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有限的关于其急性危险因素和时间动态的经验知识相矛盾。获得这些知识对于发展监测或干预概念是必要的（特别是在高危人群，如精神病住院患者中）。人际自杀理论（IPTS, Joiner, 2005; Van Orden et al., 2010）提供了一个解释自杀行为和自杀意念发生的理论框架。IPTS假设两种结构（感知负担[PB]，受挫归属感[TB]）在短时间内波动，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），但缺乏分析自杀意念的时间动态及其与PB和TB关联的纵向研究。目的：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、TB和其他正在讨论的预测因素（如绝望）的关系。为了充分解决这个问题，我们使用经验抽样方法（ESM）来确保所研究的变量的时间动态被评估策略捕获（即在数小时内）。方法：在16个月内，在莱比锡大学诊所（University Clinic of Leipzig）招募N=75名精神科和心身住院患者，每隔两周（T0和T1）进行两次诊断性评估（如诊断访谈、问卷调查）。ESM阶段（即患者回答有关自杀意念和感兴趣的预测因素的问题）在6至10天内包含60个采样点，发生在T0和T1之间（技术上由智能手机应用程序movisensXS软件实现）。在为期三个月的试点阶段，将制定适当的抽样策略（频率、间隔），并验证ESM项目对变化的敏感性。在几个连续的多水平多元回归中，自杀意念将被建模为因变量，而正在研究的预测因子将被建模为自变量（第一层次是由ESM评估的IPTS和竞争变量的概念，第二层次是特征变量[T0]）。相关性：本研究首次纵向分析了自杀意念的时间动态及其与应用ESM的IPTS中心构念（PB， TB）的关联。我们期望研究结果能显著改善自杀意念的预测。在制定监测和干预概念（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.