Suicide is a leading cause of death, especially among young adults (ages 18-35) where it ranks second after accidental injury. Although hope can be found in rapidly developing new drug and brain stimulation treatments, reliance on intensive in-person procedures and expensive technology presents a significant obstacle to access and widespread impact. Fortunately, progress is also being made in mobile health technology interventions for suicide, which can complement less accessible treatments by offering remote, on-demand care, potentially providing vital support during critical moments of need. Here we focus on music as an especially potent and flexible form of mobile health intervention, proposing to implement and test Standardized Tunable Music Medicine for Suicidality (STAMM-S) as a first-of-its-kind listening-based mobile health intervention that systematically applies music’s core effects on brain reward, affect, and entrainment against suicidal ideation in young adults. To do this, we will create STAMM-S as a custom-built web application that integrates: (1) personalized playlists of therapeutically aligned music derived through a novel discovery process; (2) intuitive digital controls that provide real-time control over tempo, spectrum, and amplitude to promote synchrony and entrainment; and (3) psychoeducation to teach patients how to use these controls to modulate mood and interrupt suicidal ideation. Preliminary data on the efficacy and feasibility of this STAMM-S web application will then be tested in single-arm intervention study of 28 young adults (aged 18-35) will suicidal ideation. This intervention will involve listening to music from STAMM-S for 20 minutes a day, every day, for 25 consecutive days, for a total dosage of 500 minutes, which corresponds to the average dose in music therapy literature showing clinically significant antidepressant effects. The primary outcome will be change in the intensity of suicidal ideation, as measured via the Columbia-Suicide Severity Rating Scale. Feasibility will be assessed in terms of pre-specified progression rules for recruitment, retention, treatment fidelity, and overall acceptability. Finally, feedback from participants (i.e., stakeholders) will be collected through a qualitative exit interview designed to provide the study team with insight into patient experience and protocol improvement. We hypothesize that STAMM-S will significantly reduce the intensity of suicidal ideation over the course of the intervention, and that it will exhibit relatively high levels of feasibility. These hypotheses are supported by extensive literature on the psychological and neurobiological effects of music, as well as demographic research indicating that lifetime musical engagement peaks in early adulthood (with listening at 3-4 hours/day on average). This latter point suggests that musical treatment may be viewed as especially favorable among young adults with suicidal ideation, increasing internal motivation and compliance, and potentially improving outcomes. We expect this work to provide a foundation for subjecting STAMM-S to a more rigorous study in a follow-on randomized double-blind placebo-controlled efficacy trial. More broadly, we expect it to advance the integration of musical treatment into mental health care, where it is well-supported but remains scarcely applied.
