(PS2-C59) Reasons for Participant Dropout in an Intensive Longitudinal Study of Suicidal Behaviors

Intensive longitudinal studies, including ecological momentary assessment (EMA) and passive data collection, involve participants answering surveys about their mood, behavior, and experiences in real time (often up to several times a day) and being monitored using phones and sensors in their natural setting over a prolonged period of time. EMA, specifically, addresses some of the limitations inherent to other self-report sampling techniques, such as clinician biases, limited ecological validity, and recall bias. Notably, studies of suicidal thoughts and behaviors (STBs) are enhanced by EMA, as suicidal thinking often fluctuates throughout the day and week (Kleiman & Nock, 2017).

However, even with all these benefits, there are still limitations that may promote study dropout or barriers to engagement. Participants have reported fatigue when answering repetitive EMA surveys or becoming frustrated with technology (Moitra, et al., 2017), and while EMA studies generally report high adherence and retention rates, longer protocols may have lower retention rates (Burke, et al., 2017). Therefore, intensive longitudinal studies may be introducing bias: it may be that findings are limited to only those who are able to continuously engage in this relatively high-burden research. In addition, many EMA studies that report retention rates typically do not report the reasons why participants have withdrawn (Kim et al., 2020), leaving a critical gap in our understanding of barriers to participation. As EMA studies become more common, it is important to investigate how we can make these studies more accessible and feasible to a larger population.

In the current study, we asked participants who withdrew from an ongoing intensive longitudinal study of STBs about their reasons for ending participation (N=52). Two raters (NNR and RGF) independently coded responses for relevant themes. In cases of discrepancy, final coding was achieved through consensus.

We identified 25 different reasons reported for study withdrawal. Overall, reasons sorted into those related to study-associated distress (n=14), disliking components of the study (n=21), situational barriers (n=21), and other reasons (n=9). The most cited reasons included being too busy to participate (n=18), the study being too involved and taking too much time and effort (n=8), participants being reminded of suicidal thoughts and other aspects of their clinical history (n=5), the study being “triggering” (n=5), and interference from psychiatric symptoms such as low motivation, depression, and anxiety (n=5). Most participants provided 1 reason for withdrawing, with a range from 1 to 5 reasons provided. Additional analyses will explore associations between participant gender identity, age, and racial identity with reasons for study withdrawal. Overall, we identified several themes for barriers to continued participation in intensive longitudinal research, all of which provide insight and direction to refine research design to promote participant engagement.