App-Supported Inpatient Intervention to Prevent Postdischarge Suicide Attempts

girl on smartphone
girl on smartphone
The rate of suicide attempts in participants assigned to intervention plus treatment as usual was half of that in participants in the treatment as usual-alone group.

App-supported inpatient intervention may have the potential to reduce postdischarge suicidal behavior in adolescents hospitalized for suicidal ideation or an attempt, according to research published in the American Journal of Psychiatry.

In this pilot study, researchers evaluated the efficacy of As Safe As Possible (ASAP), a 3-hour intervention program geared toward emotion regulation and safety planning. The researchers assigned 26 adolescents hospitalized for suicidal ideation and 40 for a recent suicide attempt to either the intervention group, which received the ASAP program in addition to treatment as usual, or the control group, which received only treatment as usual ( identifier: NCT02272179).

Supplemental to the intervention, participants in the ASAP program were given access to a smartphone app that prompted them daily to rate their level of emotional distress and provided personalized strategies for emotional regulation and safety planning.

Study results revealed no statistically significant difference in the rate of suicide attempts at 4, 12, and 24 weeks after hospital discharge, with 5 in the intervention group and 9 in the control group (P =.17). Researchers deemed past history of a suicide attempt to be a significant moderator of treatment outcome; there was a stronger but insignificant effect of the ASAP intervention in participants who had a history of a suicide attempt.

They also discovered no treatment effects with regard to suicidal ideation. Furthermore, while 70.6% of the intervention group used the app at least once, researchers did not find any relationship between frequency of use and the risk for suicide attempt (P =.59) or decline in suicidal ideation (P =.23). However, intervention participants reported a generally high level of satisfaction with the treatment and the app.

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Although this trial was not large enough to detect substantial clinical effects, it demonstrates the acceptability and feasibility of this treatment in this population. “The rate of suicide attempt[s] among participants assigned to ASAP plus treatment as usual was half that of participants in the treatment as usual-alone group, indicating that this intervention is promising and may have utility in the reduction of postdischarge suicide attempts among hospitalized, suicidal adolescents,” noted the investigators.

Multiple limitations to the study were noted, including an inability to generalize to the broader population due to a small sample size that was largely female and white.


Dr Kennard receives research support from NIMH and royalties from Guilford Press. Dr Goldstein receives research support from the American Foundation for Suicide Prevention, the Brain and Behavior Foundation, and NIMH, and royalties from Guilford Press. Dr Foxwell receives royalties from Guilford Press. Dr Douaihy receives research support from Alkermes, the National Institute on Drug Abuse, NIMH, the Substance Abuse and Mental Health Services Administration, and the US Health Resources and Services Administration, and royalties from PESI Publishing and Media and Oxford University Press. Dr Brent receives research support from NIMH and royalties from Guilford Press, eResearch Technology (for an electronic self-rated version of the Columbia-Suicide Severity Rating Scale), and UptoDate Psychiatry; he also receives consulting fees from Healthwise. All other authors report no financial relationships with commercial interests.


Kennard BD, et al. As safe as possible (ASAP): a brief app-supported inpatient intervention to prevent postdischarge suicidal behavior in hospitalized, suicidal adolescents [published online July 19, 2018]. American Journal of Psychiatry. doi:10.1176/appi.ajp.2018.17101151