Suicide Risk Management Protocols in Adolescent Ecological Momentary Assessment Research on Suicidal and Self-Injurious Thoughts and Behaviors

Abstract: Theoretical Background: Ecological momentary assessment (EMA) is a promising approach for studying suicidal and self-injurious thoughts and behaviors (SITBs) in adolescents, where safety and ethics are crucial. Objective: As EMA gains popularity, this review is intended to update the systematic review by Bai et al. (2021 ), who provided an overview of reported suicide risk management protocols in EMA studies on SITBs in adolescents from 2000 to June 2019. We aim to update this review by including studies from July 2019 onward and examining them with regard to safety strategies, parental involvement, and safety-related study outcomes. Reports on safety, ethics, and reactivity are assumed to be lacking. Method: We searched PubMed, PsycInfo, and Google Scholar for peer-reviewed English-language studies on EMA of SITBs in individuals under 18, published since July 2019. Evaluated aspects were safety strategies, parental involvement, and relevant outcomes. Results: In total, 23 studies met the inclusion criteria. All but one reported using safety strategies, most commonly preventive, followed by staff-led, and then automated strategies. Parents were involved in 43 % of included studies. No suicides occurred and reactivity reports were rare. Discussion and Conclusion: Results were contrary to our expectations insofar as safety strategies were common in adolescent EMA SITBs studies. Nevertheless, gaps remain, for example, regarding parental involvement and the lack of guidelines.