JMIR Publications

ABSTRACT

Background:

Individuals at high risk for suicide are phenomenologically heterogeneous, yet most evidence-based interventions deliver the same content to everyone. Dialectical behavior therapy (DBT) is effective but lengthy, in part because every patient receives the full skills curriculum regardless of which skills address their own drivers of risk. PeRsonalizEd Clinical Intervention for Suicidal Events (PRECISE) uses idiographic models derived from each participant’s ecological momentary assessment (EMA) data to identify and teach only the DBT skills most relevant to that individual, allowing treatment to be delivered in six weeks.

Objective:

This study aimed to evaluate the feasibility, acceptability, and preliminary impact of PRECISE on suicidal thoughts and behaviors (STBs), depressive and anxiety symptoms, and related secondary outcomes.

Methods:

Thirty young adults (ages 18–26) with active STBs, recruited from a university and the surrounding community, enrolled in a six-week course of PRECISE alongside five times per day EMA in a single-arm open trial. STBs were assessed at baseline, 6 weeks, and 12 weeks using the Columbia-Suicide Severity Rating Scale (CSSRS) and the Modified Scale for Suicidal Ideation (MSSI); depressive and anxiety symptoms (PROMIS), coping self-efficacy (CSES), and emotion regulation strategy use (CERQ) were also assessed. Bayesian multilevel models with participant-level random intercepts estimated change over time.

Results:

Retention was 93% (28/30) at 6 weeks and 87% (26/30) at 12 weeks. Participants attended a mean of 5.4 of 6 coaching sessions and rated the intervention as highly acceptable (AIM: M = 17.2), appropriate (IAM: M = 16.9), and feasible (FIM: M = 17.2; each out of 20). From baseline to 12 weeks, suicidal ideation declined on both measures (CSSRS: −2.28 points, 95% CrI [−2.75, −1.81]; MSSI: −5.38 points, 95% CrI [−8.21, −2.53]; probability of direction [pd] ≥ 99.99%). Depressive symptoms (−6.51 T-score points, 95% CrI [−8.60, −4.38]) and anxiety symptoms (−3.60, 95% CrI [−5.70, −1.50]) also declined, and coping self-efficacy increased (+29.30 points, 95% CrI [18.21, 40.50]; all pd ≥ 99.95%). Maladaptive emotion regulation strategy use showed a smaller, less certain decline (−3.20 points, 95% CrI [−6.42, 0.03]; pd = 97.36%), and adaptive strategy use showed no credible change (0.97 points, 95% CrI [−3.75, 5.63]). No serious adverse events or suicide attempts occurred; 11 mild episodes of non-suicidal self-injury were reported by 5 participants.

Conclusions:

In this open trial, a brief intervention that personalizes DBT skills using participants' own idiographic EMA data was feasible, acceptable, and associated with clinically meaningful and sustained reductions in STBs, psychiatric symptoms, and maladaptive coping skills as well as improvements in coping self-efficacy. Pending further confirmatory testing, PRECISE may be a useful suicide prevention approach. Clinical Trial: ClinicalTrials.gov NCT07749391