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. 2025 Nov 9:1-11.
doi: 10.1080/10615806.2025.2584314. Online ahead of print.

Bidirectional associations between negative relationship events and suicidal ideation: an EMA study of stress exposure and generation

Adam G Horwitz  1 , Nadia Al-Dajani  2 , Kaitlyn McCarthy  3 , Victor Hong  1 , Cheryl A King  1 , Ewa K Czyz  1
Affiliations

Bidirectional associations between negative relationship events and suicidal ideation: an EMA study of stress exposure and generation

Adam G Horwitz et al. Anxiety Stress Coping. .

Abstract

Background: Ecological momentary assessments (EMA) have recently enabled the examination of near-term associations between interpersonal stressors and suicide risk. Yet, studies have typically considered the impact of negative relationship events (NREs) on subsequent suicidal ideation (SI) (i.e., stress exposure), with little research examining the impact of SI on subsequent NREs (i.e., stress generation). The present study examined next-day bidirectional associations between NREs and SI, as well as between NREs and interpersonal constructs linked to SI (thwarted belongingness, perceived burdensomeness).

Method: Young adults (N = 102; Ages 18-25 (M = 20.9); 67% cisgender women; 75% White) completed EMAs for 2 months following an emergency department visit for suicide risk-related concerns.

Results: In multi-level models testing bidirectional relationships with next-day outcomes, within-person main effects were not detected, in either direction, for the constructs under consideration. However, between-person associations were present for NREs and perceived burdensomeness, wherein individuals who generally experience greater burdensomeness endured more daily NREs and those with more NREs reported higher daily-level burdensomeness.

Conclusions: Results did not suggest that daily fluctuations in SI or NREs correspond to next-day outcomes in this high-risk group. However, person-level differences suggest chronic stressors play a significant role in day-to-day experiences.

Keywords: Stress generation; daily diary; interpersonal conflict; perceived burdensomeness; suicidal ideation.

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Conflict of interest statement

Declaration of competing interest: The authors have no known competing financial interest or personal relationships that might appear to influence the work reported in this manuscript.

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