A Mobile Intervention to Reduce Suicidality During the Partial Hospital to Outpatient Transition

Partial hospital programs (PHPs) are intensive, short-term mental health programs that serve as a mid-level service between outpatient treatment and inpatient hospitalization. Suicidal thoughts and behaviors commonly occur in patients admitted to PHP, and they are predictive of outcomes up to one year following PHP discharge. The transition period from PHP to outpatient treatment is a critical period of heightened risk for suicide, relapse, and rehospitalization, in part due to the sudden removal of frequent support that occurred during PHP treatment and delays in the onset or re-initiation of outpatient treatment. Interventions that are efficacious, cost-effective, and feasible/acceptable are needed to reduce suicide risk during this care transition period. Mobile interventions are uniquely poised to support patients during the PHP-to-outpatient transition, as they can provide frequent and convenient guidance to patients to help them apply skills in the moment. In addition, mobile interventions can provide ongoing feedback to outpatient treatment providers to aid in clinical monitoring and treatment planning. Although some suicide prevention mobile apps exist, they address only one or a few suicide prevention best practices and none have been developed specifically for patients transitioning from PHP to outpatient care. Based on previous pilot work we conducted with PHP patients, we propose to test a new mHealth intervention called My Values Program (MVP). MVP delivers multiple suicide prevention best practices with therapist coaching based on principles from Acceptance and Commitment Therapy, a transdiagnostic, evidence-based treatment that has demonstrated efficacy for a variety of mental health problems, including suicidality. MVP is delivered for up to 6 months post-PHP discharge and utilizes a personalized approach by helping individuals clarify their values and identify daily activities to increase meaning and purpose in life and reduce suicide risk. For this project, we propose to further develop and refine MVP based on feedback from patients in a focus group (n=10), and then conduct an open trial (n=30) to pilot test MVP for use by patients in the months immediately following PHP discharge, the time of highest suicide risk. We will measure outcomes at baseline (prior to PHP discharge), and at 1, 3, and 6 months post-PHP discharge. We hypothesize that MVP will be feasible and acceptable to patients and will show initial effects with respect to reduced suicidal thoughts and behaviors (primary outcome), depression symptoms, hopelessness, functional impairment, and rehospitalization rates. We also expect that patients will show increases in values-consistent action and psychological acceptance (target mechanisms), and quality of life over the 6-month follow-up period. The work done in this pilot study will lay the foundation for a future, full-scale randomized controlled trial to test MVP as a personalized, adjunctive mHealth intervention for patients transitioning from partial hospital to outpatient care.