Oskar Flygare

Research problem and specific questionsDelivering active contact and follow-up interventions to patients recently discharged from inpatient psychiatric treatment is a promising strategy for suicide prevention. One intervention in particular, Caring Contacts, has been shown to reduce repeat suicide attempts by 40% in the year after discharge, but it has not been evaluated in Sweden and is currently unavailable in regular clinical practice.The objective of the proposed project is therefore to address the following research questions:- Does Caring Contacts lead to fewer suicide attempts in the year after discharge? (Primary outcome)- Is Caring Contacts a cost-effective intervention?- Does Caring Contacts lead to reduced all-cause mortality, suicide mortality, and fewer days in inpatient psychiatric care?- Is Caring Contacts more effective for some individuals than others, for example among those not attending outpatient psychiatric care after discharge?Data and methodPatients receiving inpatient psychiatric care due to recent suicidal behaviour, severe depression, or elevated suicide risk (N = 582), will be included in a randomised controlled trial of Caring Contacts plus standard care, versus standard care alone. The Caring Contacts intervention will be delivered as a series of text messages over the course of one year, expressing care and concern for the recipient´s well-being without placing any demands on them.Primary and secondary outcomes will be evaluated using linked national registers. Participation in the project will not pose any restrictions on access to standard care during the trial period.Societal relevance and utilisationThe project addresses multiple priorities in Forte´s strategic research agenda on mental health and brings together a multidisciplinary team of researchers, clinicians and lived experience representatives. An active collaboration with clinicians and patient organisations will facilitate implementation and ensure that the research is informed by individuals with lived experience.Plan for project realisationParticipants will be recruited at the emergency and inpatient psychiatric units at Psykiatri Sydväst, Region Stockholm, where our research team has previously evaluated and implemented digital interventions. Our multidisciplinary team brings together research expertise and clinical experience in assessing and treating self-harm. We seek funding from Forte for salary support of the main applicant and a project manager.

Self-injury is a growing health crisis among youth, and the strongest risk factor for suicide attempts. Scalable treatments are needed but lacking. We have recently shown that a brief digital treatment, IERITA (Internet-delivered Emotion Regulation Individual Therapy for Adolescents), can be efficacious and cost-effective. However, not all patients respond sufficiently to the standard treatment procedure. Now we aim to implement and evaluate IERITA within regular health services and optimize treatment outcomes. First, we will develop and validate a classification tool to predict non-remission (continued self-injury after treatment). This tool will subsequently be used in the second step: a randomized controlled trial (N=341) between 2025 to 2028, which compares adaptable to standard IERITA. Adolescents allocated to adaptable IERITA and classified as likely non-remission in treatment week four will recieve adapted IERITA (e.g., personalized dose and treatment delivery) for the remaining eight weeks. We will (1) follow participants one- three- and twelve-month post-treatment

(2) use self-reports and blinded assessments

(3) study distal effects in national registers

(4) investigate several clinically relevant outcomes

and (5) conduct cost-effectiveness analyses. If successful, more patients could receive evidence-based treatment for self-injury, and treatment outcomes could be improved. In extension, queues to care may be reduced, and suicide attempts and suicides prevented.