Tech-Based Interventions for Suicide Risk in Adolescents

Recruiting at 1 trial location

Overseen By Ewa Czyz

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Michigan

Disqualifiers: Severe cognitive impairment, Acute psychosis, Acute manic state, others

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

Compensation: Varies

Number of Visits: Unknown

300 Participants Needed

Trial Summary

What is the purpose of this trial?

This study is being completed to examine different combinations of technology-augmented strategies to identify an effective Adaptive intervention (AI) addressing post-discharge suicide risk with high implementation potential.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Tech-Based Interventions for Suicide Risk in Adolescents?

Research shows that smartphone-based safety plans and apps are well-received by patients, with high satisfaction and usability ratings. These tech-based interventions, like the SmartCrisis 2.0 app, have been found feasible and acceptable for managing suicidal behavior, suggesting they could be effective in supporting adolescents at risk. ^{1 2 3 4 5}

Is tech-based intervention for suicide risk in adolescents safe?

Research shows that tech-based interventions, like smartphone apps for safety planning, are generally safe and well-accepted by users. Studies indicate high satisfaction and feasibility, suggesting these interventions can be safely used to support adolescents at risk of suicide. ^{2 4 5 6 7}

How is the MI-Safety Plan treatment different from other treatments for adolescent suicide risk?

The MI-Safety Plan treatment is unique because it incorporates technology to enhance engagement and support for adolescents at risk of suicide, potentially using apps or other digital tools to supplement traditional in-person interventions. This approach aims to make safety planning more accessible and effective, especially for underserved groups, by integrating technology into the intervention process. ^{2 8 9 10 11}

Research Team

Ewa Czyz, PhD

Principal Investigator

University of Michigan

Eligibility Criteria

This trial is for adolescents recently in psychiatric care due to a suicide attempt or having suicidal thoughts within the last week. They must be able to provide consent through a legal guardian, own a cell phone, and not have severe cognitive impairments or require transfer to medical care.

Inclusion Criteria

A suicide attempt in the last month or past-week suicidal ideation based on the Columbia-Suicide Severity Rating Scale (C-SSRS). In the absence of C-SSRS ratings in the chart, attending physician indication in the chart of the presence of suicidal ideation within the last week or the presence of a suicide attempt in the last month will be used.

Exclusion Criteria

I do not have a legal guardian.

I am a teenager and I do not own a cell phone.

I am a teenager with severe cognitive issues or experiencing a severe mental health crisis.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment Phase 1

Participants receive MI-enhanced safety planning (MI-SP) during hospitalization, followed by 4 weeks of supportive texts and monitoring post-discharge

4 weeks

In-person during hospitalization, daily virtual monitoring

Treatment Phase 2

Non-responders are re-randomized to either portal follow-up or booster call

2 weeks

Virtual follow-up

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

Regular virtual check-ins

Treatment Details

Interventions

• Booster call
• MI- Safety Plan
• Monitoring
• Portal follow-up
• Texts messages

Trial Overview The study tests various tech-augmented strategies like portal follow-ups, safety planning with motivational interviewing (MI), booster calls, monitoring, and text messages. It aims to find an effective post-discharge plan that reduces suicide risk.

Participant Groups

Group I: MI-SP +supportive Texts + monitoring (Sequence A) Experimental Treatment 3 Interventions

Sequencing of intervention components (Phase 1 and Phase 2) resulting in Sequence or Group A: Participants will receive the in-person MI-enhanced safety plan (MI-SP) during hospitalization followed by 4 weeks of supportive Texts and monitoring post discharge.

Group II: MI-SP + supportive Texts + monitoring + portal follow-up for non-responders (Sequence B). Experimental Treatment 4 Interventions

Sequencing of intervention components (Phase 1 and Phase 2) resulting in Sequence or Group B: Participants will receive the in-person MI-enhanced safety plan (MI-SP) during hospitalization followed by 4 weeks of supportive Texts and monitoring post discharge in addition to the portal follow-up for non-responders.

Group III: MI-SP + supportive Texts + monitoring + booster call for non-responders (Sequence C) Experimental Treatment 4 Interventions

Sequencing of intervention components (Phase 1 and Phase 2) resulting in Sequence or Group C: Participants will receive the in-person MI-enhanced safety plan (MI-SP) during hospitalization followed by 4 weeks of supportive Texts and monitoring post discharge in addition to the booster call for non-responders.

Group IV: MI-SP + monitoring + portal follow-up for non-responders (Sequence E) Experimental Treatment 3 Interventions

Sequencing of intervention components (Phase 1 and Phase 2) resulting in Sequence or Group E: Participants will receive the in-person MI-enhanced safety plan (MI-SP) during hospitalization followed by 4 weeks of monitoring post discharge in addition to the portal follow-up for non-responders.

Group V: MI-SP + monitoring + booster call for non-responders (Sequence F) Experimental Treatment 3 Interventions

Sequencing of intervention components (Phase 1 and Phase 2) resulting in Sequence or Group F: Participants will receive the in-person MI-enhanced safety plan (MI-SP) during hospitalization followed by 4 weeks of monitoring post discharge in addition to the booster call for non-responders.

Group VI: MI-SP + monitoring (Sequence D) Experimental Treatment 2 Interventions

Sequencing of intervention components (Phase 1 and Phase 2) resulting in Sequence or Group D: Participants will receive the in-person MI-enhanced safety plan (MI-SP) during hospitalization followed by 4 weeks of monitoring post discharge.

Who Is Running the Clinical Trial?

University of Michigan

Lead Sponsor

Trials

1,891

Recruited

6,458,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Findings from Research

Health technologies, including measurement scales and computational algorithms, effectively enhance the assessment of risk factors for suicidal behavior by analyzing individual and environmental markers.

The review of 12 primary studies indicates that these technologies improve care practices and communication, making them valuable tools for planning necessary interventions for individuals at risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contributions of health technologies in risk assessment for suicide behavior: an integrative review. Rocha, DM., Cavalcante, AKCB., Oliveira, AC., et al.[2021]

The pilot study involving 66 adolescents showed that the ASAP intervention, which includes a smartphone app for emotion regulation, did not significantly reduce suicide attempts post-discharge, but indicated a trend towards fewer attempts (16% vs. 31%).

Participants with a history of previous suicide attempts may benefit more from the ASAP intervention, suggesting that this program could be tailored for those at higher risk, and overall, the intervention and app were well-received by users.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

As Safe as Possible (ASAP): A Brief App-Supported Inpatient Intervention to Prevent Postdischarge Suicidal Behavior in Hospitalized, Suicidal Adolescents. Kennard, BD., Goldstein, T., Foxwell, AA., et al.[2023]

A 1-hour virtual training significantly improved clinicians' knowledge and self-efficacy in using electronic safety plans for suicide prevention, with lasting effects observed at a 6-month follow-up.

Among clinicians working with suicidal youth, 81% attempted to use the electronic safety plan template, and 63% completed it, indicating that this training can enhance the implementation of safety planning in community settings despite some challenges like technology issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of a Virtual Suicide Safety Planning Training on Clinician Knowledge, Self-Efficacy, and Use of Safety Plans in Community Mental Health Clinics. Whitmyre, ED., Esposito-Smythers, C., Goldberg, DG., 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]

The study involving 20 adolescents discharged from a mental health ward showed that the smartphone apps BeyondNow and BlueIce were feasible and acceptable, with most participants accessing them at least once during the six-week follow-up.

While many participants found the apps easy to use, a significant portion (47%) felt they would not ensure safety during a crisis; however, improvements in suicide resilience were noted, indicating potential benefits in managing self-harm and suicidal behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The feasibility of using smartphone apps to manage self-harm and suicidal acts in adolescents admitted to an inpatient mental health ward. Muscara, F., Ng, O., Crossley, L., et al.[2022]

The ETUDES Center engaged various stakeholders, including adolescents, parents, and healthcare providers, to gather feedback on technology-based interventions for adolescent depression and suicidality, ensuring the interventions are relevant and effective.

Feedback from stakeholders highlighted key issues such as equitable access to care and the importance of addressing stigma, which were incorporated into the development of the interventions, demonstrating a collaborative approach to improving mental health resources for teens.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stakeholder perspectives on digital behavioral health applications targeting adolescent depression and suicidality: Policymaker, provider, and community insights. Radovic, A., Kirk-Johnson, A., Coren, M., 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]

Technology can play a crucial role in engaging underserved youth in suicide prevention interventions, either as a supplement to in-person methods or as a standalone automated solution.

To maximize the effectiveness of technology-enhanced interventions, it's essential to consider individual, organizational, and societal factors that influence their implementation, highlighting the importance of implementation science in this field.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Innovating Technology-Enhanced Interventions for Youth Suicide: Insights for Measuring Implementation Outcomes. Szlyk, HS., Tan, J., Lengnick-Hall, R.[2023]

A review of 12 studies on new technologies for adolescent suicide prevention found that telemedicine, especially web-based approaches, is the most commonly used tool, while mobile apps primarily focus on screening for depressive symptoms and suicidal thoughts.

Despite the acceptance of these technologies among adolescents, there is limited evidence supporting their effectiveness in preventing suicide, highlighting the need for further research to establish their clinical efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Role of New Technologies to Prevent Suicide in Adolescence: A Systematic Review of the Literature. Forte, A., Sarli, G., Polidori, L., et al.[2023]

The study successfully implemented the Safety Planning Intervention (SPI) for adolescent suicidality in emergency services, showing that training significantly improved providers' attitudes and knowledge about the intervention.

Collaboration with stakeholders and brief training were effective strategies for integrating structured safety planning into pediatric emergency settings, which is crucial for enhancing care for suicidal youths.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety Planning Intervention for Adolescents: Provider Attitudes and Response to Training in the Emergency Services Setting. Bettis, AH., Donise, KR., MacPherson, HA., et al.[2022]

Over 90% of adolescents recently hospitalized for suicide risk reported having access to their safety plans after discharge, indicating high retention and potential for use during critical periods.

While safety plan use and suicidal ideation both declined over time, the relationship between them varied by sex: girls showed a correlation in changes, while boys' safety plan use decreased regardless of their suicidal ideation changes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety plan use in the daily lives of adolescents after psychiatric hospitalization. May, AM., Al-Dajani, N., Ballard, ED., et al.[2023]

References

1. Brazil pubmed.ncbi.nlm.nih.gov

Contributions of health technologies in risk assessment for suicide behavior: an integrative review. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

As Safe as Possible (ASAP): A Brief App-Supported Inpatient Intervention to Prevent Postdischarge Suicidal Behavior in Hospitalized, Suicidal Adolescents. [2023]

3. England pubmed.ncbi.nlm.nih.gov

Impact of a Virtual Suicide Safety Planning Training on Clinician Knowledge, Self-Efficacy, and Use of Safety Plans in Community Mental Health Clinics. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Smartphone-based safety plan for suicidal crisis: The SmartCrisis 2.0 pilot study. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

The feasibility of using smartphone apps to manage self-harm and suicidal acts in adolescents admitted to an inpatient mental health ward. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Stakeholder perspectives on digital behavioral health applications targeting adolescent depression and suicidality: Policymaker, provider, and community insights. [2023]

7. England pubmed.ncbi.nlm.nih.gov

The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. [2022]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Innovating Technology-Enhanced Interventions for Youth Suicide: Insights for Measuring Implementation Outcomes. [2023]

9. Switzerland pubmed.ncbi.nlm.nih.gov

The Role of New Technologies to Prevent Suicide in Adolescence: A Systematic Review of the Literature. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Safety Planning Intervention for Adolescents: Provider Attitudes and Response to Training in the Emergency Services Setting. [2022]

11. England pubmed.ncbi.nlm.nih.gov

Safety plan use in the daily lives of adolescents after psychiatric hospitalization. [2023]