JMIR Publications

ABSTRACT

Background:

Young adults (YAs) in the US are experiencing accelerating rates of suicidal thoughts and behaviors (STBs) but have the lowest rates of formal mental health care. Digital suicide prevention interventions have the potential to increase access to suicide prevention care by circumventing attitudinal and structural barriers that prevent access to formal mental health care. These tools should be designed in collaboration with YAs who have lived experience of STBs to optimize acceptability and use.

Objective:

We aimed to identify the needs, preferences, and features for an automated text messaging-based safety planning service to support the self-management of STBs among YAs.

Methods:

We enrolled 30 YAs (age 18-24) with recent STBs to participate in asynchronous remote focus groups via an online private forum. Participants responded to researcher-posted prompts and were encouraged to reply to fellow participants — creating a threaded digital conversation. Researcher-posted prompts centered on participants’ experiences with STB-related coping, safety planning, and technologies for STB self-management. Focus group transcripts were analyzed using thematic analysis to extract key needs, preferences, and feature considerations for an automated text messaging-based safety planning tool.

Results:

YAs indicated that an automated digital text message-based safety planning intervention must address drivers of STBs by supporting individuals’ ability to cope with suicidal crises and build and deepen interpersonal connections. YAs also shared that the intervention technology must prioritize transparency about how the intervention functions, the kinds of actions it does and does not take, the limits of confidentiality, and the role of human oversight within the program. Additionally, YAs shared the need for privacy — data security was extremely important to them given the sensitive nature of suicide-related personal data. Usability needs were also raised, including having an approachable and engaging message tone, customizable message delivery options (e.g., length, number, content focus), and straightforward menu navigation. YA participants also wanted specific features that could support core coping skill acquisition.

Conclusions:

Engaging YAs in the design process of a digital suicide prevention tool revealed critical considerations that must be addressed if the tool is to effectively expand access to evidence-based care to reach young people at risk for STBs. Specifically, automated digital safety planning interventions must support building skillfulness to cope effectively with suicidal crises, deepening interpersonal connections, system transparency and data privacy.