Examining heterogeneity in the affect-regulating function of suicidal ideation: Person-specific analyses in male inpatients with depression.

INTRODUCTION: Men have an increased risk to die by suicide compared to women but are underrepresented in suicide research. To improve individual risk prediction for suicide-related thoughts and behaviors (STBs), risk factors are increasingly being studied at an individual level. The possible affect-regulatory function of suicidal ideation has hardly been investigated ideographically and has not yet been tested in a male sample. METHODS: We investigated the bidirectional associations between suicidal ideation and negative and positive affect in a sample of n = 21 male inpatients with unipolar depression and a history of suicidal ideation both at the group level and at the individual level. Participants underwent an intensive ecological momentary assessment for 6 days with 10 data points per day. RESULTS: We found no evidence for an affect-regulatory function of suicidal ideation at the group level, neither for effects of affect on subsequent suicidal ideation (antecedent affect-regulatory hypothesis) nor for effects of suicidal ideation on subsequent affect (consequence affect-regulatory hypothesis). Person-specific analyses revealed substantial variability in strength and direction of the considered associations, especially for the associations representing the antecedent hypothesis. CONCLUSION: The demonstrated between-person heterogeneity points to the necessity to individualize the investigation of risk factors to enhance prediction and prevention of STBs.

Torn between living or dying-analyses of influencing factors on suicide ambivalence and its longitudinally impact on suicidal ideation and behavior in a high-risk sample.

INTRODUCTION: Findings on the role of suicide ambivalence, an individual's wish to live (WL), and wish to die (WD) in the development of suicidality have been heterogenous. The main goal of this study was to examine associations of these constructs within the past week with sociodemographic factors and to longitudinally investigate their predictive power for suicidal ideation (SI) and suicide attempts (SA). METHODS: N = 308 patients (54% female; M = 36.92 years, SD = 14.30), admitted to a psychiatric ward due to suicidality, were assessed for all constructs after admission, after six, nine, and 12 months. Data were analyzed with univariate fixed-effect models and lagged mixed-effect regression models. RESULTS: Decreased, WL increased post-baseline. Gender showed no significant link to ambivalence, WD, and WL. Ambivalence and WD correlated negatively with age and positively with depressiveness. More participants in a relationship showed a WL compared with single/divorced/widowed participants. More single participants or those in a relationship showed ambivalence than divorced/widowed participants. More single participants showed a WD than participants in a relationship/divorced/widowed. Longitudinally, ambivalence and WD predicted SI and SA. CONCLUSION: The findings underscore the importance of taking suicide ambivalence and WD into account in risk assessment and treatment.

Understanding suicidal ideation-a network analysis of the Interpersonal Needs Questionnaire.

INTRODUCTION: Identifying various interacting risk factors for suicidality is important to develop preventive measures. The Interpersonal-Psychological Theory of Suicidal Behavior (IPTS) postulates suicidal ideation resulting from the occurrence of Perceived Burdensomeness (PB) and Thwarted Belongingness (TB). Suicidal behavior ultimately occurs if people have a Capability for Suicide. In past studies, the validity of TB was often not empirically confirmed, questioning which of the aspects of TB are central and related to suicidal ideation and whether applied measurement methods adequately capture the construct. METHOD: Using a sample of 3,404 individuals from different clinical and nonclinical settings, 30% (1,023) of whom reported suicidal ideation, two network analyses were conducted on the Interpersonal Needs Questionnaire (INQ) and a variable mapping suicidal ideation. RESULTS: Analyses revealed that some items of the INQ were not related to suicidal ideation and the most central items did not have the strongest associations to suicidal ideation. CONCLUSION: Based on these results, a shortened version of the INQ with the four items that showed the strongest associations with suicidal ideation in the network analyses was suggested.

Phenotyping suicidal ideation and behavior: Comparing clinical characteristics and future suicide attempts between suicidal subtypes in two clinical samples.

OBJECTIVES: To further validate the concept of suicidal subtypes distinguished by indicators of suicidal thinking and behavior with regard to clinical characteristics and past and future suicide attempts. METHODS: Psychiatric inpatients were assessed (study 1: ecological momentary assessments in 74 depressed inpatients with suicidal ideation; study 2: clinical assessments in 224 inpatients after a suicide attempt and over a 12-month follow-up period). Subtypes were identified using latent profile analysis (based on indicators of real-time suicide ideation) and latent class analysis (based on features of past suicide ideation and suicide attempt characteristics). Comparisons between subtypes included clinical characteristics (depression, suicidal ideation, trait impulsivity, childhood trauma) as well as past (study 1) and future (study 2) suicide attempts. RESULTS: Suicidal subtypes emerged that are characterized by suicidal ideation means and stability and features of past suicidal behavior (four in study 1, three in study 2). The subtypes differed in terms of depression/suicidal ideation, but not in terms of trait impulsivity/childhood trauma. Although not significant, the subtypes "high-stable" and "low-moderate stable" reported multiple re-attempts more frequently during follow-up than the "low-stable" subtype in study 2. CONCLUSION: Differences in clinical variables (and by trend in future suicide attempts) clearly point to the clinical relevance of suicidal subtypes (with variability of suicidal thoughts playing a particularly important role).

Association of real-time assessed mood, affect and suicidal ideation in psychiatric inpatients with unipolar depression.

Previous research provided preliminary support of a potential reinforcing effect of suicidal ideation demonstrating reduced negative affect and increased positive affect after thinking about suicide. The present study therefore sought to investigate the role of mood and affect as a proximal risk factor of suicidal ideation in a high-risk sample. Seventy-four psychiatric inpatients (72% female) with unipolar depression and current and/or lifetime suicidal ideation aged 18 to 85 years (M = 37.6, SD = 14.3) took part in an ecological momentary assessment (EMA) over 6 days. Multilevel analyses were calculated. Analyses revealed negative valence of mood and low positive affect to be predictors of subsequent intensity of suicidal ideation (active, passive) as well as predictors of change in suicidal ideation (active, passive) since the last measurement. High negative affect only predicted intensity of passive suicidal ideation. Suicidal ideation (active, passive) was prospectively associated with subsequent negative valence of mood and lower positive affect as well as with higher intensity of negative affect. Suicidal ideation (active, passive) also predicted the change in valence of mood, positive affect and negative affect since the last measurement. Mood and affect should be taken into account as important proximal risk factors of active and passive suicidal ideation. The results do not support the idea of a reinforcing effect of suicidal ideation. In fact, they show a pattern of reduced subsequent positive affect, negative valence of mood and increased negative affect. Replication studies with larger samples and longer EMA follow-ups are needed.

Sleep disturbances predict active suicidal ideation the next day: an ecological momentary assessment study.

BACKGROUND: Sleep disturbances are an underestimated risk factor for suicidal ideation and behavior. Previous research provided preliminary support of a temporal relationship between sleep disturbances and suicidal ideation. The present study therefore sought to investigate the prospective association between sleep disturbances, passive and active suicidal ideation, and further psychological risk factors, such as state impulsivity and depression. METHODS: Seventy-three psychiatric inpatients (71% female) with unipolar depressive disorder and current or lifetime suicidal ideation took part in an ecological momentary assessment (EMA). Participants filled out a baseline assessment and data were collected via smartphones over a 6-days period. Multilevel analyses with sleep disturbance as predictor for active and passive suicidal ideation, state impulsivity, and depression were carried out. RESULTS: Patients with sleep disturbance experienced more active suicidal ideation, but no passive suicidal ideation, the following day. Of the four state impulsivity items, one item was significantly associated with sleep disturbance. Sleep disturbance had no effect on next-day depression. Limiting factors are the small and homogeneous sample along with the rather short observation period in an inpatient setting. CONCLUSIONS: The micro-longitudinal study provides preliminary support for sleep disturbance as a proximal risk factor for next-day active suicidal ideation. Clinically, results indicate to consider the evaluation and treatment of sleep disturbances for an improved risk assessment and prevention of suicide.

Predicting suicidal behavior by implicit associations with death? Examination of the death IAT in two inpatient samples of differing suicide risk.

Assessment of implicit self-associations with death, measured by a death Implicit Association Test (IAT), has shown promise for the prediction of suicide risk. The present study examined whether the performance on the death IAT is associated with lifetime, recent, or future suicide attempt status as well as self-report measures of suicide risk factors (e.g., perceived burdensomeness, thwarted belongingness) in two inpatient samples with low versus high severity of suicidality. Furthermore, we investigated whether explicit suicidal ideation and implicit associations with death predict recent and future suicide attempt status. Seventy-one depressed inpatients with recent/lifetime suicidal ideation (first sample) as well as 226 inpatients with a recent suicide attempt or a severe suicidal crisis (second sample) were interviewed on lifetime suicidal ideation and behavior, completed self-report measures (i.e., suicidal ideation, thwarted belongingness, perceived burdensomeness), and conducted the death IAT. The second sample was also interviewed and completed self-report measures longitudinally, 6, 9, and 12 months later. The IAT was conducted twice in this sample, at the beginning of the assessment (T0) as well as 12 months later (T3). Implicit associations with death neither differ between lifetime suicide ideators, single attempters, and multiple attempters, nor between recent and future nonattempters and attempters. IAT scores were unrelated to other suicide risk factors. Neither the IAT scores nor the interaction of IAT scores and explicitly stated suicidal ideation was predictive of recent or future suicide attempts. The present study points to a limited utility of the death IAT for the prediction of suicide risk. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychometric evaluation of the Interpersonal Needs Questionnaire (INQ) using item analysis according to the Rasch model.

The Interpersonal Needs Questionnaire (INQ) assesses Thwarted Belongingness (TB) and Perceived Burdensomeness (PB), two predictors of suicidal thoughts. Up to now, the use of item response theory (IRT) for the evaluation of the INQ has been restricted to a single study with clinically depressed and suicidal youth. Therefore, the psychometric properties of the two INQ-15-subscales TB and PB were now evaluated in a general population sample (N = 2508) and a clinical adult population sample (N = 185) using IRT, specifically the Rasch model (RM) and the graphical log-linear Rasch model (GLLRM). Of special interest was whether the INQ-subscales displayed differential item functioning (DIF) across the two different samples and how well the subscales were targeted to the two sample populations. For the clinical sample, fit to a GLLRM could be established for the PB-subscale and fit to a RM was established for a five-item version of the TB-subscale. In contrast, for the general population sample fit to a GLLRM could only be achieved for the PB-subscale. Overall, there was strong evidence of local dependence (LD) across items and of some age- and gender-related DIF. Both subscales exhibited massive DIF related to the sample, indicating that they don't work the same across the general population and clinical sample. As expected, targeting of both INQ-subscales was much better for the clinical population. Further investigations of the INQ-15 under the Rasch approach in a large clinical population are recommended to determine and optimize the scale performance.

How Is the Presence of Company Related to Thwarted Belongingness in Real Time? Taking a Closer Look at the Conceptualization of the Construct of the Interpersonal Theory of Suicide.

(1) Background: The role of thwarted belongingness (TB) in predicting suicidal ideation, as originally assumed by the Interpersonal Theory of Suicide, is repeatedly challenged by empirical findings. This could be due to an inadequate conceptualization of the construct of TB that is assumed to be influenced by intrapersonal and interpersonal factors. (2) Methods: We examined the associations of TB with intrapersonal variables related to depression, and with interpersonal variables related to an individual's actual social environment. We analyzed data from an ecological momentary assessment study in psychiatric inpatients with depressive disorders. N = 73 participants rated momentary TB, depressive affect and status of company up to 10 times per day, over a period of six days, on smartphones. (3) Results: TB was lower when assessed while participants were in company compared to when they were alone, and the more desired the company was, the less TB was experienced. Individuals who had a partnership experienced less momentary TB. Furthermore, higher levels of momentary depressive affect, as well as more stable levels of depression, were related to higher levels of TB, and the relation between the presence of company and TB was weaker for more depressed persons. (4) Conclusions: Our findings can be seen as evidence that both intrapersonal and interpersonal factors relate to TB, and thus support the conceptualization of TB as proposed by the Interpersonal Theory of Suicide.

Do Feelings of Defeat and Entrapment Change over Time? An Investigation of the Integrated Motivational-Volitional Model of Suicidal Behaviour Using Ecological Momentary Assessments.

(1) Background. Defeat and entrapment have been highlighted as major risk factors of suicidal ideation and behavior. Nevertheless, little is known about their short-term variability and their longitudinal association in real-time. Therefore, this study aims to investigate whether defeat and entrapment change over time and whether defeat predicts entrapment as stated by the integrated motivational-volitional model of suicidal behavior. (2) Methods. Healthy participants (n = 61) underwent a 7-day smartphone-based ecological momentary assessment (EMA) on suicidal ideation/behavior and relevant risk factors, including defeat and entrapment and a comprehensive baseline (T0) and post (T2) assessment. (3) Results. Mean squared successive differences (MSSD) and intraclass correlations (ICC) support the temporal instability as well as within-person variability of defeat and entrapment. Multilevel analyses revealed that during EMA, defeat was positively associated with entrapment at the same measurement. However, defeat could not predict entrapment to the next measurement (approximately two hours later). (4) Conclusion. This study provides evidence on the short-term variability of defeat and entrapment highlighting that repeated measurement of defeat and entrapment-preferably in real time-is necessary in order to adequately capture the actual empirical relations of these variables and not to overlook significant within-person variability. Further research-especially within clinical samples-seems warranted.

Depression, suicidal ideation and suicide risk in German veterinarians compared with the general German population.

BACKGROUND: Higher rates of depression, suicidal ideation and suicide risk have been reported for veterinarians in various studies worldwide. This study investigates whether this is also true for German veterinarians. METHODS: A total of 3.118 veterinarians (78.8 per cent female, mean age 41.3 years) between 22 and 69 years were included and compared with two general population samples of the same age range using the Suicide Behaviours Questionnaire-Revised and Patient Health Questionnaire. RESULTS: Current suicidal ideation was found in 19.2 per cent of veterinarians, compared with only 5.7 per cent in the general population. 32.11 per cent of veterinarians were classified with increased suicide risk, compared with 6.62 per cent in the general population. 27.78 per cent of veterinarians screened positive for depression, compared with 3.99 per cent of the general population. CONCLUSION: The study shows that veterinarians have an increased risk of depression and suicidal ideation and suicide risk compared with the general population in Germany. Similar to previous findings, the level of depression was higher among veterinarians than in the general population. However, this study does not explore causes for higher rates in depression, suicide risk and suicidal ideation. Since other studies strongly suggest specific risk factors lead to higher suicide risk and consequently elevated numbers of completed suicides, future research should focus on identifying and preventing causes.

Short defeat and entrapment scale: A psychometric investigation in three German samples.

BACKGROUND: The present study aimed to validate the German version of the Short Defeat and Entrapment Scale (SDES). METHODS: Validity and reliability were established in an online (N = 480), an outpatient (N = 277) and an inpatient sample (N = 296). Statistical analyses included confirmatory factor analyses (CFA) and group differences in defeat and entrapment. RESULTS: For the online and the inpatient sample, the CFA indicated a two-factor solution, whereas for the outpatient sample both one- and two-factor solutions fitted the data equally well. Scale properties for the two-factor solution (defeat and entrapment subscale) were excellent. Thus, further analyses were based on this solution. For the online and the outpatient sample, suicidal ideators and suicide attempters scored significantly higher in defeat and entrapment than non-ideators and non-attempters. LIMITATIONS: Limiting factors of the study were the different measures across the samples and the cross-sectional design of the study. CONCLUSION: Though results were partly mixed, we found support for a two-factor solution of the instrument showing excellent psychometric properties in all three samples. The two-factor solution is further expected to have higher clinical utility than a one-factor solution. Suicidal ideators and suicide attempters in the online and outpatient sample showed higher scores in defeat and entrapment than non-ideators and non-attempters, emphasizing these two concepts as predictors for suicidal ideation. All in all, the present study supports the general validity and reliability of the SDES. However, future investigations based on prospective data are warranted.

Modelling suicide ideation from beep to beep: Application of network analysis to ecological momentary assessment data.

•EMA data were analyzed using network analysis (e.g., temporal networks).•Suicidal ideation at t was predicted by itself and perceived burdensomeness at t - 1.•Suicidal ideation at t - 1 predicted perceived burdensomeness, depression etc. at t.•At the same beep, suicidal ideation was related to all variables in the network.•Patients with higher average suicidal ideation had higher average hopelessness.

INPART - a psycho-oncological intervention for partners of patients with haemato-oncological disease - study protocol.

BACKGROUND: Suffering from cancer confronts both the patient and their partner with a number of psychosocial challenges in various aspects of their life. These challenges may differentially impact on quality of life, coping ability and compliance to treatment. This especially holds true for haemato-oncological diseases. To date, psychological interventions have predominantly been developed for oncological patients however specific interventions for partners of haemato-oncological patients are rare. In this study we aim to conduct a psycho-oncological group-intervention for partners of patients with haemato-oncological diseases. The aim of the intervention is to significantly reduce symptoms of depression and anxiety in the partners and the patient, as well as enhancing dyadic coping. METHODS: The design of the INPART-study is an unblinded, randomised controlled trial with 2 treatment conditions (experimental and control) and assessments at baseline, 3 and 6 months. It will be conducted at three study centres: the university medical centre's in Leipzig, Hannover and Ulm. The outcome criteria will be a reduction in depressive and anxiety symptoms as well as an improvement of dyadic coping. DISCUSSION: This trial shall provide information regarding the efficiency of a psycho-oncological intervention for partners of patients with haemato-oncological diseases and give references to the possible outcome in terms of dyadic coping and the reduction of mental strain. The study was supported by a grant from the German José Carreras Leukaemia Foundation. TRIAL REGISTRATION: ISRCTN16085028 ; 20/03/2019.

Psychological interventions targeting partners of cancer patients: A systematic review.

PURPOSE: Cancer patients' intimate partners often experience levels of psychological burden that are comparable to or even exceed that of the patients, making it imperative that they too be provided with appropriate psychological support. This review aimed to present the content and the effects of interventions delivered to caregiving partners of cancer patients on both partners and patients. Furthermore, we provide information about the acceptability of the interventions and study quality. METHODS: An initial search in Web of Science, PsycINFO, and PubMed databases was conducted. We included RCTs as well as pre-post studies that focused on enhancing partners' wellbeing or diminishing partners' distress. To be included, interventions had to have been offered to partners either only or predominantly. We included studies published until December 2017. The methodological quality of the trials was assessed with the EPHPP assessment tool. RESULTS: Nine studies met the inclusion criteria. Intervention topics included social support, short-term problem solving, the marital relationship quality, role expectations, emotional resilience, and coping strategies. Positive intervention effects were found with regard to social support, emotional distress, improved communication, posttraumatic growth, self-efficacy, and coping. Despite considerably low response rates, the interventions were generally well accepted. Most of the studies suffer limitations because of methodological flaws, the lack of randomization, and small sample sizes. CONCLUSION: Interventions delivered to partners of cancer patients may have positive effects on both partners and patients. We derive several implications for future research: Intervention programs should be tailored to the specific needs of caregiving partners with regard to the cancer trajectory and gender. Effort has to be made to increase sample sizes as well as to include particularly burdened individuals. Selected measurement instruments should be sensitive to specific intervention effects. Finally, information on both statistical as well as clinical relevance of research findings should be provided.

Psychometric properties of the German version of the suicide cognitions scale in two clinical samples.

The present study aimed at evaluating the psychometric properties of German Suicide Cognitions Scale (SCS-18/SCS-9) in two clinical samples. Validity and reliability were established in an outpatient- (n = 277) and in an inpatient sample (n = 75). Statistical analyses included confirmatory factor analyses, correlation analyses, between-group comparison by history of lifetime suicide attempts, and regression analyses. The three-factor model showed good model fit for the long version of the SCS (SCS-18). For the short version of the SCS (SCS-9), a bifactor model yielded the best fit. Overall, the total scale of the SCS-18 and the SCS-9 and the subscales of the SCS-18 showed satisfactory internal consistency, as well as good convergent validity. The SCS-18 subscales and the SCS-9 demonstrated clinical utility by differentiating between participants with prior and without prior suicide attempts. The SCS (subscale unsolvability and SCS-9 score) predicted current suicide ideation as well as suicide ideation 7-10 days later - even after controlling for established risk-factors (e.g., depression, hopelessness, interpersonal variables). Results suggest that the SCS-18 and the SCS-9 are reliable and valid measures to assess suicidal cognitions that can be used in clinical as well as in research settings.

(In)stability of Capability for Suicide in Psychiatric Inpatients: Longitudinal Assessment Using Ecological Momentary Assessments.

OBJECTIVE: The study examines the temporal stability of capability for suicide (i.e., its state-like component), because it has been recently discussed that capability for suicide may be subject to shift over time. METHOD: Seventy-four psychiatric inpatients with an unipolar depressive disorder were included in the study (mean age 37.9 years, 71.6% female, 32.4% with a history of suicide attempt). After a baseline assessment with several self-report questionnaires, ecological momentary assessments were applied over six consecutive days using smartphones. Capability for suicide was rated with three items once a day. For daily capability for suicide, descriptive and variability statistics and associations with baseline clinical characteristics (depression, suicidal ideation, childhood maltreatment, and history of suicide attempt) were analyzed. The prospective association of daily level of active suicidal ideation and daily capability was investigated by multilevel analysis. RESULTS: Indicators of within-person variability and temporal instability supported considerable fluctuation in daily capability for suicide. Yet the degree of temporal instability showed individual differences. Baseline and daily suicidal ideation were positively associated with daily fearlessness about death and perceived capability. CONCLUSION: The results provide first evidence that capability for suicide includes a dynamic short-term component that is linked to clinical variables such as suicidal ideation.

The association of trait impulsivity and suicidal ideation and its fluctuation in the context of the Interpersonal Theory of Suicide.

BACKGROUND: Although the relationship of trait impulsivity and suicidal behavior is well established, its relationship with suicidal ideation and its fluctuation still remains unclear. Our aim is to examine (1) the relationship of trait impulsivity and suicidal ideation and behavior in the context of the Interpersonal Psychological Theory of Suicide (IPTS) and (2) the association of trait impulsivity with the fluctuation of suicidal ideation in an inpatient sample with unipolar depression. METHOD: Eighty-four inpatients with unipolar depression and current and/or lifetime suicidal ideation were assessed with a baseline assessment including trait impulsivity, suicidal ideation, suicidal behavior and the constructs of the IPTS. Seventy-four of these patients underwent a 6-day ecological momentary assessment (EMA) with 10 assessments per day across six days assessing passive and active suicidal ideation. Mean squared successive differences (MSSD) across EMA assessments of suicidal ideation were calculated to test fluctuation as an indicator of temporal variability. Correlation analyses were conducted to test the associations. RESULTS: There were no associations of trait impulsivity with suicidal ideation, thwarted belongingness and perceived burdensomeness, except the rather low but significant association between thwarted belongingness and the attention subdomain of trait impulsivity (r = 0.23*, p ≤ 0.05). Moreover, trait impulsivity showed a significant positive correlation with capability for suicide but not with the two subdomains of capability for suicide. The only significant but rather low correlation was identified between the motor aspect of trait impulsivity and fearlessness about death (r = 0.26, p ≤ 0.01). Suicidal behavior showed a positive correlation with trait impulsivity, but not with the different subdomains of trait impulsivity. Trait impulsivity showed a significant correlation with the MSSD of passive suicidal ideation (r = 0.26, p ≤ 0.05), but not with active suicidal ideation. Furthermore, the motor aspect of trait impulsivity (BIS motor) showed a significant correlation (r = 0.32, p ≤ 0.01) with the MSSD of passive suicidal ideation, but not with active suicidal ideation or the MSSD total score. CONCLUSION: Overall the findings are in line with our assumptions and the IPTS and underline that trait impulsivity is related to suicidal behavior and the fluctuation of suicidal ideation, but not to suicidal ideation itself. Thus, trait impulsivity seems to act as a distal risk factor via capability for suicide and it seems to play a role for the dynamics of suicidal ideation. The results have to be investigated in larger samples, with a higher risk of suicide and in prospective studies. Moreover, the role of the fluctuation of suicidal ideation for the prediction of suicide risk should be investigated in future studies.

Assessing suicidality in real time: A psychometric evaluation of self-report items for the assessment of suicidal ideation and its proximal risk factors using ecological momentary assessments.

Suicidal ideation is a major risk factor for suicidal behavior and has recently been shown to be fluctuating in studies applying ecological momentary assessments (EMAs). The aims of this study are to introduce a reliable and valid item set for assessing suicidal ideation and relevant proximal risk factors that can be used in future EMA studies within suicidology. Additionally, we provide data on the ability of the items to capture moment-to-moment variability and discuss feasibility aspects of EMA studies on suicidal ideation in a clinical sample. Psychiatric inpatients diagnosed with a depressive disorder (N = 74) rated a set of 28 items measuring suicidal ideation, thwarted belongingness, perceived burdensomeness, depression, anxiety, hopelessness, and positive affect 10 times per day on 6 consecutive days. In addition, these constructs were assessed by self-report questionnaires before and after the EMA period. Intraclass correlations and mean squared successive differences were calculated as indicators of item variability. Reliability was calculated at the prompt (within-person) and the person (between-person) level, applying an approach based on multilevel factor analysis. Convergent validity was assessed by correlating the EMA scores with a self-report questionnaire measuring the same constructs. All items demonstrated moment-to-moment-variability and substantial within-person variance. Moreover, all items and scales, except those assessing anxiety, showed satisfying reliability at the prompt and the person level, and correlations indicated convergent validity of the EMA item set. Compliance with the EMAs was excellent (89.7%). Researchers are encouraged to apply this useful tool in future EMA studies in the field of suicidology. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Investigating the Dynamics of Suicidal Ideation.

BACKGROUND: Although the fluctuating nature of suicidal ideation (SI) has been described previously, longitudinal studies investigating the dynamics of SI are scarce. AIM: To demonstrate the fluctuation of SI across 6 days and up to 60 measurement points using smartphone-based ecological momentary assessments (EMA). METHOD: Twenty inpatients with unipolar depression and current and/or lifetime suicidal ideation rated their momentary SI 10 times per day over a 6-day period. Mean squared successive difference (MSSD) was calculated as a measure of variability. Correlations of MSSD with severity of depression, number of previous depressive episodes, and history of suicidal behavior were examined. RESULTS: Individual trajectories of SI are shown to illustrate fluctuation. MSSD values ranged from 0.2 to 21.7. No significant correlations of MSSD with several clinical parameters were found, but there are hints of associations between fluctuation of SI and severity of depression and suicidality. LIMITATIONS: Main limitation of this study is the small sample size leading to low power and probably missing potential effects. Further research with larger samples is necessary to shed light on the dynamics of SI. CONCLUSION: The results illustrate the dynamic nature and the diversity of trajectories of SI across 6 days in psychiatric inpatients with unipolar depression. Prediction of the fluctuation of SI might be of high clinical relevance. Further research using EMA and sophisticated analyses with larger samples is necessary to shed light on the dynamics of SI.