Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Understanding suicidal crises through digital safety plans in adolescents: a mixed-methods analysis embedded within the SmartCrisis-Teen study
ABSTRACT
Background:
Digital safety plans are increasingly used to support adolescents at risk of suicidal thoughts and behaviours (SITBs), yet little is known about how young people personalize these tools or how they conceptualize suicidal crises.
Objective:
This study aimed to characterize the content and use of a smartphone-based safety plan among adolescents with recent SITBs.
Methods:
This mixed-methods study was embedded within the multicentre SmartCrisis-Teen randomized clinical trial. Forty-four adolescents (13–17 years) with a recent suicide attempt or non-suicidal self-injury (NSSI) completed a personalized safety plan within the MEmind smartphone application. Open-ended responses across the seven safety plan domains, together with qualitative information on suicidal thoughts and behaviours, were analysed using conventional content analysis. Descriptive and exploratory quantitative analyses examined safety plan use during three months of follow-up.
Results:
Participants described suicidal experiences ranging from passive wishes to be dead to active suicide planning and preparatory behaviours. Cutting was the predominant form of NSSI, with a mean age at onset of 11.8 years. Childhood adversity was highly prevalent, and traumatic memories frequently reappeared as warning signs during suicidal crises, suggesting that childhood maltreatment may function not only as a distal risk factor but also as a proximal trigger. Most participants actively engaged with the safety plan, particularly the Reasons to live and External coping strategies sections. Safety plans were predominantly organized around interpersonal connectedness, behavioural coping strategies, and future-oriented motivations, with family and peers emerging as central protective resources.
Conclusions:
Adolescents conceptualize suicidal crises as experiences strongly shaped by interpersonal relationships, emotional distress, and behavioural coping. While the overall structure of the Safety Planning Intervention appears suitable for adolescents, its content should be developmentally tailored. These findings may inform the refinement of digital safety planning interventions for youth at high risk of suicidal behaviour.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.