Symptoms of a feather flock together; Dynamic time warp analysis of 11 single case time series of suicide ideation and related symptoms

There is a notable diversity in how suicidality manifests and evolves across individuals, highlighting the need for a deeper comprehension of the fluctuating nature of suicidal ideation and other symptoms. Through ecological momentary assessment (EMA) data from 11 depressed psychiatric outpatients with suicide ideation collected over a period of months, the research explores the temporal clustering of psychological symptoms related to suicidal ideation using Dynamic Time Warp (DTW) analysis. Results reveal significant inter-individual variability in symptom severity and clustering, with certain symptoms often clustering over time, notably feeling sad, hopelessness, feeling stuck, and worrying. Directed network analyses shed light on the temporal order and influence of symptom changes, highlighting entrapment and worrying as a central drivers for suicide ideation co-varying with other symptoms within the network. Still, all patients showed unique networks. While for some patients entrapment directly influenced suicide ideation, the reverse relation was also found. Relatedly, within some patients, perceived burdensomeness played a pivotal role, whereas in others it was unconnected to other symptoms. The study underscores the individualized nature of symptom dynamics and challenges linear models of progression, advocating for personalized treatment strategies.