Given the increasing prevalence of suicide risk among young adults, identifying proximal risk factors remains a key challenge. Traditional approaches focusing on distal predictors provide limited insight into short-term fluctuations in risk. The present study examined whether daily variations in sleep, physical activity, and physiological arousal, in interaction with positive and negative life events, were associated with short-term changes in suicide risk. A sample of 104 university students completed an 8-day ecological momentary assessment protocol with four daily prompts assessing suicide risk and affect. Sleep and physical activity were continuously monitored via wrist actigraphy, and heart rate was assessed using a wearable device. Linear mixed-effects models were used to examine within- and between-person associations between total sleep time, daytime acceleration, and heart rate and next-day suicide risk, as well as their interactions with daily positive and negative life events. Within-person decreases in total sleep time and increases in heart rate predicted higher next-day suicide risk. Within-person increases in daytime acceleration were also associated with higher next-day suicide risk, although this effect was weaker in robust sensitivity analyses and should be interpreted cautiously. Daily negative life events moderated the associations between both physical activity and heart rate and suicide risk, such that these relationships were stronger on days characterized by higher levels of negative events. In contrast, positive life events showed limited buffering effects. These findings suggest that suicide risk in university students is linked to day-to-day changes in sleep, physical activity, and physiological arousal, especially in the presence of daily stressors.
Proximal contributors to suicide risk in college students: A multidimensional ecological momentary assessment
Dell'Acqua C.
;Mastromatteo L. Y.;Degasperi G.;Cellini N.;Soliman L.;Scrimin S.;Messerotti Benvenuti S.
2026
Abstract
Given the increasing prevalence of suicide risk among young adults, identifying proximal risk factors remains a key challenge. Traditional approaches focusing on distal predictors provide limited insight into short-term fluctuations in risk. The present study examined whether daily variations in sleep, physical activity, and physiological arousal, in interaction with positive and negative life events, were associated with short-term changes in suicide risk. A sample of 104 university students completed an 8-day ecological momentary assessment protocol with four daily prompts assessing suicide risk and affect. Sleep and physical activity were continuously monitored via wrist actigraphy, and heart rate was assessed using a wearable device. Linear mixed-effects models were used to examine within- and between-person associations between total sleep time, daytime acceleration, and heart rate and next-day suicide risk, as well as their interactions with daily positive and negative life events. Within-person decreases in total sleep time and increases in heart rate predicted higher next-day suicide risk. Within-person increases in daytime acceleration were also associated with higher next-day suicide risk, although this effect was weaker in robust sensitivity analyses and should be interpreted cautiously. Daily negative life events moderated the associations between both physical activity and heart rate and suicide risk, such that these relationships were stronger on days characterized by higher levels of negative events. In contrast, positive life events showed limited buffering effects. These findings suggest that suicide risk in university students is linked to day-to-day changes in sleep, physical activity, and physiological arousal, especially in the presence of daily stressors.
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