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Introduction: The transition from suicidal thoughts to behaviors often involves considering the consequences of suicide as part of the decision‐making process. This study explored the relationship between this consideration process and the decision to either abort or carry out a suicide attempt. Methods: Among inpatients with a suicide‐related event in the past 2 weeks (suicide attempt n = 30 or aborted attempt n = 16), we assessed the degree to which they considered six domains of consequences, the impact of these considerations on their inclination to attempt suicide, and the duration of their decision‐making. Results: All the participants who aborted and 87% of those who attempted considered consequences of suicide. Participants who aborted took longer to progress through decision‐making stages and considered more suicide‐hindering factors, especially interpersonal ones, though these differences were no longer significant after correction. Group status moderated the relationship between the balance of suicide‐facilitating and suicide‐hindering considerations and decision‐making duration. Considering the consequences of suicide more favorably was related to a shorter ideation‐to‐action period before a suicide attempt and a longer ideation period before aborting an attempt. Conclusion: This study highlights the complexity of suicide decision‐making and its role in better understanding the progression from ideation to action. [ABSTRACT FROM AUTHOR]

Introduction Mental illness affects approximately one in five persons in any given year and is the leading cause of disability worldwide. (1-3) Nevertheless, there are approximately nine specialty care providers [...], The application of digital technology to psychiatry research is rapidly leading to new discoveries and capabilities in the field of mobile health. However, the increase in opportunities to passively collect vast amounts of detailed information on study participants coupled with advances in statistical techniques that enable machine learning models to process such information has raised novel ethical dilemmas regarding researchers' duties to: (i) monitor adverse events and intervene accordingly; (ii) obtain fully informed, voluntary consent; (iii) protect the privacy of participants; and (iv) increase the transparency of powerful, machine learning models to ensure they can be applied ethically and fairly in psychiatric care. This review highlights emerging ethical challenges and unresolved ethical questions in mobile health research and provides recommendations on how mobile health researchers can address these issues in practice. Ultimately, the hope is that this review will facilitate continued discussion on how to achieve best practice in mobile health research within psychiatry. L'application des technologies numeriques a la recherche psychiatrique entraine rapidement de nouvelles decouvertes et capacites en matiere de sante mobile. Cependant, la multiplication des opportunites de recueillir passivement d'immenses quantites d'informations detaillees sur les participants aux etudes combinee aux progres des techniques statistiques permettant aux modeles d'apprentissage automatique de traiter de telles informations a souleve de nouveaux dilemmes ethiques concernant l'obligation des chercheurs: (i) de surveiller les effets indesirables et d'intervenir en consequence; (ii) d'obtenir un consentement pleinement eclaire et volontaire; (iii) de proteger la vie privee des participants; et enfin, (iv) d'ameliorer la transparence des puissants modeles d'apprentissage automatique afin de garantir une application ethique et impartiale dans le domaine des soins psychiatriques. Ce rapport identifie les defis qui en decoulent ainsi que les questions ethiques non resolues en matiere de sante mobile. Il formule egalement des recommandations sur la facon dont les chercheurs en sante mobile peuvent resoudre ces problemes dans la pratique. A terme, nous esperons que ce rapport favorisera la poursuite des discussions portant sur les moyens de definir des methodes de recherche adequates pour la sante mobile en psychiatrie. La aplicacion de la tecnologia digital a la investigacion en psiquiatria esta conduciendo rapidamente a descubrimientos y capacidades nuevas en el ambito de la salud movil. No obstante, el incremento de las oportunidades para recopilar pasivamente grandes volumenes de informacion detallada sobre los participantes en los estudios, junto con los avances en las tecnicas de estadistica que permiten a los modelos de aprendizaje automatico procesar tal informacion, ha planteado nuevos dilemas eticos relativos a los deberes de los investigadores: (i) hacer un seguimiento de los eventos adversos e intervenir en consecuencia; (ii) obtener un consentimiento voluntario plenamente informado; (iii) proteger la privacidad de los participantes; y (iv) aumentar la transparencia de los modelos potentes de aprendizaje automatico para asegurar que puedan aplicarse de manera etica y justa en la atencion psiquiatrica. En este analisis se destacan tanto los desafios eticos nuevos como las cuestiones eticas aun sin resolver en la investigacion sobre la salud movil y se formulan recomendaciones sobre como los investigadores de la salud movil pueden abordar dichas cuestiones en la practica. En ultima instancia, se espera que este analisis facilite un debate continuo sobre como lograr las mejores practicas en la investigacion de la salud movil dentro de la psiquiatria.

Introduction: Little research has been done on how people mentally simulate future suicidal thoughts and urges, a process we term suicidal prospection. Methods: Participants were 94 adults with recent suicidal thoughts. Participants completed a 42‐day real‐time monitoring study and then a follow‐up survey 28 days later. Each night, participants provided predictions for the severity of their suicidal thoughts the next day and ratings of the severity of suicidal thoughts over the past day. We measured three aspects of suicidal prospection: predicted levels of desire to kill self, urge to kill self, and intent to kill self. We generated prediction errors by subtracting participants' predictions of the severity of their suicidal thoughts from their experienced severity. Results: Participants tended to overestimate (although the average magnitude was small and the modal error was zero) the severity of their future suicidal thoughts. The best fitting models suggested that participants used both their current suicidal thinking and previous predictions of their suicidal thinking to generate predictions of their future suicidal thinking. Finally, the average severity of predicted future suicidal thoughts predicted the number of days participants thought about suicide during the follow‐up period. Conclusions: This study highlights prospection as a psychological process to better understand suicidal thoughts and behaviors. [ABSTRACT FROM AUTHOR]

Ecological momentary assessment (EMA) is increasingly used to study suicidal thoughts and behaviors (STBs). There is a potential ethical obligation for researchers to intervene when receiving information about suicidal thoughts in real time. A possible concern, however, is that intervening when receiving responses that indicate high risk for suicide during EMA research may impact how participants respond to questions about suicidal thoughts and thus affect the validity and integrity of collected data. We leveraged data from a study of adults and adolescents (N = 434) recruited during a hospital visit for STBs to examine whether monitoring and intervening on high-risk responses affects subsequent participant responding. Overall, we found mixed support for the notion that intervening on high-risk responses influences participants' ratings. Although we observed some evidence of discontinuity in subsequent responses at the threshold used to trigger response-contingent interventions, it was not clear that such discontinuity was caused by the interventions; lower subsequent responses could be due to effective intervention, participant desire to not be contacted again, or regression to the mean. Importantly, the likelihood of completing surveys did not change from before to after response-contingent intervention. Adolescents were significantly more likely than adults, however, to change their initial suicidal intent ratings from above to below the high-risk threshold after viewing automated response-contingent pop-up messages. Studies explicitly designed to assess the potential impact of intervening on high-risk responses in real-time monitoring research are needed, as this will inform effective, scalable strategies for intervening during moments of high suicide risk. Public Significance Statement: There may be an ethical obligation to intervene when participants in real-time monitoring studies report being at high risk for suicide; however, one possible concern is that intervening could impact how (and whether) participants respond to questions about suicide. Overall, we found some evidence that contacting participants when they report high suicidal intent may impact their responses, although the mechanism through which the lowering of responses occurs is not clear. [ABSTRACT FROM AUTHOR]

Introduction: The inclusion of suicide gestures in modern nomenclatures for self‐injurious thoughts and behaviors (SITB) is contentious due to their history of pejorative connotations and inconsistent operationalization and measurement. Here we sought to investigate the extent to which participants who endorse this behavior on a standardized SITB measure: (1) describe their behavior in a way that is consistent with contemporary definitions for suicide gestures; (2) accurately classify their behavior when presented with multiple SITB response options; and (3) consistently report their level of intent to die across survey items. Methods: Participants were 83 adults from a community‐based sample who endorsed lifetime suicide gesture(s) in an online survey containing self‐report measures assessing their prior SITB engagement, followed by open‐ended questions eliciting narrative descriptions of their behaviors. Results: Approximately 13% of participants who endorsed lifetime suicide gestures provided narrative descriptions that met criteria for the behavior, and around one‐third consistently reported zero intent to die in their explicit ratings. Additionally, some participants reported non‐zero intent to die from behaviors without direct potential for physical injury. Conclusions: Overall, this study highlights substantial issues with the validity of current approaches to measuring suicide gestures. Implications for the classification of suicide gestures in clinical and research settings are discussed. [ABSTRACT FROM AUTHOR]