Ecological momentary assessment of self-harm thoughts and behaviours: A systematic review of constructs from the Integrated Motivational-Volitional model (Preprint)

Abstract

The Integrated Motivational-Volitional (IMV) model is one of the leading theoretical models of suicidal thoughts and behaviour. There has been a recent proliferation in the assessment of suicidal and non-suicidal self-harm thoughts and behaviours (SHTBs) in daily life.

This systematic review synthesises evidence from ecological momentary assessment (EMA) studies to address the following questions: i) Which constructs within the IMV model have been assessed using EMA, and how have they been assessed? ii) Do different constructs from the IMV model fluctuate in daily life? iii) What is the relationship between the different IMV constructs and SHTBs in daily life?

Consistent with PRISMA guidelines, we conducted systematic searches of five databases – Web of Science, Embase, MEDLINE, PsycInfo, and Europe PMC Preprints – from inception to 26th March 2024.

Our searches resulted in the inclusion and narrative synthesis of 53 studies across 58 papers. Fifteen IMV constructs were measured using EMA across included papers. The most frequently measured constructs were thwarted belongingness (24 studies), future thinking (20 studies) and perceived burdensomeness (16 studies). The least frequently measured were humiliation, social problem-solving, mental imagery, and perceived capability for suicide. None of the included papers measured memory biases, goals, norms, or resilience using EMA. Comparison of intra-class coefficients (45 studies) revealed inconsistency in, but at least moderate, within-person variance across all examined constructs. We found evidence (39 studies) of concurrent associations between almost all constructs and SHTBs in daily life, with some evidence that entrapment, shame, rumination, thwarted belongingness, hopelessness, social support and impulsivity are additionally associated with SHTBs in lagged (i.e. longitudinal) relationships.

Comparisons were hindered by variation in methodology, including populations studied, EMA sampling scheme, operationalisation of IMV constructs and SHTBs, and statistical approach used. Our findings suggest that EMA studies are a useful methodology for examining risk factors for SHTB, however more research is needed for some IMV constructs. Quality assessment suggested several areas for how reporting EMA studies in this field might be improved.