Eating Dysregulation as a Dynamic Marker of Passive Suicidal Ideation: A One-Year Longitudinal Ecological Momentary Assessment (EMA) Study

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Abstract
Eating dysregulation has been associated with suicide risk, but its short-term relationship with suicidal ideation remains unclear. Given its dynamic nature, appetite-related disturbances may be suitable for real-time monitoring using Ecological Momentary Assessment (EMA). This study examined the prospective association between daily eating dysregulation and passive suicidal ideation over 12 months. A prospective EMA study was conducted in 550 psychiatric outpatients with recent suicidal ideation or suicide attempts. Participants completed daily smartphone-based assessments through the MEmind app. Linear mixed-effects models evaluated between-person (mean levels) and within-person (daily fluctuations) associations between eating dysregulation and passive suicidal ideation, adjusting for age, sex, time, and missingness. A total of 81,023 EMA responses were analyzed. No significant linear changes over time were observed. Higher average eating dysregulation was associated with greater passive suicidal ideation (b = 10.11, p < .001). Within individuals, days with higher-than-usual eating dysregulation were also associated with increased passive suicidal ideation (b = 2.32, p < .05). The model explained 27% of the variance. Eating dysregulation is both a stable and dynamic correlate of passive suicidal ideation. Daily variations in eating behavior may serve as a real-time marker of suicide risk, highlighting the potential of EMA to support early detection and personalized prevention strategies.

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