As Safe as Possible (ASAP): A Brief App-Supported Inpatient Intervention to Prevent Postdischarge Suicidal Behavior in Hospitalized, Suicidal Adolescents
As Safe as Possible (ASAP): A Brief App-Supported Inpatient Intervention to Prevent Postdischarge Suicidal Behavior in Hospitalized, Suicidal Adolescents
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DOI：
10.1176/appi.ajp.2018.17101151
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发表时间：
2018-09-01
影响因子：
17.7
通讯作者：
Brent, David
中科院分区：
文献类型：
--
作者：
Kennard, Betsy D.;Goldstein, Tina;Brent, David
目的：作者报告了一项针对自杀青少年的住院干预的试点研究，尽可能安全（ASAP），由智能手机应用程序（BRITE）支持，以减少出院后的自杀企图。方法：在两个地点，66名因自杀意念住院的青少年（N=26）或最近有自杀企图的青少年（N=40）被随机分配到尽快干预方案加常规治疗或单独治疗。ASAP的重点是情绪调节和安全规划，是在住院部提供的3小时干预。BRITE应用程序促使参与者每天评估自己的情绪困扰程度，并为情绪调节和安全规划提供个性化策略。一名独立的盲评者在出院后4周、12周和24周对出院后的自杀企图和自杀意念进行评估。结果：ASAP干预对自杀企图没有统计学意义上的显著影响，尽管研究结果与自杀企图发生的假设方向一致（16%比31%；chi(2)=1.86, df=1, g= -0.36）和自杀企图时间（风险比=0.49,95% CI=0.16, 1.47）。自杀企图史是治疗结果的显著调节因子，在有自杀企图史的参与者中，ASAP干预的效果更强，尽管不显著（风险比= 0.23,95% CI=0.05, 1.09）。对自杀意念没有治疗效果。大多数参与者（70%）使用BRITE应用程序（中位数使用次数为19次）。结论：ASAP干预方案在降低因自杀住院的青少年出院后自杀企图发生率方面显示出良好的前景，值得进一步研究。
Objective: The authors report on a pilot study of an inpatient intervention for suicidal adolescents, As Safe as Possible (ASAP), supported by a smartphone app (BRITE) to reduce suicide attempts following hospital discharge.Method: Across two sites, 66 adolescents hospitalized for suicidal ideation (N=26) or a recent suicide attempt (N=40) were randomly assigned to the ASAP intervention program plus treatment as usual or to treatment as usual alone. ASAP, which focuses on emotion regulation and safety planning, is a 3-hour intervention delivered on the inpatient unit. The BRITE app prompted participants to rate their level of emotional distress on a daily basis and provided personalized strategies for emotion regulation and safety planning. A blind, independent evaluator assessed suicide attempts following hospital discharge and suicidal ideation at 4,12, and 24 weeks after discharge.Results: The ASAP intervention did not have a statistically significant effect on suicide attempt, although findings were in the hypothesized direction for occurrence of an attempt (16% compared with 31%; chi(2)=1.86, df=1, g= -0.36) and time to an attempt (hazard ratio=0.49, 95% CI=0.16, 1.47). Past history of a suicide attempt was a significant moderator of treatment outcome, with a stronger, albeit nonsignificant, effect of the ASAP intervention among participants with a history of suicide attempt (hazard ratio= 0.23, 95% CI=0.05, 1.09). There were no treatment effects on suicidal ideation. The majority of participants (70%) used the BRITE app (median usage, 19 times). Participants reported high satisfaction with both the intervention and the app.Conclusions: The ASAP intervention program shows promise in reducing the incidence of postdischarge suicide attempts among adolescents hospitalized for suicidality and merits further study.