Czyz Ewa K, Arango Alejandra, Healy Nathaniel, King Cheryl A, Walton Maureen
Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.
Department of Psychology, University of Houston, Houston, TX, United States.
JMIR Ment Health. 2020 May 25;7(5):e17345. doi: 10.2196/17345.
Suicide is the second leading cause of death among adolescents. A critical need exists for developing promising interventions for adolescents after psychiatric hospitalization who are at a high risk of experiencing repeated suicidal behaviors and related crises. The high-risk period following psychiatric hospitalization calls for cost-effective and scalable continuity of care approaches to support adolescents' transition from inpatient care. Text messages have been used to improve a wide range of behavioral and health outcomes and may hold promise as an accessible continuity of care strategy for youth at risk of suicide.
In this study of 40 adolescents at elevated suicide risk, we report on the iterative development and acceptability of a text-based intervention designed to encourage adaptive coping and safety plan adherence in the high-risk period following psychiatric hospitalization.
Adolescents (aged 13-17 years) who were hospitalized because of last-month suicide attempts or last-week suicidal ideation took part in either study phase 1 (n=25; 19/25, 76% female), wherein message content was developed and revised on the basis of feedback obtained during hospitalization, or study phase 2 (n=15; 11/15, 73% female), wherein text messages informed by phase 1 were further tested and refined based on feedback obtained daily over the course of a month after discharge (n=256 observations) and during an end-of-study phone interview.
Quantitative and qualitative feedback across the 2 study phases pointed to the acceptability of text-based support. Messages were seen as having the potential to be helpful with the transition after hospitalization, with adolescents indicating that texts may serve as reminders to use coping strategies, contribute to improvement in mood, and provide them with a sense of encouragement and hope. At the same time, some adolescents expressed concerns that messages may be insufficient for all teens or circumstances. In phase 2, the passage of time did not influence adolescents' perception of messages in the month after discharge (P=.74); however, there were notable daily level associations between the perception of messages and adolescents' affect. Specifically, higher within-person (relative to adolescents' own average) anger was negatively related to liking text messages (P=.005), whereas within-person positive affect was associated with the perception of messages as more helpful (P=.04).
Text-based support appears to be an acceptable continuity of care strategy to support adolescents' transition after hospitalization. The implications of study findings are discussed. Future work is needed to evaluate the impact of text-based interventions on suicide-related outcomes.
自杀是青少年死亡的第二大主要原因。对于那些在精神病住院后有反复自杀行为和相关危机高风险的青少年，迫切需要开发有前景的干预措施。精神病住院后的高风险期需要具有成本效益且可扩展的持续护理方法，以支持青少年从住院护理过渡。短信已被用于改善广泛的行为和健康结果，对于有自杀风险的青少年来说，可能有望成为一种易于获得的持续护理策略。
在这项针对40名自杀风险较高的青少年的研究中，我们报告了一种基于短信的干预措施的迭代开发过程及其可接受性，该干预措施旨在鼓励在精神病住院后的高风险期进行适应性应对并坚持安全计划。
因上个月有自杀未遂或上周有自杀意念而住院的青少年（年龄在13 - 17岁之间）参与了研究的第1阶段（n = 25；19/25，76%为女性），在该阶段，根据住院期间获得的反馈来制定和修订短信内容；或者参与研究的第2阶段（n = 15；11/15，73%为女性），在该阶段，根据第1阶段的短信内容，在出院后的一个月内（n = 256次观察）以及在研究结束时的电话访谈中，根据每天获得的反馈进一步测试和完善短信内容。
两个研究阶段的定量和定性反馈都表明了基于短信的支持的可接受性。短信被认为有可能有助于住院后的过渡，青少年表示短信可以作为使用应对策略的提醒，有助于改善情绪，并给他们带来鼓励和希望的感觉。同时，一些青少年担心短信对所有青少年或所有情况可能不够充分。在第2阶段，时间的推移在出院后的一个月内并未影响青少年对短信的看法（P = 0.74）；然而，短信看法与青少年情绪之间存在显著的每日水平关联。具体而言，个体内部（相对于青少年自身平均水平）较高的愤怒与对短信的喜爱呈负相关（P = 0.005），而个体内部的积极情绪与认为短信更有帮助的看法相关联（P = 0.04）。
基于短信的支持似乎是一种可接受的持续护理策略，以支持青少年住院后的过渡。讨论了研究结果的意义。未来需要开展工作来评估基于短信的干预措施对自杀相关结果的影响。
