Efficacy of Web-Based Collection of Strength-Based Testimonials for Text Message Extension of Youth Suicide Prevention Program: Randomized Controlled Experiment

Implementation Determinants and Outcomes of a Technology-Enabled Service Targeting Suicide Risk in High Schools: Mixed Methods Study

BACKGROUND

Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential.

OBJECTIVE

This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting.

METHODS

A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES.

RESULTS

Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care.

CONCLUSIONS

Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation.

Leveraging the Web and Social Media to Promote Access to Care Among Suicidal Individuals

After two decades of exponential development, the Internet has become an inseparable component of suicide prevention matters. More specifically, social media has turned out to be a privileged space for suicidal individuals to express their distress and seek support. Although this tendency carries with it specific risks and challenges, it creates unprecedented opportunities to face the challenges of help seeking and access to care. In this paper, we present the empirical, technological, and theoretical evidence supporting the implementation of a digitally augmented prevention policy that would increase its reach. Congruent to the clinical observations and theories on the help-seeking process, we argue that social media can help undertake three main functions of increasing proactivity to bring suffering Web users to care. The gateway function relates to the properties of social media interactions to leverage help-seeking barriers and enable ambivalent individuals to access the mental healthcare system. The communication outreach function aims to broadcast pro-help-seeking messages, while drawing on the functional structure of the social media network to increase its audience. The intervention outreach function consists in using machine learning algorithms to detect social media users with the highest risk of suicidal behaviors and give them a chance to overcome their dysfunctional reluctance to access help. We propose to combine these three functions into a single coherent operational model. This would involve the joint actions of a communication and intervention team on social networks, working in close collaboration with conventional mental health professionals, emergency service, and community resources.

Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test

BACKGROUND

Suicide is a leading cause of death among 10- to 19-year-olds in the United States, with 5% to 8% attempting suicide each year. Suicide risk rises significantly during early adolescence and is higher in rural and underserved communities. School-based universal prevention programs offer a promising way of reducing suicide by providing strategies for emotion regulation and encouraging help-seeking behaviors and youth-adult connectedness. However, such programs frequently run into difficulties in trying to engage a broad range of students. Text messaging is a dominant medium of communication among youths, and studies show both efficacy and uptake in text messaging interventions aimed at adolescents. Text-based interventions may, thus, offer a means for school-based universal prevention programs to engage adolescents who would otherwise be difficult to reach.

OBJECTIVE

We field tested Text4Strength, an automated, interactive text messaging intervention that seeks to reach a broad range of early adolescents in rural communities. Text4Strength extends Sources of Strength, a peer-led school suicide prevention program, by encouraging emotion regulation, help-seeking behaviors, and youth-adult connectedness in adolescents. The study tested the appeal and feasibility of Text4Strength and its potential to extend universal school-based suicide prevention.

METHODS

We field tested Text4Strength with 42 ninth-grade students. Over 9 weeks, students received 28 interactive message sequences across 9 categories (Sources of Strength introduction, positive friend, mentors, family support, healthy activities, generosity, spirituality, medical access, and emotion regulation strategies). The message sequences included games, requests for advice, questions about students' own experiences, and peer testimonial videos. We measured baseline mental health characteristics, frequency of replies, completion of sequences and video viewing, appeal to students, and their perception of having benefited from the program.

RESULTS

Of the 42 participating students, 38 (91%) responded to at least one sequence and 22 (52%) responded to more than a third of the sequences. The proportion of students who completed multistep sequences they had started ranged from 35% (6/17) to 100% (3/3 to 28/28), with responses dropping off when more than 4 replies were needed. With the exception of spirituality and generosity, each of the content areas generated at least a moderate number of student replies from both boys and girls. Students with higher and lower levels of risk and distress interacted with the sequences at similar rates. Contrary to expectations, few students watched videos. Students viewed the intervention as useful-even those who rarely responded to messages. More than 70% found the texts useful (3 items, n range 29-34) and 90% (36) agreed the program should be repeated.

CONCLUSIONS

Text4Strength offers a potentially engaging way to extend school-based interventions that promote protective factors for suicide. Text4Strength is ready to be revised, based on findings and student feedback from this field test, and rigorously tested for efficacy.

A Systematic Literature Review of Technologies for Suicidal Behavior Prevention

Suicide is the second cause of death in young people. The use of technologies as tools facilitates the detection of individuals at risk of suicide thus allowing early intervention and efficacy. Suicide can be prevented in many cases. Technology can help people at risk of suicide and their families. It could prevent situations of risk of suicide with the technological evolution that is increasing. This work is a systematic review of research papers published in the last ten years on technology for suicide prevention. In September 2017, the consultation was carried out in the scientific databases PubMed, ScienceDirect, PsycINFO, The Cochrane Library and Google Scholar. A general search was conducted with the terms "prevention" AND "suicide" AND "technology. More specific searches included technologies such as "Web", "mobile", "social networks", and others terms related to technologies. The number of articles found following the methodology proposed was 90, but only 30 are focused on the objective of this work. Most of them were Web technologies (51.61%), mobile solutions (22.58%), social networks (12.90%), machine learning (3.23%) and other technologies (9.68%). According to the results obtained, although there are technological solutions that help the prevention of suicide, much remains to be done in this field. Collaboration among technologists, psychiatrists, patients, and family members is key to advancing the development of new technology-based solutions that can help save lives.

Toward mHealth Brief Contact Interventions in Suicide Prevention: Case Series From the Suicide Intervention Assisted by Messages (SIAM) Randomized Controlled Trial

Background

Research indicates that maintaining contact either via letter or postcard with at-risk adults following discharge from care services after a suicide attempt (SA) can reduce reattempt risk. Pilot studies have demonstrated that interventions using mobile health (mHealth) technologies are feasible in a suicide prevention setting.

Objective

The aim of this study was to report three cases of patients recruited in the Suicide Intervention Assisted by Messages (SIAM) study to describe how a mobile intervention may influence follow-up.

Methods

SIAM is a 2-year, multicenter randomized controlled trial conducted by the Brest University Hospital, France. Participants in the intervention group receive SIAM text messages 48 hours after discharge, then at day 8 and day 15, and months 1, 2, 3, 4, 5, and 6. The study includes participants aged 18 years or older, who have attended a participating hospital for an SA, and have been discharged from the emergency department (ED) or a psychiatric unit (PU) for a stay of less than 7 days. Eligible participants are randomized between the SIAM intervention messages and a control group. In this study, we present three cases from the ongoing SIAM study that demonstrate the capability of a mobile-based brief contact intervention for triggering patient-initiated contact with a crisis support team at various time points throughout the mobile-based follow-up period.

Results

Out of the 244 patients recruited in the SIAM randomized controlled trial, three cases were selected to illustrate the impact of mHealth on suicide risk management. Participants initiated contact with the emergency crisis support service after receiving text messages up to 6 months following discharge from the hospital. Contact was initiated immediately following receipt of a text message or up to 6 days following a message.

Conclusions

This text message–based brief contact intervention has demonstrated the potential to reconnect suicidal individuals with crisis support services while they are experiencing suicidal ideation as well as in a period after receiving messages. As follow-up phone calls over an extended period of time may not be feasible, this intervention has the potential to offer simple technological support for individuals following discharge from the ED.

Trial Registration

ClinicalTrials.gov NCT02106949; https://clinicaltrials.gov/ct2/show/NCT02106949 (Archived by WebCite at http://www.webcitation.org/6wMtAFL49)

Mobile Apps for Suicide Prevention: Review of Virtual Stores and Literature

BACKGROUND

The best manner to prevent suicide is to recognize suicidal signs and signals, and know how to respond to them.

OBJECTIVE

We aim to study the existing mobile apps for suicide prevention in the literature and the most commonly used virtual stores.

METHODS

Two reviews were carried out. The first was done by searching the most commonly used commercial app stores, which are iTunes and Google Play. The second was a review of mobile health (mHealth) apps in published articles within the last 10 years in the following 7 scientific databases: Science Direct, Medline, PsycINFO, Embase, The Cochrane Library, IEEE Xplore, and Google Scholar.

RESULTS

A total of 124 apps related to suicide were found in the cited virtual stores but only 20 apps were specifically designed for suicide prevention. All apps were free and most were designed for Android. Furthermore, 6 relevant papers were found in the indicated scientific databases; in these studies, some real experiences with physicians, caregivers, and families were described. The importance of these people in suicide prevention was indicated.

CONCLUSIONS

The number of apps regarding suicide prevention is small, and there was little information available from literature searches, indicating that technology-based suicide prevention remains understudied. Many of the apps provided no interactive features. It is important to verify the accuracy of the results of different apps that are available on iOS and Android. The confidence generated by these apps can benefit end users, either by improving their health monitoring or simply to verify their body condition.