thwarted belongingness, perceived burdensomeness, depression, anxiety, hopelessness, and positive affect 10 times per day on 6 consecutive days. In addition, these constructs were assessed by self-report questionnaires before and after the EMA period. Intraclass correlations and mean squared successive differences were calculated as indicators of item variability. Reliability was calculated at the prompt (within-person) and the person (between-person) level, applying an approach based on multilevel factor analysis. Convergent validity was assessed by correlating the EMA scores with a self-report questionnaire measuring the same constructs. All items demonstrated moment-to-moment-variability and substantial within-person variance. Moreover, all items and scales, except those assessing anxiety, showed satisfying reliability at the prompt and the person level, and correlations indicated convergent validity of the EMA item set. Compliance with the EMAs was excellent (89.7%). Researchers are encouraged to apply this useful tool in future EMA studies in the field of suicidology.

The results illustrate the dynamic nature and the diversity of trajectories of SI across 6 days in psychiatric inpatients with unipolar depression. Prediction of the fluctuation of SI might be of high clinical relevance. Further research using EMA and sophisticated analyses with larger samples is necessary to shed light on the dynamics of SI.

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Objective The study examines the temporal stability of capability for suicide (i.e., its state‐like component), because it has been recently discussed that capability for suicide may be subject to shift over time. Method Seventy‐four psychiatric inpatients with an unipolar depressive disorder were included in the study (mean age 37.9 years, 71.6% female, 32.4% with a history of suicide attempt). After a baseline assessment with several self‐report questionnaires, ecological momentary assessments were applied over six consecutive days using smartphones. Capability for suicide was rated with three items once a day. For daily capability for suicide, descriptive and variability statistics and associations with baseline clinical characteristics (depression, suicidal ideation, childhood maltreatment, and history of suicide attempt) were analyzed. The prospective association of daily level of active suicidal ideation and daily capability was investigated by multilevel analysis. Results Indicators of within‐person variability and temporal instability supported considerable fluctuation in daily capability for suicide. Yet the degree of temporal instability showed individual differences. Baseline and daily suicidal ideation were positively associated with daily fearlessness about death and perceived capability. Conclusion The results provide first evidence that capability for suicide includes a dynamic short‐term component that is linked to clinical variables such as suicidal ideation.