Background: Lifestyle is a key determinant of physical and mental health. Addressing and modifying unhealthy behaviors early in life, such as inadequate sleep, physical inactivity and poor diet, may prevent serious long-term consequences on physical and mental health. However, limited research has explored the dynamic interrelationships between mood states and multiple lifestyle behaviors in adolescents. The aims of this study are to (1) identify various profiles of mood states and lifestyle behaviors (i.e., sleep, physical activity, and eating habits) among adolescents using ambulatory assessments; and (2) examine associations between these profiles and internalized symptoms.
Methods: We recruited a total of 109 participants (56.9% females) aged 14-17 years from a community setting. Participants underwent three 21-day monitoring periods, during which they wore actigraphy devices on their wrists and completed Ecological Momentary Assessment (EMA) surveys. EMA prompts were administered four times daily, capturing data on environmental context, sleep quality, physical activity, eating habits, and current mood states. Internalized symptoms were assessed at baseline using the Child Behavior Checklist – Youth Self-Report.
Results: We will employ latent profile analysis to identify different lifestyle profiles among adolescents, shedding light on their daily routines. We will then test the associations between these profiles and internalized symptoms among adolescents using generalized estimating equation (GEE).
Conclusions: The findings of this study will allow identifying specific physical and mental health targets for future early detection and prevention strategies, in particular for adolescents experiencing internalized symptoms. Moreover, the use of mobile technologies opens new opportunities for the implementation of real-time, ecological momentary interventions or just-in-time adaptive intervention to promote health lifestyles among youths.

Introduction: There is increasing evidence on the transdiagnostic symptom of irritability as a predictor of suicidal thoughts and behaviors. However, little is known on irritability as a proximal indicator, occurring immediately before adolescents engage in suicidal behaviors. Ecological momentary assessment (EMA) has the potential to examine temporal changes of affective states, in a non-laboratory setting and unbiased by retrospective recall. Thereby, it might in the future improve short-term prediction of suicidal behavior. The present study seeks to investigate whether momentary irritability is associated with suicidal thoughts and self-harm in adolescent in-patients.
Method: Intensive EMA on irritability and suicidal thoughts as well as self-injury were collected from n = 49 adolescent in-patients. Patients were prompted hourly, twelve times a day for five consecutive weekdays. Logistic multilevel and mixed linear regression were used to examine associations between momentary irritability and suicidal thoughts, the intensity of suicidal thoughts, self-harm as well as the urge to self-harm. Lagged models examined whether irritability from one sampling was able to predict suicidal thoughts and behaviors in the next sampling.
Results: In total, n = 2066 EMA samplings were obtained, with an average of 4.3 (SD = 1.1) days of participation and 42.2 (SD = 17.6, range 3 - 60) prompts answered. Overall, higher irritability was associated with higher odds for self-harm (OR = 1.02 [95%CI = 1.00, 1.03], p < .001; urge to self-harm: b = 0.18 [0.15, 0.21], p < .001) and suicidal thoughts (OR = 1.03 [95%CI = .03, 1.04], p < .001; intensity of suicidal thoughts: b = 0.17 [0.14, 0.21], p < .001). Higher irritability further predicted the presence of suicidal thoughts at the next sampling, i.e. one hour later (OR = 1.02 [1.01, 1.02], p < .001), as well as two, three and four hours, but not five hours later (OR = 1.0 [0.99, 1.01], p = .48). Similarly, higher irritability predicted self-harm one and two, but not three hours later.
Conclusion: Self-reported states of momentary irritability were associated with the presence and intensity of suicidal thoughts and self-harm. However, across models, effect sizes were small. While self-reported momentary irritability may have some potential as a proximal indicator of suicidal thoughts and self-harm in adolescent patients, this research needs replication and will benefit from further refinement of irritability EMA.

Background: Affective and interpersonal instability are suggested to underlie adolescent non-suicidal self-injury (NSSI) and borderline personality disorder. However, previous research has not directly compared adolescents with NSSI to those with other psychiatric conditions and therefore it is unknown whether and to what extent affective and interpersonal instability are specific to adolescent NSSI.
Methods: Based on a clinical sample of 70 adolescents (56 female and 14 male), we compared a group with NSSI (n = 50) with a clinical comparison group diagnosed with major depression and no engagement in NSSI (n = 20). We used high-frequency ecological momentary assessments (EMA) of affect and interpersonal attachment over four days. Mean affect and mean attachment as well as the root mean squares of successive differences (RMSSD) indicating instability of affect and attachment were calculated. The groups were compared using regression modeling.
Results: Adolescents with NSSI reported less positive affect and poorer attachment to their mothers and best friends than those with depression. Moreover, models adjusting for gender and mean affect and attachment, respectively, revealed that the NSSI group experienced more affective instability (b = 6.26, 95% CI = 0.79—11.73, p = 0.025). The two groups experienced similar average levels of attachment instability.
Conclusions: Affective instability is especially high among adolescents with NSSI. When co-occurring with other disorders, NSSI may serve as an identifier of a patient’s particularly strong need for treatment aiming at affect stabilization.

Einleitung:
Die ‘affective pathways to psychosis’-Hypothese besagt, dass eine erhöhte emotionale Reaktivität auf situative Stressoren im Alltag ein Vulnerabilitätsfaktor für die Entwicklung von psychotischen Störungen darstellt. Basierend auf dieser Hypothese wurde in der vorliegenden Studie an einer klinischen Hochrisiko-Stichprobe für Psychosen (engl. Clinical High Risk; CHR) untersucht, ob (i) situativer Stress zu einem Anstieg der CHR-Symptome führt, oder umgekehrt (ii) CHR-Symptome zu einem Anstieg im situativen Stresserleben führen, und (iii) ob die Art der CHR-Symptome (z. B. perzeptiv vs. non-perzeptiv) diese Zusammenhänge moderiert.

Methodik:
Mithilfe von Ecological Momentary Assessment (EMA) via Smartphone wurde eine Stichprobe (N = 80; Alter: 11-36; 50% weiblich) aus dem Früherkennungs- und Therapiezentrum für Psychosen während sieben Tagen acht Mal pro Tag befragt (Items zu Stress, Basissymptomen und attenuierten psychotischen Symptomen). Die Zeitreihendaten wurden mithilfe von Residual Dynamic Structural Equation Modeling (R-DSEM) im Sinne eines Cross-Lagged-Panel-Designs untersucht.

Ergebnisse:
Es fand sich kein Einfluss von situativem Stress auf zukünftige CHR-Symptome. Hingegen fanden wir einen schwachen Effekt von CHR-Symptomen auf das zukünftige Stresserleben. Besonders ausgeprägt war der zeitgleiche Effekt der CHR-Symptome auf das momentane Stresserleben. Dieser Zusammenhang fiel für nicht-perzeptive CHR-Symptome (z. B. Wahngedanken, kognitive Basissymptome) stärker aus als für perzeptive (z. B. akustische Halluzinationen).


Fazit und Ausblick:
Die Hypothese, dass Stresserleben zu einer Zunahme psychotischer Symptome im Alltag beiträgt, konnte in der vorliegenden Studie nicht bestätigt werden. Hingegen wurden Hinweise darauf gefunden, dass psychotische Symptome, insbesondere non-perzeptive, das momentane und zukünftige Stresserleben verstärken. Inwiefern Kontextfaktoren (z. B. soziale Kontakte) diese Zusammenhänge beeinflussen, könnte das Ziel weiterer Forschung sein.

Background: In the last decade, Ecological Momentary Assessment (EMA) has experienced exponential growth in clinical research, notably within child and adolescent psychiatry. It has become the preferred source of data for cutting-edge modeling of affect and symptom dynamics. However, the requirement for participants to complete smartphone questionnaires multiple times daily for extended periods introduces significant challenges. These include unavoidable missing data and dropout rates, critically undermining the validity of research findings, if, for instance, clinically relevant information is selectively omitted from EMA studies.

Motivation: This meta-analysis update extends previous work to explore how design and participant characteristics influence response compliance, retention, and willingness to participate in studies.

Methods: We reviewed literature from 2002 onwards, focusing on empirical studies that collected EMA data via mobile devices from children and adolescents. Our comprehensive data extraction process examined sample characteristics, clinical features, study design, incentivization strategies, and assessment targets, as well as rates of response compliance participant retention and acceptance to participation.

Results: The present meta-analytic update included 251 studies with effect sizes, marking a sixfold increase since the initial review from 2017. Despite robust but small effects of study length on participant retention (b = -.002; SE = < .001, 95%CI = [-.003; -.001], p < .001), most of the tested sample and design characteristics did not explain the substantial heterogeneity in effect sizes across studies.

Discussion: This extensive meta-analysis adds to the growing body of evidence that missing data in EMA studies involving youth stems from more complex factors than previously recognized. To address the continuous challenge of self-selection bias and the exclusion of clinically significant information, a concerted effort is required. This effort should focus on enhancing transparency in reporting, expanding primary methodological research, and incorporating direct feedback from participants.