A Brief Mobile-Augmented Suicide Prevention Intervention for People With Psychotic Disorders in Transition From Acute to Ongoing Care: Protocol for a Pilot Trial

Abstract

Background People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions. Objective The primary aim of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention. Methods A 6-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, and current active suicidal ideation were randomized to START or START with mobile augmentation. START consists of 4 weekly sessions addressing early warning signs and triggers, symptoms influencing suicidal thinking, and social relationships. Recovery planning is followed by biweekly telephone coaching. START with mobile augmentation includes personalized automated cognitive behavioral therapy scripts that build from in-person content. Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching), and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial was the change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcome included the rate of outpatient engagement. Results The trial is ongoing. Feasibility and acceptability across conditions will be assessed using t tests or Mann-Whitney tests or chi-square tests. The reduction of SSI over time will be assessed using hierarchical linear models. Conclusions The design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings. Trial Registration ClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364 International Registered Report Identifier (IRRID) DERR1-10.2196/14378

Pilot feasibility trial of a brief mobile-augmented suicide prevention intervention for serious mental illness.

“…Suicide ideation severity may have improved for reasons other than mSTART (e.g., regression to the mean, impact of other treatments). Yet, people with SMIs are more likely to have chronic ideation than are people without psychosis and therefore would be less likely to experience natural reductions in ideation (Depp et al, 2021). As such, sustained improvement in suicide ideation is a positive indication of the potential impact of mSTART, comparable in magnitude to clinically significant improvements in ideation severity to other suicide-specific interventions not tested in SMI (Ballard et al, 2021).…”

Psychological Resilience to Suicidal Experiences in People with Non-Affective Psychosis: A Position Paper

“…That said, some studies have the potential to do so. For instance, one pilot trial, the results of which were not yet known at the time of writing, aims to examine the transition from acute to ongoing care for people with psychoses (bipolar disorder, schizophrenia, schizoaffective disorder) who are actively suicidal, using a bespoke suicide-focused SafeTy and Recovery Therapy (START) comprising four weekly therapy sessions [ 115 ]. The results, which centre on acceptability, feasibility and effectiveness, seem to represent an intriguing and promising start to this work.…”

Information and communication technology-based interventions for suicide prevention implemented in clinical settings: A scoping review

“…Identi ed ICTs were used as universal (n = 4), selective (n = 10 Three studies provided opportunities for clinicians to participate in discussion for improvement in the implementation of the ICT, contributing to iterative changes in the implementation process during the study [72,77,91]. Two studies reported tailored approaches to implementation; one created a new clinical work ow to ensure that the implementation was seamless and minimized interruptions by leveraging existing staff roles and processes as much as possible [93], and the other provided site-speci c training [55].…”

“…To prevent digital divide ampli cation and to avoid unintended harm, implementation efforts for new innovations must account for digital equity considerations [124]. However, very few included studies considered equity concerns and provided patients with ICT devices [72,74,80,84], free data plans [125], or options for alternative ICTs (e.g., email instead of texts) as per patients' preferences [71,126]. In contrast, several studies made ownership of ICT devices as one of the inclusion criteria [54, 63-65, 67, 68, 79, 97-99, 125, 127-130], and one study excluded participants who reported di culty using a computer [131].…”

“…Of the 75 included papers, 31 reported implementation strategies, but the level of detail varied. Training clinicians (n = 15) was the most commonly reported implementation strategy for the new ICT, focusing on building new skills[55, 56, 63,[69][70][71][72][73][74][75][76][77][78][79][80]. A few studies speci cally reported using demonstration[74] and simulation methods for training[73].…”