Digital phenotyping of suicidal thoughts

Kleiman, Evan M.; Turner, Brianna J.; Fedor, Szymon; Beale, Eleanor E.; Picard, Rosalind W.; Huffman, Jeffery C.; Nock, Matthew K.

doi:10.1002/da.22730

Cited by 183 publications

(137 citation statements)

References 29 publications

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“…change scores), evaluating different contextual factors or mood states as well as the impact of treatment (attendance, adherence, type), or, as found in this study, by examining synergistic effects of risk indicators. A focus on distinct phenotypes of SI, accounting for its intensity and variability, in real‐time (Kleiman et al., ) could offer another promising approach to short‐term risk identification. Research employing frequent assessments across different populations as well as settings is needed to help address these research questions and ultimately help identify meaningful targets of intervention for individuals at elevated suicide risk.…”

Section: Discussionmentioning

confidence: 99%

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

Czyz

Horwitz

Arango

et al. 2018

Child Psychology Psychiatry

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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 shortterm 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.Little is known about the dynamic nature of suicidal ideation and its near-term association with risk factors; this study of adolescent utilized daily electronic diaries for a month after psychiatric hospitalization. Suicidal ideation, and its risk factors (hopelessness, connectedness, burdensomeness), fluctuated considerably day-to-day in the postdischarge period. These risk factors were concurrently, but not short-term prospectively, associated with suicidal ideation. Low connectedness combined with either high hopelessness or high burdensomeness was reliability associated with more severe same-and next-day ideation.

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Section: Discussionmentioning

confidence: 99%

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

Czyz

Horwitz

Arango

et al. 2018

Child Psychology Psychiatry

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“…There are now new efforts to develop apps that will offer users help in emergencies. Recent research on real-time smartphone monitoring of suicidal ideation in those recently discharged from inpatient psychiatric units highlights the potential of apps to offer actionable insights on the real-time and personalised risk factors for suicidal ideation 43. Some start-ups are also exploring how peer crowd sourcing-based smartphone apps may help direct users in need to immediate help via suicide hotlines 44…”

Section: Improving App Engagementmentioning

confidence: 99%

Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements

Torous

Nicholas

Larsen

et al. 2018

Evid Based Mental Health

589

447

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The potential of smartphone apps to improve quality and increase access to mental health care is increasingly clear. Yet even in the current global mental health crisis, real-world uptake of smartphone apps by clinics or consumers remains low. To understand this dichotomy, this paper reviews current challenges surrounding user engagement with mental health smartphone apps. While smartphone engagement metrics and reporting remains heterogeneous in the literature, focusing on themes offers a framework to identify underlying trends. These themes suggest that apps are not designed with service users in mind, do not solve problems users care most about, do not respect privacy, are not seen as trustworthy and are unhelpful in emergencies. Respecting these current issues surrounding mental health app engagement, we propose several solutions and highlight successful examples of mental health apps with high engagement. Further research is necessary to better characterise engagement with mental health apps and identify best practices for design, testing and implementation.

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“…Building upon these findings, future studies may want to evaluate different qualitative aspects relating to NSSI thoughts [i.e., intensity, duration, controllability; (71,78)], and explore whether meaningful patterns can be identified in relationship to risk for NSSI behavior. In suicide research, for instance, scholars have identified different phenotypes of suicidal thinking, and were able to associate a thought profile characterized by severe persistent suicidal thoughts to a recent suicide attempt (79).…”

Section: Limitations and Future Research Directionsmentioning

confidence: 99%

Fluctuations in Affective States and Self-Efficacy to Resist Non-Suicidal Self-Injury as Real-Time Predictors of Non-Suicidal Self-Injurious Thoughts and Behaviors

et al. 2020

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Introduction: Although research over the past decade has resulted in significantly increased knowledge about distal risk factors for non-suicidal self-injury (NSSI), little is known about short-term (proximal) factors that predict NSSI thoughts and behaviors. Drawing on contemporaneous theories of NSSI, as well as the concept of ideation-to-action, the present study clarifies (a) real-time factors that predict NSSI thoughts and (b) the extent to which theoretically important momentary factors (i.e., negative affect, positive affect, and selfefficacy to resist NSSI) predict NSSI behavior in daily life, beyond NSSI thoughts.Methods: Using experience sampling methodology, intensive longitudinal data was obtained from 30 young adults with frequent NSSI episodes in the last year. Participants completed assessments up to eight times per day for 12 consecutive days (signal-contingent sampling). This resulted in the collection of 2,222 assessments (median compliance = 79.2%) during which 591 NSSI thoughts and 270 NSSI behaviors were recorded. Using the dynamic structural equation modeling framework, multilevel vector autoregressive models were constructed.Results: Within the same assessment, negative affect was positively associated with NSSI thoughts, whereas positive affect and self-efficacy to resist NSSI were each negatively associated with NSSI thoughts. Across assessments, higher-than-usual negative affect and self-efficacy to resist NSSI were predictive of short-term change in NSSI thoughts. While fluctuations in both negative affect and positive affect prospectively predicted NSSI behavior, these factors became non-significant in models that controlled for the predictive effect of NSSI thoughts. In contrast, self-efficacy to resist NSSI incrementally predicted a lower probability of engaging in NSSI, above and beyond NSSI thoughts.Discussion: This study provides preliminary evidence that affective fluctuations may uniquely predict NSSI thoughts but not NSSI behaviors, and point to the role of personal belief in the ability to resist NSSI in preventing NSSI behavior. These findings illustrate the need to differentiate between the development of NSSI thoughts and the progression from NSSI thoughts to behavior, as these are likely distinct processes, with different predictors.

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Digital phenotyping of suicidal thoughts

Cited by 183 publications

References 29 publications

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

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

Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements

Fluctuations in Affective States and Self-Efficacy to Resist Non-Suicidal Self-Injury as Real-Time Predictors of Non-Suicidal Self-Injurious Thoughts and Behaviors

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