# Adaptive intervention to prevent adolescent suicidal behavior following psychiatric hospitalization: A Sequential Multiple Assignment Randomized Trial

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $696,609

## Abstract

ABSTRACT
The increasing rates of suicide among adolescents is an urgent public health concern. In parallel, emergency
department (ED) visits and psychiatric hospitalizations due to youth suicide risk have also been on the rise.
Although psychiatric hospitalization provides critical stabilization, discharged adolescents remain at elevated
risk for recurrent suicidal crises (e.g., suicide attempts, rehospitalizations). New approaches are urgently
needed to alter risk trajectories and prevent suicidal behavior among adolescents transitioning from inpatient
care. Bridging an adaptive intervention (AI) strategy—wherein type, intensity, and timing of treatment can be
individualized to address suicidal adolescents’ changing and heterogenous treatment needs—together with
mobile technology to reach adolescents during the high-risk post-discharge period, our goal is to identify an
optimal AI for reducing youth suicidal behavior after inpatient care. We build on promising evidence from our
recently completed NIMH-funded pilot sequential multiple assignment randomized trial (SMART) of a multi-
component intervention comprised of: a Motivational Interview (MI)-enhanced safety plan delivered to
adolescents and parents during hospitalization (MI-SP); post-discharge booster calls provided to youth and
parents; and text-based support (Texts) delivered to adolescents daily for a month after discharge. In addition
to feasibility and acceptability, the pilot SMART results suggested that certain intervention sequences improved
key mechanisms of change (self-efficacy, safety plan use, coping) and were, preliminarily, associated with
lower suicidal behavior 3 months after discharge. In this application, we propose to conduct a full-scale
SMART to address the following specific aims: (1) Compare the AIs that begin with MI-SP alone or MI-SP plus
Texts on the primary outcome of suicidal behavior (actual, interrupted, or aborted attempts) within 3 months
post discharge and the two secondary outcomes of time-to-suicidal behavior and severity of suicidal ideation
over 6 months; and (2) Determine the optimal sequence of intervention components by comparing four AIs
embedded in the SMART on primary and secondary outcomes. Adolescents (N=300), ages 13-17, hospitalized
due to suicidal ideation and/or attempt will be initially randomized to MI-SP alone or MI-SP with Texts. Based
on adolescents’ responses to daily surveys, those classified as non-responders within 2 weeks post discharge
will be re-randomized to added low-intensity booster calls (one call with adolescent and one call with parent) or
high-intensity boosters (six calls with each). Secondary aims are to: (1) Identify moderators of initial
intervention options and of augmentation strategies for non-responders; and (2) Examine whether mechanisms
of change (self-efficacy, safety plan use, coping) mediate the impact of MI-SP plus Texts and that of high-
intensity boosters. The proposed research will have significant publi...

## Key facts

- **NIH application ID:** 10846554
- **Project number:** 5R01MH126871-04
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Ewa Karina Czyz
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $696,609
- **Award type:** 5
- **Project period:** 2021-09-07 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10846554

## Citation

> US National Institutes of Health, RePORTER application 10846554, Adaptive intervention to prevent adolescent suicidal behavior following psychiatric hospitalization: A Sequential Multiple Assignment Randomized Trial (5R01MH126871-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10846554. Licensed CC0.

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