Preliminary Effectiveness of a Therapist-Supported Digital Mental Health Intervention in Reducing Suicidal Ideation

Figures & data

TABLE 1. Patient demographic and clinical characteristics (N = 778).

Variable	N	Percentage	Mean (SD), Range
Age	778		40 (11.2), 19–82
Gender
Female	600	77.12%
Male	177	22.75%
Other	1	0.13%
Baseline PHQ-8 Severity			11.1 (5.9), 0-24
Less than Mild	117	15.04%
Mild	222	28.53%
Moderate	187	24.04%
Moderately Severe	182	23.39%
Severe	70	9.00%
MDEs
None	376	48.33%
First	114	14.65%
Recurrent	288	37.02%
Taking Psychiatric Medication
Yes	334	44.22%
No	434	55.78%
Lifetime Suicide Attempt
Yes	35	4.50%
No	743	95.50%
Lifetime Psychiatric Hospitalization
Yes	39	5.01%
No	739	94.99%
Lifetime History of Major Traumatic Event
Yes	327	42.03%
No	435	55.91%
Unknown	16	2.06%

Notes: MDE = Major Depressive Episode; PHQ = Patient Health Questionnaire

Symptom severity is measured by baseline PHQ-8 score as follows: less than mild = 0–4, mild = 5–9, moderate = 10–14, moderately severe = 15–19, severe = 20+.

FIGURE 1. Severity of suicidal ideation during and after treatment (N = 778).

Notes: Suicidal ideation over the last 2 weeks is measured by the ninth item of the Patient Health Questionnaire-9 item (PHQ-9), with 0 = not at all, 1 = several days, 2 = more than half the days, and 3 = nearly every day. Non-significant Wilcoxon Test comparisons for changes in suicidal ideation are not shown. That is, there were no significant differences between end-of-treatment and 3-month follow-up, between end-of-treatment and 6-month follow-up, or between 3-month and 6-month follow-up.

FIGURE 2. Suicidal ideation during and after treatment by baseline depressive symptom severity.

Notes: Suicidal ideation over the last 2 weeks is measured by the ninth item of the Patient Health Questionnaire-9 item (PHQ-9), with 0 = not at all, 1 = several days, 2 = more than half the days, and 3 = nearly every day. Treatment week 0 is the pretreatment (baseline) assessment. Treatment week 12 is the end-of-treatment assessment. Treatment week 25 is the 3-month follow-up assessment. Treatment week 38 is the 6-month follow-up assessment. Symptom severity is measured by baseline PHQ-8 score as follows: less than mild = 0–4, mild = 5–9, moderate = 10–14, moderately severe = 15–19, severe = 20+. Light lines are individual trajectories and dark lines are pretreatment symptom severity group trajectories.

TABLE 2. Suicidal ideation during and after treatment.

	Baseline	End-of-Treatment	3 Month Follow-Up	6 Month Follow-Up
Suicidal Ideation	n (%)	n (%)	n (%)	n (%)
0 (not at all)	607 (78.02%)	708 (91.00%)	717 (92.16%)	724 (93.06%)
1 (several days)	127 (16.32%)	63 (8.10%)	58 (7.46%)	53 (6.81%)
2 (more than half the days)	33 (4.24%)	6 (0.77%)	2 (0.26%)	1 (0.13%)
3 (nearly every day)	11 (1.41%)	1 (0.13%)	1 (0.13%)	0 (0.00%)
Mean (SD)	0.29 (0.61)	0.10 (0.34)	0.08 (0.30)	0.07 (0.26)
Effect Size		0.33 (0.27, 0.38)	0.32 (0.27, 0.38)	0.32 (0.27, 0.38)

Notes: SD = standard deviation. Suicidal ideation over the last 2 weeks is measured by the ninth item of the Patient Health Questionnaire-9 item (PHQ-9), with 0 = not at all, 1 = several days, 2 = more than half the days, and 3 = nearly every day.

TABLE 3. Adjusted associations of changes in suicidal ideation across meru health program treatment.

	Linear Model			Poisson Model				Negative Binomial Model
Predictors	Std. Beta	Std. SE	P-Value	Log-Mean		SE	P-Value	Log-Mean		SE	P-Value
(Intercept)	−0.321	0.062	<0.001	−4.197		0.481	<0.001	−4.197		0.560	<0.001
Treatment Week	−0.110	0.013	<0.001	−0.158		0.022	<0.001	−0.158		0.013	<0.001
Gender- Male	0.087	0.055	0.111	0.259		0.171	0.130	0.259		0.177	0.144
Gender- Other	−0.620	0.631	0.326	−15.901		2063.644	0.994	−22.229		65819.200	1.000
Age	−0.045	0.023	0.054	−0.016		0.006	0.014	−0.016		0.007	0.017
Average Days Active Weekly	−0.098	0.012	<0.001	−0.047		0.010	<0.001	−0.047		0.010	<0.001
Single MDE	0.121	0.069	0.078	0.472		0.233	0.043	0.472		0.249	0.058
Recurrent MDE	0.205	0.055	<0.001	0.871		0.176	<0.001	0.871		0.185	<0.001
Lifetime Psychiatric Hospitalization-Yes	0.433	0.116	<0.001	0.563		0.290	0.053	0.563		0.290	0.052
Lifetime Suicide Attempt-Yes	−0.005	0.123	0.967	−0.090		0.314	0.774	−0.090		0.316	0.775
Lifetime Major Traumatic Event-Unknown	−0.018	0.162	0.910	0.151		0.427	0.724	0.151		0.434	0.728
Lifetime Major Traumatic Event-Yes	−0.015	0.048	0.753	0.152		0.154	0.322	0.152		0.160	0.342
Baseline PHQ-8 Symptom Severity- Mild	0.012	0.068	0.864	1.049		0.437	0.016	1.049		0.533	0.049
Baseline PHQ-8 Symptom Severity- Moderate	0.131	0.072	0.068	2.010		0.424	<0.001	2.010		0.515	<0.001
Baseline PHQ-8 Symptom Severity- Moderately Severe	0.420	0.075	<0.001	2.797		0.420	<0.001	2.797		0.509	<0.001
Baseline PHQ-8 Symptom Severity- Severe	0.579	0.099	<0.001	3.210		0.441	<0.001	3.210		0.526	<0.001
Taking Psychotropic Medication	0.022	0.034	0.519	0.005		0.114	0.967	0.005		0.118	0.968
Marginal R^2 / Conditional R^2 = 0.289 / 0.540					0.289 / 0.540				0.313 / 0.556

Notes: CI = confidence interval, MDE = Major Depressive Episode, PHQ = Patient Health Questionnaire, SE = standard error. Symptom severity is measured by baseline PHQ-8 score as follows: less than mild = 0–4, mild = 5–9, moderate = 10–14, moderately severe = 15–19, severe = 20+.