What triggers suicidal ideation in daily life? A real-time study among young people with mood disorders at risk of suicide.

Suicidal ideation (SI) is a dynamic phenomenon influenced by environmental, interpersonal, and emotional factors. However, its short-term predictors in daily life remain poorly understood. This study aimed to identify factors associated with SI in daily life among young people with mood disorders at risk of suicide, using ecological momentary assessment (EMA) to capture contextual data in real time. Over 14 days, 112 young people (75 % female, aged 12-24) who were diagnosed with mood disorders completed EMA surveys three times daily. Multilevel logistic regression models assessed concurrent, time-lagged, and adjusted associations between SI and environmental, interpersonal, and emotional factors. SI was most reported when participants were at home (61.0 %) or not alone (56.3 %). Key factors associated with increased SI risk included being with family (vs. alone) (OR = 1.54, 95 %CI: 1.01-2.34), experiencing family-related life events, such as conflicts (OR = 3.13, 95 %CI: 1.10-8.90). Other emotional factors linked to SI included perceived burdensomeness (OR = 1.37, 95 %CI: 1.14-1.64), thwarted belongingness (OR = 1.29, 95 %CI: 1.10-1.53), and sadness (OR = 1.93, 95 %CI: 1.56-2.40). In contrast, happiness was associated with a lower risk of SI (OR = 0.71, 95 %CI: 0.57-0.89). Sadness also predicted subsequent SI (OR = 1.54, 95 %CI: 1.26-1.90) and was a significant predictor of changes in SI, even after accounting for prior SI (OR = 1.32, 95 %CI: 1.06-1.65). These findings underscore the importance of real-time emotional and interpersonal contexts, particularly family conflict and negative affect, in the emergence and persistence of SI in daily life.