Abstract
BackgroundMany suicide risk factors have been identified, but traditional clinical methods do not allow for the accurate prediction of suicide behaviors. To face this challenge, emma, an app for ecological momentary assessment (EMA), ecological momentary intervention (EMI), and prediction of suicide risk in high-risk patients, was developed.ObjectiveThe aim of this case report study was to describe how subjects at high risk of suicide use the emma app in real-world conditions.MethodsThe Ecological Mental Momentary Assessment (EMMA) study is an ongoing, longitudinal, interventional, multicenter trial in which patients at high risk for suicide are recruited to test emma, an app designed to be used as a self-help tool for suicidal crisis management. Participants undergo clinical assessment at months 0, 1, 3, and 6 after inclusion, mainly to assess and characterize the presence of mental disorders and suicidal thoughts and behaviors. Patient recruitment is still ongoing. Some data from the first 14 participants who already completed the 6-month follow-up were selected for this case report study, which evaluated the following: (1) data collected by emma (ie, responses to EMAs), (2) metadata on emma use, (3) clinical data, and (4) qualitative assessment of the participants' experiences.ResultsEMA completion rates were extremely heterogeneous with a sharp decrease over time. The completion rates of the weekly EMAs (25%-87%) were higher than those of the daily EMAs (0%-53%). Most patients (10/14, 71%) answered the EMA questionnaires spontaneously. Similarly, the use of the Safety Plan Modules was very heterogeneous (2-75 times). Specifically, 11 patients out of 14 (79%) used the Call Module (1-29 times), which was designed by our team to help them get in touch with health care professionals and/or relatives during a crisis. The diversity of patient profiles and use of the EMA and EMI modules proposed by emma were highlighted by three case reports.ConclusionsThese preliminary results indicate that patients have different clinical and digital profiles and needs that require a highly scalable, interactive, and customizable app. They also suggest that it is possible and acceptable to collect longitudinal, fine-grained, contextualized data (ie, EMA) and to offer personalized intervention (ie, EMI) in real time to people at high risk of suicide. To become a complementary tool for suicide prevention, emma should be integrated into existing emergency procedures.Trial RegistrationClinicalTrials.gov NCT03410381; https://clinicaltrials.gov/ct2/show/NCT03410381
Highlights
ContextAccording to the World Health Organization (WHO), suicide is the cause of 1 million deaths per year, accounting for nearly 2% of all deaths worldwide; this number should increase to 1.5 million by 2021
To become a complementary tool for suicide prevention, emma should be integrated into existing emergency procedures
Baseline Assessment From May 2018 to March 2019, participation in the Ecological Mental Momentary Assessment (EMMA) study was proposed to 43 patients at risk for suicide who were admitted to the ED or hospitalized in a postemergency department; 38 (88%) agreed to participate
Summary
ContextAccording to the World Health Organization (WHO), suicide is the cause of 1 million deaths per year, accounting for nearly 2% of all deaths worldwide; this number should increase to 1.5 million by 2021. People at risk of suicide often do not seek help and do not remain connected to the health service after an attempt [8]. It is reported that less than half of patients at risk of suicide are in contact with the health system, including mental health services [10]. Many suicide risk factors have been identified, but traditional clinical methods do not allow for the accurate prediction of suicide behaviors. To face this challenge, emma, an app for ecological momentary assessment (EMA), ecological momentary intervention (EMI), and prediction of suicide risk in high-risk patients, was developed
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