Momentary stress and social context among adolescents at risk for suicide: An experience sampling study
- PMID: 41076153
- DOI: 10.1016/j.jad.2025.120407
Momentary stress and social context among adolescents at risk for suicide: An experience sampling study
Abstract
Adolescent suicide is a public health emergency with interpersonal factors playing a critical role in risk for suicidal thoughts and behaviors (STB). This study examined whether smartphone-based ecological momentary assessment (EMA) surveys capturing stress and social context could enhance the identification of youth at risk for STB. Adolescents ages 13-18-years-old (N = 207, 166 female sex) reporting depressive, anxiety, and/or substance use disorders were recruited from psychiatric outpatient programs, emergency departments, medical research registries, and social media. Participants with STB history were oversampled; 66 % reported current suicidal ideation and 27 % had a past-year attempt. Assessments of suicidal events (attempts, emergency department visits, hospitalizations for suicide concerns) were completed at baseline, 1-, 3-, and 6-month follow-up assessments. EMA probed momentary stress severity, affect, and recent social context (time spent with peers, family, or alone) 4-7×/day. Compared to psychiatric controls (N = 64), adolescents with STB history (N = 143) were more likely to report spending time alone (aOR = 1.75, 95 % CI = [1.15, 2.39]), less time with family (aOR = 0.59, 95 % CI = [0.31, 0.91]), and higher stress (d = 0.28). Further, EMA of stress (aOR = 1.86, 95 % CI = [1.11, 3.26]) and negative affect (aOR = 2.32, 95 % CI = [1.34, 4.36]) were prospectively associated with suicidal events above and beyond prior STB history. Broadly, results were similar between EMA measures of stress and negative affect, indicating such responses may reflect shared underlying processes. These findings underscore the importance of evaluating dynamic family and peer contact among adolescents at risk for STB and highlight EMA as a potential tool for assessing interpersonal exposures related to STB risk. Preprint link: doi:10.31234/osf.io/kepxw.
Keywords: Adolescent; EMA; Peer; Smartphone; Social; Stress; Suicide.
Copyright © 2025 Elsevier B.V. All rights reserved.
Conflict of interest statement
Declaration of competing interest In the past 3 years, Dr. Auerbach has received consulting fees and equity from Get Sonar Inc. He also has received consulting fees from RPA Health Consulting, Inc. and Covington & Burling LLP, which is representing a social media company in litigation. Nicholas B. Allen receive salary from, and has an equity interest in, Ksana Health Inc., who hold the license for commercial sales of the EARS software described in this application. David Brent receives research support from NIMH, American Foundation for Suicide Prevention (AFSP), the Once Upon a Time Foundation, and the Beckwith Foundation, receives royalties from Guilford Press, from the electronic self-rated version of the Columbia Suicide Severity Rating Scale (C-SSRS) from ERT, Inc., and from performing duties as an UptoDate Inc. Psychiatry Section Editor receives consulting fees from Healthwise. David Brent has invention disclosures and intellectual property rights over the applications, Computerized Adaptive Screen for Suicidal Youth, BRITE, and Screening Wizard. All other authors have declared no conflicts of interest.
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