Just-in-Time Adaptive Interventions for Suicide Prevention: Promise, Challenges, and Future Directions

Abstract

The suicide rate (currently 14 per 100,000) has barely changed in the United States over the past 100 years. There is a need for new ways of preventing suicide. Further, research has revealed that suicidal thoughts and behaviors and the factors that drive them are dynamic, heterogeneous, and interactive. Most existing interventions for suicidal thoughts and behaviors are infrequent, not accessible when most needed, and not systematically tailored to the person using their own data (e.g., from their own smartphone). Advances in technology offer an opportunity to develop new interventions that may better match the dynamic, heterogeneous, and interactive nature of suicidal thoughts and behaviors. Just-In-Time Adaptive Interventions (JITAIs), which use smartphones and wearables, are designed to provide the right type of support at the right time by adapting to changes in internal states and external contexts, offering a promising pathway toward more effective suicide prevention. In this review, we highlight the potential of JITAIs for suicide prevention, challenges ahead (e.g., measurement, ethics), and possible solutions to these challenges.

Disclosure statement

Dr. Nock receives publication royalties from Macmillan, Pearson, and UpToDate. He has been a paid consultant in the past year for Microsoft Corporation, the Veterans Health Administration, Cerebral, and for a legal case regarding a death by suicide. He is an unpaid scientific advisor for Empatica, Koko, and TalkLife.

Additional information

Funding

DDLC is supported by the National Science Foundation Graduate Research Fellowship under Grant No. DGE-1745303. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Science Foundation. KHB is supported by the National Institute of Mental Health under Grant K23MH120436. This work was also supported by the Fuss Family Research Fund at Harvard University to MKN.

Notes on contributors

Daniel D.L. Coppersmith

Daniel Coppersmith is a PhD candidate in clinical psychology in the Department of Psychology at Harvard University.

Walter Dempsey

Walter Dempsey is an Assistant Professor of Biostatistics and Assistant Research Professor at the Institute for Social Research at the University of Michigan.

Evan M. Kleiman

Evan Kleiman is an Assistant Professor of Psychology at Rutgers University, with a secondary appointment in the Department of Health Behavior, Society, and Policy in the School of Public Health.

Kate H. Bentley

Kate Bentley is an Assistant Professor at Harvard Medical School and a Clinical Psychologist at Massachusetts General Hospital.

Susan A. Murphy

Susan Murphy is the Mallinckrodt Professor of Statistics and of Computer Science and Radcliffe Alumnae Professor at the Radcliffe Institute at Harvard University.

Matthew K. Nock

Matthew Nock is the Edgar Pierce Professor and Chair in the Department of Psychology at Harvard University and a Research Scientist at Massachusetts General Hospital and Franciscan Children’s Hospital.