The dynamics of self-injurious and suicidal thoughts and behaviors in adolescence: a narrative review and critical evaluation of ambulatory assessment studies

INTRODUCTION: Suicide is a major public health issue among adolescents, the fourth leading cause of death among 15-19-year-olds. Ambulatory Assessment (AA), or real-time monitoring, refers to a range of techniques (e.g., ecological momentary assessment (EMA), daily diaries) designed to assess individuals' thoughts, feelings, and behaviors in their natural environment, intensively and repeatedly over time. It represents a suitable approach for capturing these fluctuations and dynamics. EVIDENCE ACQUISITION: The present narrative review aimed to describe all the published studies evaluating AA and suicide-related outcomes in adolescents and to critically evaluate the reported dynamic processes. A PubMed search was performed up to March 2022 to include studies focused on 1) adolescents; 2) any suicide-related outcome; and 3) AA and dynamic processes. EVIDENCE SYNTHESIS: We included 27 studies based on EMA (multiple assessments per day) (k=17), daily diary (one assessment per day) (k=9), or both (k=1). Among EMA studies, different types of sampling strategies were used: signal-contingent (self-report after a notification) (k=11), event-contingent (self-report after the event) (k=1), and mixed-based (k=4) sampling strategies. Nearly half of the studies measured positive and negative affects, while most studies measured suicidal ideation (SI), self-injurious thoughts and non-suicidal self-injury (NSSI). Nineteen studies yielded a dynamic aim, using a nomothetic (k=5) or an idiographic approach (k=22), respectively, a group-based and an individual-based approach. CONCLUSIONS: The shortness of NSSI episodes (from 1 to 30 minutes) and the high SI fluctuation over time suggest the importance of a real-time assessment of these phenomena. However, an idiographic approach to data analysis should accompany this type of monitoring. This approach captures the dynamics underlying these phenomena. It considers their intimate and individual nature, gaining a basic understanding of the phenomenology of both SI and NSSI episodes as they occur in the real world.