Feasibility and Acceptability of using Ecological Momentary Assessment Among Youth with recent Suicidal attempt in Lusaka, Zambia
This study demonstrates that smartphone-based Ecological Momentary Assessment is a feasible and acceptable method for monitoring suicidal ideation among youth in Lusaka, Zambia, despite challenges like intermittent connectivity, while also revealing potential therapeutic benefits for participants.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Suicide is a leading cause of death for young people worldwide, but understanding why it happens is notoriously difficult. Traditional methods of studying this crisis rely on asking people to look back at their past weeks or months, trying to remember exactly how they felt or what triggered a dark thought. Human memory is imperfect, and feelings of despair often shift rapidly, sometimes within hours. To capture these fleeting moments, researchers have developed a method called ecological momentary assessment. Instead of looking back, this approach asks people to report their thoughts and feelings in real time, right as they are happening, using the smartphones they carry every day. This technique offers a clearer, more immediate picture of a person's mental state, but it has mostly been tested in wealthy nations with reliable internet and stable power supplies. It remains an open question whether this high-tech approach can work in places where resources are scarce and daily life is more unpredictable.
In a new study conducted in Lusaka, Zambia, researchers set out to see if this real-time monitoring could work for young people who had recently survived a suicide attempt. The team recruited twenty-one participants, aged seventeen to twenty-five, from public hospitals in the city. These were individuals who had received emergency care after trying to end their own lives. The researchers asked these young people to use a specific smartphone application for two weeks. Twice a day, once in the morning and once in the evening, the app would send a notification prompting the participant to answer a few questions about their current mood, their surroundings, and any thoughts of self-harm. The study was designed to test two main things: whether the participants could stick with the plan despite technical or personal hurdles, and whether they found the process acceptable and not too burdensome.
The results showed that the method was both possible and well-received. Of the twenty-eight people who met the initial requirements, twenty-one agreed to join the study, and twenty of them completed at least one part of the daily check-ins. Over the fourteen-day period, the team sent out five hundred and sixty prompts in total. The participants answered three hundred and eight of them, meaning they completed just over half of the requests. While this might sound like a missed opportunity, the researchers considered this level of participation to be moderate and comparable to what is seen in wealthier countries. The young people generally found the app easy to use and the questions easy to answer. They reported that the process felt manageable within their daily lives, even when they faced challenges like intermittent internet connections or difficulties keeping their phones charged.
Beyond the numbers, the study revealed something unexpected about how the participants experienced the process. Many of the young people described the daily check-ins not as a chore or an interrogation, but as a supportive interaction. Several participants noted that answering the questions made them feel like someone was talking to them, which provided comfort. Some said that the act of stopping to answer the prompts helped them analyze their own emotions and realize how they were truly feeling. One participant shared that the experience encouraged them to persevere through difficult moments and even stated that it helped them decide never to attempt suicide again. This suggests that for some, the tool did more than just collect data; it offered a moment of reflection and validation that felt therapeutic.
The researchers also had to be prepared for moments of acute danger. The app included a safety protocol that would trigger an alert if a participant indicated they had a serious plan to harm themselves. During the two weeks, this safety system was activated forty-two times. The research team responded to every single alert, making phone calls to check in on the participants. While some calls went unanswered, many led to immediate counseling or referrals to mental health services. This rapid response capability highlighted a crucial advantage of real-time monitoring: it allows for intervention at the exact moment risk is highest, rather than waiting for a scheduled appointment weeks later.
Despite the success, the study was not without its hurdles. Some participants struggled with the instructions, occasionally answering questions about their general feelings rather than their feelings at that specific moment. Others faced practical barriers, such as network breakdowns that prevented them from submitting their answers on time. The researchers noted that the study only included people who already owned a smartphone, which means the findings might not apply to the most vulnerable youth who lack access to technology. Nevertheless, the study demonstrated that with the right support, such as providing mobile data and clear guidance, real-time monitoring is feasible even in a resource-limited setting.
The findings suggest that using smartphones to track suicide risk in real time is a viable strategy for young people in low-resource environments. It is not a perfect solution, as compliance was not perfect and technical issues arose, but it proved that the approach is workable and acceptable to the people it aims to help. The study indicates that this method can bridge the gap between a hospital visit and the next clinical check-in, offering a way to monitor risk continuously. By capturing the rapid shifts in mood and thought that happen between doctor visits, this tool could help clinicians and families respond more quickly to danger. The research team concluded that while more work is needed to refine the process and reach those without phones, the potential to save lives through immediate, real-time awareness is a significant step forward for mental health care in regions where such resources are often missing.
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