Social connectedness as a predictor of suicidal outcomes in psychiatric outpatients: A 12-month prospective EMA study
A. A. Porras-Segovia, F. M. Herrmann, L. Albarracín-García, C. Díaz-Téllez, E. Baca-GarcíaIntroduction
Suicide is a leading global public health problem, accounting for over 700,000 deaths each year. Beyond its lethality, suicidal thoughts and behaviours carry a significant morbidity burden. Social connectedness has been identified as a key protective factor for suicide, yet most studies rely on static, cross-sectional assessments. Ecological Momentary Assessment (EMA) allows for the capture of real-time fluctuations in risk factors and the protective nature of social connectedness.
Objectives
This study aims to advance the field by examining the prospective association between EMA-measured social connectedness and suicidal outcomes (both EMA-based and EHR outcomes), over a 12-month EMA follow-up period.
Methods
We conducted a 12-month prospective EMA study involving 550 psychiatric outpatients from four Spanish hospitals who had experienced recent suicidal thoughts or attempts. Participants received a daily survey containing 2–4 randomly selected items from a pool of 34. These items included measures of social connectedness, active and passive suicidal ideation, and non-suicidal self-injury (NSSI). Information on suicide attempts was extracted from electronic medical records. Multilevel mixed-effects models were used to distinguish between-person (average levels) and within-person (daily deviations) associations, adjusting for age, sex, time, and missingness.
Results
Across 81,023 completed assessments, higher average connectedness was significantly associated with lower active suicidal ideation (b = −0.18, p = .014) and NSSI (b = −0.28, p = .003). Within-person increases in connectedness also predicted reductions in active suicidal ideation (b = −0.12, p < .001), but not NSSI or passive ideation. Lastly, the only significant predictor of suicide attempts was the missingness of active suicidal ideation EMA in the 7 days prior.
Descriptive and variability statistics for suicide outcomes and social connectedness Table 1. Long description.