Short, frequent mental health prompts sent directly to patients' cellphones may offer a more accurate picture into their risk for suicide, according to a newly published study from Penn.

For roughly one month, 62 veterans and active-duty military personnel who were all considered at-risk for suicide were sent four check-ins every other day to evaluate their mental health. Researchers found that the spikes reported between therapy sessions gave medical providers valuable information about patients' well-being.

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Lily Brown, director of the Center for the Treatment and Study of Anxiety at Penn’s Perelman School of Medicine, led the research team’s evaluation of Ecological Momentary Assessment, which is meant to collect real-time information from patients about their thoughts and emotions. The paper is going to be published in the November 2026 edition of the Journal of Affective Disorders.

EMA often uses smartphone notifications to prompt its users to describe their current mental state, rather than asking them to recall their general well-being as is standard in regular therapy sessions.

Participants were recruited from Marine Corps Base Camp Lejeune in North Carolina. They were considered at risk of suicidal ideation and attended regular therapy sessions. Every other day, they received four messages at random times between 8 a.m. and 9 p.m. that asked them to evaluate suicidal urges.

Among the whole sample, 54 of the 62 participants had reported a non-zero suicidal urge via smartphone during the study period. Researchers said these fluctuations taking place throughout the day are often not accurately reflected in regular therapy sessions that rely on patients’ imperfect memory.

“A patient who experiences consistently moderate suicidal ideation between sessions and another patient who experiences minimal ideation for most days but had an intense spike may provide similar ratings at the session, despite markedly different risk trajectories,” the study said.

Over the course of the research period, patients' peak levels of suicidal urges in between regular therapy sessions were shown to be an even stronger predictor of future suicidal thoughts than their average level of stress.

Researchers concluded that EMA prompts, when disseminated frequently enough, could provide key insight for clinicians looking to predict future suicide risks for their patients.

While the method has shown promise, safety and liability concerns prevent the practice from becoming more mainstream, Brown said.

“Clinicians are overwhelmed and understandably concerned about changing their practice in ways that they perceive could increase liability —like assessing suicide risk between sessions, when they might not be available to respond to an emergency,” she said in a statement to Penn's Leonard Davis Institute of Health Economics.

Researchers said the study is also limited by its relatively small sample size and suggest that future studies expand the research methods to a wider population.