Brent and Colleagues Test New Smartphone-based Intervention to Reduce Suicide Attempts by Teens Following Hospital Discharge

Adolescent suicide and suicidal behavior have shown dramatic increases in the past decade, making suicide the second leading cause of death in this age group. The standard practice is to hospitalize adolescents at highest imminent risk for a suicide attempt, but the risk for suicidal behavior is highest within the first three weeks after discharge. Currently there are no interventions designed to decrease the risk of suicide attempt during the transition from inpatient to outpatient care.

David Brent, MD, Endowed Chair in Suicide Studies and Professor of Psychiatry, Pediatrics, Epidemiology, and Clinical and Translational Science, collaborated with Department of Psychiatry investigators Tina Goldstein, PhD, Antoine Douaihy, MD, Candice Biernesser, MPH, LCSW, and colleagues Jamie Zelazny, PhD, MPH in Pitt’s School of Nursing and Betsy Kennard, PsyD at the University of Texas Southwestern Medical Center to test a new inpatient intervention called As Safe as Possible (ASAP) for suicidal adolescents. ASAP is a three-hour intervention delivered on the inpatient unit which focuses on emotion regulation and safety planning. The intervention is supported by a newly developed smartphone app called BRITE and aims to reduce suicide attempts following hospital discharge. Their findings appear in the American Journal of Psychiatry.

In a randomized study of 66 adolescents hospitalized for suicidal ideation or a recent suicide attempt, 34 participants were assigned to the ASAP intervention program plus treatment as usual while 32 participants were assigned to receive treatment as usual alone. The BRITE app prompted participants to rate their level of emotional distress on a daily basis and provided personalized strategies for emotion regulation and safety planning. A blind, independent evaluator assessed suicidal ideation and suicide attempts following hospital discharge at 4, 12, and 24 weeks.

While the ASAP intervention did not have a statistically significant effect on suicide attempt, participants receiving the intervention tended to have a lower hazard of suicide attempts after discharge, with half the rate of suicide attempts of the usual care condition. There was also significant moderation among adolescents with a history of a suicide attempt. The investigators found no treatment effects on suicidal ideation. The majority of participants (70%) actively used the BRITE app to modify content, rate their level of distress and activate the personal contacts on their safety plan, and reported high satisfaction with the ASAP intervention and the app. Findings from this study demonstrate the acceptability and feasibility of the ASAP intervention program and the supporting BRITE app. Dr. Brent, the study’s senior author, said the next step will be to conduct a dismantling study to test the impact of the BRITE app, ASAP, the combination and usual care.

The ASAP intervention and BRITE app are examples of how advances in technology are playing an important role in the development of new, innovative interventions designed to supplement current standards of care. Dr. Brent and his colleagues have several projects planned to  build on this work. “As part of their work at the recently funded Center for Enhancing Triage and Utilization for Depression and Emergent Suicidality in Pediatric Primary Care (ETUDES Center), Dr. Stephanie Stepp and colleagues are adapting the BRITE app so that clinicians can be led step by step in the development of a safety plan and population of the app,” said Dr. Brent. “We are also working on methods to monitor suicidal risk in real time using passive cell phone monitoring, and it is possible that, with inflections in suicidal risk that patients could be encouraged to open and use the BRITE app.” 

As Safe as Possible (ASAP): A Brief App-Supported Inpatient Intervention to Prevent Post-discharge Suicidal Behavior in Hospitalized, Suicidal Adolescents
Kennard BD, Goldstein T, Foxwell AA, McMakin DL, Wolfe K, Biernesser C, Moorehead A, Douaihy A, Zullo  L, Wentroble E, Owen V, Zelazny J, Iyengar S, Porta G, and Brent B 

American Journal of Psychiatry, ePub Online, 2018