(PS13-3) Just-in-time Intervention for Promoting Adaptive Coping Strategy Use for Suicidal Thoughts: Results from a Pilot Micro-randomized Trial

There is currently a deficit of scalable, effective interventions for patients during the highest-risk time for suicide – the month after inpatient psychiatric hospitalization. Developing a stepwise, personalized list of coping strategies to use in suicidal crises (“safety planning”) is an effective intervention for reducing the risk of suicidal behavior (e.g., Nuij et al., 2021). However, up to 60% of patients who develop a safety plan while hospitalized do not use it post-discharge (Leonard et al., 2021). This presents an opportunity to optimize the promotion of coping strategy use when it is most needed most post-hospitalization. Leveraging mobile devices to promote in-the-moment coping strategy use through just-in-time adaptive intervention (JITAI) approaches may address this need. The current project aims to use a micro-randomized trial (MRT) design to evaluate the effects of automated, just-in-time, smartphone-based recommendations of adaptive coping strategies when experiencing suicidal thoughts. Participants were asked to complete six brief smartphone surveys per day that assessed suicidal urge and intent during hospitalization and 28 days after. After discharge, when a participant reported high-intensity suicidal urge or moderate intent, but not deemed to be high-risk, they were randomized to immediately receive either a series of automated interactive messages recommending the use of specific coping strategies or no intervention. The coping strategies presented were either personalized (from the participant’s safety plan developed in the hospital) or general (the most common strategies coded from others’ safety plans). Brief follow-up surveys sent 15 minutes post-randomization assessed coping strategy use, suicidal urge, and intent. Seventy-five adults hospitalized for suicidal thoughts or behaviors in one of two Boston-based hospitals were recently enrolled in this MRT. Of these, 37 (49.3%) were randomized at least once into the intervention. Risk ratio models were used to compare proximal outcomes following intervention versus no intervention, averaged across both people and time. Results from preliminary analyses (n=14 randomized at least once) show that the likelihood of reporting the use of a coping strategy was higher (RR: 0.335, 95% CI: 0.081-0.589) after receiving any vs. no intervention. Intensity of suicidal intent was also lower after receiving any vs. no intervention (RR: -0.447, 95% CI: -0.889 - -0.005). Final results will include exploratory analyses comparing the effects of general vs. personalized coping strategy recommendations on strategy use and proximal suicidal urge and intent, as well as contextual moderators of intervention efficacy. Interim findings suggest that automated, interactive, just-in-time smartphone messages that recommend the use of coping strategies at elevated suicidal thoughts may increase in-the-moment coping strategy use and be associated with proximal lowered suicidal intent. Given the urgent need for scalable, effective interventions to reduce suicide risk over short, high-risk periods, such as after psychiatric hospitalization, studies that provide foundational guidance for future JITAIs are crucial.