Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.
ICM - Brain and Spine Institute, hôpital de la Pitié-Salpêtrière, Paris, France.
JMIR Mhealth Uhealth. 2020 Oct 9;8(10):e15741. doi: 10.2196/15741.
Many suicide risk factors have been identified, but traditional clinical methods do not allow for the accurate prediction of suicide behaviors. To face this challenge, emma, an app for ecological momentary assessment (EMA), ecological momentary intervention (EMI), and prediction of suicide risk in high-risk patients, was developed.
The aim of this case report study was to describe how subjects at high risk of suicide use the emma app in real-world conditions.
The Ecological Mental Momentary Assessment (EMMA) study is an ongoing, longitudinal, interventional, multicenter trial in which patients at high risk for suicide are recruited to test emma, an app designed to be used as a self-help tool for suicidal crisis management. Participants undergo clinical assessment at months 0, 1, 3, and 6 after inclusion, mainly to assess and characterize the presence of mental disorders and suicidal thoughts and behaviors. Patient recruitment is still ongoing. Some data from the first 14 participants who already completed the 6-month follow-up were selected for this case report study, which evaluated the following: (1) data collected by emma (ie, responses to EMAs), (2) metadata on emma use, (3) clinical data, and (4) qualitative assessment of the participants' experiences.
EMA completion rates were extremely heterogeneous with a sharp decrease over time. The completion rates of the weekly EMAs (25%-87%) were higher than those of the daily EMAs (0%-53%). Most patients (10/14, 71%) answered the EMA questionnaires spontaneously. Similarly, the use of the Safety Plan Modules was very heterogeneous (2-75 times). Specifically, 11 patients out of 14 (79%) used the Call Module (1-29 times), which was designed by our team to help them get in touch with health care professionals and/or relatives during a crisis. The diversity of patient profiles and use of the EMA and EMI modules proposed by emma were highlighted by three case reports.
These preliminary results indicate that patients have different clinical and digital profiles and needs that require a highly scalable, interactive, and customizable app. They also suggest that it is possible and acceptable to collect longitudinal, fine-grained, contextualized data (ie, EMA) and to offer personalized intervention (ie, EMI) in real time to people at high risk of suicide. To become a complementary tool for suicide prevention, emma should be integrated into existing emergency procedures.
ClinicalTrials.gov NCT03410381; https://clinicaltrials.gov/ct2/show/NCT03410381.
已经确定了许多自杀风险因素，但传统的临床方法无法准确预测自杀行为。为了应对这一挑战，开发了 emma 应用程序，用于进行生态瞬时评估（EMA）、生态瞬时干预（EMI）以及对高危患者的自杀风险进行预测。
本病例报告研究旨在描述处于自杀高危状态的患者在真实环境中如何使用 emma 应用程序。
生态心理瞬时评估（EMMA）研究是一项正在进行的、纵向的、干预性的、多中心试验，招募处于自杀高危状态的患者来测试 emma，这是一款旨在作为自杀危机管理自助工具的应用程序。参与者在纳入后第 0、1、3 和 6 个月进行临床评估，主要评估和描述精神障碍和自杀意念和行为的存在情况。患者招募仍在进行中。本病例报告研究选择了已经完成 6 个月随访的前 14 名参与者中的一些数据，评估了以下内容：（1）emma 收集的数据（即对 EMAs 的响应），（2）关于 emma 使用的元数据，（3）临床数据，（4）参与者体验的定性评估。
EMA 完成率差异极大，随着时间的推移急剧下降。每周 EMA（25%-87%）的完成率高于每日 EMA（0%-53%）。大多数患者（10/14，71%）自发回答 EMA 问卷。同样，安全计划模块的使用也非常多样化（2-75 次）。具体来说，14 名患者中的 11 名（79%）使用了我们团队设计的呼叫模块（1-29 次），以帮助他们在危机期间与医疗保健专业人员和/或亲属取得联系。三个病例报告突出了患者的不同临床和数字特征以及 emma 提出的 EMA 和 EMI 模块的使用。
这些初步结果表明，患者具有不同的临床和数字特征以及需求，这需要一个高度可扩展、互动和可定制的应用程序。它们还表明，对处于自杀高危状态的人实时收集纵向、细粒度、上下文相关数据（即 EMA）并提供个性化干预（即 EMI）是可能且可接受的。为了成为自杀预防的补充工具，emma 应该集成到现有的紧急程序中。
ClinicalTrials.gov NCT03410381；https://clinicaltrials.gov/ct2/show/NCT03410381。
