Qualitative content analysis of reactivity effects and feasibility of ecological momentary assessments of suicide-related thoughts and behaviors in the long-term and in suicidal crises

Background This study explored participant experiences with ecological momentary assessment (EMA) in the context of suicidal thoughts and behaviors (STBs). Methods 16 participants of a long-term EMA study (with varying STB occurrence during the study and low vs. high compliance) were interviewed on reactivity effects and feasibility of EMA. Qualitative content analysis was performed using an inductive-deductive approach and consensual coding. Results Reactivity to EMA was reported by some participants, with suicidal thoughts occasionally intensifying/being triggered by survey prompts. Importantly, no evidence indicated that EMA triggered suicidal actions. However, the burden increased over time for some, calling for more personalized monitoring durations. EMA’s feasibility during acute suicidal crises was questioned due to reduced ability and willingness to respond. Conclusions Long-term EMA monitoring after psychiatric discharge was perceived as feasible and beneficial. Selection bias and the lack of quantitative validation limit generalizability. Findings underscore the value of mixed-methods approaches and participatory protocol design.