Just-in-Time Adaptive Interventions for Suicide: the Right Idea at the Right Time.

In the article “Just-in-Time Adaptive Interventions for Prevention: Promise, Challenges, and Future Directions,” Coppersmith and colleagues provide a theoretical framework for leveraging advanced digital technologies to improve suicide risk detection and intervention through just-in-time adaptive interventions (JITAIs; Coppersmith et al., 2022). In the following commentary, we will address several key issues the article raises and provide a holistic and pragmatic framework to further analyze the main tenets of the article. According to the Centers for Disease Control, Suicide claims a life in the US approximately every 11 minutes (Centers for Disease Control and Prevention, 2021). Over the last several decades, there has been growing interest and investment in developing strategies and interventions to drive down the number of suicide deaths (Action Alliance, 2012). Unfortunately, suicide is a vexing problem to solve, and many of the interventions and strategies deployed to prevent suicide have yet to produce significant declines in suicide rates. At the center of this vexing problem is not knowing precisely who is contemplating suicide, when the person is thinking of attempting suicide and how to best reach out and help the person who is considering suicide. Recent studies indicate that over half of clinical patients who attempt or die by suicide screen negative for suicide ideation (Bryan, Thomsen, et al., 2022), and 95% of individuals who think of suicide do not attempt or die by suicide (Bryan, 2022). Further complicating the identification of people who may be at risk for suicide is how quickly many individuals progress from thinking about suicide to acting on it. Study findings show that many individuals transition from thinking about suicide within 10 minutes (Deisenhammer et al., 2009; Simon et al., 2001). Therefore, novel approaches to swiftly identify individuals who are contemplating suicide that do not rely on self-report of suicide ideation are urgently needed. In the current article by Coppersmith and colleagues, the authors posit several novel “wearable” technology approaches that aim to formulate digital phenotypes and address the challenge of identifying individuals who may be at risk for suicide, in-real-time. Another main point of the article by Coppersmith and colleagues is how to best, in-situ, provide help to individuals who exhibit physical changes measured by wearable device or information reported via smartphone or web-based interactions that identify potential risk of suicide. Providing help to those in suicide crisis can be challenging. Often, individuals who are experiencing an acute suicidal crisis do not think about needing help (Bryan, Bryan, et al., 2022), cannot physically access mental health care due to