Variability and Influencing Factors of Suicidal Ideation in Adolescents—An Ecological Momentary Assessment Study

OBJECTIVE: Recent research demonstrated considerable variability in suicidal ideation (SI) among adults. This study aimed to extend these findings to adolescents by examining the variability of SI and exploring temporal and contextual factors contributing to SI in adolescents. METHOD: We recruited 51 adolescents (aged 12-18 years) from three German inpatient child and adolescent psychiatric hospitals, who reported current passive and active SI via smartphone-based ecological momentary assessment 7 times per day over 7 days. Variability statistics included intra-class correlation coefficient (ICC), within-person variance (WPV), mean square of successive differences (MSSD) and its root (RMSSD), and probability of acute change (PAC). Furthermore, we investigated whether temporal (time of day, day of week) and contextual factors (physical activity, being alone) contributed to SI using multilevel models. RESULTS: All variability measures indicated substantial within-person variability of SI between measurements. Multilevel analyses found significant effects of time of day, day of week, and physical activity on SI, whereas being alone showed no significant effect. CONCLUSIONS: These findings underline the importance of considering SI as a dynamic construct and emphasize the need for continuous, context-sensitive assessment to guide tailored interventions that reduce suicide risk among adolescents.