ABSTRACT. This is a request to supplement grant award R01MH123484 Using Search Engine Data for Detection and Early Intervention in Suicide Prevention in response to NOT-OD-22-026 Administrative Supplement for Research and Capacity Building Efforts Related to Bioethical Issues. This supplement proposal focuses on Bioethics Research. The parent award will determine whether internet search histories and on search behavior on the Google Search Engine donated by and prospectively collected by people with varying degrees of suicide risk will be successful in determining proximal risk of suicide. In a previous study, people with a recent suicide attempt donated retrospective data downloaded from the Google Take Out tool (GTO). We were able to identify behavioral and linguistic patterns that predicted suicide attempts 30-60 days before the event occurred. The currently funded study will ask 1,000 people with varying risk for suicide to donate retrospective data and to continue to donate these data for 1 year. Participants complete a retrospective interview and prospective surveys every two weeks about the occurrence of suicidal behavior and attempts. Should we be able to demonstrate to scale the same results we found in the previous pilot project, the data from this current study could be game changing in the detection of proximal suicide risk. Given that 77 percent of the US population1 seek information online almost entirely using Google Search, any risk prediction algorithm and subsequent intervention should be able to reach at-risk Americans to prevent this serious public health outcome. However, should we be successful, there are a number of ethical, legal, and societal implications that still need to be addressed. To understand these implications, we will qualitatively interview 50 study participants in a series of focus groups (25 with no previous experience with treatment for suicide and 25 with that experience) and 20 interventionists (clinicians and community workers) about ethical and equitable application of such an algorithm to interventions to prevent suicide. We include the perspectives of interventionists in this study to identify where consumers and interventionists agree on ethical, legal, and societal implications and where there maybe divergence of opinion. Consultation with ethicists will guide the development of the questions and interpretation of results. Guided by the Digital Health Framework, we will present participants with different scenarios about privacy concerns (choice to share, what data to share), risk/benefit concerns (which agent should have access to the MLA and be responsible for acting on a MLA recommendation), accessibility and usability concerns (diversity representation and access; which interventions are acceptable with a specific eye toward moral and equitable resource allocation), and data management concerns (where and how the data should be stored). Participants will also be asked to consider what potential ...