Suicidal thoughts, suicidal behaviours and self-harm in daily life: A systematic review of ecological momentary assessment studies

Abstract

Background Ecological Momentary Assessments (EMA) offer an approach to understand the daily risk factors of suicide and self-harm of individuals through the use of self-monitoring techniques using mobile technologies. Objectives This systematic review aimed to examine the results of studies on suicidality risk factors and self-harm that used Ecological Momentary Assessments. Methods Pubmed and PsycINFO databases were searched up to April 2020. Bibliographies of eligible studies were hand-searched, and 744 abstracts were screened and double-coded for inclusion. Results The 49 studies using EMA included in the review found associations between daily affect, rumination and interpersonal interactions and daily non-suicidal self-injury (NSSI). Studies also found associations between daily negative affect and positive affect, social support, sleep, and emotions and a person’s history of suicide and self-harm. Associations between daily suicide thoughts and self-harm, and psychopathology factors measured at baseline were also observed. Conclusions Research using EMA has the potential to offer clinicians the ability to understand the daily predictors, or risk factors, of suicide and self-harm. However, there are no clear reporting standards for EMA studies on risk factors for suicide. Further research should utilise longitudinal study designs, harmonise datasets and use machine learning techniques to identify patterns of proximal risk factors for suicide behaviours.

Trajectories in suicide attempt method lethality over a five-year period: Associations with suicide attempt repetition, all-cause, and suicide mortality

“…However, as so few studies have investigated associations between psychiatric illness trajectories, including symptom severity, with suicide attempt risk, the relative contribution of state versus trait psychiatric symptomatology remains poorly understood at present [ 28 ]. Future work in this area could capitalise on the potential offered by ecological momentary assessment (EMA) to assist in the identification of the relative impact of daily symptom fluctuations on self-harm risk, as well as any associations with self-harm method, over time [ 29 ].…”

The Brief Suicide Cognitions Scale: Development and Clinical Application

“…The application of ecological momentary assessment (EMA) to suicidal thinking has, arguably, revealed one possible reason for the poor predictive value of traditional approaches. More specifically, EMA studies [e.g., ( 5 , 6 )] have revealed significant natural variability in suicidal thinking, negative affect, and individual history of self-harm, with fluctuations on an hour to hour, day to day, and week to week basis, characterized by wide shifts for those at highest risk. EMA also revealed periods of suicidal thinking that are likely undetected by traditional, retrospective approaches.…”

Predicting Lifetime Suicide Attempts in a Community Sample of Adolescents Using Machine Learning Algorithms

“…In reference to the integrated motivational-volitional model of suicidal behavior (O'Connor & Kirtley, 2018;Wetherall et al, 2018), to prevent suicide attempts, clinicians would ideally aim to predict concrete behaviors within a volitional phase. However, doing so requires assessing fluctuating states in a very fine-grained way, for example, by using ecological momentary assessments (e.g., Gee et al, 2020). Since such a detailed recording of emotional states and behaviors is only warranted for adolescents at risk for both ethical and economic reasons, an early screening that is as accurate as possible remains a worthy diagnostic goal.…”