1 - (SYM 7) Who and What Retrospective Risk Assessments Miss: Examining Retrospective Denial of Momentary Suicidal Ideation in Adolescents

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.

Eighty community-based adolescents (47 with lifetime SI, 33 without lifetime SI or behaviors) were recruited via online social media advertisements. Adolescents completed a baseline online survey assessing demographic and clinical characteristics, followed by a 14-day EMA assessing their momentary states including suicidal ideation (5x/day). At the conclusion of the EMA period, adolescents retrospectively reported their SI during the past two weeks via an online survey and an interview with research staff. Descriptive analyses were conducted to examine the frequency of discrepancies across EMA and each of the retrospective measures. Adolescents with and without discrepant reports were compared using independent samples t-tests and chi-squared tests.

Of 48 adolescents who endorsed some SI during EMA, 35-42% 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=.001-.004, φ_c=.39-.53), lower SI severity, depression, and hopelessness at baseline (ps=.001-.004, ds=.52-.64), as well as less frequent and less severe SI during EMA compared to those who endorsed SI across both EMA and retrospective measures, ps< .05, ds=.33-.72.

The current findings indicate that 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, while currently at an early stage of the suicide risk trajectory, might be nonetheless at risk of further escalation.