Innovation in technology – not unlike academic research – isn’t a straight line forward. It’s a jagged one, bent by setbacks, rebounds, and second guesses. Not that we needed it, but new research reinforces that frustrating altruism.
A smartphone app that delivers suicide-focused cognitive behavioral therapy (CBT) has apparently failed to reduce overall first-time suicide risk after psychiatric hospitalization.
However, this new report reveals that it could help a high-risk subgroup – patients with a history of suicide attempts.
This encouraging revelation stems from a randomized clinical trial published in August in JAMA Network Open. The study tested whether a digital therapeutic could extend lifesaving support into the critical weeks after discharge, when suicide risk is highest.
“The weeks and months following a suicide crisis and discharge from a hospital are among the highest risk periods for suicide attempts and mortality, making it imperative to offer effective, suicide-specific interventions during this vulnerable window,” co-first author Patricia Simon, PhD, Assistant Professor Adjunct at Yale School of Medicine explained in a statement. “OTX-202 addresses this critical need.”
Methodology
University researchers enrolled 339 adults who’d been admitted to six psychiatric units between April 2022 and April 2024 for suicidal thoughts or a recent attempt.
The research team then randomly instructed participants to sign up for one of two smartphone apps:
- The first was a digital therapeutic with a dozen interactive sessions drawn from CBT for suicide prevention. The app covered crisis planning, emotion regulation, and cognitive reappraisal.
- The second, a control app, included safety planning and psychoeducation. But it lacked CBT-specific skills training.
While participants completed the first session before they earned their discharge, the researchers let them pursue the remaining sessions at their own pace.
Mixed – Yet Promising – Results
After a year, the probability of a suicide attempt hovered at 18.3% in the digital therapy group versus 9% in the control group. While the difference fell short of statistical significance, once researchers looked at patients who had attempted suicide before, things looked different.
Among that subgroup, the app helped produce a 58% drop in repeat attempts along with much higher odds of clinical improvement at 24 weeks. The digital therapy group also maintained fewer suicidal thoughts for six months, while ideation in the control group started to creep back up after week 12.
“Although suicide-specific therapy is highly effective for reducing suicidal thoughts and urges, finding therapists who know how to do this life-saving therapy after leaving the hospital can be challenging,”co-first author Craig Bryan, PsyD, professor in Ohio State’s Department of Psychiatry and Behavioral Health and director of its Suicide Prevention Program. “OTX-202 provides a possible solution to that problem.”
A Few Caveats. A Lot of Hope.
The researchers conceded, however, that app engagement was modest. On average, participants in the digital therapeutic arm completed 4.4 of the 12 sessions, compared to 5.9 in the control group. And only 12.5% of digital therapy users completed the full program.
Unfortunately, one participant in the control group committed suicide, while none in the digital therapy group did. Members of both groups reported few adverse events.
The control app also included safety planning, an evidence-based intervention on its own, potentially narrowing the gap between groups. The study’s early end — triggered when it crossed a futility threshold for its main outcome — limited the sample size.
Still, the authors say the subgroup findings and sustained reduction in suicidal thoughts warrant further testing, especially if paired with clinical follow-up to boost completion rates.
“Patients and those who care for them do not have access to reliable and effective tools and resources to reduce future suicide risk. This population faces arguably the biggest gap in access to effective interventions of any leading killer,” senior author and Yale faculty member Seth Feuerstein, MD, JD, added. “The potential clinical and population health impact of this new option is extraordinary.”
Further Reading
U.S. Suicide Deaths Reach Record High
