Personalized Internet-Based Multi-Approach Treatment for Suicide Prevention (MoshiMoshi): Design, Implementation, Pilot on Feasibility and Randomized Controlled Trial on Efficacy

Research aims: Mental illnesses are on the rise and the recent pandemic seems to have significantly contributed to this increase. MoshiMoshi (a Japanese expression used picking up the phone) aims at developing a new personalized Internet-Based Multi-Approach Intervention (IB-MAI) for inpatients at suicide risk. Inpatients will benefit from IB-MAI through a mobile app. The design phase of MoshiMoshi will address both the strictly therapeutic aspects and the way in which the treatment will be provided (Internet-Based). The implementation phase will be carried out using the newest technology and in accordance with the guidelines of mobile development. The evaluation phase will include a feasibility analysis through a pilot study; an efficacy analysis through a randomized controlled trial (RCT) comparing IB-MAI to treatment as usual (TAU); and a deep analysis of the collected data through Machine Learning. Hypotheses: We hypothesize the design and implementation of IB-MAI to be feasible. Concerning the evaluation, we expect the personalized IB-MAI to be more efficacious compared to TAU. Sample: The sample will be composed of n=100 patients at their discharge from the University Hospital of Novara (NoH) who reported at the beginning of their hospitalization to have current suicidal ideation (SI) (n=50) or current suicide attempt (SA) in the last 2 years (n=50). Measures: The main outcome measure will be the Columbia-Suicide Severity Rating Scale (C-SSRS). Three types of assessments will be conducted: Long-Term Evaluation, Daily Evaluation, and Weekly Evaluation. Long-Term Evaluation in turns includes four assessments: T0) at the hospital discharge before starting the treatment; T1) after the 7-week IB-MAI treatment or TAU completion; T2) at 12-week follow-up; and T3) at 24-week follow-up. Daily Evaluation and Weekly Evaluation allow to screen participants each day and each week respectively (for 24 weeks). Procedures: The first phase of the study will be focused on IB-MAI design and implementation. During the second phase (IB-MAI evaluation), a sub-sample of n=20 subjects will be recruited at the University of Milan-Bicocca (UMiB) for the pilot study (they will all receive IB-MAI), the sample for the RCT will be recruited, and patients will be randomized to IB-MAI (n=50) or TAU (n=50). MoshiMoshi will be performed through a collaboration between the Departments of Psychology and of Informatics, Systems and Communication of UMiB and NoH, Italy. Potential impact: MoshiMoshi will contribute to the: a) development of a new Internet-Based Intervention for individuals at suicide risk tailored to the individual’s needs and targeting specific symptoms; b) improvement of the quality of life of individuals at suicide risk; c) reduction of health care system costs. Next steps: MoshiMoshi may be easily used in different contexts: different populations (e.g., outpatients, university workers, immigrants); targeting somatic symptoms (e.g., chronic pain).