ETUDESBritePath

Background: Many youth with significant mental health concerns face limited access to mental health services. Digital programs, such as mobile apps designed to address mental health issues, have the potential to expand access to strategies for managing these conditions. However, few mental health apps are specifically designed for youth experiencing severe concerns, such as suicidal ideation. BritePath is a new app developed to enhance communication and interaction between providers and youth at risk for suicidal behavior. Objective: This study aims to explore health care providers' opinions and concerns regarding the use of mental health apps for youth at significant risk of suicidal behavior. Methods: We conducted individual semistructured interviews with 17 providers across 7 states. Interviews were conducted via video, recorded, and transcribed. Codes were developed using a team-based approach, with discrepancies resolved through team discussions. Results: Most providers were aware of mental health apps in general and expressed interest in trying the BritePath app with patients experiencing depression, suicidality, or both. Analyses identified 4 key themes related to mental health apps: (1) almost all providers viewed mental health apps as an adjunct to, rather than a replacement for, psychotherapy visits; (2) most providers were concerned about the cost of apps and youth access to them; (3) providers noted the challenge of maintaining patient engagement with apps over time; and (4) providers were concerned about patient privacy, in terms of both data shared with app developers and data privacy within families. Analyses of providers' opinions specifically about the BritePath app identified 4 additional themes: (1) providers believed that access to safety plans within BritePath could be beneficial for youth at risk for suicidal behavior; (2) providers reported that BritePath's interactive features could enhance communication between providers and youth; (3) providers appreciated BritePath's flexibility and the ability for both youth and providers to tailor its content to individual needs; and (4) providers expressed concerns about integrating BritePath into clinical workflows within health systems. Conclusions: The use of mental health apps is expanding, yet there is limited understanding of how to effectively integrate these tools into mental health treatment. Providers are increasingly referring patients to mental health apps, and most expressed interest in trying the BritePath app for patients with depression, suicidality, or both. However, providers also identified several concerns, particularly regarding privacy and safety.

Objective We present results from a 2-site, randomized clinical trial to assess the efficacy of a brief intervention (As Safe As Possible [ASAP]), a safety plan phone application (BRITE), and their combination on suicide attempts, suicidal ideation, non-suicidal self-injury, re-hospitalizations. and suicidal events among adolescents. Method Adolescents (n= 240; 12-17 years of age) who were hospitalized for suicidal ideation with plan and/or intent, and/or suicide attempt, were assigned to 1 of 4 treatment conditions in a 2 by 2 design: ASAP+BRITE app+treatment as usual (TAU); (2) BRITE+TAU; (3) ASAP+TAU; and (4) TAU alone. Independent evaluators assessed suicidal ideation and behavior at 4, 12, and 24 weeks using the Columbia–Suicide Severity Rating Scale (C-SSRS) and re-hospitalization using the Child and Adolescent Services Assessment (CASA). Results No group differences were found on primary outcomes, except that ASAP participants were less likely to be re-hospitalized over 6 months (15.6%, vs 26.5%, p = .046). Participants hospitalized for an attempt and assigned to BRITE had a lower rate of subsequent attempts (odds ratio [OR] = 0.16, p = .01) and a greater time to attempt (hazard ratio [HR] = 0.20, p = .02). ASAP+BRITE, albeit not statistically significant, was most consistently associated with a reduction (60% reduction) in suicide attempts. Conclusion ASAP, BRITE, and their combination are equally effective at decreasing risk for suicidal events 6 months post hospital discharge among suicidal adolescents; the ASAP intervention (with or without BRITE) was associated with lower rates of re-hospitalization. The BRITE app in youth hospitalized for suicide attempt had promising outcomes in regard to future attempts. Plain language summary This randomized clinical trial examined the efficacy of brief intervention and/or a safety plan phone application for suicide prevention after discharge. A total of 240 youth aged 12 to 17 years of age who were hospitalized at 2 inpatient psychiatric facilities for suicidal thoughts or behaviors were randomly assigned to 1 of 4 treatment conditions: a brief intervention (As Safe As Possible, ASAP), a safety planning phone app (BRITE), their combination, or treatment as usual and followed over 6 months post-hospitalization. Findings indicate ASAP, BRITE, and their combination are equally effective at decreasing risk for suicidal events over 6 months posthospital discharge. Lower rehospitalization rates were associated with ASAP, whereas BRITE was associated with lower risk of suicide attempt over follow-up among those hospitalized for attempt.