Suicide Risk Management in Ecological Momentary Assessment: Participant Concealment of Suicidal Thoughts and Experiences with Safety Procedures

Ecological momentary assessment (EMA) has advanced the study of real-time suicide risk; however, the ethical obligations of researchers in responding to potential participant safety concerns are a topic of continued discussion. Initial research found that participants may modify their EMA ratings to avoid researcher contact, but the rates of underreporting or concealing of suicidal ideation (SI) are unknown, as are motivations for and correlates of these thoughts and behaviors. Beyond impacting participant reports, suicide risk assessment in response to elevated participant risk may also introduce intervention effects into EMA studies. This line of research is imperative to understanding barriers to ecologically valid data while also protecting participants. This study sought to fill these research gaps among a sample of community participants reporting past 6-month SI (N = 94; M_age = 33.63; 62.80 % female, 78.70 % white) who completed an EMA period and follow-up measures as part of a larger study. Underreporting and concealing SI was common during EMA. Multiple concerns motivated underreporting/concealing and several characteristics influenced the likelihood of this. Smaller within-person increases in SI were experienced when a risk assessment was completed, versus not, and a higher-than-usual SI intensity was reported prior to the assessment (Cohen's d = 0.39). Survey responses following heightened or average within-person positive affect reflected smaller increases in reported positive affect when an assessment was completed, versus not (Cohen's d = 0.49, 0.33, respectively). Although, many participants retrospectively believed the impact was more considerable and prolonged. Finally, participants provided multiple suggestions to mitigate the underreporting and concealment of SI.