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Randomized Controlled Trial
. 2018 Sep 1;175(9):864-872.
doi: 10.1176/appi.ajp.2018.17101151. Epub 2018 Jul 19.

As Safe as Possible (ASAP): A Brief App-Supported Inpatient Intervention to Prevent Postdischarge Suicidal Behavior in Hospitalized, Suicidal Adolescents

Betsy D Kennard  1 , Tina Goldstein  1 , Aleksandra A Foxwell  1 , Dana L McMakin  1 , Kristin Wolfe  1 , Candice Biernesser  1 , Alexandra Moorehead  1 , Antoine Douaihy  1 , Lucas Zullo  1 , Erin Wentroble  1 , Victoria Owen  1 , Jamie Zelazny  1 , Satish Iyengar  1 , Giovanna Porta  1 , David Brent  1
Affiliations
Randomized Controlled Trial

As Safe as Possible (ASAP): A Brief App-Supported Inpatient Intervention to Prevent Postdischarge Suicidal Behavior in Hospitalized, Suicidal Adolescents

Betsy D Kennard et al. Am J Psychiatry. .

Erratum in

Abstract

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%; χ2=1.86, df=1, g=-0.36) 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.

Trial registration: ClinicalTrials.gov NCT02272179.

Keywords: Adolescents; Inpatient Intervention; Phone Application; Suicide Prevention.

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Conflict of interest statement

The other authors report no conflict of interests or financial disclosures.

Figures

Figure 1
Figure 1. Consort Diagram
Consolidated Standards of Reporting Trials Diagram of Flow of Participants: Screening to Analysis
Figure 2
Figure 2
Phone App Examples
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Comment in

References

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