Feasibility and adherence to ecological momentary assessment among community-dwelling adults with suicide risk

Ecological momentary assessment (EMA) has seen increasing application in mental health research. However, there is a challenge in applying EMA to assess daily suicide risk in community settings due to poor adherence to the complex protocol and high dropout rates. The aim of this study is to assess the feasibility and adherence to the EMA when monitoring the daily risk of suicide in community-dwelling adults with suicidal ideation.

This secondary analysis was based on primary data from an observational study. The study participants with suicidal ideation responded to a 28-day EMA online survey and pressed an event marker on an actigraphic device when feeling strong suicidal impulses. Feasibility was evaluated using the EMA response rate and actigraphic device adherence rate based on descriptive statistics. Mental health characteristics related to feasibility were assessed in self-reporting questionnaires, and nonparametric correlation coefficients were identified to assess the relevance to feasibility.

A total of 22 participants were enrolled, with 20 remaining in the final sample (90.9%). The average EMA response rate was 82.05%, decreasing from 86.96% during the first 2 weeks to 76.31% in the second 2 weeks. The Actiwatch adherence rate was maintained at 98.1%. Actiwatch adherence and EMA response rates were moderately correlated (r =.53, p =.016). Higher depression and anxiety scores were associated with lower Actiwatch adherence, whereas a higher perceived stress score was associated with lower EMA response rates. The peak of suicidal impulse patterns in event button activations usually occurred between 9 to 10 pm, while activations were lowest in the early morning hours, particularly between 4 and 6 am.

This study indicated that EMA using smartphones and actigraphic devices were feasible to monitor suicidal ideation and impulse for a month in community-dwelling adults; thus, it could be a complementary tool to assess daily suicide risk. However, there are still challenges to be overcome when EMA-based monitoring in the community is used for those with mental vulnerability. Thus, mental health professionals should carefully tailor the pros and cons of EMA based on our findings to enhance this vulnerable group's participation and adherence to EMA for suicide prevention.