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ViewAttendees 13

Symposia

Suicide and Self-Injury

Session: Increasing the effectiveness of real-time suicide intervention

2 - (SYM 65) Just-in-time Interventions for Promoting Safety Plan and Coping Strategy Use for Suicidal Thoughts:
A Pilot Micro-randomized Trial

Saturday, November 18, 2023
10:30 AM – 11:30 AM PST
Location: Skykomish (604), Level 6
Effective, scalable interventions for the highest-risk time for suicide – after inpatient psychiatric hospitalization – are urgently needed. Safety planning involves developing a personalized list of coping strategies for suicidal crises, and has been shown to prevent suicidal behavior. However, roughly 40% of patients with a safety plan never use it. The safety plan also includes multiple components (e.g., different internal coping strategies, seeking social support), yet we have little understanding of the internal and external contexts that may impact the accessibility and effectiveness of individual components. Improving both the ability to promote safety plan use when needed and the understanding of when specific coping strategies are most accessible and effective has the potential to optimize this already evidence-based intervention. Our aim is to leverage the recent micro-randomized trial (MRT) design to evaluate the proximal effects of automated, smartphone-based reminders to implement the safety plan and its coping strategies at different levels of suicidal urges and intent. We received IRB approval in January and will begin recruitment for this pre-registered MRT in March 2023. Twenty-five (N = 25) adults hospitalized for suicidal thoughts or behaviors will undergo our intensive longitudinal monitoring protocol, which includes completing up to six brief smartphone surveys per day that assess momentary suicidal urges and intent on a 0 to 10 scale during hospitalization and the 28 days after discharge. After each post-discharge survey with reported high intensity suicidal urges or moderate intent, participants will be “micro-randomized” to receive either a series of automated interactive intervention messages or no intervention. Whether the message content is personalized (from the individual’s safety plan) or general (top-rated from others’ safety plans) and the specific coping strategy type(s) recommended will also be randomized. Brief proximal follow-up surveys will assess coping strategy use, perceived helpfulness, and suicidal urges and intent. Qualitative data on acceptability and feasibility will be collected from participants and used to inform future refinements. Results regarding acceptability, feasibility, and preliminary efficacy of the just-in-time interventions for promoting increased safety plan and coping strategy use and reducing suicidal thoughts will be presented, and key priorities for future work aimed to develop just-in-time adaptive interventions for reducing suicide risk discussed.