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

项目摘要/摘要 自杀在美国是一个严重的公共卫生问题。然而，尽管理论上的 关于自杀的模式和治疗，自杀率自1999年以来上升了33%。鉴于广泛存在的 由于智能手机技术的可用性，通过移动平台提供干预措施的潜力很大。 然而，尽管用于自杀的智能手机工具激增，但很少有提供循证支持的工具，一些 包括潜在有害内容。作为回应，我们已经进行了移动自杀的初步开发 预防系统：防止自杀的移动应用程序(MAP)。地图是专门为识别 增加自杀风险，并为走出精神病院的患者提供个性化干预， 一个风险极高的时期。Maps同时提供移动应用程序和临床医生支持，并包括多个 基于证据的组成部分：(1)通过生态瞬间监测思想、情绪和行为 评估(EMA)，(2)基于参与者当前的个性化、交互式应对策略管理 风险状态；(3)直接接触临床医生和危机支持服务；(4)心理教育。我们将利用 地图的现有组件，并开发和测试新功能。为了规划地图的可持续性，我们将 通过巴特勒医院过渡门诊计划提供干预，将参与者分配到 硕士级别的医院临床医生，并召集利益相关者咨询委员会，重点关注计划 可持续发展。具体地说，这项调查的主要目的是确定可行性、可接受性、安全性和 估计主要结果的关键参数(即自杀意念和行为；再次住院)和目标 机制(即自我监测、应对策略的使用、减少负面情绪、自我效能)。这个 该项目的最终目标是进一步开发和完善地图系统，并进行初步测试 为了准备一项完全有效的随机临床试验(R01)，以确定干预措施的有效性 更大的医疗保健系统，并进一步优化干预组件和交付(例如，机器学习 技术)。该提案概述了干预和临床医生培训计划细化的程序，通过 焦点小组以及开放和随机的试点试验。因此，本研究旨在开发工具， 程序和知识库，为一种新的干预。

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.