Study
Suicidal behavior has become widespread during the last years and is therefore a major problem in the health care delivery system. Suicidal ideation forms an important risk factor for suicide attempts and completed suicides. For the development of prevention and intervention concepts addressing acute suicidality it is of major importance to identify risk factors which can lead to a suicidal crisis. To date, there are only few studies dealing with acute risk factors of suicidal behavior. A new and little investigated area in this context is the Ecological Momentary Assessment (EMA) which allows specific and high-resolution real-time analyses. The aims of the present study are (1) to describe the course of suicidal ideation and (2) to identify possible risk factors and their impact on suicidality. Therefore, the data sampling is based on the assumptions of two models: the interpersonal theory of suicidal behavior (Joiner, 2005) and the cry of pain model (Williams, 2001). The first one posits interpersonal and behavior-related concepts (thwarted belongingness and perceived burdensomeness). The second model understands suicidality to be an expression of unbearable pain and burden when persons are exposed to stressors. According to the described theories, this study seeks to outline the mechanisms standing behind suicidal behavior. The respective hypothesis is that fluctuation in the assumed constructs (thwarted belongingness, perceived burdensomeness and entrapment) directly precedes the fluctuation of suicidal ideation. Therefore, negative change in those constructs can possibly serve as a predictor of a suicidal crisis.
The data acquisition takes place in an inpatient psychiatric environment and will cover approx. 100 test subjects. The study consists of two parts. First, a diagnostic interview (DIPS-5) and an interview on suicidality (SITBI-G) are carried out and the subjects complete a series of questionnaires. These questionnaires help capturing constructs associated with suicidality. The second part of the study covers one week and contains the record of suicidal ideation and of associated risk factors. This main part of the study requires real-time data sampling with the help of EMA. During this phase, subjects every day at fixed points answer questions, which are being presented to them in a smartphone app. The subjects carry the device with them throughout this week. To be able to record several data sets at the same time, it is of advantage to use approx. 10 devices simultaneously. The test supervisor is present in the respective clinic all along during sampling and can be consulted in case of questions or problems. Moreover, the supervisor monitors the real-time sampling and is able to contact the subjects if she detects problems or deficient compliance.
