PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.
Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.
It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.
The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.
And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.
Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.
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PDAs helped to remind adolescents about a range of coping strategies they could use to avoid harming themselves.
The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.
Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.
"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.
On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.
Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.
That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.
Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.
Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.