Examining associations between negative affect arousal dimensions and self-injurious thoughts: Findings from two real-time monitoring studies with psychiatrically acute adolescents.

Adolescence is a critical period for the onset of self-injurious thoughts and behaviors (SITBs). This study examined the proximal associations between negative affect (NA) arousal dimensions and self-injurious thoughts using ecological momentary assessment in two independent samples of psychiatrically acute adolescents. Several times a day for 28 days, adolescents reported high arousal NA (e.g., anger, agitation), low arousal NA (e.g., sadness, guilt), passive suicidal thought intensity, active suicidal thought intensity, and nonsuicidal self-injury (NSSI) thought intensity. Multilevel modeling revealed that both high and low arousal NA were associated with increased passive suicidal thought intensity, active suicidal thought intensity, and NSSI thought intensity in contemporaneous models across samples, with low arousal NA prospectively predicting greater passive and active suicidal thought intensity at subsequent within-day time points. Findings highlight the importance of distinguishing NA arousal dimensions to inform real-time prediction of self-injurious thoughts. Future research is needed in larger samples to examine between-person associations and to explore additional affect dynamic components of NA arousal dimensions to augment understanding of SITB risk in adolescents.