Engagement as a predictor of suicidal ideation and suicide attempts: Evidence from a 12-month ecological momentary assessment study in psychiatric outpatients
In brief
Regular suicide-risk app check-ins linked to 28% lower odds of attempts
Among 585 psychiatric outpatients at elevated suicide risk followed for a year, more consistent daily check-ins were associated with 28% lower odds of a suicide attempt. The relationship was nonlinear, and consistency showed an inverted-U association with active suicidal thoughts; the observational findings do not show that check-ins prevent attempts, but suggest engagement itself may help flag risk.
- Journal
- Journal of psychiatric research (Q1)
- Published
- 29 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Felipe M Herrmann, Maria Luisa Barrigón, Jorge López-Castroman, Philippe Courtet, Alejandro Porras-Segovia, Enrique Baca-García
- PMID
- 42826673
- DOI
- 10.1016/j.jpsychires.2026.09.034
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 4 October 2026): EMA engagement predicts lower suicide‑attempt risk
Abstract
Ecological momentary assessment (EMA) enables real-time monitoring of suicidal thoughts, offering a window into dynamic risk processes that static assessments miss. However, it remains unclear whether patterns of EMA engagement-rather than the content of responses-carry clinical significance for suicide risk. This year-long prospective cohort study examined whether EMA engagement predicted daily suicidal ideation and clinician-assessed suicide attempts during the 12-month period among psychiatric outpatients at elevated suicide risk. Participants (N = 585; M age = 44.1 years, SD = 14.4; 64.4% female) completed daily EMAs via the MEmind mobile application. Engagement was indexed by (1) total EMA responses and (2) EMA consistency, defined as the cumulative proportion of days with at least one EMA completed. Mixed-effects models estimated associations between engagement and (a) daily active and passive suicidal ideation and (b) suicide attempts obtained from electronic health records. Quadratic models revealed an inverted-U relationship between EMA consistency and active ideation (β2 = -185.55, p = .035). Higher EMA consistency predicted a lower likelihood of a suicide attempt (aOR = 0.72, p = .038), and this protective effect followed a nonlinear pattern (β2 = -10.75, p = .031). Consistent EMA engagement was associated with reduced suicide-attempt risk, independent of demographic factors. Engagement itself, beyond self-reported ideation, may serve as a behavioral marker of suicidality.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.