Department of Psychiatry, Stein Institute for Research on Aging, University of California San Diego.
VA San Diego Healthcare System.
Psychiatr Rehabil J. 2023 Mar;46(1):74-82. doi: 10.1037/prj0000547.
People with serious mental illnesses (SMIs) are at high risk for suicidal ideation and behavior, and yet few suicide prevention interventions have been customized for this group. We describe the outcomes of a pilot trial of Mobile SafeTy And Recovery Therapy (mSTART), a four-session suicide-focused cognitive behavioral intervention for SMI, designed for the transition from acute to outpatient care and augmented with ecological momentary intervention to reinforce intervention content.
The primary objective of this pilot trial was to evaluate the feasibility, acceptability, and preliminary effectiveness of START. Seventy-eight people with SMI and elevated suicidal ideation were randomized to either: (a) mSTART or (b) START alone (i.e., without mobile augmentation). Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of mobile intervention), and 24 weeks. The primary outcome of the study was change in suicidal ideation severity. Secondary outcomes included psychiatric symptoms, coping self-efficacy, and hopelessness.
A total of 27% of randomized persons were lost to follow-up after baseline, and engagement with mobile augmentation was variable. There was clinically significant improvement (d = 0.86) in suicidal ideation severity scores sustained over 24 weeks, with similar effects seen for secondary outcomes. Preliminary comparison indicated a medium effect size (d = 0.48) advantage at 24 weeks of mobile augmentation in suicidal ideation severity scores. Treatment credibility and satisfaction scores were high.
START, regardless of mobile augmentation, was associated with sustained improvement in suicidal ideation severity and secondary outcomes in people with SMI at-risk for suicide in this pilot trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
患有严重精神疾病（SMI）的人有很高的自杀意念和行为风险，但很少有预防自杀的干预措施针对这一群体。我们描述了一项针对 Mobile SafeTy And Recovery Therapy（mSTART）的试点试验结果，mSTART 是一种针对 SMI 的四节自杀焦点认知行为干预，旨在从急性护理过渡到门诊护理，并通过生态瞬间干预来增强干预内容。
该试点试验的主要目的是评估 START 的可行性、可接受性和初步效果。78 名患有 SMI 和自杀意念升高的患者被随机分为以下两组：（a）mSTART 或（b）仅接受 START（即没有移动增强）。参与者在基线、4 周（面对面课程结束时）、12 周（移动干预结束时）和 24 周进行评估。研究的主要结果是自杀意念严重程度的变化。次要结果包括精神病症状、应对自我效能感和绝望感。
共有 27%的随机患者在基线后失访，移动增强的参与情况各不相同。自杀意念严重程度评分在 24 周内持续改善（d = 0.86），次要结果也有类似的效果。初步比较表明，在 24 周时，移动增强组在自杀意念严重程度评分方面具有中等效应大小（d = 0.48）的优势。治疗可信度和满意度评分很高。
在这项试点试验中，无论是否进行移动增强，START 都与 SMI 患者自杀风险的自杀意念严重程度和次要结果的持续改善相关。
