Conceptualizing Student Problem Dynamics Using Idiographic and Data-Driven Networks: A Feasibility Trial

BackgroundThe wide use of smartphones offers large-scale opportunities for real-time data collection methods such as ecological momentary assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents’ feeding practices and feeding goals, particularly when feeding children with high food approaches.ObjectiveThe main objectives of this study were to (1) assess parents/caregivers’ compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children’s eating occasions and parents’ feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions.MethodsParents in the United Kingdom with a child aged 3 to 5 years who exhibit avid eating behavior were invited to participate in a 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey.ResultsOf those parents who completed the EMA study, 104 (87.4%) parents provided at least 7 “full” days of data (2 signal surveys and 1 event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), 3 daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the 10 days. Over the EMA period, a total of 2524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD 0.18; min=1.7, max=2.3). The majority of parents felt that the surveys made them more aware of their feelings (105/118, 89%) and activities (93/118, 79%). The frequency of daily food requests estimated by parents at baseline was significantly correlated with the frequency of food requests reported daily during the EMA period (r=0.483, P<.001). However, the number of daily food requests per day estimated at baseline (mean 4.5, SD 1.5) was significantly higher than the number of food requests reported per day during the EMA period (mean 3.7, SD 1.1), (t116=18.8, P<.001).ConclusionsThis paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents’ involvement to ensure successful data collection.

This study assessed whether baseline levels of distal and proximal minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating in daily life among sexual minority women with overweight/obesity. Fifty-five sexual minority women ages 18-60 (M = 25 ± 9) with BMI > 25kg/m2 (M = 32 ± 5) completed baseline assessments of distal and proximal minority stressors due to sexual orientation, gender, and weight. Participants then completed an Ecological Momentary Assessment (EMA) protocol. For five days, participants responded to five random prompts assessing engagement in dysregulated eating (i.e., overeating, binge eating). The cumulative number of EMA-measured overeating and binge eating episodes was summed per participant. Several minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating behaviors during EMA. Women with higher (vs. lower) baseline levels of internalized homophobia reported more cumulative episodes of binge eating during the EMA period. Women reporting greater (vs. less) baseline sexual orientation concealment reported more episodes of overeating during the EMA period. Women with greater (vs. less) baseline weight bias experiences and internalization reported more overeating and binge eating episodes during the EMA period. Findings from this pilot study identify internalized homophobia, sexual orientation concealment, and experienced and internalized weight bias as potential risk factors for dysregulated eating behaviors among sexual minority women of higher body weight.

BACKGROUND The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as Ecological Momentary Assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents’ feeding practices and feeding goals, particularly when feeding children with a high food approach. OBJECTIVE The main objectives of this study were to: (1) assess parents/caregivers’ compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children’s eating occasions and parents’ feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions. METHODS Parents living in the UK with a child aged between 3 and 5 years with avid eating behavior were invited to participate in the 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey. RESULTS Of those parents who completed the EMA study, 104 (87.4%) provided at least seven ‘full’ days of data (two signal surveys and one event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), three daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the ten days. Over the EMA period, a total of 2,524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD = 0.18, min = 1.7, max = 2.3). The majority of parents felt that the surveys made them more aware of their feelings (89%) and activities (79%). CONCLUSIONS This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents’ involvement to ensure successful data collection. INTERNATIONAL REGISTERED REPORT RR2-10.2196/55193

ABSTRACTIntroductionDepressive symptoms are common in cancer survivors. Recognizing depression can be complicated due to recall bias or oncological treatment‐related symptoms including cognitive problems, which in turn may undermine the reliability of self‐report questionnaires.AimTo explore the feasibility and patient satisfaction of smartphone‐based Ecological Momentary Assessment (EMA) in primary care cancer survivors.MethodsPatients > 18 years, curatively treated for cancer within the past two years, regardless whether they experienced depressive symptoms, were selected based on the GPs' health records. EMA questionnaires were sent three times daily for 6 weeks, covering positive and negative affect, along with related experiences. Patients received weekly EMA feedback reports. After the EMA period, they completed an evaluation questionnaire and participated in a follow‐up phone call to discuss their EMA experiences.ResultsPatient recruitment achieved a reach of 17.0% who were invited for participation (158/931), of whom 33/158 agreed to participate yielding a response rate of 20.9%. Patients found the EMA questions clear and study participation easy with a completion rate of 67% among those who started. However, 64% felt the frequency of EMA prompts was excessive, with 52% considering the 6‐week duration appropriate and 48% feeling it was too long. During phone call evaluations, patients reported becoming inattentive with filling out the EMA's. Weekly reports were viewed as relevant and provided valuable insights into levels and changes in their mood.ConclusionThe relatively low reach and response rate do not entirely support the feasibility and acceptability of a 6‐week EMA in cancer survivors in primary care without depressive symptoms. EMA was, however, completed by a majority among those who started and was regarded as a user‐friendly tool that offered valuable insights to individuals. It could potentially benefit cancer survivors or other patients who do experience depressive symptoms in primary care.

Behaviour and emotional problems are common in individuals with high-functioning autism and Asperger’s Disorder (High-Functioning Autism Spectrum Disorders, HFASD), with onset frequently occurring during adolescence. Stressful experiences and coping are important predictors of mental health outcome in nonclinical populations, yet few studies have investigated these relationships in individuals with HFASD. One methodology used to assess coping in typically developing individuals is Ecological Momentary Assessment (EMA), which involves having participants complete multiple reports of a target behaviour in their natural environment. EMA may increase the accuracy of data by minimising the time between occurrence of a behaviour and its reporting, hence decreasing the impact of recall biases that affect traditional pen and paper questionnaires. Only one prior study has used EMA with individuals with HFASD, and its feasibility and validity have not been examined. The overarching aims of this thesis were to investigate the feasibility and validity of having adolescents with HFASD report about their mood, coping and stressors using EMA, and to examine the relationships between these variables and behaviour and emotional problems. These aims were examined over three studies, using the same sample of 31 adolescents with HFASD, who completed a mobile phone-based EMA program that assessed their mood, stressors and coping up to four times a day for two weeks. Parents reported their children’s stressors and coping from their perspective during this two-week period via questionnaires. In addition, adolescents, their parents and teachers completed questionnaires assessing the adolescents’ behaviour and emotional problems and coping. The first study examined the feasibility and validity of using EMA to investigate the stressors and coping of adolescents with HFASD. Moderate compliance with the EMA program was achieved that was comparable to rates found within nonclinical populations. Some convergent validity was found for the Involuntary Engagement coping style, but not for the other coping styles assessed. When Involuntary Engagement was assessed via EMA, it was moderately correlated with traditional questionnaires assessing this coping style that were completed by the parent and the adolescents. The second study examined the relationships between daily hassles, coping and behaviour and emotional problems using EMA and questionnaires. The Disengagement coping style was consistently associated with more behaviour and emotional problems regardless of whether it was assessed via EMA or questionnaires and independent of the observer of the coping style (self- or parent-report). Perceived frequency of hassles was also generally associated with higher levels of behaviour and emotional problems. The third study examined the temporal relationships between mood, coping and behaviour and emotional problems in young people with HFASD. There was a positive correlation between pre-existing behaviour and emotional problems measured at baseline and Disengagement coping during the EMA period. Disengagement and Secondary Control Engagement coping were negatively correlated with subsequent negative mood (i.e. resulted in better mood). Taken together, the findings from these three interrelated studies suggest that psychological interventions that target coping strategies may be valuable for individuals with HFASD who have behaviour and emotional problems. The findings also suggest that adolescents with HFASD are capable of completing EMA and self-report questionnaires about abstract constructs such as their mood and coping. These initial findings suggest EMA may be a feasible and valid methodology for use with adolescents with HFASD.

Introduction Alcohol use disorder (AUD) is characterized by sleep disturbances, but differentiating the effects of acute alcohol exposure, withdrawal, and chronic consumption remains an unsolved problem. This study takes a unique approach to examine proximate alcohol consumption effects on sleep electroencephalography (EEG) in young adults who engage in heavy episodic drinking. We aim to relate sleep physiology to progression from binge drinking towards AUD. Methods Young adults aged 21-30 years (N=88) who report weekly binge drinking (4+/5+ drinks per occasion for female/male assigned at birth) completed two nine-day ecological momentary assessment (EMA) protocols, each followed by overnight in-lab polysomnography (PSG) after negative alcohol breath test. Drinking events were recorded by EMA. EEG sleep analyses (AASM criteria) assessed sleep-wake staging and power spectral analysis. Linear mixed effect modeling examined the effects of drink number during the EMA period on measures of sleep continuity, architecture, and spectral power, adjusting for sociodemographic and behavioral covariates. Results Participants reported an average of 17.5+/-1.0 drinks over 3.0+/-0.1 days in each 9-day EMA period. Unexpectedly, higher drink counts were associated with lower time spent awake after sleep onset (WASO, log-transformed, BETA-STD=-0.17, p=0.028) without significant changes in sleep efficiency (p=0.06) or sleep onset latency (SOL, p=0.656). More drinks also correlated with higher number of REM periods (log-transformed, BETA-STD=0.17, p=0.022) and less REM fragmentation (log-transformed, BETA-STD=-0.21, p=0.005) without correlating with REM latency (p=0.058). Finally, consumption of more drinks was associated with decreased alpha power (8-12 Hz, log-transformed, BETA-STD=-0.1, p=0.03) but not associated with other aspects of sleep architecture or spectral power (p&amp;gt;0.05). Conclusion Contrary to our expectation of worse sleep in those with higher drinking frequency, we found that greater drink consumption was actually associated with better sleep based on parameters assessing continuity (WASO), REM sleep (number of periods, fragmentation), and spectral power (alpha power). Possible explanations include effects from binge drinking pattern, sleep improvement after alcohol detoxification, age-related resilience, or differential effects across the night. Future analyses will investigate sex differences, day-to-day drinking and sleeping relationships during EMA study period, subjective sleep quality, sleep changes across the night, and other putative covariates. Support (if any) NAH T32HL082610, BPH/SLP R01AA026249

Because audiometric evaluation, symptom histories, questionnaires, and similar standard assessment tools may not adequately sample the effects of chronic tinnitus on day-to-day activities, there is a need for alternative methodological approaches to study the impact of tinnitus on day-to-day life. An innovative methodological approach that has shown great promise in the study of chronic health problems characterized by reported temporal and/or situational variability in symptoms and distress is known as ecological momentary assessment (EMA). EMA involves the real-time measurement of states, situational factors, and symptoms by individuals as they go about their day-to-day activities. The objective of this pilot investigation was to explore the feasibility of using EMA methods to examine within- and between-day effects of tinnitus. This study was conducted in three phases: (1) design and development of an EMA methodology that could be used to assess effects of tinnitus; (2) refinement of the methodology through the use of two focus groups; and (3) field-test the methodology with individuals who experienced bothersome tinnitus. For Phase 3, each of the 24 participants wore, throughout their waking hours for 2 weeks, a personal digital assistant that produced alerts four times a day. The alerts prompted participants to respond to 19 questions, including 9 relating to situational and mood factors and 10 comprising the Tinnitus Handicap Inventory-Screening version (THI-S). To evaluate for potential reactive effects of performing the EMA protocol, each participant completed the paper-and-pencil version of the full 25-item THI before and after the 2-week EMA period. Participants responded to the alerts with a 90% compliance rate, providing a total of 1210 completed surveys. At the time of their response, participants indicated that they were in their house or apartment (67.7%), alone (50.2%), happy (50%), and calm (54.5%). Across most responses, participants could hear their tinnitus (97%), and the loudness of their tinnitus averaged 4.7 on a 7-point increasing-loudness scale. The mean THI-S index score (out of a possible maximum 40 points for greatest tinnitus severity) was 17.0 (moderate self-perceived tinnitus handicap). Repeated THI-S index scores varied considerably both within and between participants. Mean 25-item THI scores were not significantly different before and after the EMA period, suggesting little reactivity of the EMA. The high compliance rate, positive feedback from participants, lack of reactivity as a result of performing the EMA protocol, and data collected indicate that EMA methodology is feasible with patients who have tinnitus. Outcome data obtained with this methodology cannot be obtained any other way because retrospective questionnaires cannot capture the day-to-day reactions. This methodology has the potential to provide more in-depth and accurate assessments of patients receiving therapy for tinnitus.

BackgroundMultiple independent lines of research on self-regulation point to executive cognitive ability (executive function/cognitive control) as a factor that underlies the capacity to successfully regulate one’s thoughts, emotions, and behavior. Critically, while leading theories point to the role of executive control in modifying “in-the-moment” regulatory processes (eg, enacting physical activity, resisting a poor dietary choice, reflecting on a stressful experience), few studies have tested the executive hypothesis at this timescale. Moreover, given the normative changes in executive control across the adult lifespan, it is essential to understand how cognitive aging might impact these processes.ObjectiveThe Physical Activity, Imaging, and Ambulatory Testing (PHIAT) project was designed to test how variation in executive control at multiple timescales (from moment-to-moment within days to age differences across decades) influences self-regulation across the adult lifespan.MethodsA 14-day, high-frequency, ambulatory assessment protocol was designed for this study. The study was conducted in a measurement burst design and included a 14-day ecological momentary assessment (EMA) protocol involving 6 assessments per day. Ultra-brief ambulatory cognitive assessments of multiple domains of cognition were included in the EMA protocol. Throughout the measurement burst, participants also wore 3 activity monitors on the hip, thigh, and wrist to measure physical activity/exercise, measure sedentary behavior, and self-monitor physical activity behavior, respectively.ResultsA total of 221 participants ranging from 18 to 89 years of age completed the PHIAT protocol over the course of 2021-2024, and data collection is complete. EMA data were collected from participants reflecting a wide range of psychosocial factors surrounding participation in health-promoting behaviors (motivation, intention, stress, built environment, and social cognitive factors). This EMA data stream is complemented by data from high-frequency, ambulatory cognitive assessments measuring processing speed, working memory capacity, inhibitory control, and divided/sustained attention administered 5 times per day throughout the 14-day burst. In addition, health-promoting behaviors, including sleep, diet, hydration, physical activity, and exercise, were assessed throughout the 14-day burst through a combination of EMA self-report and continuous activity monitoring.ConclusionsA rich, high-frequency dataset was generated by the PHIAT project that will provide a range of novel insights into the motivational factors, information processing, and environmental factors that surround self-regulation of health-promoting behavior.

BackgroundBipolar spectrum disorders (BSDs) are associated with a heightened sensitivity to rewards and elevated reward-related brain function in cortico-striatal circuitry. A separate literature documents social and circadian rhythm disruption in BSDs. Recently, integrated reward-circadian models of BSDs have been proposed. These models draw on work indicating that the two systems influence each other and interact to affect mood functioning. When dysregulated, reward and circadian system signaling may combine to form a positive feedback loop, whereby dysregulation in one system exacerbates dysregulation in the other. Project CREST (Circadian, Reward, and Emotion Systems in Teens) provides a first systematic test of reward-circadian dysregulation as a synergistic and dynamic vulnerability for first onset of BSD and increases in bipolar symptoms during adolescence.MethodsThis NIMH-funded R01 study is a 3-year prospective, longitudinal investigation of approximately 320 community adolescents from the broader Philadelphia area, United States of America. Eligible participants must be 13–16 years old, fluent in English, and without a prior BSD or hypomanic episode. They are being selected along the entire dimension of self-reported reward responsiveness, with oversampling at the high tail of the dimension in order to increase the likelihood of BSD onsets. At Times 1–6, every 6 months, participants will complete assessments of reward-relevant and social rhythm disruption life events and self-report and diagnostic assessments of bipolar symptoms and episodes. Yearly, at Times 1, 3, and 5, participants also will complete self-report measures of circadian chronotype (morningness-eveningness) and social rhythm regularity, a salivary dim light melatonin onset (DLMO) procedure to assess circadian phase, self-report, behavioral, and neural (fMRI) assessments of monetary and social reward responsiveness, and a 7-day ecological momentary assessment (EMA) period. During each EMA period, participants will complete continuous measures of sleep/wake and activity (actigraphy), a daily sleep diary, and three within-day (morning, afternoon, evening) measures of life events coded for reward-relevance and social rhythm disruption, monetary and social reward responsiveness, positive and negative affect, and hypo/manic and depressive symptoms. The fMRI scan will occur on the day before and the DLMO procedure will occur on the first evening of the 7-day EMA period.DiscussionThis study is an innovative integration of research on multi-organ systems involved in reward and circadian signaling in understanding first onset of BSD in adolescence. It has the potential to facilitate novel pharmacological, neural, and behavioral interventions to treat, and ideally prevent, bipolar conditions.

BackgroundAdolescent tobacco and nicotine use is a major public health concern, with lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) adolescents showing disproportionately high use compared to their heterosexual and cisgender peers. Research suggests factors such as socialization, stress, mood, and craving exacerbate tobacco and nicotine use. However, there is a dearth of knowledge of how these factors influence tobacco, nicotine, and cannabis use among LGBTQ+ adolescents in general and particularly on a momentary basis.ObjectiveThis study aims to use ecological momentary assessment (EMA) to assess real-time predictors of tobacco, nicotine, and cannabis product use among LGBTQ+ adolescents.MethodsThe Puff Break protocol was adapted from existing EMA protocols, key informant recommendations, LGBTQ+ adolescent perspectives, and insights from community members. Recruitment occurred through multiple channels, with high recruitment results via social media. Eligible participants were aged 14 to 19 years; self-identified as LGBTQ+; and used tobacco, nicotine, or cannabis products at least once in the past 30 days. The EMA pilot began with a 1.5-hour in-person or remote meeting where participants completed a timeline follow-back assessment for tobacco and nicotine use, salivary cotinine assessment, baseline survey, and EMA protocol training. Then, participants completed a 2-week EMA trial during which they received 1- to 2-minute surveys 5 times a day. Within a week of completing the EMA trial, participants concluded with an exit survey and exit interview.ResultsFunded in July 2022, the Puff Break study conducted EMA data collection between August 2023 and November 2024, recruiting a sample of 50 participants. Analyses evaluating the feasibility and acceptability of the Puff Break EMA protocol will be completed by July 2025. Multilevel modeling techniques to estimate both contemporaneous and lagged associations among stress, socialization, and craving (exposures) and smoking (outcomes—combustible cigarette, smokeless product, e-cigarette, and cannabis use) are expected to be completed by November 2025. Finally, qualitative thematic analyses to identify robust tailoring variables, intervention options, and decision rules to support future just-in-time-adaptive intervention development are expected to be completed by May 2026.ConclusionsPuff Break is an innovative EMA protocol developed to capture factors influencing tobacco, nicotine, and cannabis use among LGBTQ+ youth. Despite some inherent limitations to the EMA design, the Puff Break protocol has the potential to inform the development of a just-in-time-adaptive intervention to reduce tobacco, nicotine, and cannabis use among LGBTQ+ adolescents.International Registered Report Identifier (IRRID)DERR1-10.2196/71927

Individuals with eating disorders transdiagnostically engage in binge eating (BE) and/or purging, despite life-threatening consequences. Little is known about factors that contribute to the persistence of these behaviors. This study explored whether habitual control over binge/purge (B/P) spectrum behaviors contributes to symptom persistence and whether negative reinforcement via reductions in negative affect is less influential in maintaining B/P behaviors that are under habitual control and are persistent. Women with BE and/or purging (N = 81) completed self-report measures assessing habit strength of BE and purging. Then, they completed a 14-day ecological momentary assessment (EMA) protocol during which they completed measures of negative affect, BE, and purging multiple times per day. Habitual control over purging was associated with a greater frequency of purging during the EMA period. However, habitual control over BE was not associated with the severity of loss of control eating or the frequency of BE episodes. Habitual control did not moderate temporal relations between negative affect and B/P behaviors during the EMA period. However, exploratory analyses revealed that individuals with a longer duration of BE and greater habitual control over BE showed a less pronounced reduction in negative affect following BE. Overall, these findings suggest that purging may be maintained by habitual stimulus-response learning. In addition, they support the possibility that reduction in negative affect may play a less prominent role in maintaining BE that is habitual and persistent. This study investigated whether habit contributes to the persistence of symptoms in women with binge/purge spectrum behaviors and whether negative reinforcement via reductions in negative affect is less influential in maintaining binge/purge behaviors that are under habitual control. The findings suggest that purging may be maintained through habit. This supports the potential utility of habit reversal interventions to decrease habitual purging.

Real-time monitoring of the associations between self-critical and self-punishment cognitions and nonsuicidal self-injury

BackgroundPrescription drug misuse and abuse is an established public health challenge, and young adults are particularly affected. There is a striking lack of real-time, naturalistic data collection assessing intentions to misuse and other precipitating factors at the time of actual misuse, leaving the conditions under which individuals are most likely to misuse prescription medications unknown. Ecological momentary assessment (EMA) apps and protocols designed to capture this information would accelerate and expand the knowledge base and could directly contribute to prevention and treatment efforts.ObjectiveThe objectives of this study are to describe the development and administration of a mobile app and the EMA protocol designed to collect real-time factors associated with college students’ prescription drug misuse intentions and behaviors in daily life; present completion rates, compliance, acceptability, and reactivity associated with the EMA protocol for participants who endorsed recent prescription drug misuse at screening (ie, risk group; n=300) and those who did not (ie, nonrisk group; n=55); and establish initial construct validity by linking the reports of misuse behaviors in daily life collected via the EMA app to prescription drug misuse reported on a standard survey.MethodsAn EMA data collection app and protocol were designed specifically to capture hypothesized contextual factors along with prescription drug misuse intentions and behaviors in daily life. Using this protocol, young adult college students (N=352) completed signal- and event-contingent reports over a 28-day period. When the intention to misuse a prescription drug was endorsed, a brief follow-up prompt was sent 15 min later to collect participants’ indications of whether or not misuse had occurred.ResultsRisk-group participants were significantly more likely than nonrisk counterparts to endorse any prescription drug misuse intentions in daily life (P<.001), to complete one or more follow-up reports (P<.001), and to endorse any prescription drug misuse behavior in daily life on the follow-ups (P<.001). Overall, participants demonstrated consistent engagement with the EMA procedures and returned an average of 74.5 (SD 23.82; range 10-122) reports. Participants in the risk and nonrisk groups did not differ in the number of reports they completed (P=.12), the number of their reporting days (P=.32), or their average completion rates (P=.14). The results indicated some evidence of reactivity to the momentary reporting procedure. Participants reported uniformly positive experiences and remained highly engaged throughout the reporting protocol and broader study.ConclusionsThe novel EMA app and protocol provide an effective way to assess real-time factors associated with prescription drug misuse intentions and behaviors in daily life. The resulting investigations offer the potential to provide highly translatable information for research and prevention efforts.

Background Emerging evidence indicates that real‐time assessments such as ecological momentary assessment (EMA) detect individuals experiencing suicidal ideation (SI) who go undetected by retrospective assessments. However, it remains unclear for whom and why such discrepancies occur. Few prior studies accounted for method variance (e.g., survey vs. interview), and no studies have comprehensively examined which individual characteristics differentiate those with and without discrepant reports across EMA and retrospective measures. The current study aimed to address these gaps by examining discrepancies in SI endorsement across EMA and two forms of retrospective measures (survey, interview), as well as comparing those with and without discrepant reports on demographic, clinical, and EMA‐based variables. Methods Eighty community‐based adolescents completed a baseline online survey assessing demographic and clinical characteristics, followed by a 14‐day EMA assessing momentary SI (5x/day). At the conclusion of the EMA period, adolescents retrospectively reported their SI during the past 2 weeks via a survey and an interview. Results Of 48 adolescents who endorsed some SI during EMA, 35%–41% retrospectively denied having experienced SI during the EMA period on the follow‐up survey and interview. Adolescents with retrospective denial had a lower likelihood of lifetime SI ( ps &lt; 0.05, φ c = 0.53–0.55), lower SI and depression severity ( ps &lt; 0.05, ds = 0.52–0.64), and lower hopelessness at baseline ( ps &lt; 0.05, ds = 0.56–0.60), as well as less frequent and less severe SI ( ps &lt; 0.05, ds = 0.32–0.72) during EMA compared to those who endorsed SI across both EMA and retrospective measures. Conclusion Real‐time monitoring detects more adolescents experiencing SI than retrospective assessments, particularly those with lower clinical severity. Therefore, real‐time monitoring has the potential to facilitate early interventions by identifying adolescents who are not yet as advanced in the suicide risk trajectory but are at risk of further escalation.

Ecological momentary assessment (EMA) is a measurement methodology that involves the repeated collection of real-time data on participants' behavior and experience in their natural environment. While EMA allows researchers to gain valuable insights into dynamic behavioral processes, the need for frequent self-reporting can be burdensome and disruptive. Compliance with EMA protocols is important for accurate, unbiased sampling; yet, there is no "gold standard" for EMA study design to promote compliance. The purpose of this study was to use a factorial design to identify optimal study design factors, or combinations of factors, for achieving the highest completion rates for smartphone-based EMAs. Participants recruited from across the United States were randomized to 1 of 2 levels on each of 5 design factors in a 2×2×2×2×2 design (32 conditions): factor 1-number of questions per EMA survey (15 vs 25); factor 2-number of EMAs per day (2 vs 4); factor 3-EMA prompting schedule (random vs fixed times); factor 4-payment type (US $1 paid per EMA vs payment based on the percentage of EMAs completed); and factor 5-EMA response scale type (ie, slider-type response scale vs Likert-type response scale; this is the only within-person factor; each participant was randomized to complete slider- or Likert-type questions for the first 14 days or second 14 days of the study period). All participants were asked to complete prompted EMAs for 28 days. The effect of each factor on EMA completion was examined, as well as the effects of factor interactions on EMA completion. Finally, relations between demographic and socioenvironmental factors and EMA completion were examined. Participants (N=411) were aged 48.4 (SD 12.1) years; 75.7% (311/411) were female, 72.5% (298/411) were White, 18.0% (74/411) were Black or African American, 2.7% (11/411) were Asian, 1.5% (6/411) were American Indian or Alaska Native, 5.4% (22/411) belonged to more than one race, and 9.6% (38/396) were Hispanic/Latino. On average, participants completed 83.8% (28,948/34,552) of scheduled EMAs, and 96.6% (397/411) of participants completed the follow-up survey. Results indicated that there were no significant main effects of the design factors on compliance and no significant interactions. Analyses also indicated that older adults, those without a history of substance use problems, and those without current depression tended to complete more EMAs than their counterparts. No other demographic or socioenvironmental factors were related to EMA completion rates. Finally, the app was well liked (ie, system usability scale score=82.7), and there was a statistically significant positive association between liking the app and EMA compliance. Study results have broad implications for developing best practices guidelines for future studies that use EMA methodologies. ClinicalTrials.gov number NCT05194228; https://clinicaltrials.gov/study/NCT05194228.