From Repetition to Relevance: Initial development of a multidimensional computerized adaptive test for intensive longitudinal assessment of suicide risk

Intensive longitudinal designs support temporally granular study of social, behavioral, and psychological processes making methods like ecological momentary assessment (EMA) increasingly common. However, the repetitive and intensive measurement strategies associated with these designs increase participant burden which limits the breadth and precision of EMA surveys. This is particularly problematic for complex clinical phenomena, such as suicide risk, which research has shown is multidimensional and fluctuates over narrow time intervals (e.g., hours). To overcome this limitation, we proposed the computerized adaptive test for suicide risk pathways (CAT-SRP) which is the first multidimensional computerized adaptive test (MCAT) designed for intensive longitudinal data. The CAT-SRP leverages multidimensional item response theory to support the simultaneous assessment of multiple empirically informed risk domains and facilitate personalized survey content. Study 1 calibrates the CAT-SRP item bank using a large community sample (N = 1759, 36.33% with a history of suicidal ideation [SI]). Study 2 evaluates the performance, feasibility, and acceptability of the CAT-SRP in an EMA study of participants with a past month SI history (N = 29 across 2,134 observations). The calibration study suggested twelve risk domains and two SI domains (active and passive). Results from the EMA study suggested that the CAT-SRP 1) administered surveys with low to moderate item overlap, 2) incurred low participant burden, and 3) may improve near-term prediction of suicidal thoughts relative to traditional EMA measurement. Although additional work is needed, the CAT-SRP marks the first MCAT for EMA and represents a significant methodological advancement for ambulatory measurement.