Examining feasibility, acceptability, and sustainability of a novel personalized smartphone intervention for suicide.

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PROJECT SUMMARY/ABSTRACT Suicide is a serious public health concern in the United States. However, despite an increase in theoretical models of and treatments for suicide, the suicide rate has risen 33% since 1999. Given the widespread availability of smartphone technology, there is great potential to deliver interventions via mobile platforms. However, despite the proliferation of smartphone tools for suicide, few offer evidence-based support and some include potentially harmful content. In response, we have conducted initial development of a mobile suicide prevention system: Mobile Application to Prevent Suicide (MAPS). MAPS was specifically designed to identify increased suicide risk and deliver personalized intervention for patients transitioning out of a psychiatric hospital, a time of extraordinarily high risk. MAPS provides both a mobile app and clinician support, and includes multiple evidence-based components: (1) monitoring of thoughts, emotions, and behaviors via ecological momentary assessment (EMA), (2) personalized, interactive coping strategy administration based on participants’ current risk state, (3) direct access to clinicians and crisis support services, and (4) psychoeducation. We will leverage existing components of MAPS and develop and test new features. To plan for sustainability of MAPS, we will deliver the intervention through the Butler Hospital Transitional Outpatient Program, assigning participants to master’s level hospital clinicians, and convene a Stakeholder Advisory Board with a focus on program sustainability. Specifically, the primary aim of this investigation is to establish feasibility, acceptability, safety, and estimate key parameters for primary outcomes (i.e., suicidal ideation and behavior; re-hospitalization), and target mechanisms (i.e., self-monitoring, use of coping strategies, reduction of negative affect, self-efficacy). The ultimate goal of this project is to further develop and refine the MAPS system and engage in preliminary testing in preparation for a fully-powered randomized clinical trial (R01) to establish effectiveness of the intervention in a larger health care system and to further optimize intervention components and delivery (e.g., machine learning techniques). This proposal outlines procedures for intervention and clinician training program refinement through focus groups and open and randomized pilot trials. Thus, the present study is designed to develop the tools, procedures, and knowledge base for a novel intervention.