"Lock and Protect": Development of a Digital Decision Aid to Support Lethal Means Counseling in Parents of Suicidal Youth

Overview

Journal Front Psychiatry

Specialty Psychiatry

Date 2021 Oct 25

PMID 34690841

Citations 6

Authors

Joan R Asarnow

Lucas Zullo

Stephanie M Ernestus

Chase W Venables

David B Goldston

Angela M Tunno

Marian E Betz

Affiliations

Soon will be listed here.

Abstract

Reducing access to lethal methods is an effective suicide prevention strategy that is often neglected in routine care. Digital interventions have shown promise for addressing such gaps in care; and decision aids have proven useful for supporting complicated health-related decisions, like those involving lethal means restriction. This article describes a parent/caregiver-facing web-based decision aid, the development process, and user testing. A user-centered, participatory, mixed methods development design was employed. Beginning with an adult-focused decision aid developed by members of our team, we assessed ten iterations of the parent/caregiver decision aid with stakeholders ( = 85) using qualitative interviews and quantitative surveys. Stakeholders included: parents/caregivers whose children had histories of suicidal episodes before age 25, young adults with histories of suicidal thoughts/behaviors, firearm owners/representatives from firearm stores/ranges/groups, mental and medical health care providers, and emergency responders. The final "Lock and Protect" decision aid was viewed as "useful for changing access to lethal means" by 100% of participants. Ninety-four percent of participants rated the information on reducing access to lethal means as good to excellent, and 91% rated the information on storage options as good to excellent. Qualitative feedback underscored a preference for offering this digital tool with a "human touch," as part of safety and discharge planning. "Lock and Protect" is a user-friendly web-based tool with potential for improving rates of lethal means counseling for parents/caregivers of suicidal youth and ultimately reducing pre-mature deaths by suicide.

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References

Glenn C, Lanzillo E, Esposito E, Santee A, Nock M, Auerbach R . Examining the Course of Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors in Outpatient and Inpatient Adolescents. J Abnorm Child Psychol. 2016; 45(5):971-983. PMC: 5397367. DOI: 10.1007/s10802-016-0214-0. View

Betz M, Miller M, Barber C, Beaty B, Miller I, Camargo Jr C . LETHAL MEANS ACCESS AND ASSESSMENT AMONG SUICIDAL EMERGENCY DEPARTMENT PATIENTS. Depress Anxiety. 2016; 33(6):502-11. PMC: 4800489. DOI: 10.1002/da.22486. View

Barber C, Miller M . Reducing a suicidal person's access to lethal means of suicide: a research agenda. Am J Prev Med. 2014; 47(3 Suppl 2):S264-72. DOI: 10.1016/j.amepre.2014.05.028. View

Runyan C, Brooks-Russell A, Tung G, Brandspigel S, Betz M, Novins D . Hospital Emergency Department Lethal Means Counseling for Suicidal Patients. Am J Prev Med. 2017; 54(2):259-265. PMC: 5898970. DOI: 10.1016/j.amepre.2017.10.023. View

Brent D, Perper J, Moritz G, Baugher M, Schweers J, Roth C . Firearms and adolescent suicide. A community case-control study. Am J Dis Child. 1993; 147(10):1066-71. DOI: 10.1001/archpedi.1993.02160340052013. View

Patel M, Volpp K, Asch D . Nudge Units to Improve the Delivery of Health Care. N Engl J Med. 2018; 378(3):214-216. PMC: 6143141. DOI: 10.1056/NEJMp1712984. View

Wysocki T, Hirschfeld F, Miller L, Izenberg N, Dowshen S, Taylor A . Consideration of Insulin Pumps or Continuous Glucose Monitors by Adolescents With Type 1 Diabetes and Their Parents: Stakeholder Engagement in the Design of Web-Based Decision Aids. Diabetes Educ. 2016; 42(4):395-407. DOI: 10.1177/0145721716647492. View

Stacey D, Legare F, Lewis K, Barry M, Bennett C, Eden K . Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017; 4:CD001431. PMC: 6478132. DOI: 10.1002/14651858.CD001431.pub5. View

Onie S, Li X, Liang M, Sowmya A, Larsen M . The Use of Closed-Circuit Television and Video in Suicide Prevention: Narrative Review and Future Directions. JMIR Ment Health. 2021; 8(5):e27663. PMC: 8140380. DOI: 10.2196/27663. View

10.

Bauer B, Capron D . How Behavioral Economics and Nudges Could Help Diminish Irrationality in Suicide-Related Decisions. Perspect Psychol Sci. 2019; 15(1):44-61. DOI: 10.1177/1745691619866463. View

11.

Swanson S, Eyllon M, Sheu Y, Miller M . Firearm access and adolescent suicide risk: toward a clearer understanding of effect size. Inj Prev. 2020; . PMC: 8165151. DOI: 10.1136/injuryprev-2019-043605. View

12.

Zdenkowski N, Butow P, Tesson S, Boyle F . A systematic review of decision aids for patients making a decision about treatment for early breast cancer. Breast. 2016; 26:31-45. DOI: 10.1016/j.breast.2015.12.007. View

13.

Clarke A, Kuosmanen T, Barry M . A systematic review of online youth mental health promotion and prevention interventions. J Youth Adolesc. 2014; 44(1):90-113. DOI: 10.1007/s10964-014-0165-0. View

14.

Mohr D, Lyon A, Lattie E, Reddy M, Schueller S . Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment. J Med Internet Res. 2017; 19(5):e153. PMC: 5443926. DOI: 10.2196/jmir.7725. View

15.

Betz M, Knoepke C, Simpson S, Siry B, Clement A, Saunders T . An Interactive Web-Based Lethal Means Safety Decision Aid for Suicidal Adults (Lock to Live): Pilot Randomized Controlled Trial. J Med Internet Res. 2020; 22(1):e16253. PMC: 7016618. DOI: 10.2196/16253. View

16.

Conner A, Azrael D, Miller M . Suicide Case-Fatality Rates in the United States, 2007 to 2014: A Nationwide Population-Based Study. Ann Intern Med. 2019; 171(12):885-895. DOI: 10.7326/M19-1324. View

17.

Hedegaard H, Curtin S, Warner M . Suicide Mortality in the United States, 1999-2019. NCHS Data Brief. 2021; (398):1-8. View

18.

Anestis M . Prior suicide attempts are less common in suicide decedents who died by firearms relative to those who died by other means. J Affect Disord. 2015; 189:106-9. DOI: 10.1016/j.jad.2015.09.007. View

19.

Bridge J, Olfson M, Caterino J, Cullen S, Diana A, Frankel M . Emergency Department Management of Deliberate Self-harm: A National Survey. JAMA Psychiatry. 2019; 76(6):652-654. PMC: 6552299. DOI: 10.1001/jamapsychiatry.2019.0063. View

20.

Betz M, Knoepke C, Siry B, Clement A, Azrael D, Ernestus S . 'Lock to Live': development of a firearm storage decision aid to enhance lethal means counselling and prevent suicide. Inj Prev. 2018; 25(Suppl 1):i18-i24. PMC: 6533157. DOI: 10.1136/injuryprev-2018-042944. View