4 - (SYM 65) Engagement in Just-in-time Digital Interventions for Suicide: Bringing Back People

Despite years of research on suicide assessment and interventions, the field of psychology has struggled to make changes with regard to the suicide rate. This may be due in part to the use of assessment and intervention methods that do not adequately map on to rapid fluctuations in suicidal thoughts and behaviors. Moreover, this reliance on standard intervention models (e.g., weekly therapy) may lead to suicide intervention occurring in contexts that are unrelated to suicide risk, presenting barriers to generalization, as well as ignoring the well-established need-provider gap. Understandably, this has led to increased interest in applying just-in-time digital intervention methods to suicide. However, digital health interventions struggle with declines in engagement over time, as well as user abandonment. Moreover, these problems exist in the context of research protocols that incentivize engagement (e.g., payment per response); this presents a significant barrier to adoption and broader dissemination. While a small number of just-in-time studies in behavioral health have removed incentives to combat this, they have occurred in small, self-selecting samples, findings of which may not generalize if delivered to suicidal populations, particularly if they are less willing (e.g., adolescents whose parents are driving engagement). One solution that has received minimal attention in the context of real-time suicide intervention studies is the inclusion of a person in the loop. There is evidence that having a person in the loop of a digital intervention can help with engagement and user retention. This may include parents, use of peer supporters with lived experience, and potentially therapists or medical doctors who can review progress and help troubleshoot. To illustrate how people can be integrated into just-in-time digital interventions, pilot data will be presented from (1) adults (N = 232) presenting to the emergency department with suicidality who were subsequently enrolled in a digital+peer support intervention, as well as (2) adolescents (N = 72) with conduct disorder and their caregiver who both participated in a digital intervention. Results from both studies indicate high feasibility and acceptability, as well as significant decreases in primary outcomes (i.e., suicidal thoughts and behaviors, externalizing behaviors of adolescents, parent management behaviors).