Promising or discouraging? Potentials and reactivity of real-time data collection in monitoring suicide-related thoughts and behaviors over weeks and months. Participants' views on ecological momentary assessments and wearable use.

Background: Increasingly, studies and reviews have highlighted the potentials of ecological momentary assessments (EMAs) and wearables in suicide research. However, to date it is only poorly understood how patients experience frequent assessment of suicidal ideation over weeks and months. Methods: Following discharge from inpatient psychiatric care due to a suicidal crisis or suicide attempt, patients started a 21- to 24-day EMA (EMA 1) with four semi-random prompts per day. After that, participants received four prompts per day, on two randomly chosen consecutive days per week for the following 26 weeks (EMA 2). Participants were additionally given a wearable during EMA 1 and 2. Debriefings on participants' thoughts and experiences were conducted via telephone interviews after EMA 1 (n = 68) and after EMA 2 (n = 51) using rating scales and open questions. Qualitative and quantitative methods were used to analyze the data. Results: After EMA 1, 62% of participants stated that they had experienced a change in their behavior or mood due to the study (66% in EMA 2). Different aspects were mentioned, highlighting the helpfulness of EMA (e.g. improving insight and grounding oneself) but also the burden (e.g. feeling weighed down/exhausted) and reactivity effects (e.g. feeling worse/annoyed and increased brooding). Discussion: The findings illustrate positive and negative effects of EMAs over longer observation intervals in individuals at high risk of suicide-related thoughts and behaviors. These findings can help in the development of study protocols, to evaluate data quality and enhance the interpretation of EMA data.