Adaptive intervention for prevention of adolescent suicidal behavior after hospitalization: a pilot sequential...

Area of Science:

• Psychiatry
• Clinical Psychology
• Digital Health

Background:

• Adolescent suicide risk after hospitalization requires personalized interventions.
• Adaptive interventions (AIs) offer a tailored approach to managing varying postdischarge suicide risk.
• A pilot Sequential, Multiple Assignment, Randomized Trial (SMART) was conducted to inform AI development for this population.

Purpose of the Study:

• To guide the development of an adaptive intervention (AI) for adolescent suicide risk post-hospitalization.
• To evaluate the feasibility and acceptability of a SMART design in this population.
• To assess the preliminary efficacy of different intervention components.

Main Methods:

• Eighty adolescent inpatients (ages 13-17) were randomized in Phase 1 to Motivational Interview-Enhanced Safety Plan (MI-SP) alone or with postdischarge text support (Texts).
• In Phase 2, participants were re-randomized to receive telephone booster calls or no calls.
• Mechanisms of change were assessed via daily diaries and 1- and 3-month follow-ups.

Main Results:

• Procedures were feasible and acceptable.
• Adolescents receiving MI-SP + Texts showed significant improvements in safety plan use, self-efficacy, and coping.
• Exploratory analyses suggested a reduced risk of suicide attempts and suicidal behavior with MI-SP + Texts, though booster calls had a less consistent impact.

Conclusions:

• The SMART trial was feasible and acceptable for informing an AI for suicidal adolescents.
• Postdischarge text-based support is a promising augmentation to in-hospital safety planning.
• Further study is warranted to refine AI for adolescent suicide risk.