NIMH funds Micro-randomized Trial to Reduce Suicide Risk

Emergency Departments (EDs) are a critical point for initiating suicide prevention interventions, often serving as the only clinical contact for individuals at risk for suicide. But EDs often lack adequate resources to offer interventions consistently and with fidelity. Led by Dr. Ewa Czyz of Michigan Medicine Psychiatry, an exploratory research project will leverage d3center methods to design a just-in-time adaptive intervention to improve continuity of care by supporting post-discharge coping strategy and safety plan use.

The project, funded by the National Institute of Mental Health, involves the development and pilot testing of an ED-initiated intervention package that includes an Electronic Safety Plan (ESP) and an adaptive text-based support system. This multi-component approach aims to provide personalized, scalable, and resource-efficient support during the vulnerable post-discharge period. 

The intervention is set to be trialed with 120 adults who present to the ED due to suicide-related concerns, with participants being randomly assigned to receive either the ESP alone or the ESP in conjunction with the text-based support program for one month post-discharge. 

The combined ESP and text-based support condition of the study is particularly innovative, featuring an embedded micro-randomized trial (MRT) designed by Center Director Dr. Inbal Billie Nahum-Shani. The MRT will optimize the intervention’s effectiveness by tailoring the frequency, timing, and content of the support messages, allowing researchers to refine a just-in-time adaptive intervention (JITAI) aimed at reducing suicidal behavior effectively.

Initial follow-ups will be conducted at 1 and 3 months post-discharge, with additional assessments occurring twice daily during the first month. These follow-ups will evaluate the feasibility, acceptability, and preliminary impact of the intervention on key outcomes such as coping self-efficacy, motivation for safety plan usage, and severity of suicidal ideation.

The project’s impact will be strengthened by input from stakeholders on future implementation and the integration with existing health system technologies. This collaboration between the d3center and Michigan Medicine exemplifies the potential for Center methods to have a significant public health impact, opening the door to improved outcomes in suicide prevention at a national scale.