Dynamic course and acute risk factors of suicidal ideation. Real time assessment using the experience sampling method (ESM) in an inpatient sample with major depression

背景：自杀行为和自杀意念的相关性和普遍性与关于其急性危险因素和时间动态的有限的经验知识相矛盾。获得这些知识对于发展监测或干预概念是强制性的(特别是在精神科住院患者等高危人群中)。自杀的人际理论(IPTS，Joiner，2005；Van Orden等人，2010)为解释自杀行为和自杀意念的发生提供了一个理论框架。IPTS假设有两个结构(感知到的负担[PB]和受挫的归属感[TB])在短时间内波动，并可能作为预测自杀意念的急性危险因素。虽然横断面研究支持IPTS及其假设的有效性(Wachtel&Teismann，2013)，但分析自杀意念的时间动力学及其与PB和TB的关联的纵向研究还很缺乏。目的：这是第一个研究自杀意念的时间动力学及其与PB和TB以及其他预测因素(如无望感)的关系的纵向前瞻性研究。为了充分解决这个问题，我们使用经验抽样方法(ESM)来确保评估策略(即在几个小时内)捕获被研究变量的时间动态。方法：在16个月的时间里，在莱比锡大学诊所招募N=75名精神科和心身住院患者，在两周内(T0和T1)进行两次诊断性评估(如诊断性访谈、问卷调查)。ESM阶段(即患者对自杀意念和感兴趣的预测因素的问题做出反应)包含60个采样点，在6到10天内发生在T0到T1之间(技术上是通过智能手机应用程序、软件movisensXS实现的)。在为期三个月的试验阶段，将制定适当的抽样策略(频率、间隔)，并将就ESM项目对变化的敏感性进行验证。在多个连续的多水平多元回归中，自杀意念将被建模为因变量，而被研究的预测变量将被建模为自变量(IPTS的概念和竞争变量由ESM在水平1上评估，特质类变量[T0]在水平2上)。相关性：本研究首次应用ESM对自杀意念的时间动态及其与IPTS(PB，TB)中心结构的关系进行了纵向分析。我们期望这一结果能显著提高自杀意念的预测能力。在可以开发监测和干预概念(可能是实时的)之前，必须在理论框架内分析临床环境中自杀行为的急性危险因素。

Background: The relevance and prevalence of suicidal behavior and suicidal ideation is contradicted by the limited empirical knowledge with regards to its acute risk factors and temporal dynamics. Gaining such knowledge is mandatory for the development of monitoring or intervention concepts (especially in high-risk populations such as psychiatric inpatients). The Interpersonal Theory of Suicide (IPTS, Joiner, 2005; Van Orden et al., 2010) offers a theoretical framework explaining the occurrence of suicidal behavior and suicidal ideation. The IPTS postulates two constructs (perceived burdensomeness [PB], thwarted belongingness [TB]) that fluctuate within a short time frame and might serve as acute risk factors predicting suicidal ideation. While cross-sectional studies support the validity of the IPTS and its assumptions (Wachtel & Teismann, 2013), longitudinal studies analyzing the temporal dynamics of suicidal ideation and its association with PB and TB are lacking.Objectives: This is the first longitudinal prospective study investigating the temporal dynamics of suicidal ideation and its associations with PB and TB and other predictors under discussion (e.g. hopelessness). To address this question adequately, we use the experience sampling method (ESM) to ensure that the temporal dynamics of the variables under study are captured by the assessment strategy (i.e. within hours). Methods: During 16 months, N=75 psychiatric and psychosomatic inpatients at the University Clinic of Leipzig will be recruited and diagnostically assessed (e.g. diagnostic interview, questionnaires) twice within a two-week interval (T0 and T1). The ESM phase (i.e. patients responding to questions regarding suicidal ideation and predictors of interest) containing 60 sampling points within 6 to 10 days takes place between T0 and T1 (technically realized by smartphone app, software movisensXS). During a three-month pilot phase, an adequate sampling strategy (frequency, interval) will be developed and ESM items will be validated with regards to their sensitivity to change. In several sequential multilevel multiple regressions, suicidal ideation will be modeled as dependent variable, whereas the predictors under study will be modeled as independent variables (concepts of the IPTS and competing variables assessed by ESM on level 1, trait-like variables [T0] on level 2).Relevance: This study is the first analyzing longitudinally the temporal dynamics of suicidal ideation and its association with the central constructs of the IPTS (PB, TB) applying ESM. We expect the results to significantly improve the prediction of suicidal ideation. Analyzing acute risk factors of suicidal behavior in clinical settings within a theoretical framework is mandatory before monitoring and intervention concepts (possibly in real-time) can be developed.