Ecological momentary assessment of suicide risk among adolescents during a high-risk post-hospitalization period

• In Event: 3-087 - Developmental Perspectives on Adolescent Self-Injurious Thoughts and Behaviors

Integrative Statement

Suicide is the second leading cause of death among U.S. adolescents, 12-18 years old, with over 2,000 suicide deaths annually in this age group. Although research on suicide risk factors has increased knowledge about which youth are at greatest risk for suicide over long-term periods of months and years, much less is known about when youth are most at risk over short-term periods of hours and days. One of the highest risk periods for suicidal behavior is in the months after discharge from acute psychiatric hospitalization. This presentation will discuss findings from an ecological momentary assessment (EMA) study examining near-term risk factors for suicidal thoughts and behaviors among youth during the month following hospital discharge, as well as relevant ethical and safety issues to consider when working with high-risk suicidal youth.

Participants are 36 adolescents, 12-18 years old, who were hospitalized for suicide risk (i.e., severe suicide ideation, suicide plans, suicide attempts). Over the 28 days following the baseline assessment, adolescents complete three types of EMA measures via smartphone-based EMA: (1) Interval-contingent measurement, which participants complete every morning to assess sleep quantity and quality from the night before; (2) Signal-contingent measurement, which participants complete at random intervals during the day to measure affective states (negative and positive), hopelessness, belongingness (with friends and family), and suicidal desire, suicidal intent, desire for life, and ability to keep self safe; and (3) Event-contingent measurement, which participants complete whenever they experience a self-injurious or suicidal thought or behavior (SITB). Following the EMA phase, participants complete a final interview including questions about SITBs over the past month and a user feedback survey about their experience participating in the EMA study.

Adolescents reported overall enjoyment participating in the EMA design and compliance rates were high (>75%) for most adolescents. Rates of anticipated adverse events (suicide attempts and rehospitalizations) over the study period were consistent with rates typically reported during the post-hospitalization period among youth not included in the study. More instances of SITBs were reported during the EMA phase of the study than during the final interview, which covered the same time period. Finally, a number of short-term predictors were identified. Sleep disturbance (e.g., lower sleep efficiency and poorer sleep quality) predicted next day lower desire for life and more difficulty keeping self safe. In addition, greater negative emotions (e.g., agitation, sadness, guilt), greater hopelessness, and reduced belongingness predicted same day suicidal desire and intent, lower desire for life, and more difficulty keeping self safe.

Results from this study suggest that EMA research designs are both acceptable and feasible with high-risk suicidal youth. In addition, findings from this study suggest a range of affective, cognitive, and behavioral factors that relate to short-term increases in suicide risk among youth during the post-hospitalization period. This research represents an important step toward improving short-term prediction of suicide risk as well as identifying modifiable treatment targets for high-risk suicidal youth.

Authors

• Catherine R. Glenn, University of Rochester
  Presenting Author

• Evan M. Kleiman, Rutgers University
  Non-Presenting Author

• Linda J. Alpert-Gillis, University of Rochester Medical Center
  Non-Presenting Author