Original Investigation 

Psychiatry

Passive vs Active Nighttime Smartphone Use as Markers of Next-Day Suicide Risk

Ross Jacobucci, Stephanie G. Jones, Miguel Blacutt, et al

JAMA Netw Open 2025;8;(11):e2542675. doi:10.1001/jamanetworkopen.2025.42675

Key Points

Question  Are the timing and type (passive vs active) of nighttime smartphone use associated with next-day suicidal ideation and suicide planning in high-risk adults?

Findings  In this study combining surveys and passive data collection in 79 adults with recent suicidal thoughts, late-night phone use (11:00 pm to 1:00 am) was associated with higher next-day suicide risk, while keyboard-based activity during middle-night hours (1:00 to 5:00 am) was associated with lower risk.

Meaning  These findings suggest that specific usage patterns of nighttime smartphone use may be a more important focus for future suicide prevention interventions than total screen time.

Abstract

Importance  Nighttime represents a high-risk period for suicidal thoughts, yet current understanding of how digital technology use during these hours influences suicide risk remains limited. Distinguishing between passive consumption and active engagement may inform the future development of targeted suicide intervention efforts.

Objective  To examine whether the timing and type (passive vs active) of nighttime smartphone use are associated with next-day suicidal ideation and suicide planning in adults at a high risk of suicide.

Design, Setting, and Participants  This survey and passive data sensing study used ecological momentary assessment (EMA) and smartphone screenshots collected every 5 seconds during active phone use over 28 days per participant. Data were collected from August 24, 2022, to January 9, 2024. The community-based sample included adults aged 18 years or older with past-month suicidal thoughts or behaviors from South Bend, Indiana, and the surrounding area. Inclusion criteria were smartphone ownership and variability in key variables across the 28-day period.

Exposure  Timing and type of nighttime smartphone use were assessed in 3 ways: (1) maximum phone-free interval (8:00 pm to 10:00 am), (2) use during self-reported sleep windows, and (3) hourly use (11:00 pm to 8:00 am). Keyboard presence, detected via a deep learning model trained on 1000 manually annotated screenshots, served as a proxy for active engagement.

Main Outcomes and Measures  The primary outcomes were next-day passive suicidal ideation, active suicidal ideation, and suicide planning assessed via EMA (6 prompts daily). Bayesian multilevel models tested within-person and between-person associations.

Results  The study enrolled 79 participants (mean [SD] age, 35.2 [11.1] years; 54 female [68.3%]). The overall EMA compliance rate was 68.8%, and participants generated 7.5 million screenshots (of which 1.05 million [14.0%] showed keyboard presence). Late-night (11:00 pm to 1:00 am) phone use was consistently associated with higher next-day passive or active suicidal ideation and suicide planning. Participants with 7- to 9-hour phone-free gaps showed the lowest suicidal ideation compared with those with 4- to 7-hour phone gaps (B = 0.35; 95% credible interval [CrI], 0.14-0.55). Keyboard activity was associated with lower suicidal ideation when occurring during middle-night hours (1:00 to 5:00 am) (simple slope, −0.10; 95% CrI, −0.13 to −0.07), self-reported sleep windows for both passive (B = −0.14; 95% CrI, −0.24 to −0.02) and active (B = −0.13; 95% CrI, −0.24 to −0.02) suicidal ideation, and nonsleep periods for both passive (B = −0.16; 95% CrI, −0.29 to −0.03) and active (B = −0.12; 95% CrI = −0.24 to −0.001) suicidal ideation. These timing-dependent, within-person associations were independent of total usage.

Conclusions and Relevance  This study found temporally specific associations between nighttime smartphone use and next-day suicidal ideation and suicide planning. Late-night use signaled vulnerability, while middle-night active engagement seemed protective. These findings differentiate harmful passive consumption from potentially adaptive digital coping, potentially serving to advance precision approaches to suicide prevention.