Mobile Intervention for Suicidal Thoughts

Overseen By Angela C Kirby, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Psychosis, Mania, Alcohol use disorder, others

Stay on Your Current Meds You can continue your current medications while participating

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 4 weeks

50 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to test a mobile app called MIST, designed to help reduce suicidal thoughts in Veterans. The app targets specific negative beliefs that contribute to suicidal feelings. Participants will receive either the usual mental health treatments with MIST or without MIST to determine which is more effective. Veterans who have experienced suicidal thoughts (but not plans) in the last 30 days and use the Durham VA Health System might be suitable candidates. As an unphased trial, this study provides Veterans the opportunity to contribute to innovative mental health solutions.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on adding a mobile intervention to your existing treatment.

What prior data suggests that the Mobile Intervention for Suicidal Thoughts (MIST) is safe for Veterans with suicidal ideation?

Research has shown that mobile tools like the Mobile Intervention for Suicidal Thoughts (MIST) are generally safe and helpful. Several studies have found that mobile apps for suicide prevention can reduce suicidal thoughts. For example, one study showed that people who used a digital safety plan were less likely to return to the emergency room. Another study found that using a safety planning app helped lower suicidal thoughts by improving coping skills.

While the effectiveness of these apps can vary, no clear evidence indicates they cause harm. So far, they seem well-tolerated, with no major safety concerns reported. This suggests that MIST could be a safe option for managing suicidal thoughts. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Mobile Intervention for Suicidal Thoughts (MIST) because it offers a novel approach by using a mobile platform to provide support and intervention directly to individuals experiencing suicidal thoughts. Unlike traditional methods that rely on in-person therapy sessions, MIST can be accessed anytime and anywhere, increasing accessibility and immediacy of care. This mobile intervention aims to supplement existing treatments, like cognitive behavioral therapy and medication, by providing real-time, personalized support, potentially reducing the risk of suicide by offering help exactly when it's needed most.

What evidence suggests that the Mobile Intervention for Suicidal Thoughts (MIST) is effective for reducing suicidal ideation?

Research has shown that mobile apps can help with suicidal thoughts. In this trial, participants in one arm will receive the Mobile Intervention for Suicidal Thoughts (MIST) along with safety planning and treatment as usual. Some studies have found that digital tools, like MIST, can lower the chances of having these thoughts and attempting to act on them. For example, one study suggested a 30% drop in suicide attempts when using these tools. However, results can vary, and not all studies provide strong evidence of their effectiveness. Overall, mobile tools might offer a promising way to reduce harmful thoughts, but more research is needed to confirm their impact. ^{6 7 8 9 10}

Who Is on the Research Team?

Kirsten H Dillon, PhD

Principal Investigator

Durham VA Medical Center, Durham, NC

Are You a Good Fit for This Trial?

This trial is for veterans experiencing suicidal thoughts. It's designed to see if a mobile intervention can help change harmful belief systems related to suicide risk. Participants should be military personnel who are open to using their mobile device as part of the treatment.

Inclusion Criteria

Can read at least 6th grade level material, established by their demonstrated ability to read the consent form and answer basic questions about it

Veterans using the Durham VA Health Care System

Endorsing suicidal ideation without intent in the last 30 days, established via C-SSRS

Exclusion Criteria

Currently in a period of active psychosis or mania, established via the SCID-5

Endorsing suicidal intent, established via C-SSRS

Have used the MIST intervention before as part of another research study

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the MIST intervention along with treatment as usual and safety planning

4 weeks

Post-treatment visit (approximately one month after enrollment)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Study Completion

Final data collection and analysis for study outcomes

18 months

What Are the Treatments Tested in This Trial?

Interventions

• Mobile Intervention for Suicidal Thoughts (MIST)

Trial Overview The study tests a new mobile app called MIST, which aims to modify beliefs and reduce suicidal thoughts. It will be used alongside usual treatments and compared with safety planning alone, without the app.

How Is the Trial Designed?

Group I: Safety planning, treatment as usual, and MIST Experimental Treatment 3 Interventions

Participants will get a safety plan, treatment as usual, and the MIST intervention.

Group II: Safety planning and treatment as usual Active Control 2 Interventions

Participants will get a safety plan and treatment as usual.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

MYPLAN is a mobile application developed to help individuals at risk of suicide create personalized safety plans, making it more accessible than traditional paper versions.

Since its launch in 2013, MYPLAN has been positively received, with nearly 8,000 downloads in Denmark and Norway, indicating its potential utility in supporting at-risk individuals, especially among younger populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

MYPLAN - A Mobile Phone Application for Supporting People at Risk of Suicide. Skovgaard Larsen, JL., Frandsen, H., Erlangsen, A.[2022]

Out of 66 mobile apps reviewed for suicide prevention, 42 were specifically designed for individuals with suicidal thoughts, and 89% included at least one feature aimed at reducing suicide risk, indicating a strong focus on user engagement and safety.

The average usability score of these apps was 3.5 out of 5, suggesting that while many apps are engaging and usable, there is a need for more clinically evaluated options, especially for healthcare providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

User Engagement and Usability of Suicide Prevention Apps: Systematic Search in App Stores and Content Analysis. Wilks, CR., Chu, C., Sim, D., et al.[2021]

The mobile app developed as part of the SERO suicide prevention program aims to reduce suicides and suicide attempts by enhancing self-management for individuals at risk, incorporating strategies like safety planning and mood tracking.

The app's design was informed by collaboration among health professionals, individuals at risk, and their families, ensuring it addresses real needs and integrates essential suicide prevention strategies effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

SERO - A New Mobile App for Suicide Prevention. Meier, L., Gurtner, C., Nuessli, S., et al.[2022]

Digital interventions, such as apps, showed a reduction in suicidal ideation scores among 3,356 participants across 14 studies, suggesting they may be more effective than simply waiting for treatment.

However, there was no evidence that these interventions reduced self-harm or suicide attempts, and many studies had design biases, indicating that more research is needed to confirm their safety and effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of online and mobile telephone applications ('apps') for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis. Witt, K., Spittal, MJ., Carter, G., et al.[2022]

The Virtual Hope Box (VHB) app was found to be more regularly used and preferred by high-risk patients and their clinicians compared to a traditional hope box, indicating its potential effectiveness in helping patients cope with negative thoughts and stress.

Patients reported that the VHB was beneficial, easy to set up, and expressed a strong likelihood of continued use and recommendation to others, suggesting its practicality as a therapeutic tool.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Virtual Hope Box smartphone app as an accessory to therapy: proof-of-concept in a clinical sample of veterans. Bush, NE., Dobscha, SK., Crumpton, R., et al.[2022]

The WellPATH app, used during a 12-week psychotherapy intervention for middle-aged and older adults after suicide-related hospitalization, showed high feasibility and acceptability, with participants and therapists expressing satisfaction with the app.

Case studies indicated that using WellPATH helped patients reduce negative emotions and improve their ability to regulate emotions, suggesting potential benefits for suicide prevention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Emotion Regulation Tablet App for Middle-Aged and Older Adults at High Suicide Risk: Feasibility, Acceptability, and Two Case Studies. Kiosses, DN., Monkovic, J., Stern, A., et al.[2022]

The telehealth suicide safety planning intervention (SPI) was found to be highly acceptable and feasible among high-risk Veterans, with participants rating it positively on acceptability (M=17.50), appropriateness (M=17.25), and feasibility (M=18) on a scale of 1 to 20.

Participants reported enhanced suicidal disclosure and improved management of urges, indicating that the SPI effectively supported their mental health needs while also addressing barriers like privacy and technology issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Qualitative Study of Telehealth Delivery of Suicide-Specific Group Treatment "Project Life Force". Patel, SR., Sullivan, SR., Mitchell, EL., et al.[2023]

The Safety Planning Intervention (SPI) is effective in reducing suicidal ideation and behavior, as well as improving depression and treatment engagement among adults experiencing suicide-related distress, based on a systematic review of 26 studies.

The SPI is adaptable and can be delivered in various formats (in-person or online) and as a standalone or combined intervention, making it a flexible tool in suicide prevention practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. Ferguson, M., Rhodes, K., Loughhead, M., et al.[2022]

The study evaluated the feasibility of two mental health apps, BackUp and mEMA, for treating depressed outpatients with suicidal ideation, involving 17 participants over a 3-month period.

Both apps were found to be usable and acceptable, scoring above the thresholds for usability and satisfaction, but the study did not meet the criteria for sufficient uptake, indicating that further exploration is needed for integrating these apps into routine mental healthcare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The feasibility of using smartphone apps as treatment components for depressed suicidal outpatients. Nuij, C., van Ballegooijen, W., de Beurs, D., et al.[2023]

The pilot phase of the SmartCrisis 2.0 trial demonstrated that a smartphone-based safety plan for patients with recent suicidal behavior is feasible and well-accepted, with a participation rate of 77% and high satisfaction ratings (overall satisfaction score of 9.6 out of 10).

Patients found the safety plan useful (7.4/10) and easy to use (8.9/10), with common coping strategies including walking and exercise, indicating that the app could be a valuable tool in clinical practice for supporting mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Smartphone-based safety plan for suicidal crisis: The SmartCrisis 2.0 pilot study. Porras-Segovia, A., De Granda-Beltrán, AM., Gallardo, C., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12561950/

Effectiveness of Mobile Applications for Suicide Prevention Thus, the effectiveness of mobile applications in reducing suicidality remains inconclusive with previous findings showing inconsistent outcomes ...

2. bmcpsychiatry.biomedcentral.com bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1458-0

a systematic review and meta-analysis - BMC Psychiatry Online and mobile telephone applications ('apps') have the potential to improve the scalability of effective interventions for suicidal ideation and self-harm.

3. mental.jmir.org mental.jmir.org/2024/1/e55528/

Efficacy of BrighterSide, a Self-Guided App for Suicidal Ideation Results: Suicidal ideation reduced over time for all participants, but there was no significant interaction between group and time. Similar ...

4. tandfonline.com tandfonline.com/doi/full/10.1080/13811118.2023.2262540

Preliminary Effectiveness of a Therapist-Supported Digital ... Results also indicated an estimated 30.49% reduction (95%CI = 25.15%-35.13%) in suicide attempts and death by suicide across treatment. This ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S2589750019301992

Suicide prevention using self-guided digital interventions Self-guided digital interventions directly targeting suicidal ideation are effective immediately post-intervention. Indirect interventions were not significant.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9573577/

The Effectiveness of Mobile Apps for Monitoring and ... In terms of efficacy, several studies reported a statistically significant positive effect of the mobile app intervention on one or more suicide outcomes.

7. mental.jmir.org mental.jmir.org/2025/1/e70253

Impact of Digital Safety Plan Activation on Subsequent ... Results: At follow-up, participants who activated the digital safety plan showed a 50% lower likelihood of returning to the ED, when compared to ...

8. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0165178124000350

Digital safety plan effectiveness and use: Findings from a ... Among users of a self-guided safety planning app, increases in suicide-related coping uniquely predicted decreases in suicidal ideation. · App-related variables ...

9. mdpi.com mdpi.com/2076-328X/15/10/1345

Effectiveness of Mobile Applications for Suicide Prevention Mobile applications are increasingly used for suicide prevention; however, their effectiveness remains unclear. This meta-analysis evaluated the ...

10. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2829550

Using Smartphone GPS Data to Detect the Risk of ... This case series study examines whether an app installed on adolescents' personal smartphones could identify risk of next-week suicidal ...