JMIR Publications

ABSTRACT

Background:

Background:

People with past suicidal thoughts and behavior (STB) are often excluded from digital mental health intervention (DMHI) treatment trials. This may perpetuate barriers to care and reduce treatment generalizability, especially in populations with elevated rates of STB, like body dysmorphic disorder (BDD). We conducted a randomized controlled trial (RCT, N = 80) of a smartphone-based cognitive behavioral therapy (CBT) for BDD that allowed for most forms of past STB except for past-month active suicidal ideation.

Objective:

Objective:

This study had two objectives: to (1) characterize the sample’s lifetime prevalence of STB, and (2) estimate and predict STB incidence during the trial.

Methods:

Methods:

We completed secondary analyses on data from an RCT of smartphone-delivered CBT for BDD. The primary outcomes consisted of STB severity and suicide attempt assessed at baseline with the Columbia-Suicide Severity Rating Scale (C-SSRS) and weekly during the trial via one item from the Quick Inventory of Depressive Symptomatology—Self Report (QIDS-SR item #12; 1,043 observations). We computed descriptive statistics (M, %) and ran a series of bi- and multivariate linear regressions predicting STB incidence during the three-month trial.

Results:

Results:

At baseline, 40% of participants reported lifetime history of active suicidal thoughts and 10% reported lifetime suicide attempts. During the three-month trial, 42.5% reporting thinking about death- and/or suicide via weekly assessment. No participants reported frequent/acute suicidal thoughts, plans, or attempts. Lifetime suicide attempt (OR = 11.0, p < .01) and lifetime severity of suicidal thoughts (OR = 1.76, p < .01) were significant bivariate predictors of death-/suicide-related thought incidence reported during the trial. Multivariate models including STB risk factor covariates (e.g., age, sexual orientation) modestly improved prediction of death-/suicide-related thoughts (e.g., PPV = .91, NPV = .75, AUC =.83).

Conclusions:

Conclusions:

Although some participants may think about death and/or suicide during a DMHI trial, it may be safe and feasible to include participants with most forms of past STB. Among other procedures, researchers should carefully select eligibility criteria, use frequent, ongoing, low-burden, and valid monitoring procedures, and implement risk mitigation protocols tailored to the presenting problem. Clinical Trial: Trial Registration: ClinicalTrials.gov NCT04034693; https://www.clinicaltrials.gov/study/NCT04034693