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App-supported intervention shows promise for teens with suicidality
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Preliminary study results indicated an inpatient intervention — As Safe as Possible — which includes a smartphone app, may help reduce the incidence of post-discharge suicide attempts among teenagers hospitalized for suicidality.
“A large proportion of suicidal events ... occur within the first 3 weeks of outpatient treatment following hospital discharge,” Betsy D. Kennard, PsyD, from the department of Psychiatry at the University of Texas Southwestern Medical Center, and colleagues wrote. “Because suicidal events commonly occur early in outpatient care following hospitalization, one possible strategy for reducing the risk for these early events is to provide an intervention during hospitalization designed to protect suicidal patients as they transition to outpatient care.”
This study reported the results from a two-site, treatment development randomized controlled trial of As Safe as Possible (ASAP), a 3-hour intervention designed to help protect against recurrent suicidal behavior following hospital discharge among adolescents with suicidality.
The intervention, delivered via an interviewing framework on the inpatient unit, consisted of chain analysis and safety planning; distress tolerance and emotion regulation; boosting positive affect with savoring and switching; and review of the skills, safety plan and app. The smartphone app, BRITE, encourages emotion regulation and allows teen users to access to a personalized safety plan during their transition to outpatient care.
The researchers randomly allocated 26 teens hospitalized for suicidal ideation and 40 hospitalized for recent suicide attempt to the ASAP intervention program plus treatment as usual or to treatment as usual alone. Then, an independent evaluator examined suicide attempts following hospital discharge and suicidal ideation at 4, 12 and 24 weeks post-discharge.
There were no significant differences in the rates of suicide attempts after hospital discharge between the ASAP intervention group and the treatment-as-usual group; however, the results were in the hypothesized direction (ASAP plus treatment as usual group: 16.1% vs. treatment as usual group: 31%) as were the results for time to suicide attempt (HR = 0.49; 95% CI, 0.16-1.47).
Kennard and colleagues found that past history of a suicide attempt moderated treatment outcome, with a stronger effect of ASAP plus treatment as usual observed among participants with a history of suicide attempt (HR = 0.23; 95% CI, 0.05-1.09). They also reported no treatment effects on suicidal ideation. In total, 70% of teens used the BRITE app, and participants reported liking both the intervention and the app.
“These findings indicate that ASAP and the BRITE smartphone app are acceptable, feasible and promising interventions for hospitalized, suicidal adolescents,” the authors concluded. “Further study is needed to determine which aspects of ASAP and the BRITE app are most active, and hence worth disseminating and whether the intervention can be effectively delivered on inpatient units by existing staff.” – by Savannah Demko
Disclosure: Kennard reports support from NIMH and royalties from Guilford Press. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Jonathan B. Singer, PhD, LCSW
I'm very encouraged by this study and these results. I think the general public assumes that interventions for adolescents already incorporate apps, but that's not the case. Tech-minded practitioners are using off-the-shelf apps such as the Virtual Hope Box and MY3 with their suicidal clients, but haven't been able to point to research like this to show that it can be effective. I was very encouraged that the youth used the app and seemed to like it. The psychosocial intervention, even without the app, is outstanding. It includes all of the best components of empirically supported treatments for suicidal youth, and is wrapped up in a motivational interviewing sandwich. The authors were right to point out that although encouraging, this study raised as many questions as it answered about how this tech-mediated treatment worked, for whom, and under what circumstances. I was surprised that the authors did not provide information about if or how people can access the app. Even if the app remains locked in the ivory tower, I would hope that inpatient settings adopt the psychosocial intervention.
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