Using a Tablet-Based App to Deliver Evidence-Based Practices for Suicidal Patients in the Emergency Department: Pilot Randomized Controlled Trial

Abstract

Background Emergency departments (EDs) have the potential to provide evidence-based practices for suicide prevention to patients who are acutely suicidal. However, few EDs have adequate time and personnel resources to deliver recommended evidence-based assessment and interventions. To raise the clinical standard of care for patients who are suicidal and seeking psychiatric crisis services in the ED, we developed Jaspr Health, a tablet-based app for direct use by such patients, which enables the delivery of 4 evidence-based practices. Objective This study aims to evaluate the feasibility, acceptability, and effectiveness of Jaspr Health among suicidal adults in EDs. Methods Patients who were acutely suicidal and seeking psychiatric crisis services participated in an unblinded pilot randomized controlled trial while in the ED. Participants were randomly assigned to Jaspr Health (n=14) or care as usual (control; n=17) groups. Participants were assessed at baseline, and a 2-hour posttest using self-report measures and a semistructured interview were conducted. Results Conditions differed significantly at baseline with regard to age but not other demographic variables or baseline measures. On average, participants had been in the ED for 17 hours before enrolling in the study. Over their lifetime, 84% (26/31) of the sample had made a suicide attempt (mean 3.4, SD 6.4) and 61% (19/31) had engaged in nonsuicidal self-injurious behaviors, with an average rate of 8.8 times in the past 3 months. All established feasibility and acceptability criteria were met: no adverse events occurred, participants’ app use was high, Jaspr Health app user satisfaction ratings were high, and all participants using Jaspr Health recommended its use for other suicidal ED patients. Comparisons between study conditions provide preliminary support for the effectiveness of the app: participants using Jaspr Health reported a statistically significant increase in receiving 4 evidence-based suicide prevention interventions and overall satisfaction ratings with their ED experience. In addition, significant decreases in distress and agitation, along with significant increases in learning to cope more effectively with current and future suicidal thoughts, were observed among participants using Jaspr Health compared with those receiving care as usual. Conclusions Even with limited statistical power, the results showed that Jaspr Health is feasible, acceptable, and clinically effective for use by ED patients who are acutely suicidal and seeking ED-based psychiatric crisis services. Trial Registration ClinicalTrials.gov NCT03584386; https://clinicaltrials.gov/ct2/show/NCT03584386

The effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) compared to alternative treatment conditions: A meta‐analysis

“…To date, there have been a number of studies adding to the evidence base for CAMS, including randomized controlled trials (RCTs) with active controls (Andreasson et al, 2016;Comtois et al, 2011;Jobes et al, 2017;Johnson et al, 2019;O'Connor et al, 2012;Pistorello et al, 2020;Ryberg et al, 2019), naturalistic controlled trials (Ellis et al, 2015(Ellis et al, , 2017Jobes et al, 2005), uncontrolled descriptive studies (Ellis et al, 2012;Nielsen et al, 2011), and recent investigations of app-based deliveries of CAMS (Dimeff et al, 2018;Dimeff et al, 2021;O'Toole et al, 2019). These have included investigations conducted in a number of contexts, such as inpatient psychiatric hospitals (Ellis et al, 2012(Ellis et al, , 2015, military settings (Jobes et al, 2005(Jobes et al, , 2017, community mental health centers (Comtois et al, 2011;Nielsen et al, 2011), and emergency departments (Dimeff et al, 2018;Dimeff et al, 2021). Together, these studies also capture patients with presenting problems such as Borderline Personality Disorder (Andreasson et al, 2016), depression, anxiety, and traumarelated concerns (Ellis et al, 2017;Jobes et al, 2017).…”

“…All but one study (Dimeff et al, 2021) included outcome data on suicidal ideation. See Figure 2 for a forest plot diagram of the results.…”

“…Given that the Dimeff et al (2021) article did not include suicidal ideation data, it was not included in any of the moderator analyses. Four study variables (efficacy vs. effectiveness, study quality, CAMS originator as co-investigator, and outcome time point) were tested as moderators of the outcome effect on suicidal ideation (the primary outcome of this metaanalysis) between CAMS and the alternative interventions.…”

“…Researchers should also seek to incorporate repeated assessments of potential mechanisms of change (e.g., therapeutic alliance, increasing hope) in future studies, given that it is unclear the degree to which CAMS components individually contribute to enhanced treatment outcomes, which is also a concern with research on other suicide interventions (Fox et al, 2020); dismantling studies may also help clarify which components of CAMS are most effective in producing change. Last, compared to research evaluating individual formats of CAMS, less is known about the effectiveness of group (Johnson et al, 2019) and computerized (Dimeff et al, 2021) formats. Evaluating such alternative modalities that may optimize cost effectiveness could facilitate implementation and dissemination efforts while enhancing clinical outcomes.…”

Using the Delphi Method for Determining Key Performance Elements for Delivery of Optimal Suicide-Specific Interventions in Emergency Departments

“…The present study was undertaken as part of an ongoing research effort involving the development and evaluation of Jaspr Health (Dimeff et al, , 2021, an evidencebased suicide prevention digital platform designed for use by acutely suicidal patients seeking psychiatric crisis care in the ED. Grounded in David Jobes' Collaborative Assessment and Management of Suicidality (CAMS), Jaspr Health guides patients in completing a comprehensive suicide risk assessment and lethal means counseling, builds a crisis stabilization plan, and teaches behavioral skills to reduce imminent distress; video-recorded messages by PLEs offer wisdom and hope for getting through suicide crises.…”