Abstract:

Over the past 20 years, the application of ecological momentary assessment (EMA) in suicide research has grown exponentially, attracting significant interest from mental health professionals and clinical psychologists. EMA serves as a valuable data collection method in suicide research, utilizing technologies such as smartphones to monitor participants' real-time suicidal ideation, emotional states, and behaviors. This allows for a more fine-grained measurement in suicide risk (within hours) and effectively predicts short-term changes in suicidal ideation and behavior, playing a crucial role in the field of suicide research.

The research design influences researchers' ability to effectively observe variables and accurately capture changes in suicide risk and related factors. Generally, In terms of study design, EMA employs event-contingent, time-contingent, or hybrid designs for data collection. To thoroughly understand the trends in suicidal ideation at different times, researchers may prioritize time-contingent designs to capture the dynamic characteristics of suicide risk. To examine temporal trends along with the specific contexts and influencing factors at the time of events, a hybrid design that combines time-contingent and event-contingent approaches can effectively reveal the mechanisms underlying suicidal behavior.

EMA is suitable for both clinical and community populations, primarily focusing on adults, with limited research on adolescents and the elderly. Future EMA studies on suicide should emphasize demographic diversity while also considering mental health diagnoses and suicide-related features to identify daily risk factors for specific populations. By examining the trajectories of suicidal ideation and their links to future suicide tendencies among clinical patients with various mental disorders, researchers can identify key predictive factors for suicidal behavior.（77）In EMA suicide research among adolescents, daily diaries can reveal the trajectories of suicidal thoughts and behaviors during acute risk periods, capturing daily fluctuations in suicide risk. To explore the triggers of adolescent suicide-related events and variations in suicidal thoughts, it is crucial to enhance communication with schools and parents, coordinate adolescents' access to electronic devices, and address concerns about EMA participation. Additionally, to reduce technological challenges for older adults, wearable technology can unobtrusively collect continuous data on physiological, sleep, and activity levels, enabling real-time monitoring of suicide risk in this population.

The application of EMA in suicide research requires careful consideration of feasibility. Compliance range from 44 to 90%, influenced by factors such as questionnaire length, assessment frequency, incentives, and the severity of suicidal ideation, which does not significantly affect compliance. Researchers can enhance feasibility by prioritizing frequent, brief assessments or using single-item indicators, adjusting the wording of questions, setting assessment prompts, and shortening prompt intervals. Developing a sampling schedule that balances time coverage with participant burden and using personalized feedback as alternative incentives can improve compliance and ensure the feasibility of EMA in suicide research.

Safety is another critical consideration in EMA suicide research. While studies show no significant negative effects of EMA on individuals in short-term or long-term assessments, rigorous review by institutional review boards (IRBs) is still necessary. This review should address safety, privacy issues, and assess the crisis management and referral capabilities of the research team to ensure proper responses to potential crises. For safety management, researchers should conduct real-time reviews of participant data, especially regarding "high-risk" responses, and promptly contact participants for suicide risk assessment and intervention. To maximize benefits, researchers can implement a combination of preventive, staff-led, and supportive strategies as part of their safety management measures.

To enhance short-term predictions of suicide risk, EMA should adopt innovative methods and technologies, utilizing digital technology and artificial intelligence for improved predictive capabilities. Additionally, it is crucial to address the legal and ethical issues related to EMA data in suicide research and to conduct localized studies within the context of Chinese culture.

Key words: ecological momentary assessment, suicide, risk factors, feasibility, safety