Abstract
BackgroundPeople with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions.ObjectiveThe primary aim of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention.MethodsA 6-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, and current active suicidal ideation were randomized to START or START with mobile augmentation. START consists of 4 weekly sessions addressing early warning signs and triggers, symptoms influencing suicidal thinking, and social relationships. Recovery planning is followed by biweekly telephone coaching. START with mobile augmentation includes personalized automated cognitive behavioral therapy scripts that build from in-person content. Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching), and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial was the change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcome included the rate of outpatient engagement.ResultsThe trial is ongoing. Feasibility and acceptability across conditions will be assessed using t tests or Mann-Whitney tests or chi-square tests. The reduction of SSI over time will be assessed using hierarchical linear models.ConclusionsThe design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings.Trial RegistrationClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364International Registered Report Identifier (IRRID)DERR1-10.2196/14378
Highlights
IntroductionThe burden of suicide is exceptionally high in serious mental illnesses (SMIs) such as bipolar disorder and schizophrenia
Suicide in Serious Mental IllnessesThe burden of suicide is exceptionally high in serious mental illnesses (SMIs) such as bipolar disorder and schizophrenia
A handful of trials of psychosocial interventions have been evaluated for their impact on suicidal ideation or behavior in schizophrenia, and data on psychosocial interventions in suicide prevention are virtually nonexistent in bipolar disorder [9]
Summary
The burden of suicide is exceptionally high in serious mental illnesses (SMIs) such as bipolar disorder and schizophrenia. Recent evidence indicates that direct interventions (ie, those that target suicidal thoughts, such as cognitive behavioral therapy [CBT] techniques) are more effective in reducing suicide risk than indirect interventions (eg, those that target depressive symptoms and promote treatment engagement) [4,5]. A handful of trials of psychosocial interventions have been evaluated for their impact on suicidal ideation or behavior in schizophrenia (some of which are suicide-specific CBT [7,8]), and data on psychosocial interventions in suicide prevention are virtually nonexistent in bipolar disorder [9]. Intervention Targets for Suicide Prevention in People With SMIs. People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. Trial Registration: ClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364 International Registered Report Identifier (IRRID): DERR1-10.2196/14378
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
