The development of new technologies such as the wearable biosensors and smartphone-based ecological momentary assessment (EMA) provide unprecedented opportunities to study suicidal thoughts (or urges) and behaviors as they unfold out in the real-world in real-time. This unprecedented access to thoughts, feelings, and actions of participants has the potential to significantly advance understanding of those at risk for harm to themselves or others. Although the parent study?s data collection is primarily focused on the inpatient period, a clear next step for this study (and likely many others like it) is to expand real-time monitoring to the extremely high risk period of time immediately after discharge from inpatient psychiatric care, using smartphone-based ecological momentary assessment (EMA) to capture fine grained assessments of suicidal thoughts and behaviors as they occur along with other information (e.g., GPS, call logs). Along with the unprecedented opportunity to understand suicidal thoughts and behaviors as they occur, these new technologies also bring unprecedented ethical, legal, methodological, and clinical concerns regarding participant safety. Specifically, having in situ data about urges to harm the self or others (especially in tandem with location data), raises the question how to respond when a participant reveals that they are highly suicidal? The goal of this administrative supplement is to collect information regarding this topic from two key stakeholders, suicidal adolescents and their parents, enabling the design of an intervention protocol that takes into account the wishes, needs and perspective of those with lived experience and their caretakers.
Harmful behaviors (e.g., harm to self or others) resulting from rapidly increasing distress are unfortunately common experiences on adolescent inpatient units and often lead to interventions like seclusion and restraint, rather than more proactive methods that might have been effective before the distress escalated. The goal of this study is to use wearable physiological monitors to identify the early stages of distress that lead to harmful behaviors, which is not easily detectable by clinical observation alone. This will serve as the first step in creating a collaborative decision-making tool that can be used to detect distress in the early stages before it escalates to a harmful behavior, alerting clinical staff to windows of time where more proactive interventions may be possible.
