(PS9-10) Just-in-time adaptive intervention for suicide risk reduction: Perspectives from adults recently hospitalized for suicidal thoughts or behaviors

Abstract Text:

Introduction: Despite increasing awareness of suicide as a public health problem, it continues to claim the lives of over 49,000 annually. The month after inpatient psychiatric hospitalization is the highest-risk time for suicidal behavior. Hence, it is imperative to identify accessible and feasible strategies to reduce suicide risk after hospital discharge. Mobile devices have great potential to aid in the identification of rapid fluctuations in suicide risk and deployment of timely support during this high-risk time. The just-in-time adaptive intervention (JITAI) framework may have particular applicability to detecting changes in suicide risk and delivering the optimal type of support when needed.

Method: Our team recently completed the pilot phase (N = 10) of an upcoming NIMH-funded micro-randomized trial (MRT) (target N = 175) testing components of a JITAI aimed to promote safety plan use during episodes of suicidal thoughts via both automated (e.g., smartphone-based messages) and clinician-delivered (e.g., phone/text outreach) interventions during the four weeks after hospitalization. Of the 10 enrolled participants, n = 8 completed the 28-day post-discharge MRT period and n = 2 either withdrew themselves or were withdrawn by study staff prior to starting the post-discharge MRT. A total of n = 6 completed participants participated in an audio-recorded qualitative interview at the end of the study (approximately 28 days post-discharge) to provide their impressions about and feedback on the digital and clinician-delivered intervention components.

Results: Preliminary findings from rapid coding of interview transcripts include a general preference for smartphone-based messages to include only a single component of their safety plan (e.g., internal coping strategies, specific people for support) instead of their full safety plan. If being contacted by a clinician to assess safety and review their safety plan, all participants preferred to be texted and not called. Half of participants preferred to be contacted by a clinician after reporting strong suicidal thoughts, whereas the other half preferred to receive exclusively automated interventions reminding them of key coping strategies and crisis resources from their safety plan. Participants were in support of the potential option to receive an automated intervention at a random or fixed time once per day, rather than intervention delivery being fully contingent on engaging with momentary surveys. Complete findings on extracted themes and how feedback informed modifications to the protocol and interventions prior to the full trial will be presented.

Conclusion: JITAIs may be a promising approach to delivering tailored support based on individuals’ evolving needs and contexts. Incorporating feedback from end users is crucial to continue the development and refinement of effective and ultimately implementable real-time interventions for suicide prevention.