The association between suicidal ideation and negative affect: A 6-month ecological momentary assessment study (Preprint)

<sec> <title>BACKGROUND</title> Suicide is a major public health challenge. Ecological Momentary Assessment (EMA) can improve suicide risk assessment, but EMA burden often results in short follow-up periods. </sec> <sec> <title>OBJECTIVE</title> In this study, we explore the association between suicidal ideation and multiple variables collected in real time using smartphone-based EMA for 6 months. </sec> <sec> <title>METHODS</title> This is a prospective EMA-based study carried out among outpatients at high risk of suicide, attended at Madrid (Spain). At baseline, depression, suicidality and psychological and physical pain were explored using traditional questionnaires. During the 6-month follow-up, patients answered daily EMA questions covering suicidal ideation, non-suicidal self-injuries, negative affect, interpersonal experiences, sleep, and eating habits in their smartphones. We explored the association between baseline variables and EMA variables, as well as the association between different EMA variables. </sec> <sec> <title>RESULTS</title> : N=99 participants were included in the final analysis, and 13,900 EMA answers were obtained. The slope of suicidal ideation showed no significant changes over the follow-up. Similar results were obtained for negative affect, interpersonal difficulties, sleep problems, and appetite. The variables statistically significantly associated with suicidal ideation were negative affect (b (SE)=0.193 (0.03), t=6.21, p&lt;0.001) and interpersonal difficulties (b (SE) =0.168 (0.03), t=5.96, p=0.001). </sec> <sec> <title>CONCLUSIONS</title> This study provides novel insights into the real-time relationship between suicidal ideation and several psychological and behavioural variables using EMA in a high-risk clinical population. Future studies should aim to translate EMA-based monitoring into actionable interventions to provide real-time support for individuals at high risk of suicide. </sec>