SP 16: Micro-randomized trial to assess brief, just-in-time interventions for reducing short- term suicide risk

Suicide is the tenth leading cause of death in the U.S., with the highest risk period occurring in the weeks following psychiatric hospitalization. Scalable, effective strategies to prevent suicide-related behavior (SRB) after discharge are urgently needed. Safety planning – a brief intervention listing coping strategies and supports – is standard care but often underused by patients. This project uses a micro-randomized trial (MRT) to test just-in-time interventions (via calls or automated texts) that promote real-world safety plan use based on individuals’ current suicidal urges. Psychiatric inpatients will complete daily smartphone surveys for 28 days post-discharge and be repeatedly randomized to different intervention methods and content. Aim 1 is to refine interventions through pilot feedback (N=10). Aim 2 is to assess their immediate effects on safety plan use and suicidal thoughts in a larger MRT (N=175).

SP16 is interested in the personalization algorithms proposed by TR&D2, particularly how causal domain expertise (Aim 2) can be utilized to improve personalization.  Further this SP is interested in potentially using the (under development) JusTIn Toolkit for Just-in-Time Adaptive mHealth Interventions and the pJITAI toolbox.  If the TR&D algorithms under Aim 2 are demonstrated to be robust, this SP would be potentially interested in assessing feasibility of these algorithms for use in informing the SP’s future research. TR&D2 pushes personalization algorithms that incorporate causal domain expertise to enhance the tailoring of JITAIs for suicide risk prevention. The mDOT Center also pushes stress monitoring. By integrating TR&D2’s personalization algorithms and tools, SP16 will improve the precision and effectiveness of JITAIs in promoting safety plan adherence and stress management.

1. Nahum-Shani, I., Potter, L.N., Lam, C.Y., Yap, J., Moreno, A., Stoffel, R., Wu, Z., Wan, N., Dempsey, W., Kumar, S., Ertin, E., Murphy, S.A., Rehg, J., Wetter, D.W. The Mobile-Assistance for Regulating Smoking (MARS) Micro-Randomized Trial Design Protocol. Contemp Clin Trials. 2021 Nov;110:106513. doi: 10.1016/j.cct.2021.106513. Epub 2021 Jul 24. PubMed PMID: 34314855; PubMed Central PMCID: PMC8824313.