Background Suicide is a prevalent public health concern in the United States across all age groups. Research has emphasized the need to identify risk markers that prevent suicide along shorter timeframes, such as days to weeks. Furthermore, little has been done to explore the relative significance of factors that can predict short-term suicide risk or to evaluate how daily variability in these factors impacts suicidal ideation or behavior. This proposed project aims to identify risk factors that best predict near-time changes in suicidal ideation and examine potential interactions between these factors to predict transitions into suicidal thinking or behaviors. Objective The aim of this proposed study is threefold: (1) To identify which psychological risk factors are most strongly associated with proximal changes in suicide risk across days and weeks. (2) To evaluate theoretical assumptions of the Integrative-Motivational-Volitional Theory of Suicide. (3) To determine how disruptions in physiological arousal interact with theoretical mechanisms of risk to predict concurrent and short-term prospective increase in suicidal thoughts and behaviors. Methods A daily diary or ecological momentary assessment design will be utilized with 200 participants. Participants will complete 2 in-person visits separated by 3 weeks during which they will complete 3 brief daily assessments within their natural environments using the ilumivu research app on a smart device. Research will occur at the Mayo Clinic Health System (MCHS) Eau Claire site. Participants will be recruited through chart review and standard care delivery assessment. Results This manuscript outlines the protocol that will guide the conduct of the forthcoming study. Conclusions The proposed project aims to lead efforts using technological advances to capture microchanges in suicidal thinking/behavior over shorter timeframes and thereby guide future clinical assessment and management of suicidal patients. Results of this study will generate robust evidence to evaluate which risk factors predict proximal changes in suicidal ideation and behaviors. They will also provide the ability to examine potential interactions with multiple theoretically derived risk factors to predict proximal transitions into worsening suicidal thinking or behaviors. Such information will provide new targets for intervention that could ultimately reduce suicide-related morbidity and mortality. International Registered Report Identifier (IRRID) PRR1-10.2196/37583

BACKGROUND Suicide is a prevalent public health concern in the United States across all age groups. Research has emphasized the need to identify risk-markers that prevent suicide along shorter timeframes, such as days to weeks. Furthermore, little has been done to explore the relative significance of factors that can predict short-term suicide risk or to evaluate how daily variability in these factors affects suicidal ideation or behavior. This proposed project aims to identify risk factors that best predict near-time changes in suicidal ideation and examine potential interactions between these factors to predict transitions into suicidal thinking and/or behaviors. OBJECTIVE The aim of this proposed study is threefold. 1) To identify which psychological risk factors are most strongly associated with proximal changes in suicide risk across days and weeks. 2) To evaluate theoretical assumptions of the Integrative-Motivational-Volitional (IMV) Theory. 3) To determine how disruptions is physiological arousal interact with theoretical mechanisms of risk to predict concurrent and short-term prospective increase in suicidal thoughts and behaviors. METHODS A daily diary or ecological momentary assessment (EMA) design will be utilized with 150 participants. Participants will complete two in-person visits separated by three weeks during which they will complete three brief daily assessments within their natural environments using the Ilumivu research app on a smart device. Research will occur at the Mayo Clinic Health System (MCHS) Eau-Claire site. Participants will be recruited through chart-review and standard care delivery assessment. RESULTS This manuscript outlines the protocol that will guide the conduct of the forthcoming study. CONCLUSIONS The proposed project aims to lead efforts using technological advances to capture micro-changes in suicidal thinking/behavior over shorter timeframes and thereby guide future clinical assessment and management of suicidal patients. Results of this study will generate robust evidence to evaluate which risk factors predict proximal changes in suicidal ideation and behaviors. They will also provide the ability to examine potential interactions with multiple theoretically derived risk factors to predict proximal transitions into worsening suicidal thinking and/or behaviors. Such information will provide new targets for intervention that could ultimately reduce suicide-related morbidity and mortality.

BACKGROUND During the COVID-19 pandemic, many healthcare institutions changed their outpatient clinical practice from face-to-face (f2f) appointments to telemedicine to prevent the spread of the virus. Despite these efforts, many patients still chose f2f appointments for non-emergent clinical care. OBJECTIVE This study explored patients’ personal and environmental barriers to the use of telemedicine from April–to December 2020. METHODS We conducted qualitative interviews of Mayo Clinic patients who attended f2f appointments at the Mayo Clinic but did not utilize Mayo Clinic video appointment services from April–to December 2020. RESULTS Our study found that while most patients were concerned about preventing COVID-19, they trusted in the Mayo Clinic to keep them safe when attending f2f appointments. Many expressed that video appointment made it difficult to establish a rapport with their providers during video appointments. Other common barriers to video appointments were poor digital access and literacy, and concerns about privacy and security. CONCLUSIONS Our study provides an in-depth investigation into barriers to engaging in video appointments for non-emergent clinical care and suggests specific aspects of rapport that need to be assessed in more detail and problem solved at an individual level. Given the rising use of telemedicine services in healthcare, major clinical practice and federal/state policy changes are warranted to provide equal care to diverse patient groups.