Quality and Contents of Self-Guided Adolescent Suicide Safety Plans

Safety planning interventions (SPIs) may prevent suicidal behavior among adolescents, but many adolescents in need do not receive an SPI. Self-guided digital SPIs could reach many vulnerable youth, but the quality of adolescents' self-produced digital safety plans is unknown.

In this longitudinal study, we analyzed 180 safety plans created using a novel SPI web-application by adolescents aged 13-18 (53% non-Hispanic white, 61% women) with past-year suicidal thoughts or behaviors. We rated safety plan quality and completeness using a validated scoring system, and participants reported safety plan usage at one-month follow-up.

Of all safety plans, 78% were rated as at least "Satisfactory." Adolescents' safety plans were mostly complete, with an average completeness score of 15.32 out of 19 (SD = 2.85). Safety plan quality was moderate, with an average quality score of 10.47 out of 18 (SD = 2.02). Safety plan scores did not differ significantly by participant age. At one-month follow-up, 33% of participants reported having used their safety plan. Adolescents whose safety plans were more complete were more likely to use their plan (OR = 1.26, p < .01), but quality and global impression did not predict use. Of those who used their safety plan, 93% said it was at least "somewhat" helpful. Safety plan scores did not predict adolescent-rated plan helpfulness.

Adolescents can use self-guided SPIs to create satisfactory safety plans without clinician guidance. Larger-scale testing of such tools is warranted, including to better understand associations between safety plan characteristics and suicide-relevant outcomes.