Using a Virtual Guide and Digital Technology to Deliver Evidence-Based Practices for Suicidal Patients in the Emergency Department: Pilot Randomized Controlled Trial (Preprint)

BACKGROUND Emergency departments (EDs) offer the promise of providing suicide prevention evidence-based practices at the point of need to patients who are acutely suicidal. However, few EDs have adequate time and personnel resources to deliver recommended evidence-based assessment and interventions. We developed Jaspr Health, a tablet-based application that enables the delivery of four evidence-based practices for patients who are acutely suicidal at the point of need to help raise the standard of care in ED settings. OBJECTIVE This study aims to test the feasibility, acceptability, and effectiveness of Jaspr Health among suicidal adults in EDs. METHODS Patients who were acutely suicidal and seeking psychiatric crisis services participated in a pilot randomized controlled trial while in the ED. Participants were assigned randomly to Jaspr Health (n=14) or care-as-usual (CAU) control (n=17). RESULTS Conditions differed significantly at baseline on age, but not on other demographic variables or baseline measures. On average, participants had been in the ED for 17 hours prior to enrolling in the research study. Over their lifetimes, 74% of the sample had made a suicide attempt (M=3.4; SD=6.4) and 61% had engaged in non-suicidal self-injurious behaviors, with an average rate of 8.8 times in the past three months. All established feasibility and acceptability criterion were met: no adverse events occurred, participants’ app usage was high, Jaspr Health app satisfaction ratings were high, and all Jaspr Health participants recommended its use for other suicidal ED patients. Comparisons between study conditions further support the application’s effectiveness: Jaspr Health participants reported a statistically significant increase in receiving four evidence-based suicide prevention interventions. Additionally, significant decreases in distress and agitation along with significant increases in learning to cope more effectively with current and future suicidal thoughts were observed among the Jaspr Health participants. Finally, in comparison to CAU, Jaspr Health participants provided higher satisfaction ratings of their overall ED experience. CONCLUSIONS Even with limited statistical power, results showed Jaspr Health to be feasible, acceptable, and clinically effective for use with ED patients who are acutely suicidal and seeking ED-based psychiatric crisis services. CLINICALTRIAL ClinicalTrials.gov NCT03584386