Ecological momentary risk signatures for suicidality in BPD

Abstract

Suicidal thoughts and behaviors in borderline personality disorder fluctuate rapidly. Capturing “in-themoment” risk may improve short-term prediction and prevention. Narrative review of ecological momentary assessment, daily-diary, and mobile sensing studies in adults with borderline personality disorder. Exposures included negative affect (shame, anger, sadness), interpersonal stress (rejection, conflict), loneliness, sleep disruption, and timing of day. Outcomes were same-day and next-day suicidal ideation and self-harm urges. Feasibility and safety indicators (completion, reactivity) were summarized. Across multiweek protocols, participants completed ~78–84% of prompts; most rated procedures positively (~69%), with a minority reporting mood worsening (~22%) or increased ideation reactivity (~18%). Suicidal ideation was reported on ~10–12% of monitored days. Same-day increases in shame and anger, spikes in loneliness, and interpersonal conflict were consistently followed by higher suicidal ideation later the same day. Nights with poorer sleep or longer sleep-onset delay were commonly followed by more suicidal thoughts the next day. Greater day-to-day variability in affect and sleep co-occurred with more frequent suicidal thoughts across the monitoring period. Momentary risk was often highest in the evening and after interpersonal stressors. Future priorities include harmonized measures, multi-site replications, and combining active reports with passive sensing to improve hour-level prediction.