Can Text Messages Identify Suicide Risk in Real Time? A Within-Subjects Pilot Examination of Temporally Sensitive Markers of Suicide Risk

Abstract

Objective tools to assess suicide risk are needed to determine when someone is at imminent risk. In this pilot laboratory investigation, we used a within-subjects design to identify patterns in text messaging (short message service) unique to high-risk periods preceding suicide attempts. Individuals reporting a history of suicide attempt (N = 33) retrospectively identified past attempts and periods of lower risk (e.g., suicide ideation). Language analysis software scored 189,478 text messages to capture three psychological constructs: self-focus, sentiment, and social engagement. Mixed-effects models tested whether these constructs differed in general (means) and over time (slopes) 2 weeks before a suicide attempt relative to lower-risk periods. Regarding mean differences, no language features uniquely differentiated suicide attempts from other episodes. However, when examining patterns over time, anger increased and positive emotion decreased to a greater extent as participants approached a suicide attempt. Results suggest private electronic communication has the potential to provide real-time digital markers of suicide risk.