JMIR Publications

ABSTRACT

Background:

Suicide ideation (SI) is a dynamic, high-risk state that can escalate rapidly, especially in clinical populations. According to the Integrated Motivational-Volitional Model (IMVM), entrapment is a central driver of SI. However, empirical evidence from real-time assessments remains limited, and prior research often treats entrapment as a unidimensional construct. Moreover, little is known about the temporal dynamics of internal entrapment (IE) and external entrapment (EE) in relation to SI across very short time intervals.

Objective:

To examine the short-term, real-time associations between internal and external entrapment and suicidal ideation using high-frequency ecological momentary assessment in a clinical outpatient sample

Methods:

An Ecological Momentary Assessment (EMA) study in a clinical sample of 91 outpatients (63.6% female, Mage = 31.6; SDage = 10.64) initiating psychotherapy was conducted. Participants rated their momentary levels of SI, IE, and EE up to 10 times per day for seven consecutive days, yielding 5,414 valid assessments. Multilevel modeling was used to investigate both cross-sectional and lagged associations between entrapment and SI. Time intervals between prompts (ranging from 30 to 120 minutes) were examined as potential moderators of the entrapment–SI relationship.

Results:

Entrapment was significantly associated with SI both cross-sectionally and longitudinally. Differentiating between entrapment subtypes revealed that IE was a stronger and more immediate predictor of SI than EE, particularly at very short time lags (30–120 minutes). As the lag increased, the predictive power of IE diminished, and EE showed only delayed effects on SI. The strength of the entrapment–SI link was not moderated by the time interval between assessments.

Conclusions:

The findings support the IMVM’s emphasis on entrapment while underscoring the need to distinguish between IE and EE in both theory and intervention. The results suggest that IE may serve as a proximal trigger of suicide ideation, whereas EE appears to exert its effects more gradually. These patterns further align with theoretical models of acute suicide risk (e.g., Suicide Crisis Syndrome, Fluid Vulnerability Theory), which posit rapid within-person shifts in suicidal states. Differentiating IE and EE provides a more precise understanding of suicidal processes and may inform the development of real-time, personalized interventions such as just-in-time adaptive interventions (JITAIs) for suicide prevention.