An Analysis of Iatrogenic Effects in the Evaluation of Suicidal Thought Using Ecological Momentary Assessment in China: Longitudinal Observational Study (Preprint)

Abstract

In recent years, there has been a significant increase in research using ecological momentary assessment (EMA) to explore suicidal thoughts and behaviors (STBs). Meanwhile, concerns have been raised regarding the potential impacts of frequent and intense STBs assessments on the study participants.

This study aims to examine whether intensive repeated assessments of suicidal thoughts increase short-term suicidal risk in Chinese context.

From November 2021 to November 2022, a total of 49 patients (age: M = 19.5 years, SD=4.1, range = 12-31 years, 73.5% female), who were with mood disorders and current suicidal ideation were recruited from three psychiatric clinics in China. Smartphone-based EMA was used to measure suicidal thoughts three to six times per day at randomly selected times for four weeks. We examined the change of suicidal thoughts in 28 days and within one day to evaluate potential adverse effects using Bayesian multilevel models.

The 2691 effective surveys nested in 49 participants (mean following-up days: 23.98 days; average 2.29 times per person per day). The results of both two- and three-level Bayesian cumulative ratio models indicated that suicidal thoughts decreased with an increasing number of surveys in 28 days (β = −0.03, 95% highest density interval (HDI) [−0.05, −0.01]) and within one day (β = −0.26, 95%HDI [−0.50, −0.04]). And this association varied among different individuals in the two-level model (median σ=0.05, 95%HDI [0.03, 0.08]).

There is no sufficient evidence to suggest that intensive repeated assessments of suicidal thoughts increase the risk of suicide in the short term, but future studies need to carefully consider the heterogeneity of the effects across individuals.