The Role of Technology and the Continuum of Care for Youth Suicidality: Systematic Review

Abstract

Background Youth suicide is a global public health issue, and using technology is one strategy to increase participation in preventive interventions. However, there is minimal knowledge on how technology-enhanced interventions for youth correspond to the stages of care, from illness or risk recognition to treatment follow-up. Objective This systematic review aims to examine the efficacy of technology-enhanced youth suicide prevention and interventions across the continuum of care. Methods Four electronic databases were searched up to spring 2019 for youth suicide preventive interventions that used technology. The review was not restricted by study design and eligible studies could report outcomes on suicidality or related behaviors, such as formal treatment initiation. An adapted version of the Methodological Quality Ratings Scale was used to assess study quality. Results A total of 26 studies were identified. The findings support the emerging efficacy of technology-enhanced interventions, including a decline in suicidality and an increase in proactive behaviors. However, evidence suggests that there are gaps in the continuum of care and recent study samples do not represent the diverse identities of vulnerable youth. Conclusions The majority of identified studies were conducted in school settings and were universal interventions that aligned with the illness and risk recognition and help-seeking stages of the continuum of care. This field could be strengthened by having future studies target the stages of assessment and treatment initiation, include diverse youth demographics, and examine the varying roles of providers and technological components in emerging interventions.

Technological and Digital Interventions for Mental Health and Wellbeing: An Overview of Systematic Reviews

“…Digital programs were explored in combination with a wide variety of interventions, for example with preventive interventions in the context of technology-enhanced youth suicide prevention and interventions ( 30 ). Others were combined with measurement and follow-up , using digital interventions for routine outcome monitoring (ROM) and measurement-based care (MBC), the routine use of outcome measurement to guide treatment decisions of patients receiving face-to-face psychotherapy ( 31 ).…”

Stakeholder perspectives on digital behavioral health applications targeting adolescent depression and suicidality: Policymaker, provider, and community insights

“…Yet adolescents who answered "no response" (neither yes or no) on a tablet suicide screener were almost as likely to have clinically significant risk (84.5%) compared to those who answered "yes" to the screener (93.4%), but were less ready to engage in mental health treatment (Hengehold et al, 2019). Technology interventions-especially in settings where mental health symptoms are being discussed for the very first time, like in primary care or in schools-may additionally help ease concerns about readiness for treatment through the promotion of symptom normalization, antistigma messaging, and additional assessment (Szlyk & Tan, 2020).…”

“…Careful incorporation of iterative stakeholder feedback into implementation strategies may decrease barriers to technology use for adolescent mental health interventions ( Montague et al, 2015 ; Newton et al, 2020 ). Improving fit between needs of patients, parents, and providers, and technical features or requirements can provide key solutions for enhanced delivery of effective behavioral health ( Montague et al, 2015 ; van Gemert-Pijnen et al, 2011 ).…”

“…It is important to iteratively engage multiple types of stakeholders in all stages of development processes and create a conduit between stakeholder feedback and researchers. Stakeholder feedback can elucidate perceptions about deficits in the current system, and initial barriers to the implementation or use of interventions ( van Gemert-Pijnen et al, 2011 ), helping researchers troubleshoot challenges earlier, saving time and money. Given that the Center supports several studies with their own recruitment of individual patients, providers, and parents (or other caregivers), to determine specific usability of interventions, we developed a network of multiple stakeholder constituencies representing these specific groups as well as policy-level stakeholders.…”

Innovating Technology-Enhanced Interventions for Youth Suicide: Insights for Measuring Implementation Outcomes

“…In this review, we incorporate work from implementation science (Proctor et al, 2010(Proctor et al, , 2011 and BIT implementation (Wozney et al, 2018;Hermes et al, 2019) to illustrate how the study of technology-enhanced interventions for youth suicide can be advanced by specifying the role of technology and measuring diverse outcomes that take into account the unique features of this implementation context. Examples are drawn from 12 RCTs that were identified as part of a larger systematic review focused on the efficacy and effectiveness outcomes of technologyenhanced suicide interventions for youth (Szlyk and Tan, 2020). The 12 international studies represent interventions conducted over the last 19 years that span common place-based settings for youth (e.g., schools, hospital, clinics) and include online platforms as the treatment setting.…”