Momentary emotion-related distress, negative emotions, and suicidal ideation: Findings from an RCT among adults in inpatient psychiatric care

J Affect Disord. 2026 Mar 13:121628. doi: 10.1016/j.jad.2026.121628. Online ahead of print.

ABSTRACT

OBJECTIVE: Examine the moderating role of distress about emotions (i.e., emotion-related distress) in the relationship between specific negative emotions and suicidal ideation (SI) among adults hospitalized for psychiatric reasons in an RCT of a brief cognitive-behavioral therapy (CBT)-based intervention. Specifically, we investigate how randomization to the study intervention versus control condition impacts these relationships.

METHOD: Participants (N = 64) were recruited from psychiatric inpatient units at two hospitals as part of a larger RCT. Participants in the treatment group completed three 1:1 structured therapy sessions focused on CBT skills for managing emotions and a 28-day ecological momentary assessment/intervention (EMA/EMI) protocol facilitating skills practice after discharge. Participants in the control condition completed post-discharge EMA only. Both groups received treatment as usual. Multi-level modeling examined the relationships between each emotion assessed via EMA (i.e., anxious, sad, overall negative emotion) with SI, moderated by emotion-related distress and study condition.

RESULTS: The three-way interactions between study condition, emotion-related distress, and emotion predicting contemporaneous SI were significant (anxiety: b = 0.05 [95% CI = 0.02-0.09], p = .006; sadness: b = 0.05 [95% CI = 0.02-0.09], p = .006; negative affect: b = 0.05 [95% CI = 0.02-0.09], p = .006). Among intervention condition participants, emotion-related distress was a significant moderator between each emotion and SI, with stronger associations at higher levels of emotion-related distress, compared to average and low levels of emotion-related distress.

DISCUSSION: Emotion-related distress moderated associations between negative emotions and SI in an intervention-specific manner, suggesting CBT-based EMI may target proximal risk processes for SI among individuals with high emotion-related distress.

PMID:41833615 | DOI:10.1016/j.jad.2026.121628