{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T21:39:20Z","timestamp":1789767560628,"version":"4.0.1"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Suicidality poses a serious global health concern, particularly in the sexual and gender minority population. While various studies have focused on investigating chronic stressors, the precise prediction effect of daily experiences on suicide ideation remains uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To test the extent to which mood fluctuations and contextual stressful events experienced by sexual and gender minority individuals may predict later short- and long-term suicide ideation.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This diagnostic study collected twice-daily data on mood states and stressful events from sexual and gender minority individuals over 25 days throughout 3 waves of the Chinese Lunar New Year (before, during, and after), and follow-up surveys assessing suicidal ideation were conducted 1, 3, and 8 months later. Online recruitment advertisements were used to recruit young adults throughout China. Eligible participants were self-identified as sexual and gender minority individuals aged 18 to 29 years. Those who were diagnosed with psychotic disorders (eg, schizophrenia spectrum or schizotypal disorder) or prevented from objective factors (ie, not having a phone or having an irregular sleep rhythm) were excluded. Data were collected from January to October 2022.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n To predict short-term (1 month) and longer-term (3 and 8 months) suicidal ideation, the study tested several approaches by using machine learning including chronic stress baseline data (baseline approach), dynamic patterns of mood states and stressful events (ecological momentary assessment [EMA] approach), and a combination of baseline data and dynamic patterns (EMA plus baseline approach).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 103 sexual and gender minority individuals participated in the study (mean [SD] age, 24.2 [2.5] years; 72 [70%] female). Of these, 19 (18.4%; 95% CI, 10.9%-25.9%), 25 (24.8%; 95% CI, 16.4%-33.2%), 30 (29.4%; 95% CI, 20.6%-38.2%), and 32 (31.1%; 95% CI, 22.2%-40.0%) reported suicidal ideation at baseline, 1, 3, and 8 months follow-up, respectively. The EMA approach showed better performance than the baseline and baseline plus EMA approaches at 1-month follow-up (area under the receiver operating characteristic curve [AUC], 0.80; 95% CI, 0.78-0.81) and slightly better performance on the prediction of suicidal ideation at 3 and 8 months\u2019 follow-up. In addition, the best approach predicting suicidal ideation was obtained during Lunar New Year period at 1-month follow-up, which had a mean AUC of 0.77 (95% CI, 0.74-0.79) and better performance at 3 and 8 months\u2019 follow-up (AUC, 0.74; 95% CI, 0.72-0.76 and AUC, 0.72; 95% CI, 0.69-0.74, respectively).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The findings in this study emphasize the importance of contextual risk factors experienced by sexual and gender minority individuals at different stages. The use of machine learning may facilitate the identification of individuals who are at risk and aid in the development of personalized process-based early prevention programs to mitigate future suicide risk.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.33164","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T11:01:21Z","timestamp":1694430081000},"page":"e2333164","source":"Crossref","is-referenced-by-count":30,"title":["Ecological Momentary Assessment and Machine Learning for Predicting Suicidal Ideation Among Sexual and Gender Minority Individuals"],"prefix":"10.1001","volume":"6","author":[{"given":"Chang","family":"Lei","sequence":"first","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing, China"},{"name":"Institute for Healthy China, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diyang","family":"Qu","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing, China"},{"name":"Institute for Healthy China, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunxu","family":"Liu","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing, China"},{"name":"Institute for Healthy China, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runsen","family":"Chen","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing, China"},{"name":"Institute for Healthy China, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,9,11]]},"reference":[{"issue":"6","key":"zoi230958r1","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1177\/09637214211043918","article-title":"Transdiagnostic approaches to sexual-and gender-minority mental health.","volume":"30","author":"Eaton","year":"2021","journal-title":"Curr Dir Psychol"},{"issue":"4","key":"zoi230958r2","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1177\/0020872820940018","article-title":"The health and well-being of LGBTQ people in mainland China: the role of social work.","volume":"65","author":"Li","year":"2020","journal-title":"Int Soc Work"},{"issue":"2","key":"zoi230958r3","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1080\/19361653.2019.1565795","article-title":"Coming out in mainland China: a national survey of LGBTQ students.","volume":"16","author":"Wei","year":"2019","journal-title":"J LGBT Youth"},{"issue":"2","key":"zoi230958r4","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1080\/19359705.2019.1568946","article-title":"Multiple minority stress: the role of proximal and distal stress on mental health outcomes among lesbian, gay, and bisexual people of color.","volume":"23","author":"Ramirez","year":"2019","journal-title":"J Gay Lesbian Ment Health"},{"issue":"9","key":"zoi230958r5","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/archpsyc.59.9.801","article-title":"Familial pathways to early-onset suicide attempt: risk for suicidal behavior in offspring of mood-disordered suicide attempters.","volume":"59","author":"Brent","year":"2002","journal-title":"Arch Gen Psychiatry"},{"key":"zoi230958r6","doi-asserted-by":"publisher","first-page":"540","DOI":"10.3389\/fpsyt.2018.00540","article-title":"Suicide and youth: risk factors.","volume":"9","author":"Bilsen","year":"2018","journal-title":"Front Psychiatry"},{"issue":"6","key":"zoi230958r7","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1097\/PSY.0000000000000600","article-title":"Chronic physiologic effects of stress among lesbian, gay, and bisexual adults: results from the National Health and Nutrition Examination Survey.","volume":"80","author":"Mays","year":"2018","journal-title":"Psychosom Med"},{"issue":"2","key":"zoi230958r8","doi-asserted-by":"publisher","first-page":"71","DOI":"10.17505\/jpor.2022.24856","article-title":"Idiographic dynamics between suicide ideation and depression, anxiety and posttraumatic stress symptoms in persons living with HIV: a pilot study.","volume":"8","author":"Zhu","year":"2022","journal-title":"J Pers Oriented Res"},{"key":"zoi230958r9","doi-asserted-by":"publisher","DOI":"10.1016\/j.newideapsych.2019.100758","article-title":"Nonlinear change processes and the emergence of suicidal behavior: a conceptual model based on the fluid vulnerability theory of suicide.","volume":"57","author":"Bryan","year":"2020","journal-title":"New Ideas Psychol"},{"issue":"1","key":"zoi230958r10","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1108\/JCMARS-10-2021-0037","article-title":"Family identity construction: an interpretation of the Lunar New Year\u2019s Eve dinner consumption ritual.","volume":"5","author":"Xue","year":"2022","journal-title":"J Contemp Mark Sci"},{"key":"zoi230958r11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmqr.2022.100044","article-title":"How do sexual and gender minority people acquire the capability for suicide? voices from survivors of near-fatal suicide attempts.","volume":"2","author":"Clark","year":"2022","journal-title":"SSM Qual Res Health"},{"issue":"13","key":"zoi230958r12","doi-asserted-by":"publisher","first-page":"1758","DOI":"10.1080\/00918369.2017.1386025","article-title":"Attitudes toward homosexuality in China: exploring the effects of religion, modernizing factors, and traditional culture.","volume":"65","author":"Xie","year":"2018","journal-title":"J Homosex"},{"issue":"2","key":"zoi230958r13","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1080\/00918369.2011.540182","article-title":"Application and testing the reliability and validity of a modified version of Herek\u2019s attitudes toward lesbians and gay men scale in China.","volume":"58","author":"Yu","year":"2011","journal-title":"J Homosex"},{"issue":"1","key":"zoi230958r14","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1002\/da.v38.1","article-title":"Detecting suicidal thoughts: the power of ecological momentary assessment.","volume":"38","author":"Gratch","year":"2021","journal-title":"Depress Anxiety"},{"issue":"3","key":"zoi230958r15","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1177\/2167702617691560","article-title":"Predicting risk of suicide attempts over time through machine learning.","volume":"5","author":"Walsh","year":"2017","journal-title":"Clin Psychol Sci"},{"issue":"4","key":"zoi230958r16","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1027\/1015-5759.23.4.258","article-title":"Assessing mood in daily life.","volume":"23","author":"Wilhelm","year":"2007","journal-title":"Eur J Psychol Assess"},{"issue":"3","key":"zoi230958r17","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1002\/ijop.v55.3","article-title":"Factor analysis of the heterosexist harassment, rejection, and discrimination scale in lesbian, gay, bisexual, transgender, and queer people of colour.","volume":"55","author":"Smith","year":"2020","journal-title":"Int J Psychol"},{"issue":"9","key":"zoi230958r18","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure.","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"zoi230958r19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jad.2022.06.064","article-title":"Utilizing daily mood diaries and wearable sensor data to predict depression and suicidal ideation among medical interns.","volume":"313","author":"Horwitz","year":"2022","journal-title":"J Affect Disord"},{"key":"zoi230958r20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/S0033291722003014","article-title":"Using machine learning with intensive longitudinal data to predict depression and suicidal ideation among medical interns over time.","author":"Horwitz","year":"2022","journal-title":"Psychol Med"},{"issue":"9","key":"zoi230958r21","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1001\/jamapsychiatry.2022.1973","article-title":"Association of everyday discrimination with depressive symptoms and suicidal ideation during the COVID-19 pandemic in the All of Us research program.","volume":"79","author":"Lee","year":"2022","journal-title":"JAMA Psychiatry"},{"issue":"3","key":"zoi230958r22","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1037\/a0012532","article-title":"Affective instability: measuring a core feature of borderline personality disorder with ecological momentary assessment.","volume":"117","author":"Trull","year":"2008","journal-title":"J Abnorm Psychol"},{"issue":"7","key":"zoi230958r23","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1017\/S0033291721005006","article-title":"Predicting short-term suicidal thoughts in adolescents using machine learning: developing decision tools to identify daily level risk after hospitalization.","volume":"53","author":"Czyz","year":"2023","journal-title":"Psychol Med"},{"key":"zoi230958r24","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2575.1999.00060.x","article-title":"Lightgbm: a highly efficient gradient boosting decision tree.","volume":"30","author":"Ke","year":"2017","journal-title":"Adv Neural Inf Process Syst"},{"issue":"5","key":"zoi230958r26","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1017\/S0954579421000699","article-title":"Sleep problems predict next-day suicidal thinking among adolescents: a multimodal real-time monitoring study following discharge from acute psychiatric care.","volume":"33","author":"Glenn","year":"2021","journal-title":"Dev Psychopathol"},{"issue":"3","key":"zoi230958r27","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.0591","article-title":"A pilot study using frequent inpatient assessments of suicidal thinking to predict short-term postdischarge suicidal behavior.","volume":"4","author":"Wang","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"7","key":"zoi230958r28","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1007\/s11920-018-0914-y","article-title":"Smartphones, sensors, and machine learning to advance real-time prediction and interventions for suicide prevention: a review of current progress and next steps.","volume":"20","author":"Torous","year":"2018","journal-title":"Curr Psychiatry Rep"},{"issue":"1","key":"zoi230958r29","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1038\/s44184-022-00002-x","article-title":"Machine learning based suicide prediction and development of suicide vulnerability index for US counties.","volume":"1","author":"Kumar","year":"2022","journal-title":"NPJ Mental Health Res"},{"issue":"3","key":"zoi230958r30","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1002\/bsl.v37.3","article-title":"Suicide crisis syndrome: a review of supporting evidence for a new suicide-specific diagnosis.","volume":"37","author":"Schuck","year":"2019","journal-title":"Behav Sci Law"},{"issue":"6","key":"zoi230958r31","doi-asserted-by":"publisher","first-page":"2286","DOI":"10.1109\/JBHI.6221020","article-title":"Deep sequential models for suicidal ideation from multiple source data.","volume":"23","author":"Peis","year":"2019","journal-title":"IEEE J Biomed Health Inform"},{"key":"zoi230958r32","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2021.100424","article-title":"Predicting acute suicidal ideation on Instagram using ensemble machine learning models.","volume":"25","author":"Lekkas","year":"2021","journal-title":"Internet Interv"},{"issue":"1","key":"zoi230958r33","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1038\/s41746-020-0287-6","article-title":"A machine learning approach predicts future risk to suicidal ideation from social media data.","volume":"3","author":"Roy","year":"2020","journal-title":"NPJ Digit Med"},{"issue":"4","key":"zoi230958r34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-025762","article-title":"Does the \u2018Chinese New Year effect\u2019 exist? hospital mortality in patients admitted to internal medicine departments during official consecutive holidays: a nationwide population-based cohort study.","volume":"9","author":"Lin","year":"2019","journal-title":"BMJ Open"},{"key":"zoi230958r35","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.1016\/j.jad.2018.12.011","article-title":"Suicidal ideation and attempted suicide amongst Chinese transgender persons: national population study.","volume":"245","author":"Chen","year":"2019","journal-title":"J Affect Disord"},{"issue":"4","key":"zoi230958r36","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1111\/jomf.2009.71.issue-4","article-title":"Intergenerational experiences of discrimination in Chinese American families: influences of socialization and stress.","volume":"71","author":"Benner","year":"2009","journal-title":"J Marriage Fam"},{"issue":"5","key":"zoi230958r37","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1080\/00918369.2013.773815","article-title":"LGB identity among young Chinese: the influence of traditional culture.","volume":"60","author":"Hu","year":"2013","journal-title":"J Homosex"},{"issue":"9","key":"zoi230958r38","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1080\/00918369.2022.2042663","article-title":"Discourses of heteronormativity and power: the ethical position of Confucianism on same-sex behaviour in China.","volume":"70","author":"Whyke","year":"2023","journal-title":"J Homosex"},{"issue":"12","key":"zoi230958r39","first-page":"10","article-title":"The Christmas effect on psychopathology.","volume":"8","author":"Sansone","year":"2011","journal-title":"Innov Clin Neurosci"},{"key":"zoi230958r40","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2022.107007","article-title":"Latent profile analysis to identify subgroups of Chinese sexual minority adolescents at risk of suicidality.","volume":"157","author":"Wang","year":"2022","journal-title":"Prev Med"},{"key":"zoi230958r41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdeveco.2023.103055","article-title":"Family companionship and elderly suicide: evidence from the Chinese Lunar New Year.","volume":"162","author":"Fang","year":"2023","journal-title":"J Dev Econ"},{"issue":"1","key":"zoi230958r42","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1177\/0306422017703591","article-title":"Squeezed in the closet: get married and be quiet are the messages China\u2019s LGBT community is given.","volume":"46","author":"Leung","year":"2017","journal-title":"Index Censorsh"},{"key":"zoi230958r44","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.copsyc.2015.01.002","article-title":"Ecological momentary assessment (EMA) of depression-related phenomena.","volume":"4","author":"Armey","year":"2015","journal-title":"Curr Opin Psychol"},{"key":"zoi230958r45","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.actpsy.2018.02.007","article-title":"The effect of mood on integration of information in a multi-attribute decision task.","volume":"185","author":"Shevchenko","year":"2018","journal-title":"Acta Psychol (Amst)"},{"issue":"4","key":"zoi230958r46","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1504\/IJBHR.2011.043414","article-title":"Measuring bias in self-reported data.","volume":"2","author":"Rosenman","year":"2011","journal-title":"Int J Behav Healthc Res"},{"key":"zoi230958r25","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4614-6849-3","volume-title":"Applied Predictive Modeling","author":"Kuhn","year":"2013"},{"key":"zoi230958r43","first-page":"385","volume-title":"Social Psychology: Handbook of Basic Principles","author":"Schwarz","year":"2007"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2809148\/lei_2023_oi_230958_1693416385.93716.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T11:01:25Z","timestamp":1694430085000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2809148"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,11]]},"references-count":46,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9,5]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.33164","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,11]]}}}