TY - JOUR
T1 - As safe as possible (ASAP)
T2 - A brief app-supported inpatient intervention to prevent postdischarge suicidal behavior in Hospitalized, Suicidal Adolescents
AU - Kennard, Betsy D.
AU - Goldstein, Tina
AU - Foxwell, Aleksandra A.
AU - McMakin, Dana L.
AU - Wolfe, Kristin
AU - Biernesser, Candice
AU - Moorehead, Alexandra
AU - Douaihy, Antoine
AU - Zullo, Lucas
AU - Wentroble, Erin
AU - Owen, Victoria
AU - Zelazny, Jamie
AU - Iyengar, Satish
AU - Porta, Giovanna
AU - Brent, David
N1 - Funding Information:
Supported by NIMH grant R34 MH100375 (to principal investigators Drs. Kennard and Brent).
Funding Information:
The authors also thank the children and families who participated in this study. ClinicalTrials.gov identifier: NCT02272179. Dr. Kennard receives research support from NIMH and royalties from Guilford Press. Dr. Goldstein receives research support from the American Foundation for Suicide Prevention, the Brain and Behavior Foundation, and NIMH and royalties from Guilford Press. Dr. Foxwell receives royalties from Guilford Press. Dr. Douaihy receives research support from Alkermes, the National Institute on Drug Abuse, NIMH, the Substance Abuse and Mental Health Services Administration, and the U.S. Health Resources and Services Administration, and he receives royalties from PESI Publishing and Media and Oxford University Press. Dr. Brent receives research support from NIMH and royalties from Guilford Press, eResearch Technology (for an electronic self-rated version of the Columbia-Suicide Severity Rating Scale), and UptoDate Psychiatry; he also receives consulting fees from Healthwise. All other authors report no financial relationships with commercial interests.
Publisher Copyright:
© 2018 American Psychiatric Association. All rights reserved.
PY - 2018/9
Y1 - 2018/9
N2 - Objective: The authors report on a pilot study of an inpatient intervention for suicidal adolescents, As Safe as Possible (ASAP), supported by a smartphone app (BRITE) to reduce suicide attempts following hospital discharge. Method: Across two sites, 66 adolescents hospitalized for suicidal ideation (N=26) or a recent suicide attempt (N=40) were randomly assigned to the ASAP intervention program plus treatment as usual or to treatment as usual alone. ASAP, which focuses on emotion regulation and safety planning, is a 3-hour intervention delivered on the inpatient unit. 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 suicide attempts following hospital discharge and suicidal ideation at 4, 12, and 24 weeks after discharge. Results: The ASAP intervention did not have a statistically significant effect on suicide attempt, although findings were in the hypothesized direction for occurrence of an attempt (16% compared with 31%; x2=1.86, df=1, g=20.36) and time to an attempt (hazard ratio=0.49, 95% CI=0.16, 1.47). Past history of a suicide attempt was a significant moderator of treatment outcome, with a stronger, albeit nonsignificant, effect of the ASAP intervention among participants with a history of suicide attempt (hazard ratio=0.23, 95% CI=0.05, 1.09). There were no treatment effects on suicidal ideation. The majority of participants (70%) used the BRITE app (median usage, 19 times). Participants reported high satisfaction with both the intervention and the app. Conclusions: The ASAP intervention program shows promise in reducing the incidence of postdischarge suicide attempts among adolescents hospitalized for suicidality and merits further study.
AB - Objective: The authors report on a pilot study of an inpatient intervention for suicidal adolescents, As Safe as Possible (ASAP), supported by a smartphone app (BRITE) to reduce suicide attempts following hospital discharge. Method: Across two sites, 66 adolescents hospitalized for suicidal ideation (N=26) or a recent suicide attempt (N=40) were randomly assigned to the ASAP intervention program plus treatment as usual or to treatment as usual alone. ASAP, which focuses on emotion regulation and safety planning, is a 3-hour intervention delivered on the inpatient unit. 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 suicide attempts following hospital discharge and suicidal ideation at 4, 12, and 24 weeks after discharge. Results: The ASAP intervention did not have a statistically significant effect on suicide attempt, although findings were in the hypothesized direction for occurrence of an attempt (16% compared with 31%; x2=1.86, df=1, g=20.36) and time to an attempt (hazard ratio=0.49, 95% CI=0.16, 1.47). Past history of a suicide attempt was a significant moderator of treatment outcome, with a stronger, albeit nonsignificant, effect of the ASAP intervention among participants with a history of suicide attempt (hazard ratio=0.23, 95% CI=0.05, 1.09). There were no treatment effects on suicidal ideation. The majority of participants (70%) used the BRITE app (median usage, 19 times). Participants reported high satisfaction with both the intervention and the app. Conclusions: The ASAP intervention program shows promise in reducing the incidence of postdischarge suicide attempts among adolescents hospitalized for suicidality and merits further study.
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U2 - 10.1176/appi.ajp.2018.17101151
DO - 10.1176/appi.ajp.2018.17101151
M3 - Article
C2 - 30021457
AN - SCOPUS:85052784365
SN - 0002-953X
VL - 175
SP - 864
EP - 872
JO - American Journal of Psychiatry
JF - American Journal of Psychiatry
IS - 9
ER -