Exploring the Safety of a General Digital Mental Health Intervention to Effect Symptom Reduction among Individuals with and without Suicidal Ideation: A Secondary Analysis

Abstract

Trials of digital mental health interventions (DMHIs) often exclude individuals with suicide-related thoughts and behaviors precluding an understanding of whether DMHIs for affective disorders are safe for, and perform similarly within, this high-risk group. We explore the safety and performance of a DMHI for depression in participants with and without suicidal ideation (SI) at baseline. Three hundred and one participants were included in this secondary data analysis from a trial of an 8-week DMHI comprising 14 smartphone apps. We found that SI decreased across the study among participants with baseline SI and that baseline SI status did not attenuate depression treatment effects. Through a case study of the IntelliCare platform, we find that DMHIs for general affective disorders can be safe.

Keywords:

• Depression
• mHealth
• prevention
• smartphone
• suicide
• technology

ACKNOWLEDGMENTS

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The National Institute of Health had no part in the study design, hypothesis generation, data collection, processing, analysis, or interpretation of results; nor did they have any role in authoring this publication.

DISCLOSURE STATEMENT

David C. Mohr, Ph.D. has accepted honoraria and consulting fees from Otsuka Pharmaceuticals, Optum Behavioral Health, and the One Mind Foundation, royalties from Oxford Press, and has an ownership interest in Adaptive Health, Inc. None of the other authors have competing interests to declare.

Additional information

Funding

This work was supported by a grant from the National Institute of Mental Health (NIMH) under [R01MH100482, P50MH119029, R34MH124960, and T32MH115882]; under the National Institute on Aging (NIA) under [P30AG064103]; and under the National Institute of Health's National Center for Advancing Translational Sciences (NCATS) under [UL1TR001422].

Notes on contributors

Jonah Meyerhoff

Jonah Meyerhoff, Kaylee P. Kruzan, and David C. Mohr, Department of Preventive Medicine, Center for Behavioral Intervention Technologies (CBITs), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Kwang-Youn A. Kim, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Kimberly Van Orden, Department of Psychiatry, University of Rochester Medical Center, NY, USA. Correspondence concerning this article should be addressed to Jonah Meyerhoff, Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA. Email: [email protected]

Kaylee P. Kruzan

Jonah Meyerhoff, Kaylee P. Kruzan, and David C. Mohr, Department of Preventive Medicine, Center for Behavioral Intervention Technologies (CBITs), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Kwang-Youn A. Kim, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Kimberly Van Orden, Department of Psychiatry, University of Rochester Medical Center, NY, USA. Correspondence concerning this article should be addressed to Jonah Meyerhoff, Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA. Email: [email protected]

Kwang-Youn A. Kim

Jonah Meyerhoff, Kaylee P. Kruzan, and David C. Mohr, Department of Preventive Medicine, Center for Behavioral Intervention Technologies (CBITs), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Kwang-Youn A. Kim, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Kimberly Van Orden, Department of Psychiatry, University of Rochester Medical Center, NY, USA. Correspondence concerning this article should be addressed to Jonah Meyerhoff, Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA. Email: [email protected]

Kimberly Van Orden

Jonah Meyerhoff, Kaylee P. Kruzan, and David C. Mohr, Department of Preventive Medicine, Center for Behavioral Intervention Technologies (CBITs), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Kwang-Youn A. Kim, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Kimberly Van Orden, Department of Psychiatry, University of Rochester Medical Center, NY, USA. Correspondence concerning this article should be addressed to Jonah Meyerhoff, Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA. Email: [email protected]

David C. Mohr

Jonah Meyerhoff, Kaylee P. Kruzan, and David C. Mohr, Department of Preventive Medicine, Center for Behavioral Intervention Technologies (CBITs), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Kwang-Youn A. Kim, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Kimberly Van Orden, Department of Psychiatry, University of Rochester Medical Center, NY, USA. Correspondence concerning this article should be addressed to Jonah Meyerhoff, Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA. Email: [email protected]