Ecological Momentary Assessment of Social Approach and Avoidance Motivations in Serious Mental Illness: Connections to Suicidal Ideation and Symptoms

Abstract

Aim

People with serious mental illness (SMI) are at an increased risk for suicide. Social approach and avoidance motivations are linked to social functioning, and social isolation is a risk factor for suicide. This study uses ecological momentary assessment (EMA) to understand social approach and avoidance motivations in relation to symptoms and suicidal ideation (SI).

Methods

Participants (N = 128) diagnosed with schizophrenia, schizoaffective disorder, or a mood disorder with psychotic features completed assessments of SI and symptoms at baseline. They completed EMA surveys 3×/day for 10 days. EMA surveys included questions about approach and avoidance motivations and psychotic symptoms. Participants were split into four groups based on the median scores of approach and avoidance.

Results

Participants with SI at baseline had higher mean social avoidance motivation, t(126) = 2.84, p = .003, and lower mean social approach motivation, t(126) = −2.44, p = .008, than participants without baseline SI. Greater baseline positive symptoms were related to greater mean avoidance, r = .231, p = .009, but not approach motivation. The low approach/high avoidance group had significantly higher current SI than those with high approach/low avoidance (p < .001). Overall, the low approach/high avoidance group reported more EMA-measured voices than the low approach/low avoidance group (p < .001) and the high approach/low avoidance group (p < .001). Similarly, the low approach/high avoidance group reported more EMA-measured suspiciousness than the low approach/low avoidance (p < .001) and the high approach/low avoidance groups (p < .001).

Conclusion

The results of this study point to the role of social approach and avoidance motivations in relation to SI and psychotic symptoms. Clinically, exposure therapies and cognitive behavioral therapies may help to address these social approach and avoidance processes linked to SI.

Keywords:

• Avoidance
• ecological momentary assessment
• psychosis
• serious mental illness
• social approach motivation
• suicidal ideation

ACKNOWLEDGEMENTS

We would like to thank Katelyn Barone, Bianca Tercero, Cassi Springfield, Linlin Fan, Ian Kilpatrick, Snigdha Kamarsu, Tess Filip, Avery Quynh, Vanessa Scott, and Maxine Hernandez for their involvement in data collection and recruitment.

DISCLOSURE STATEMENT

R.C.M. is a co-founder of KeyWise AI, Inc. and a consultant for NeuroUX. The terms of this arrangement have been reviewed and approved by UC San Diego in accordance with its conflict of interest policies. P.D.H. has received consulting fees or travel reimbursements from Alkermes, Bio Excel, Boehringer Ingelheim, Karuna Pharma, Merck Pharma, Minerva Pharma, SK Pharma, and Sunovion (DSP) Pharma in the past year. He receives royalties from the Brief Assessment of Cognition in Schizophrenia (owned by WCG Verasci, Inc. and contained in the MATRICS Consensus Cognitive Battery). He is chief scientific officer of i-Function, Inc.

Additional information

Funding

This work was supported by the National Institute of Mental Health [grant number: NIMH R01 MH116902-01A1; and T32 MH019934 to E.M.P.].

Notes on contributors

Emma M. Parrish

Emma M. Parrish, MS, San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA.

Samantha Chalker

Samantha Chalker, PhD, University of California San Diego Department of Psychiatry, San Diego, California, USA; Veterans Affairs San Diego Healthcare System, San Diego, California, USA.

Mayra Cano

Mayra Cano, BS, University of California San Diego Department of Psychiatry, San Diego, California, USA; University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA.

Philip D. Harvey

Philip D. Harvey, PhD, University of Miami Miller School of Medicine, Miami, Florida, USA; Research Service Miami VA Medical Center, Miami, Florida, USA.

Charles T. Taylor

Charles T. Taylor, PhD, University of California San Diego Department of Psychiatry, San Diego, California, USA.

Amy Pinkham

Amy Pinkham, PhD, The University of Texas at Dallas, Richardson, TX, USA.

Raeanne C. Moore

Raeanne C. Moore, PhD, University of California San Diego Department of Psychiatry, San Diego, California, USA.

Robert A. Ackerman

Robert A. Ackerman, PhD, The University of Texas at Dallas, Richardson, TX, USA.

Colin A. Depp

Colin A. Depp, PhD, University of California San Diego Department of Psychiatry, San Diego, California, USA; Veterans Affairs San Diego Healthcare System, San Diego, California, USA.