ABSTRACT
INTRODUCTION: Suicidal ideation variability refers to within-day fluctuations in suicidal ideation, and has recently been proposed as an indicator of suicide risk. However, not much is known yet about its correlates and clinical relevance. METHODS: We examined characteristics of real-time suicidal ideation using Ecological Momentary Assessment in 82 individuals with current active suicidal ideation. Data were collected four times daily over 21 days. Latent profile analysis was used to identify subtypes of suicidal ideation. We further examined sociodemographic and clinical correlates of the profiles, and their association with the occurrence of suicide attempts during a 1-year follow-up. RESULTS: We identified three "digital" phenotypes of suicidal ideation that differed on the frequency, intensity and variability of ideation. The profiles were: high frequency, high intensity, moderate variability (Phenotype 1), moderate/high frequency, moderate intensity, high variability (Phenotype 2), and moderate frequency, low intensity, low variability (Phenotype 3). Phenotypes 1 and 2 were associated with a worse clinical profile at baseline (higher suicidal ideation and depressive symptom severity), and increased odds of suicide attempt during follow-up, compared to Phenotype 3. Phenotype 1 was further characterized by repeated suicidal behavior. CONCLUSIONS: Two phenotypes of real-time suicidal ideation were identified that appear to confer a higher risk of suicidal behavior in the near future (12 months). These phenotypes were characterized by higher variability of suicidal ideation-and also higher intensity and frequency of ideation. Considering the small sample size, the clinical usefulness of the profiles remains to be demonstrated.
ABSTRACT
Ecological momentary assessment (EMA) can be used to examine the dynamics of suicidal ideation in daily life. While the general acceptability and feasibility of EMA in suicide research has been established, further examination of potential iatrogenic effects (i.e., negative reactivity) and identifying those more likely to react negatively is needed. Participants (N = 82) with current suicidal ideation completed 21 days of EMA (4×/day) and filled in M = 78% (Med = 84%) of the EMA. No positive or negative affect reactivity was observed in EMA ratings over the study period. Retrospectively, most participants rated their experience as positive (69%); 22% indicated mood worsening, and 18% suicidal ideation reactivity. Those with more borderline personality traits, posttraumatic stress disorder (PTSD), and higher depressive, anxiety, and suicidal ideation symptoms, were more likely to report iatrogenic effects. In conclusion, while high compliance rates and lack of affect reactivity during EMA indicate that EMA is well tolerated in suicide research, a minority of participants may report subjective mood effects in retrospect.
Subject(s)
Ecological Momentary Assessment , Feasibility Studies , Suicidal Ideation , Humans , Female , Male , Adult , Middle Aged , Young Adult , Iatrogenic Disease , Retrospective Studies , Affect , AdolescentABSTRACT
Eveningness is associated with lower daily positive affect (PA). The relationship between negative affect (NA) and chronotype, however, is less consistent in the literature. Eveningness may be further characterized by increased social isolation, which could explain the associations between chronotype and PA/NA. In the present longitudinal study, we used ecological momentary assessment (EMA) to investigate the associations of chronotype with daily PA, NA, and social contact in individuals with current and remitted major depressive disorder (MDD) and healthy controls. As part of the Netherlands Study of Depression and Anxiety (NESDA), 279 participants (n = 49 depressed, n = 172 remitted, n = 58 controls) monitored daily PA, NA, and social contact (i.e., being alone vs. with others) for two weeks, five times per day. Overall, eveningness was associated with less social contact. This effect became nonsignificant, however, after accounting for sociodemographics (gender, age, education, living situation). Chronotype was not related to PA or NA. Less social contact was associated with lower PA and higher NA independent of chronotype. In conclusion, we could not replicate the finding of lower PA among evening types, but found social contact to associate with both daily PA and NA.
Subject(s)
Depressive Disorder, Major , Ecological Momentary Assessment , Affect , Circadian Rhythm , Humans , Longitudinal Studies , NetherlandsABSTRACT
Nearly every child will experience rotavirus infection before the age of 5. Rotavirus is transmitted via a fecal-oral route. Because the virus is shed in the stool, outbreaks of rotavirus infection can occur on the pediatric hospital wards and in day care centers. Ingestion of the rotavirus particles infects the cells in the villi of the small intestine. Copious amounts of watery diarrhea will occur after an incubation period of 1 to 2 days. If untreated, children less than 2 years of age can die from the resulting severe gastroenteritis dehydration. In the United States, rotavirus infection peaks during the winter months and is the cause of most cases of diarrhea in infants and young children. Rotavirus infection accounts for approximately 70,000 hospital admissions for diarrhea and as many as 100 deaths each year in the United States. World wide rotavirus infection accounts for approximately 1 million deaths each year (Bass, 1996). Although the number of deaths from rotaviral disease in the United States is low, parents frequently miss work, have to arrange for alternative care, travel to the doctor, give their child oral rehydrating solutions, and buy extra diapers. Implementation of mass vaccination with RotaShield will significantly reduce these indirect costs.