(PS9-B26) Temporal Dynamics Between Negative Affect and Self-injurious Thoughts and Behaviors Among Adults with a History of Self-harm

Recent ecological momentary assessment (EMA) research has identified negative affect as a proximal predictor of self-injurious thoughts and behaviors (SITBs). That is, negative affect tends to be elevated (on a within-person level) in the moments prior to SITBs (e.g., Rodríguez-Blanco et al., 2018). However, few of the EMA studies have explored this association in community samples. The present study aimed to describe the short-term association between negative affect and SITBs in high-risk community adults using EMA.

We recruited 61 adults from the Bronx, NY (56% female, 85% BIPOC, M_age=36.2 years) who reported thoughts of self-harm or thoughts of suicidal ideation in the past two weeks and/or had attempted suicide or engaged in self-harm in the past month. Participants responded to 4 EMA prompts per day over 10 days, with approximately 3 hours between each prompt. Surveys assessed negative affect (e.g., “Right now how much do you feel afraid?”) and SITBs (e.g., “I thought about killing myself”, “I thought about hurting myself without meaning to kill myself”). We hypothesized that higher within-person levels of negative affect would predict greater SITB severity concurrently and prospectively (i.e., at the next EMA prompt). 

Using multilevel modeling we computed between- and within-person associations between negative affect and SITBs. At the between-person level, individuals who reported higher negative affect tended to experience higher SITBs over the study period (β = .53, p < .001). At the within-person level, when the negative affect was higher than usual, concurrent SI was also higher than usual (β = .31, p < .001). In lagged analyses, negative affect was prospectively associated with SI (β = .11, p < .001) on a within-person basis. 

Our primary findings suggest that daily fluctuations in negative affect have a significant effect on contemporaneous and near-term SITB risk. The between-person results indicate that higher levels of reported negative affect are associated with an increase in incidences of SITBs. Specifically, when people experienced higher-than-usual negative affect, they not only reported increases in SITBs at the same time point but they continued to report increases in SITBs up three hours later. This finding points to negative affect as a potentially useful treatment target in the intervention and prevention of SITBs. In particular, these results inform the application of phone coaching for immediate crisis intervention, like as offered in dialectical behavioral therapy (DBT), in BIPOC communities.