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Principal Investigator: Ewa Karina Czyz
Organization: UNIVERSITY OF MICHIGAN AT ANN ARBOR
Fiscal Year: 2024
Award: $169,230
Funding agency: National Institute of Mental Health
PROJECT SUMMARY
The increasing rates of suicide among adolescents is an urgent public health concern. In parallel, acute
services due to suicide risk, including psychiatric hospitalizations, have been on the rise, with discharged
adolescents remaining at elevated risk for recurrent suicidal crises. New approaches are urgently needed to
alter risk trajectories and prevent suicidal behavior among adolescents transitioning from inpatient care.
Bridging an adaptive intervention (AI) approach—wherein type, intensity, and timing of treatment can be
individualized to address suicidal adolescents’ heterogenous treatment needs—together with technology-
augmented follow-up support provided during the high-risk transition period, this study seeks to identify an
effective AI for reducing youth suicidal behavior after inpatient care. In our ongoing full-scale sequential
multiple assignment randomized trial (SMART) of a multi-component intervention—i.e. incorporating a
Motivational Interview (MI)-enhanced safety plan delivered during hospitalization (MI-SP) and post-discharge
supportive contacts provided via a booster call, asynchronous portal, or text messages (Texts)—hospitalized
adolescents (N=300) at risk for suicide are initially randomized to MI-SP or to MI-SP with Texts, and those
classified as non-responders within 2 weeks post discharge are re-randomized to an added booster call or
portal conditions. The R01 SMART was funded to determine the effectiveness of promising technology-
augmented intervention strategies and their sequencing, including comparing four AIs embedded in the
SMART, on the primary outcome of suicidal behavior (actual, interrupted, aborted attempts) within 3 months
post discharge and secondary outcomes of time-to-suicidal behavior and suicidal ideation severity over 6
months. In secondary analyses, we plan to investigate moderators of intervention strategies, examine
proposed mechanisms of action, and identify barriers and facilitators to implementation. The trial was
successfully launched across two health system sites; however the overall rate of recruitment across both sites
has been lower than expected, and further compounded by lower number of admissions at one of the sites. To
address these challenges and enrollment shortfalls that would limit the study’s statistical power to determine
the effectiveness and optimal sequence of different intervention strategies on the primary outcome of suicidal
behavior, we recently added an additional recruitment site–Cincinnati Children’s Hospital and Medical Center
(CCHMC). CCMHC was selected due to its relatively large child/adolescent inpatient program and diverse
patient population (~30% Black youth). We have made important study launch gains at CCHM, including
completing regulatory and study startup steps and staff training, with trial enrollment beginning midway through
Year 3. This supplement will enable completing enrollment and associated intervention and follow-up activities
at CCHM in Year 4 as well as intervention implementation planning goals in Year 5. With the addition of CCHM
as a recruitment site, the study is well-positioned to achieve its target enrollment goals and meet its aims.
Terms: <0-11 years old><Active Follow-up><Acute><Address><Administrative Supplement><Admission><Admission activity><Adolescent><Adolescent Youth><Area><Assess implementation><Black><Black race><Care Givers><Caregivers><Caring><Cell Phone><Cellular Phone><Cellular Telephone><Child><Child Youth><Children (0-21)><Children's Hospital><Classification><Communication><ED visit><ER visit><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room visit><Enrollment><Feeling suicidal><Funding><Goals><Health><Health system><Hospital Admission><Hospitalization><Hospitalized Adolescent><Implementation assessment><Inpatients><Interruption><Intervention><Intervention Strategies><Interview><Mediating><Medical center><Michigan><Mobile Phones><NIMH><National Institute of Mental Health><Outcome><Participant><Patient Recruitments><Patients><Pediatric Hospitals><Phase><Position><Positioning Attribute><Public Health><Randomized><Recurrence><Recurrent><Reporting><Research Resources><Resources><Risk><SMS support><Safety><Self Efficacy><Sequential Multiple Assignment Randomized Trial><Services><Severities><Site><Statistical Study><Suicidal thoughts><Suicide><Suicide attempt><Suicide precaution><Suicide prevention><System><Systematics><Technology><Text Messaging><Time><Training><Universities><Youth><Youth 10-21><active followup><adaptive intervention><assess effectiveness><barriers to implementation><coping><design><designing><determine effectiveness><effective intervention><effectiveness assessment><effectiveness evaluation><eligible participant><enroll><evaluate effectiveness><evaluate implementation><evaluation of implementation><examine effectiveness><facilitators to implementation><fatal attempt><fatal suicide><follow up><follow-up><followed up><followup><high risk><hospital re-admission><hospital readmission><iPhone><ideation><implementation barriers><implementation challenges><implementation evaluation><implementation facilitators><implementation intervention><inpatient care><inpatient psychiatric care><inpatient psychiatric treatment><inpatient service><intent to die><interventional strategy><juvenile><juvenile human><kids><meeting><meetings><motivational enhancement therapy><motivational interview><multi-component intervention><multi-faceted intervention><multi-modal intervention><multicomponent intervention><multifaceted intervention><multimodal intervention><new approaches><non fatal attempt><nonfatal attempt><novel><novel approaches><novel strategies><novel strategy><operation><operations><participant recruitment><patient population><post-COVID><post-COVID-19><post-coronavirus disease 2019><precision medicine><precision-based medicine><prevent><prevent suicidality><prevent suicide><preventing><primary outcome><programs><psychiatric hospitalization><randomisation><randomization><randomly assigned><re-admission><re-hospitalization><readmission><recruit><reduce suicidality><reduce suicide><reducing suicidality><reducing suicide><rehospitalization><response><secondary analysis><secondary outcome><sex><short message service><smart phone><smartphone><suicidal><suicidal adolescent><suicidal adolescents><suicidal attempt><suicidal behavior><suicidal ideation><suicidal morbidity><suicidal risk><suicidal thinking><suicidal youth><suicidal youths><suicidality><suicidality prevention><suicide behavior><suicide death><suicide ideation><suicide intervention><suicide morbidity><suicide rate><suicide risk><suicides><technology intervention><technology-based interventions><technology-enabled interventions><technology-focused interventions><text based support><text messaging support><texting><texting support><thoughts about suicide><trial design><trial enrollment><youngster>