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

背景资料：自杀行为和自杀意念的相关性和患病率与其急性风险因素和时间动态方面的有限经验知识相矛盾。获得这些知识是制定监测或干预概念的必要条件（特别是在精神病住院患者等高危人群中）。自杀的人际关系理论（IPTS，Joiner，2005;货车Orden等人，2010）提供了一个理论框架，解释自杀行为和自杀意念的发生。IPTS假设了两个结构（感知负担[PB]，挫折感[TB]），在短时间内波动，并可能作为预测自杀意念的急性风险因素。虽然横断面研究支持IPTS及其假设的有效性（Wachtel & Teismann，2013），纵向研究分析自杀意念的时间动态及其与PB和TB.Objectives的关联缺乏：这是第一个纵向前瞻性研究调查自杀意念的时间动态及其与PB和TB的关联和其他正在讨论的预测因素（例如绝望）。为了充分解决这个问题，我们使用经验抽样方法（ESM），以确保所研究的变量的时间动态被捕获的评估策略（即在几个小时内）。研究方法：在16个月期间，将招募N=75名莱比锡大学诊所的精神病和心身住院患者，并在两周内（T0和T1）进行两次诊断评估（例如诊断访谈、问卷调查）。ESM阶段（即患者对有关自杀意念和感兴趣的预测因子的问题做出回答）在6至10天内包含60个采样点，在T0和T1之间进行（技术上通过智能手机应用程序、软件movisensXS实现）。在为期三个月的试点阶段，将制定适当的抽样战略（频率、间隔），并验证无害环境管理项目对变化的敏感性。在几个序贯多水平多元回归中，自杀意念将被建模为因变量，而所研究的预测因素将被建模为自变量（IPTS的概念和ESM在第1级评估的竞争变量，在第2级评估的特质类变量[T0]）。本研究首次纵向分析了自杀意念的时间动态及其与IPTS（PB，（三）实行无害环境管理。我们希望这些结果能显著提高自杀意念的预测能力。在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风险因素。

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.