Virtual Hope Box for Suicide Prevention

(Project HOPE Trial)

Recruiting at 1 trial location

Overseen By Courtney L Bagge, PhD MA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Non-English speakers, Prisoners, Cognitive deficits, others

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

Compensation: Varies

Number of Visits: 3

928 Participants Needed

Trial Summary

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 is best to discuss this with the trial coordinators or your healthcare provider.

What data supports the effectiveness of the treatment Virtual Hope Box Enhanced Facilitation for suicide prevention?

Research shows that the Virtual Hope Box app, which is part of the treatment, is beneficial for people at risk of suicide. It helps them cope with stress and negative thoughts, making it a useful tool in therapy. ^{1 2 3 4 5}

Is the Virtual Hope Box safe for use in humans?

The Virtual Hope Box (VHB) is a smartphone app used to help people cope with stress and negative thoughts, including those at risk of suicide. Studies show that it is easy to use, beneficial, and well-received by both patients and clinicians, with no safety concerns reported. ^{1 2 4 6 7}

How is the Virtual Hope Box Enhanced Facilitation treatment different from other treatments for suicide prevention?

The Virtual Hope Box Enhanced Facilitation is unique because it is a smartphone app that provides personalized coping tools to help manage stress and negative thoughts, making it more accessible and user-friendly compared to traditional hope boxes. It is designed to be used regularly by patients and clinicians, and studies have shown it to be beneficial and easy to set up, with users likely to continue using it and recommend it to others. ^{1 2 7 8 9}

What is the purpose of this trial?

This study will test whether a novel intervention, Virtual Hope Box Enhanced Facilitation (VHB-EF), reduces suicide risk in Veterans after discharge from inpatient psychiatric hospitalization. Additionally, this study will also conduct interviews with Veterans and healthcare providers to explore barriers and facilitators to future adoption of the VHB-EF intervention in healthcare settings.

Research Team

Courtney L Bagge, PhD MA

Principal Investigator

VA Ann Arbor Healthcare System, Ann Arbor, MI

Eligibility Criteria

This trial is for Veterans who have experienced suicidal thoughts or behaviors and are being discharged from inpatient psychiatric care. It's designed to see if a new smartphone app can help them after they leave the hospital.

Inclusion Criteria

A score of 3 on the Callahan 6-item cognitive screening

Own a smartphone to download the VHB app

I am a veteran over 18, admitted for a recent suicidal crisis and am medically stable.

Exclusion Criteria

Do not own a smartphone

Veterans who do not understand English

Prisoners

Timeline

Inpatient Phase

Participants receive a single, one-on-one, 60-minute session to download and personalize the VHB app, and review mental health resources.

1 session

1 visit (in-person)

Remote-Delivery Phase

Two follow-up phone contacts within 14 days post-discharge to monitor suicide risk, review VHB content, and support app use.

2 weeks

2 visits (virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 6 weeks, 3 months, and 6 months.

6 months

Treatment Details

Interventions

• Enhanced Usual Care
• Virtual Hope Box Enhanced Facilitation

Trial Overview The study is testing 'Virtual Hope Box Enhanced Facilitation' (VHB-EF), which is an app-based intervention aimed at reducing suicide risk, against 'Enhanced Usual Care'. The effectiveness of VHB-EF will be measured by its impact on participants post-discharge.

Participant Groups

Group I: Virtual Hope Box Enhanced Facilitation (VHB-EF) Experimental Treatment 1 Intervention

The VHB-EF intervention has two phases: (1) The in-person inpatient phase involves a single, one-on-one, 60-minute session delivered by the study interventionist prior to hospital discharge. During this session, the interventionist will obtain access to the participant's personal phone and assist them in downloading the VHB app. The interventionist will provide education about the app and personalized behavioral practice for each component of the app. They will also address strategies to enhance app use. In addition, participants will review a list of Veteran mental health resources, community services, Veteran service organizations, and other Veteran social support services available to Veterans in the area. (2) The remote-delivery phase builds on the work begun in the hospital via 2 follow-up phone contacts within 14 days following discharge, during which the study interventionist will monitor risk, review/revise VHB content, and support app use and outpatient treatment engagement.

Group II: Enhanced Usual Care (EUC) Active Control 1 Intervention

The EUC condition will involve a one-on-one, 30-minute session delivered by the study interventionist prior to hospital discharge, during which the interventionist will review Veteran mental health resources, community services, Veteran service organizations, and other Veteran social support services available to Veterans in the area. The EUC session will remain focused only on reviewing the standardized list of Veteran and community services; no counseling will be provided, and the list provided by the study interventionist does not include non-services (i.e., does not list any smartphone applications, including the VHB app).

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

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]

Emphasizing early intervention and ongoing low-intensity contact with individuals at risk of suicide can be more effective than solely focusing on those deemed 'highest risk', suggesting a shift in treatment strategy.

The use of advanced interactive computer programs can enhance screening and training for healthcare providers, improving access to mental health services and continuity of care for suicidal individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suicide prevention in a treatment setting. Litman, RE.[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]

References

1. England 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. [2022]

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

A Virtual Hope Box: Randomized Controlled Trial of a Smartphone App for Emotional Regulation and Coping With Distress. [2019]

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

Suicide prevention in a treatment setting. [2022]

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

Suicide prevention using self-guided digital interventions: a systematic review and meta-analysis of randomised controlled trials. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Qualitative Study of Telehealth Delivery of Suicide-Specific Group Treatment "Project Life Force". [2023]

6. England pubmed.ncbi.nlm.nih.gov

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

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

Frequency and predictors of virtual hope box use in individuals experiencing suicidal ideation: An ecological momentary assessment investigation. [2023]

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

Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands. [2023]

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

An interactive web-based method of outreach to college students at risk for suicide. [2022]