Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing

Overview

Journal J Med Internet Res

Publisher JMIR Publications

Specialty Medical Informatics

Date 2017 May 17

PMID 28506957

Citations 16

Authors

Edwin D Boudreaux

Gregory K Brown

Barbara Stanley

Rajani S Sadasivam

Carlos A Camargo Jr

Ivan W Miller

Affiliations

Soon will be listed here.

Abstract

Background: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan.

Objective: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application.

Methods: We employed a user-centered software design strategy led by a multidisciplinary team. The application was tested for usability with a target sample of suicidal patients. Detailed observations, structured usability ratings, and Think Aloud procedures were used. Suicidal ideation intensity and perceived ability to cope were assessed pre-post engagement with the Web application.

Results: A total of 30 participants were enrolled. Usability ratings were generally strong, and all patients successfully built a safety plan. However, the completeness of the safety plan varied. The mean number of steps completed was 5.5 (SD 0.9) out of 6, with 90% (27/30) of participants completing at least 5 steps and 67% (20/30) completing all 6 steps. Some safety planning steps were viewed as inapplicable to some individuals. Some confusion in instructions led to modifications to improve understandability of each step. Ratings of suicide intensity after completion of the application were significantly lower than preratings, pre: mean 5.11 (SD 2.9) versus post: mean 4.46 (SD 3.0), t=2.49, P=.02. Ratings of ability to cope with suicidal thoughts after completion of the application were higher than preratings, with the difference approaching statistical significance, pre: mean 5.93 (SD 2.9), post: mean 6.64 (SD 2.4), t=-2.03, P=.05.

Conclusions: We have taken the first step toward identifying the components needed to maximize usability of a self-administered, Web-based safety planning application. Results support initial consideration of the application as an adjunct to clinical contact. This allows for the clinician or other personnel to provide clarification, when needed, to help the patient build the plan, and to help review and revise the draft.

Citing Articles

Automated Digital Safety Planning Interventions for Young Adults: Qualitative Study Using Online Co-design Methods.

Meyerhoff J, Popowski S, Lakhtakia T, Tack E, Kornfield R, Kruzan K JMIR Form Res. 2025; 9:e69602.

PMID: 40009840 PMC: 11904377. DOI: 10.2196/69602.

Suicide prevention via telemental health services: insights from a randomized control trial of crisis response plan and self-guided safety planning approaches.

Lohani M, Baker J, Elsey J, Dutton S, Findley S, Langenecker S BMC Health Serv Res. 2024; 24(1):1389.

PMID: 39533271 PMC: 11559151. DOI: 10.1186/s12913-024-11739-w.

Assessing the Acceptability of Technology-Based Safety Planning in Primary Care.

Braciszewski J, Llamocca E, Lockhart E, Vanderziel A, Boulay M, Ahmedani B J Gen Intern Med. 2024; .

PMID: 39438377 DOI: 10.1007/s11606-024-09116-8.

Accessibility and Utility of an Electronic Self-Guided Safety Plan for Adolescents.

Methi N, Weeks I, Hunt R, McGuire T, Rubin A, Decker M J Clin Child Adolesc Psychol. 2024; 53(6):935-943.

PMID: 39312731 PMC: 11587818. DOI: 10.1080/15374416.2024.2395271.

A Suicide Prevention Digital Technology for Individuals Experiencing an Acute Suicide Crisis in Emergency Departments: Naturalistic Observational Study of Real-World Acceptability, Feasibility, and Safety.

Dimeff L, Koerner K, Heard K, Ruork A, Kelley-Brimer A, Witterholt S JMIR Form Res. 2024; 8:e52293.

PMID: 39283664 PMC: 11443178. DOI: 10.2196/52293.

References

Van Orden K, Witte T, Cukrowicz K, Braithwaite S, Selby E, Joiner Jr T . The interpersonal theory of suicide. Psychol Rev. 2010; 117(2):575-600. PMC: 3130348. DOI: 10.1037/a0018697. View

Chakravarthy B, Frumin E, Lotfipour S . Increasing suicide rates among middle-age persons and interventions to manage patients with psychiatric complaints. West J Emerg Med. 2014; 15(1):11-3. PMC: 3935781. DOI: 10.5811/westjem.2013.12.19513. View

Vahabzadeh A, Sahin N, Kalali A . Digital Suicide Prevention: Can Technology Become a Game-changer?. Innov Clin Neurosci. 2016; 13(5-6):16-20. PMC: 5077254. View

Chesin M, Stanley B, Haigh E, Chaudhury S, Pontoski K, Knox K . Staff Views of an Emergency Department Intervention Using Safety Planning and Structured Follow-Up with Suicidal Veterans. Arch Suicide Res. 2016; 21(1):127-137. DOI: 10.1080/13811118.2016.1164642. View

Kushniruk A, Patel V . Cognitive computer-based video analysis: its application in assessing the usability of medical systems. Medinfo. 1995; 8 Pt 2:1566-9. View

Stanley B, Chaudhury S, Chesin M, Pontoski K, Bush A, Knox K . An Emergency Department Intervention and Follow-Up to Reduce Suicide Risk in the VA: Acceptability and Effectiveness. Psychiatr Serv. 2016; 67(6):680-3. DOI: 10.1176/appi.ps.201500082. View

Larsen M, Cummins N, Boonstra T, ODea B, Tighe J, Nicholas J . The use of technology in Suicide Prevention. Annu Int Conf IEEE Eng Med Biol Soc. 2016; 2015:7316-9. DOI: 10.1109/EMBC.2015.7320081. View

Kushniruk A . Analysis of complex decision-making processes in health care: cognitive approaches to health informatics. J Biomed Inform. 2002; 34(5):365-76. DOI: 10.1006/jbin.2001.1021. View

Choi J, Bakken S . Heuristic evaluation of a Web-based Educational Resource for low literacy NICU parents. Stud Health Technol Inform. 2006; 122:194-9. View

10.

King C, Merchant C . Social and interpersonal factors relating to adolescent suicidality: a review of the literature. Arch Suicide Res. 2008; 12(3):181-96. PMC: 2989173. DOI: 10.1080/13811110802101203. View

11.

Stanley B, Brown G, Currier G, Lyons C, Chesin M, Knox K . Brief Intervention and Follow-Up for Suicidal Patients With Repeat Emergency Department Visits Enhances Treatment Engagement. Am J Public Health. 2015; 105(8):1570-2. PMC: 4504270. DOI: 10.2105/AJPH.2015.302656. View

12.

Knox K, Stanley B, Currier G, Brenner L, Ghahramanlou-Holloway M, Brown G . An emergency department-based brief intervention for veterans at risk for suicide (SAFE VET). Am J Public Health. 2012; 102 Suppl 1:S33-7. PMC: 3496464. DOI: 10.2105/AJPH.2011.300501. View

13.

Curtin S, Warner M, Hedegaard H . Increase in Suicide in the United States, 1999-2014. NCHS Data Brief. 2016; (241):1-8. View

14.

Larsen M, Nicholas J, Christensen H . A Systematic Assessment of Smartphone Tools for Suicide Prevention. PLoS One. 2016; 11(4):e0152285. PMC: 4830444. DOI: 10.1371/journal.pone.0152285. View

15.

. Practice guideline for the assessment and treatment of patients with suicidal behaviors. Am J Psychiatry. 2003; 160(11 Suppl):1-60. View

16.

Ting S, Sullivan A, Boudreaux E, Miller I, Camargo Jr C . Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993-2008. Gen Hosp Psychiatry. 2012; 34(5):557-65. PMC: 3428496. DOI: 10.1016/j.genhosppsych.2012.03.020. View

17.

Boudreaux E, Miller I, Goldstein A, Sullivan A, Allen M, Manton A . The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE): method and design considerations. Contemp Clin Trials. 2013; 36(1):14-24. PMC: 3979300. DOI: 10.1016/j.cct.2013.05.008. View

18.

Yen P, Bakken S . Usability testing of a web-based tool for managing open shifts on nursing units. Stud Health Technol Inform. 2009; 146:81-5. PMC: 3129031. View