Qualitative content analysis of reactivity effects and feasibility of ecological momentary assessments of suicide-related thoughts and behaviors in the long-term and in suicidal crises

Lena Spangenberg^1*Cora Spahn¹Jana Serebriakova²Thomas Forkmann²Heide Glaesmer¹

• ¹Leipzig University, Leipzig, Germany
• ²Universitat Duisburg-Essen, Duisburg, Germany

Background: This study explored participant experiences with ecological momentary assessment (EMA) in the context of suicidal thoughts and behaviors (STBs). Methods: 16 participants of a long-term EMA study (with varying STB occurrence during the study and low vs. high compliance) were interviewed on reactivity effects and feasibility of EMA. Qualitative content analysis was performed using an inductive-deductive approach and consensual coding. Results: Reactivity to EMA was reported by some participants, with suicidal thoughts occasionally intensifying/being triggered by survey prompts. Importantly, no evidence indicated that EMA triggered suicidal actions. However, the burden increased over time for some, calling for more personalized monitoring durations. EMA's feasibility during acute suicidal crises was questioned due to reduced ability and willingness to respond. Conclusions: Long-term EMA monitoring after psychiatric discharge was perceived as feasible and beneficial. Selection bias and the lack of quantitative validation limit generalizability. Findings underscore the value of mixed-methods approaches and participatory protocol design.