Smartphone-Based Safety Planning and Self-Monitoring for Suicidal Patients: A Conceptual Basis for the CASPAR (Continuous Assessment for Suicide Prevention and Research) Study

Abstract

Suicidal behaviour remains difficult to predict and prevent, even for experienced mental health care professionals. The known distal risk factors for suicidal behaviour are not sufficiently specific to fully understand the complex dynamic processes that precede a suicide attempt. Realtime mobile monitoring data can be used to analyse proximal risk mechanisms within the suicidal process. At the same time smartphone-based safety planning and self-monitoring may enhance a patient's self-management skills thereby increasing their capacity to respond to a suicidal crisis and to become more aware of crisis symptoms. The current paper describes the theoretical and conceptual rationale for the CASPAR study which applies an innovative approach to the study of suicidal processes. It uses basic science approaches to inform the implementation of an innovative suicide prevention intervention. We aim to develop and implement mobile safety plan in conjunction with real-time monitoring in order to both directly implement suicide prevention interventions and to study the ongoing dynamics of individual suicidal behaviour by applying network analysis.

Youth Codesign of a Mobile Phone App to Facilitate Self-Monitoring and Management of Mood Symptoms in Young People With Major Depression, Suicidal Ideation, and Self-Harm

“…There are a large number of existing apps that monitor mood, although with a few notable exceptions [ 9 , 10 , 51 , 52 ], these have not been subject to research on their efficacy and safety, which has been highlighted as a major limitation of most apps that provide interventions for mental health issues [ 49 , 53 ]. Also emerging on the market are suicide prevention apps [ 54 , 55 ], particularly those that make Stanley and Brown’s safety planning intervention [ 56 ] available via an app [ 57 , 58 ]. A suite of recommendations are appearing with regard to the features that suicide prevention apps should include [ 57 ].…”

Association between suicidal symptoms and repeat suicidal behaviour within a sample of hospital-treated suicide attempters

“…The previously mentioned Dutch smartphone-based study is expected to offer first insights of the applicability of individual networks and centrality analysis during therapy. Results are expected around 2019 29 …”

“…The concept of a network of symptoms can also be used during treatment as a form of psychoeducation, to explain to the patient how suicidal behaviour can develop. Finally, in The Netherlands, an innovative study is starting that allows patients to collect such data via their smartphone 29 . The aim of this study is to provide patients with an individual network of relevant symptoms that can be shared with the therapist on a weekly basis, allowing more tailored treatment possible.…”

“…Results are expected around 2019. 29 In addition, although the SSI is the most widely used scale for suicidal thoughts and behaviour, it has many flaws, such as having an inadequate 3-point response set. 25 Other weaknesses in the SSI were identified by de Beurs et al 13 Operationalising the outcome variable is also not without its challenges; indeed, a recorded suicide attempt resulting in a hospital presentation is far from perfect.…”

Symptoms of a feather flock together; Dynamic time warp analysis of 11 single case time series of suicide ideation and related symptoms

“…The data used in this study were collected as part of the CASPAR study between March 2019 and March 2020 (Nuij et al, 2017). CASPAR aimed to test the feasibility of smartphone-based EMA and a mobile safety plan as components of routine treatment for depressed outpatients at risk of suicide.…”