As safe as possible (ASAP): A brief app-supported inpatient intervention to prevent postdischarge suicidal behavior in Hospitalized, Suicidal Adolescents

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

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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%; x2=1.86, df=1, g=20.36) 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.

Original languageEnglish (US)
Pages (from-to)864-872
Number of pages9
JournalAmerican Journal of Psychiatry
Volume175
Issue number9
DOIs
StatePublished - Sep 2018

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ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Kennard, B. D., Goldstein, T., Foxwell, A. A., McMakin, D. L., Wolfe, K., Biernesser, C., Moorehead, A., Douaihy, A., Zullo, L., Wentroble, E., Owen, V., Zelazny, J., Iyengar, S., Porta, G., & Brent, D. (2018). As safe as possible (ASAP): A brief app-supported inpatient intervention to prevent postdischarge suicidal behavior in Hospitalized, Suicidal Adolescents. American Journal of Psychiatry, 175(9), 864-872. https://doi.org/10.1176/appi.ajp.2018.17101151