Title: Emotion Intensity and Lability after Hospital Discharge
Description: Suicidal thoughts and behaviors are important public health concerns and suicide is the second leading cause of death among adolescents in the United States (CDC, 2019). The months following hospital discharge mark an increased period of risk for recurrence of suicidal thoughts and behaviors. During this elevated risk period, the first month following discharge is a particularly high-risk period for suicide death (Meehan et al., 2006). Despite this known high-risk period, the processes that place an individual at increased risk during this time are not well understood. Emotion intensity and lability are known risk factors for suicidal ideation and are demographically salient risk factors among adolescents. Historic methodologies for assessing emotion intensity and lability rely on long-term retrospective self-report questionnaires and interviews which fail to capture the variability of these risk factors that are known to fluctuate on a daily to hourly basis. The present study implemented ecological momentary assessment (EMA; a methodology for repeatedly assessing variables in real-time), to study both positive and negative emotion intensity and lability among adolescents during the first month following discharge from psychiatric hospitalization.

The current study sought to compare the power of traditional baseline assessments of emotions to that of EMA in the prediction of intensity and recurrence of suicidal ideation at 1- and 4-months post-hospitalization. Forty-five adolescents (12-18 years; M= 15.85; SD= 1.58) psychiatrically hospitalized due to a suicide related chief complaint were recruited from an inpatient unit in a larger treatment development study. Adolescents completed interviews and self-reports to assess demographic variables, baseline emotion characteristics, and history of suicidal thoughts and behavior. Following discharge, participants completed one month of daily EMA surveys, in which adolescents were asked to rate the extent to which they felt positive and negative emotions in the moment. Adolescents then completed a follow-up survey at 1-month and 4-months post-discharge to assess recurrence and intensity of suicidal ideation. We found that positive and negative emotions at baseline did not significantly predict suicidal ideation recurrence or intensity at either of the study follow-ups.

High intensity of negative emotions as assessed via EMA was significantly associated with more intense suicidal ideation severity at both 1- and 4- months post-discharge, even after controlling for baseline suicidal ideation intensity and depressive symptoms. Assessing emotions on a daily basis provided stronger prediction models of suicidal ideation intensity in the months following hospital discharge compared to traditional methods of assessment. Limitations and future directions are discussed.