Feasibility of Using Ecological Momentary Assessment to Investigate Suicidality among Inpatient Adolescents

• Frequent assessments of suicidal thoughts among adolescent inpatients are feasible • Several adolescents perceive self-reflecting on momentary emotions as helpful • Impulsive adolescents are more likely to complete assessments • Some adolescents feel worse after completing an assessment • Adolescents who felt worse were reminded of their current distress Ecological Momentary Assessment (EMA) presents a promising method to study short-term occurrences and trajectories of suicidal thoughts. This study analyzed the feasibility of using intensive EMA to assess suicidal thoughts among adolescent psychiatric inpatients in Germany. Fifty-one adolescents (12–18 years old, 74.5% female) participated in 7 days of EMA data collection during their psychiatric inpatient stay. Participants reported on momentary feelings, including suicidal thoughts, via a lent smartphone 7 times per day. In addition to a baseline meeting, adolescents attended a follow-up meeting to collect quantitative and qualitative data about their experiences of participation. Quantitative and qualitative results show a high adherence rate (i.e. percentage of answered surveys) of 78.6%, a high average satisfaction with participation, and a low average perceived burden of participation. Several participants cherished the opportunity to self-reflect and to understand current emotions by answering questions about momentary feelings frequently. However, seven adolescents (13.7%) reported an increase in negative emotions and two adolescents (3.9%) indicated an increase in suicidal thoughts after responding to the EMA surveys. These findings suggest negative emotional reactivity among some adolescents and considerable interindividual differences in emotional reactivity to EMA surveys in general. Future studies may elaborate on potential safety concerns for participants and identify which adolescents benefit from or experience distress after reporting on momentary suicidal thoughts frequently.