Treating Drivers of Suicide in Primary Care using Jaspr Health

PROJECT SUMMARY/ABSTRACTSuicide remains a serious public health problem in the U.S. as rates have risen nearly each year since 2005, from 11.0 per 100,000 to 14.8 per 100,000 in 2018, totaling 48,344 in 2018; 1.4 million U.S. adults made a suicide attempt, and another 12 million thought seriously about killing themselves that same year. Alcohol use disorder (AUD) exponentially increases suicide risk and can also interfere with suicide prevention intervention efforts. Suicide prevention initiatives over the past decade have targeted healthcare systems (HCS) in general and primary care clinics (PCC) in particular because so many who die by suicide access their primary care provider (PCP) in the months and year prior to their death. Though universal suicide screening is now routinely conducted in PCC, many HCS and PCC struggle to provide suicide prevention evidence-based practices (EBP) on par with other behavioral health EBP commonly treated in PCC. Digital technologies can efficiently and reliably help deliver suicide prevention EBP in PCC and increase the confidence and competence of PCP in treating suicide, including AUD that may interfere with these efforts.Jaspr Health (“Jaspr”; R44MH108222) is a suicide prevention platform originally designed for use by acutely suicidal patients in emergency departments (ED) to deliver suicide prevention EBP. Grounded in Jobes’ Collaborative Assessment and Management of Suicidality (CAMS), Jaspr guides patients in completing a comprehensive suicide risk assessment and lethal means counseling, builds a crisis stabilization plan, and teaches behavioral skills to reduce imminent distress; videos of people with live experience (PLE) offer wisdom and hope for getting through suicide crises. Information is summarized for the care team to aid in discharge disposition planning. A companion app provides support post-discharge. Results from a randomized controlled trial (RCT; N=31) comparing Jaspr to Care-as-Usual strongly support its feasibility, acceptability, and effectiveness in increasing delivery of EBP, reducing agitation and distress, improving capacity to cope with suicidal thoughts, and improving ED satisfaction.This 34-month fast track seeks to increase the public health impact of Jaspr Health by extending its utility to deliver evidence-based brief interventions that directly target and treat a person’s reasons for wanting to die (their “drivers” for suicide) while simultaneously addressing alcohol misuse. The proposal is defined by three project stages which include: (1) a proof-of-concept formative evaluation stage where we will iteratively design, test, and build a prototype (Phase I; Months 1-10); (2) a product design-and-build formative evaluation stage, where we will design, build and test all remaining features and apps (Phase II; Months 11- 22); and (3) a summative evaluation stage involving a pilot test (N=20) and a RCT (N=120) comparing Jaspr to a suicide prevention app and other online wellness resources (Phase II; Months 23-34).PROJECT NARRATIVE: PUBLIC HEALTH RELEVANCE With 47,151 suicides in 2019 and 12 million American adults reporting serious suicidal ideation each year, suicide remains the 10th leading cause of death among all ages and the second leading cause of death among those 10-44 years old in the U.S.; alcohol use disorder (AUD) exponentially increases suicide risk and can also interfere with suicide prevention intervention efforts. The Collaborative Assessment and Management for Suicidality (CAMS) is a flexible tool used to assess, manage, and treat suicidal behaviors. Jaspr Health (“Jaspr”) is a robust CAMS-informed evidence-based digital technology that aids in assessing and managing acutely suicidal patients, this fast-track proposal seeks to extend its public health impact by developing brief interventions that directly target individuals’ drivers of suicide in a primary care context.