Bruen Ashley Jane, Wall Abbie, Haines-Delmont Alina, Perkins Elizabeth
Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom.
Department of Nursing, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom.
JMIR Ment Health. 2020 Sep 28;7(9):e18407. doi: 10.2196/18407.
Suicide is a growing global public health problem that has resulted in an increase in the demand for psychological services to address mental health issues. It is expected that 1 in 6 people on a waiting list for mental health services will attempt suicide. Although suicidal ideation has been shown to be linked to a higher risk of death by suicide, not everybody openly discloses their suicidal thoughts or plans to friends and family or seeks professional help before suicide. Therefore, new methods are needed to track suicide risk in real time together with a better understanding of the ways in which people communicate or express their suicidality. Considering the dynamic nature and challenges in understanding suicide ideation and suicide risk, mobile apps could be better suited to prevent suicide as they have the ability to collect real-time data.
This study aims to report the practicalities and acceptability of setting up and trialing digital technologies within an inpatient mental health setting in the United Kingdom and highlight their implications for future studies.
Service users were recruited from 6 inpatient wards in the north west of England. Service users who were eligible to participate and provided consent were given an iPhone and Fitbit for 7 days and were asked to interact with a novel phone app, Strength Within Me (SWiM). Interaction with the app involved journaling (recording daily activities, how this made them feel, and rating their mood) and the option to create safety plans for emotions causing difficulties (identifying strategies that helped with these emotions). Participants also had the option to allow the study to access their personal Facebook account to monitor their social media use and activity. In addition, clinical data (ie, assessments conducted by trained researchers targeting suicidality, depression, and sleep) were also collected.
Overall, 43.0% (80/186 response rate) of eligible participants were recruited for the study. Of the total sample, 67 participants engaged in journaling, with the average number of entries per user being 8.2 (SD 8.7). Overall, only 24 participants created safety plans and the most common difficult emotion to be selected was feeling sad (n=21). This study reports on the engagement with the SWiM app, the technical difficulties the research team faced, the importance of building key relationships, and the implications of using Facebook as a source to detect suicidality.
To develop interventions that can be delivered in a timely manner, prediction of suicidality must be given priority. This paper has raised important issues and highlighted lessons learned from implementing a novel mobile app to detect the risk of suicidality for service users in an inpatient setting.
自杀是一个日益严重的全球公共卫生问题，导致对解决心理健康问题的心理服务需求增加。预计在心理健康服务等候名单上的每6人中就有1人会尝试自杀。虽然自杀意念已被证明与更高的自杀死亡风险相关，但并非每个人都会向朋友和家人公开透露自己的自杀想法或计划，也不会在自杀前寻求专业帮助。因此，需要新的方法来实时追踪自杀风险，并更好地理解人们交流或表达自杀倾向的方式。考虑到理解自杀意念和自杀风险的动态性质及挑战，移动应用程序可能更适合预防自杀，因为它们有能力收集实时数据。
本研究旨在报告在英国住院心理健康环境中建立和试用数字技术的实际情况和可接受性，并强调其对未来研究的影响。
从英格兰西北部的6个住院病房招募服务使用者。符合参与条件并提供同意的服务使用者被给予一部iPhone和一个Fitbit，为期7天，并被要求与一款新颖的手机应用程序“我内心的力量”（SWiM）进行互动。与该应用程序的互动包括写日记（记录日常活动、感受以及对情绪进行评分），以及为导致困扰的情绪制定安全计划（确定有助于应对这些情绪的策略）的选项。参与者还可以选择允许研究访问他们的个人Facebook账户，以监测他们的社交媒体使用情况和活动。此外，还收集了临床数据（即由训练有素的研究人员针对自杀倾向、抑郁和睡眠进行的评估）。
总体而言，43.0%（80/186的回复率）符合条件的参与者被招募参加该研究。在总样本中，67名参与者写了日记，每位用户的平均日记条目数为8.2（标准差8.7）。总体而言，只有24名参与者制定了安全计划，最常被选择的困扰情绪是感到悲伤（n = 21）。本研究报告了对SWiM应用程序的参与情况、研究团队面临的技术困难、建立关键关系的重要性以及将Facebook用作检测自杀倾向来源的影响。
为了开发能够及时提供的干预措施，必须优先预测自杀倾向。本文提出了重要问题，并强调了在住院环境中为服务使用者实施一款新颖的移动应用程序以检测自杀倾向风险所吸取的经验教训。
