Effect of frequent assessment of suicidal thinking on its incidence and severity: high-resolution real-time monitoring study.

Researchers, clinicians and patients are increasingly using real-time monitoring methods to understand and predict suicidal thoughts and behaviours. These methods involve frequently assessing suicidal thoughts, but it is not known whether asking about suicide repeatedly is iatrogenic. We tested two questions about this approach: (a) does repeatedly assessing suicidal thinking over short periods of time increase suicidal thinking, and (b) is more frequent assessment of suicidal thinking associated with more severe suicidal thinking? In a real-time monitoring study (n = 101 participants, n = 12 793 surveys), we found no evidence to support the notion that repeated assessment of suicidal thoughts is iatrogenic.

Daily-level assessment of the contexts under which seeking social support relates to risk of suicidal thinking.

INTRODUCTION: Perceived social support is a well-established protective factor against suicidal ideation, yet few studies have examined how actually seeking social support relates to suicidal ideation. We investigated the contexts under which social support seeking may be related to greater, or lesser, suicidal ideation. METHODS: Undergraduates completed ecological momentary assessments up to 6 times daily. Multi-level moderated logistic regressions examined interactions between presence of daily-level support seeking with burdensomeness and loneliness as indicators of same-day and next-day suicidal ideation. RESULTS: Seeking social support was positively associated with same-day, but not next-day reports of suicidal thinking. On days when participants felt burdensome and sought support, they had greater odds of reporting suicidal ideation (OR = 1.659, 95% CI = [1.420, 1.938]), compared with days they felt burdensome but did not seek support. There was no effect of burdensomeness on next-day ideation. There was no significant interaction effect between support seeking and loneliness on same-day or next-day ideation. CONCLUSIONS: Seeking support and feeling like a burden are associated with a greater likelihood of experiencing suicidal ideation. The current results underscore the importance of equipping at-risk individuals with a toolbelt of a variety of coping skills.

Randomized clinical trial of a brief, scalable intervention for mental health sequelae in college students during the COVID-19 pandemic.

This randomized clinical trial aimed to determine feasibility, acceptability, and initial efficacy of brief Dialectical Behavior Therapy (DBT) skills videos in reducing psychological distress among college students during the COVID-19 pandemic. Over six weeks, 153 undergraduates at a large, public American university completed pre-assessment, intervention, and post-assessment periods. During the intervention, participants were randomized to receive animated DBT skills videos for 14 successive days (n = 99) or continue assessment (n = 54). All participants received 4x daily ecological momentary assessments on affect, self-efficacy of managing emotions, and unbearableness of emotions. The study was feasible and the intervention was acceptable, as demonstrated by moderate to high compliance rates and video ratings. There were significant pre-post video reductions in negative affect and increases in positive affect. There was a significant time × condition interaction on unbearableness of emotions; control participants rated their emotions as more unbearable in the last four vs. first two weeks, whereas the intervention participants did not rate their emotions as any more unbearable. Main effects of condition on negative affect and self-efficacy were not significant. DBT skills videos may help college students avoid worsening mental health. This brief, highly scalable intervention could extend the reach of mental health treatment.

Real-time Mental Health Impact of the COVID-19 Pandemic on College Students: Ecological Momentary Assessment Study.

BACKGROUND: College students' mental health may be disproportionally affected by the COVID-19 pandemic because of the abrupt shift off campus and subsequent loss of a social network and potential long-term impact on job prospects. OBJECTIVE: We sought to assess the nature of COVID-19's mental health impact among a sample of undergraduates who were experiencing the pandemic as it occurred in real time. METHODS: In total, 140 college students completed smartphone-based ecological momentary assessments of anxiety and optimism related to COVID-19 and other generic mental health variables 6 times daily. RESULTS: Participants completed >23,750 surveys. Overall, >75% of these surveys indicated at least some level of anxiety about COVID-19. On average, the proportion of responses each day at the highest levels of anxiety about COVID-19 was 7 times greater than the proportion of responses at the highest levels of non-COVID-19-specific anxiety. Structural change analyses indicated a significant downward trend in COVID-19 anxiety after the first week of June, but even at the lowest point, >15% of the participants in the sample still reported high levels of COVID-19 anxiety each day. Participants felt more anxious about COVID-19 on days when the number of new cases and deaths due to COVID-19 were higher. When participants felt anxious about COVID-19, they also felt sad, anxious (in general), and had a greater desire to drink and use drugs. Participants felt more optimistic about COVID-19 when they received more support from others and from their university. CONCLUSIONS: This study demonstrated the widespread mental health impact that COVID-19 has had on college students.