(PS9-B49) The Complexities of Involving Other People in the Safety Planning Process: Implications for a Digital Suicide Prevention Intervention

Introduction

Suicidal thoughts and behaviors (STBs) present a major disease burden for young adults. Suicide is the second-leading cause of death among individuals aged 18 – 24 years, and younger adults exhibit elevated suicidal ideation compared to older adults. Existing treatments for STBs are typically delivered in face-to-face settings, which makes them less accessible to young adults due to barriers involving the access, cost, and availability of care. Young adults also display a preference for internet-based services that foster anonymity and self-reliance. Digital suicide interventions are thus suited to fit the needs of young adults with STBs that otherwise face barriers to accessing care.

Digital Safety Planning Interventions reduce the risk of suicide by providing individuals with coping strategies, support structures, and methods for reducing access to lethal means, in an accessible format. As digital safety plans can be automated and used without professional support, they may be well suited to serve young adults’ preferences for anonymity and self-reliance. However, it is currently unknown to what extent young adults want to involve others in their digital safety planning. 

Methods

To address this question, we conducted a user-centered design workshop to gauge young adults’ preferences for designing an automated text message safety planning tool. We recruited 15 participants with STBs (aged 18-24) through the Mental Health America website. Participants interacted on an asynchronous discussion platform by responding to researcher-posted prompts on digital safety planning. Discussion transcripts were subject to qualitative analysis to identify themes in social support preferences. 

Results

Participants expressed a strong desire to feel cared for during the safety planning process and were skeptical that automated text messages could communicate care; a fully automated safety plan was characterized as “impersonal” and “alienating”. Participants advocated for a digital tool that cultivated social connection during safety planning, and determined that connecting with others, particularly close others (e.g., friend, romantic partner), was key to building a digital environment in which they could feel cared for. Though, preferences for social connection in the context of digital safety planning varied according to participants’ respective attitudes towards disclosure. Individuals who reported disclosure concerns (i.e., emotional difficulty, burdensomeness) were less willing to disclose their STBs to close others and stated a preference for involving a mental health professional in safety planning. Conversely, individuals who did not report disclosure concerns were more willing to disclose their STBs to close others and stated a preference for involving close others in safety planning.

Conclusion

Our results indicate that users of a digital suicide intervention want to feel socially connected to others while safety planning, and preferences for who to involve in safety planning may be moderated by users’ attitudes toward suicide disclosure. This study can inform the design of digital safety planning tools, and lays groundwork for future research on integrating human support in digital suicide prevention.