TEEM-GIFTS: A Gamified mHealth to Reduce Post-Discharge Suicide Risk
ConditionSuicide
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorShenzhen Kangning Hospital
About this trial
Patients with mental disorders are at significantly higher risk of suicide after discharge compared to the general population and patients with other diseases. Currently, there is a lack of post-discharge community suicide risk management services in China. The research team's preliminary research suggests that mHealth interventions are well-accepted and feasible for reducing the suicide risk in patients with mental disorders. Furthermore, the inclusion of gamification elements can enhance treatment adherence and user engagement. However, determining the appropriate combination of gamification elements and evaluating the implementation effectiveness of gamified mHealth interventions for suicide risk are challenges in transforming these into regular community mental health services. This study will leverage gamification theory and community-based participatory research to design a gamified mHealth intervention model aimed at reducing suicide risk among discharged patients with mental disorders, and to develop a corresponding management strategy. Using the multi-phase optimization strategy (MOST), the study will identify the optimal combination of gamification elements to reduce suicide risk and increase the outpatient follow-up rate. Through an implementation science framework, the investigators will evaluate the process, outcomes, cost, and feasibility of this management strategy with the goal of reducing suicide risk among these patients. The findings from this study will provide a scientific basis for innovative suicide risk management models for discharged patients with mental disorders in China, thereby paving the way for the application of implementation science in mental health.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Being 18 years and above;
Being diagnosed with mental disorders;
Having received inpatient care for three days or more;
Living in Shenzhen and having no plan to leave Shenzhen in the following 12 months after discharge;
Disqualifiers
Refusing to provide written consent or be unable to provide written consent due to any cognitive problems.
Being discharged by the patient's or LHSs' demand against medical advice.
With no ID, no stable residence nor any source of income.
Refusing to provide written consent.
Trial design
Design model
Parallel
Treatments tested in this trial
TEEM
Other interventionThe TEEM app will provide four types of gamified intervention elements as Routine Tracker, Mind Care, Social Connectivity, and Achievement \& Rewards which providing services including brief contact intervention, mCBT, health education, venting space, mood sharing, etc. Only enrolled participants have access to log in and use the app.
Treatment groups
640 Participants
are divided into 18 treatment groups18
Treatment groupsSee each treatment group below.
Group A: Routine Tracker, Mind Care, Social Connectivity, and Achievement & RewardsExperimental treatment 1 intervention
Group B: Routine Tracker, Mind Care and Social ConnectivityExperimental treatment 1 intervention
Group C: Routine Tracker, Social Connectivity, and Achievement & RewardsExperimental treatment 1 intervention
Group D: Routine Tracker and Achievement & RewardsExperimental treatment 1 intervention
Group E: Routine Tracker and Social ConnectivityExperimental treatment 1 intervention
Group F: Routine Tracker and Mind CareExperimental treatment 1 intervention
Group G: Routine Tracker and Achievement & RewardExperimental treatment 1 intervention
Group H: Routine TrackerExperimental treatment 1 intervention
Group I: Mind Care, Social Connectivity, and Achievement & RewardsExperimental treatment 1 intervention
Group J: Mind Care and Social ConnectivityExperimental treatment 1 intervention
Group K: Mind Care and Achievement & RewardsExperimental treatment 1 intervention
Group L: Mind CareExperimental treatment 1 intervention
Group M: Social Connectivity and Achievement & RewardsExperimental treatment 1 intervention
Group N: Social ConnectivityExperimental treatment 1 intervention
Group O: Achievement & RewardsExperimental treatment 1 intervention
Group P: Brief contact interventionExperimental treatment 1 intervention
Group Q: Optimized TEEMExperimental treatment 1 intervention
Group R: Care as usualExperimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Suicide ideation at three months after discharge
This study will use the Beck Suicide Ideation Scale-Chinese Version (BSI-CV) to assess participants' suicide ideation. The BSI-CV includes 19 items, and each item scores from 0 to 2 with a total score ranging from 0 to 38, and a higher score indicates a higher level of suicide ideation. The total score and its trajectory from baseline to three months after discharge will be recorded and compared.
Time frame
It will be evaluated at one week, one months and three months after discharge.2
The rate of re-visits to outpatient clinic at three months after discharge
Responses to the question "How many times have you re-visited the outpatient clinic at SKH in the past three months? " will be recorded and compared. In clinic, patients must visit the outpatient clinic one week post-discharge to refill their medication, which can only be prescribed for a maximum of 30 days, resulting in at least four subsequent visits to the clinic. Thus, we define the rate of outpatient clinic revisits as the number of participants who complete all revisits divided by the total number of participants.
Time frame
It will be evaluated at one week, one months and three months after discharge.Secondary outcomes
1
Self-determination at at three months after discharge
This study will use the Self-Determination Scale-Chinese Version (SDS) to assess participants' the level of self-determination. The SDS includes 10 items, and each item includes two statements, with scoring options ranging from 'agree only with statement A' to 'agree only with statement B' on a scale of 1-9 with a total score ranging from 10 to 90, and a higher score indicates a higher level of self-determination. The total score and its trajectory from baseline to three months after discharge will be recorded and compared.
Time frame
It will be evaluated at one week, one months and three months after discharge.2
Social connectedness at three month after discharge
Social connectedness will be measured by the Social Connectedness Scale (SCS) to evaluate participants' social connected ness after discharge. The SCS is a 20-item scale, and each item is on a 6-Likert continuum (from "Strongly disagree" to "Strongly agree") scoring from 1 to 6. A higher total score indicates a higher level of social connectedness. The total score and its trajectory from baseline to three months after discharge will be recorded and compared.
Time frame
It will be evaluated at one week, one months and three months after discharge.3
Social support at three months after discharge
Social support will be measured by the 23-item Duke Social Support Index (DSSI) to evaluate participants' social support after discharge. The DSSI investigates social support by social interaction, perceived social support and instrumental social support. Every answer has been assigned a score, and the total reflects the sum of the items ranging from 11 to 45. A higher total score indicates a higher level of social support. The total score and its trajectory from baseline to three months after discharge will be recorded and compared.
Time frame
It will be evaluated at one week, one months and three months after discharge.Other outcomes
1
Times of re-hospitalization for mental disorders
Responses to the question "How many times have you been hospitalized for mental disorders" will be recorded and compared.
Time frame
It will be evaluated at one week, one months and three months after discharge.2
Attitudes towards the acceptability of the intervention
This is a mixed methods study, and the investigators will conduct community-based participatory research (CBPR) to evaluate the implementation of the intervention. After the confirmation phase, focus group interviews will be conducted with the CBPR team understand the community's attitudes towards the acceptability of the intervention. Of note, participants (the patients, LHSs, clinical and community mental health providers) are recruited for the qualitative interviews only, who are different from the MOST phases.
Time frame
It will be evaluated by three focus group interviews immediately after the confirmation phase, and each interview will be about 60 to 120 minutes.3
Attitudes towards the adoption of the intervention
This is a mixed methods study, and the investigators will conduct community-based participatory research (CBPR) to evaluate the implementation of the intervention. After the confirmation phase, focus group interviews will be conducted with the CBPR team understand the community's attitudes towards the adoption of the intervention. Of note, participants (the patients, LHSs, clinical and community mental health providers) are recruited for the qualitative interviews only, who are different from the MOST phases.
Time frame
It will be evaluated by three focus group interviews immediately after the confirmation phase, and each interview will be about 60 to 120 minutes.4
The adoption rate of the intervention in patients
The rate will be measured by the number of participants who use the TEEM app divided by the number of participants at the end of the study. Of note, this outcome evaluates the implementation process of the intervention.
Time frame
It will be evaluated at three months after discharge.Sponsors and contacts
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Source ClinicalTrials.gov