Technology hasn’t yet played the role many expected it would in helping to prevent suicides. But leveraging digital health and machine learning in three areas believed to contribute to suicide deaths could go far in helping save people’s lives, says a “Viewpoint” column published in JAMA Psychiatry.
“The current, limited technological advances in suicide prevention do not reflect a failure of technology or big data, but rather a need to realign research aims and clinical use with prevention research that address the upstream suicide risk that precedes suicide crisis,” wrote psychiatrist John Torous, MD, and clinical psychologist Rheeda Walker, PhD.
As rates of suicide attempts and deaths have recently increased to 50-year highs, the National Action Alliance for Suicide Prevention identified three health care gaps that contribute to suicide death:
- Failing to proactively identify suicide risk.
- Not acting efficiently for safety.
- Inadequately providing supportive contacts for people at risk of suicide.
“Addressing gaps in the current suicide prevention efforts can be achieved by systematically identifying those at risk and using smart technology toward risk assessment, safety planning and building support outside of clinical care,” Dr. Torous and Walker wrote.
Dr. Torous serves as web editor of JAMA Psychiatry, directs the digital psychiatry division in the Department of Psychiatry at Beth Israel Deaconess Medical Center and is an instructor at Harvard Medical School. Walker is an associate professor of psychology at the University of Houston.
Proactively identifying risk
A history of a mental health condition or prior suicide attempt are strongly associated with suicide, but studies are beginning to identify other factors that have been overlooked. For example, a cancer diagnosis is associated with an increased suicide risk in the six months following the diagnosis. Individuals who report sleep dysregulation rather than direct suicide thoughts are also at a greater risk of suicide.
Improving the knowledge about what constitute risk factors, creating algorithms that can contextualize the risk and translating the population-level risk into personal prognostications will improve medicine’s ability to proactively identify suicide risk, the essay says.
“As sensors, smartphones and even smart homes continue to offer more data on social, functional and even physiological metrics, psychiatry has an unprecedented opportunity and challenge in pairing the right data with the right methods to improve predictive values from their current nadir toward greater clinical relevance,” the authors wrote.
Safety and support
Technology may also help narrow the other two gaps contributing to suicide deaths. But using technology to keep people safe and offer better support for those at risk for suicide presents challenges.
It’s easy to imagine how a web-based computer program, text-messaging platform, smartphone app, or even smartwatch feature could include elements of safety planning, the authors wrote. But evidence from digital tools used today have shown mixed results in reducing suicide.
“Using increased access to digital technology to increase access to safety planning presents a promising target, but a novel challenge around engagement and implementation,” the authors wrote.
Poor safety planning often coincides with limited supportive contacts, the third gap contributing to suicide death.
While supportive text messaging is a relatively low-cost and low-effort way to intervene, looking at pixels on a screen may not offer the same support as personal interaction or a handwritten note, and may be more appropriate in some situations than others.
For example, a digital tool may be effective for a patient under stress who has a history of major depressive disorder without a history of suicide attempt, but not for an otherwise similar patient who was recently discharged from an inpatient psychiatric care unit after a suicide attempt.
The authors concluded that “technology is not the panacea of suicide prevention but it is a crucial tool that the field must develop today to save lives tomorrow.”
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