Development of mHealth-Supported Skills Training for Alcohol and Related Suicidality (mSTARS): Emotion Regulation Skills Training to Enhance Acute Psychiatric Care and Recovery

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Alcohol misuse is strongly associated with suicide crises (i.e., acute suicidal ideation or attempts) and death. The standard care for a suicide crisis, including for persons who misuse alcohol, is acute psychiatric hospitalization. Acute psychiatric hospitalization focuses on stabilization and crisis resolution prior to quickly discharging at-risk patients back into their stressful environments with a referral for outpatient care. Outpatient- based interventions focused on emotion regulation training have been shown to simultaneously reduce alcohol misuse and suicidal behavior. Yet, less than 50% of psychiatric inpatients follow through with outpatient treatment, which creates a dangerous gap in care; risk for suicide is the highest among recently discharging patients who misuse alcohol. This Mentored Patient-Oriented Research Career Development Award (K23) involves the development of a novel adjunctive intervention to (1) enhance standard care for at-risk psychiatric inpatients who misuse alcohol, and (2) create an opportunity for sustained recovery and reduced risk for a subsequent suicide crisis during the post-discharge period. This intervention, entitled mHealth-supported Skills Training for Alcohol and Related Suicidality (mSTARS), combines emotion regulation skills training implemented in the acute setting with a mHealth app designed to encourage utilization of these skills during the risky post-discharge period. The research plan for this K23 has two phases: development (Phase 1: AIMS 1 and 2) and evaluation of feasibility and acceptability of mSTARS (Phase 2: AIM 3). To inform mHealth app development, we will conduct a 6-week ecological momentary assessment (EMA) study on suicidal psychiatric inpatients who misuse alcohol (N = 35) to elucidate time-varying predictors for alcohol consumption and suicidal ideation, and examine the role of specific emotion regulation deficits. Analyses will facilitate adjustments to the app to make empirically-based recommendations for emotion regulation skills in real time (AIM 1). mSTARS, including the inpatient skills training component and mHealth app, will be iteratively refined per patient-driven modifications over two successive cohorts (n = 5 in each) of suicidal psychiatric inpatients who misuse alcohol (AIM 2). The finalized version of mSTARS, while incorporating AIM 1 findings, will be evaluated in AIM 3 in a three-arm feasibility/acceptability randomized control trial comparing mSTARS (n = 15) to inpatient skills training (n = 10) and treatment as usual (TAU) only (n = 10). The research plan for this K23 is closely tied to the PI’s training goals, which are to gain experience with (1) advanced longitudinal modeling of EMA data, (2) mHealth-supported treatment development, and (3) clinical trials design and management. Over the 5-year K23 award period, these training goals will facilitate the PI’s overarching career goal of becoming an independent clinical researcher. Beginning with this K23, the broader aim of the PI’s research program is to develop integrated, scalable, and cost-effective mHealth-supported interventions to treat concurrent alcohol misuse and suicidal behavior across treatment settings, reducing risk for this underserved population.