Improving Coping to Reduce Suicide Risk Following ED Discharge

Facilitating Effective Coping to Reduce Suicide Risk Following ED Discharge: A Micro-randomized Trial to Develop an Adaptive Text-based Intervention

The researchers hope to learn whether an electronic safety plan (ESP) and a supportive text messaging program are feasible and acceptable to adult patients with recent suicidal thoughts or behavior after emergency department (ED) discharge. From this study, the researchers also hope to learn how to best carry out the ESP and text messaging program to improve outcomes for patients after ED discharge.

Study Overview

• Status: Not yet recruiting
• Conditions: Suicidal Ideation; Suicide, Attempted; Suicidal
• Intervention / Treatment: Behavioral: Electronic Safety Plan (ESP); Behavioral: Text support

• Study Type: Interventional
• Enrollment (Estimated): 120
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ewa Czyz; Phone Number: 734-764-9466; Email: ewac@umich.edu

Study Locations

• United States
  • Michigan
    • Ann Arbor, Michigan, United States, 48109
      • University of Michigan
      • Contact: Ewa Czyz; Phone Number: 734-764-9466; Email: ewac@umich.edu
      • Contact: Adam Horwitz, Ph.D.; Phone Number: 734-764-0231; Email: ahor@med.umich.edu
      • Principal Investigator: Ewa Czyz, Ph.D.
      • Principal Investigator: Adam Horwitz, Ph.D.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Individuals presenting to an ED with either:

1. actual, interrupted, or aborted attempt in the last 4 weeks
2. suicidal ideation within the last week

Exclusion Criteria:

• Severe cognitive impairment or altered mental status (psychosis, manic state)
• Severe aggression/agitation,
• Being admitted or transferred into inpatient care,
• Patient not owning a cell phone with text messaging capability

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Electronic safety plan (ESP) + Text-Based Support; Participants who are randomized to this arm will receive ESP during ED care and receive a text-based support program for 4 weeks after discharge, with up to 2 messages per day. The text-based program includes a microrandomized trial (MRT), where participants are randomized twice daily to receive or not receive a message.	Behavioral: Electronic Safety Plan (ESP); Participants will receive an electronic safety plan in the ED. ESP focuses on developing a personalized coping plan to manage suicidal thoughts and urges.; Behavioral: Text support; Those in the text-based support program will receive up to 2 texts per day for a month with varying levels of tailoring, based on ESP and dynamic personalized feedback.
Experimental: Enhanced electronic safety plan (ESP) enhanced with 2 reminder text messages with ESP link	Behavioral: Electronic Safety Plan (ESP); Participants will receive an electronic safety plan in the ED. ESP focuses on developing a personalized coping plan to manage suicidal thoughts and urges.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of eligible individuals who agree to participate		At the time of ED 1 day visit
Completion of the one-month follow-up assessment survey		One month post-discharge from the ED
Completion of the three-month follow-up assessment survey		Three months post-discharge from the ED
Number of withdrawals		Up to 3 months post-discharge from the ED
Percentage of participants who remain active (in text-support condition only)		Up to 28 days post-discharge from the ED
Participant satisfaction with the intervention components	Measured with a modified Client Satisfaction Questionnaire (CSQ).	Up to 1 months

Collaborators and Investigators

• Sponsor: University of Michigan
• Collaborators: National Institute of Mental Health (NIMH)
• Investigators: Principal Investigator: Ewa Czyz, Ph.D., University of Michigan

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2026
• Primary Completion (Estimated): February 1, 2027
• Study Completion (Estimated): February 1, 2027

Study Registration Dates

• First Submitted: September 24, 2024
• First Submitted That Met QC Criteria: September 25, 2024
• First Posted (Actual): September 26, 2024

Study Record Updates

• Last Update Posted (Actual): March 31, 2026
• Last Update Submitted That Met QC Criteria: March 30, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Emergency Department
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Behavioral Symptoms; Self-Injurious Behavior; Suicide; Pathological Conditions, Signs and Symptoms; Behavior; Emergencies; Suicidal Ideation; Suicide, Attempted
• Other Study ID Numbers: HUM00244094; R34MH133057 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No