JMIR Publications

ABSTRACT

Background:

Suicide is the second leading cause of death among adolescents. A critical need exists for developing promising interventions for psychiatrically hospitalized adolescents who are at a high risk for repeated suicidal behavior and related crises. The high-risk period following psychiatric hospitalization calls for cost-effective and scalable continuity of care approaches to support adolescents’ transition from inpatient care. Text messages have been used to improve a wide range of behavioral and health outcomes and may hold promise as an accessible continuity of care strategy for youth at risk for suicide.

Objective:

In this study of 40 adolescents at elevated suicide risk, we report on the iterative development as well as acceptability of a text-based intervention designed to encourage adaptive coping and safety plan adherence in the high-risk period following psychiatric hospitalization.

Methods:

Adolescents (ages 13-17) who were hospitalized due to last-month suicide attempt and/or last-week suicidal ideation took part in either: study Phase 1 (N=25; 76% female), wherein message content was developed based on feedback obtained during hospitalization; or study Phase 2 (N=15; 73.3%), wherein text messages were tested and refined based on feedback obtained daily over the course of a month after discharge (n=256 observations) as well as during an end-of-study phone interview.

Results:

Quantitative and qualitative feedback across the two study phases pointed to the acceptability of text-based support. Messages were seen as having potential to be helpful with the transition after hospitalization, with adolescents indicating that texts may serve as reminders to use coping strategies as well as contribute to improvement in mood and provide adolescents with a sense of encouragement and hope. At the same time, some adolescents expressed concerns that messages may be insufficient for all teens or circumstances. In Phase 2, the passage of time did not influence adolescents’ perception of messages in the month after discharge (p=.742), however there were notable daily-level associations between perception of messages and adolescents’ affect. Specifically, higher within-person (relative to adolescents’ own average) anger was negatively related to liking text messages (p=.005), while within person positive affect was associated with perception of messages as more helpful (p=.035).

Conclusions:

Text-based support appears to be an acceptable continuity of care strategy to support adolescents’ transition after hospitalization. Implications are discussed. Future work is needed to evaluate the impact of text-based interventions on suicide-related outcomes.