Dimeff Linda A, Jobes David A, Koerner Kelly, Kako Nadia, Jerome Topher, Kelley-Brimer Angela, Boudreaux Edwin D, Beadnell Blair, Goering Paul, Witterholt Suzanne, Melin Gabrielle, Samike Vicki, Schak Kathryn M
Evidence Based Practice Institute, Inc, Seattle, WA, United States.
The Catholic University of America, Washington, DC, United States.
JMIR Ment Health. 2021 Mar 1;8(3):e23022. doi: 10.2196/23022.
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.
This study aims to evaluate the feasibility, acceptability, and effectiveness of Jaspr Health among suicidal adults in EDs.
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.
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.
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.
ClinicalTrials.gov NCT03584386; https://clinicaltrials.gov/ct2/show/NCT03584386.
急诊科有潜力为急性自杀倾向患者提供基于证据的自杀预防措施。然而，很少有急诊科有足够的时间和人力资源来提供推荐的基于证据的评估和干预措施。为了提高急诊科中自杀倾向患者并寻求精神科危机服务的临床护理标准，我们开发了Jaspr Health，这是一款供此类患者直接使用的平板电脑应用程序，可提供4种基于证据的措施。
本研究旨在评估Jaspr Health在急诊科有自杀倾向成年人中的可行性、可接受性和有效性。
急性自杀倾向且寻求精神科危机服务的患者在急诊科时参与了一项非盲法试点随机对照试验。参与者被随机分配到Jaspr Health组（n = 14）或常规护理组（对照组；n = 17）。在基线时对参与者进行评估，并在2小时后使用自我报告测量方法和半结构化访谈进行测试。
在基线时，两组在年龄方面存在显著差异，但在其他人口统计学变量或基线测量方面无差异。平均而言，参与者在参加研究前已在急诊科待了17小时。在他们的一生中，84%（26/31）的样本有过自杀未遂经历（平均3.4次，标准差6.4次），61%（19/31）有过非自杀性自伤行为，在过去3个月中平均发生率为8.8次。所有既定的可行性和可接受性标准均得到满足：未发生不良事件，参与者对应用程序的使用率很高，Jaspr Health应用程序用户满意度评分很高，所有使用Jaspr Health的参与者都推荐将其用于其他有自杀倾向的急诊科患者。研究条件之间的比较为该应用程序的有效性提供了初步支持：使用Jaspr Health的参与者报告说，接受4种基于证据的自杀预防干预措施以及对急诊科体验的总体满意度评分在统计学上有显著提高。此外，与接受常规护理的参与者相比，使用Jaspr Health的参与者在痛苦和激动情绪方面显著降低，同时在学习更有效地应对当前和未来自杀念头方面显著提高。
即使统计效力有限，结果表明Jaspr Health对于急性自杀倾向且寻求基于急诊科的精神科危机服务的急诊科患者来说是可行的、可接受的且具有临床有效性。
ClinicalTrials.gov NCT03584386；https://clinicaltrials.gov/ct2/show/NCT03584386。
