Drivers of Suicide Mobile App Study
Phase: NA
Conditions: Suicide, Suicide, Attempted, Suicidal Ideation, Alcohol Use Disorder, Alcoholism, Alcohol Abuse, Screening and Brief Interventions
Sponsor: Evidence-Based Practice Institute, Seattle, WA

Tr e a ti n g Dri v ers of S uici d e i n Pri m ar y C ar e usi n g J as pr H e alt h  
St u d y Pr ot o c ol & St a tis tic al A n al ysis Pl a n  
 
St erli n g I R B Pr ot o c ol: 1 2 6 0 3  
N a ti o n al Cli nic al Tri al ( N C T) I d e n ti fi e d N u m b er: N C T 0 5 4 2 7 7 3 4  
Pri nci p al I nv es ti g at ors: Li n d a Di m e ff, P h D & D avi d J o b es , P h D, A B P P 
S p o ns or: Evi d e nc e -B as e d P r ac tic e I ns tit ut e, I nc. 
Gr a nt Titl e: Tr e a ti n g Dri v ers of S uici d e i n Pri m ar y C ar e usi n g J as pr H e alt h  
Gr a nt N u m b er: R 4 4 A A 0 2 9 8 6 8  
F u n d e d by:  N a ti o n al I ns tit ut e  o n Alc o h ol A b us e a n d Alc o h olis m  
Versi o n N u m b er: 2  
2 0  M arc h 2 0 2 5  

 
 
Dri v ers  of  S uici d e  M o bil e  A p p  St u d y 
S u m m ati v e E v al u ati o n Pr ot oc ol  
 
 
2.  C o ve r  P a ge  .......................................................................................................................................................................... 2  
3.  I ntr o d ucti o n ..................................................................................................................................................................... 3 -6  
A.  T y pe of Researc h  ........................................................................................................................................................... 4  
B.  P ur p ose/ O bje cti ve  of  t he St u d y  ...................................................................................................................................... 4  
C.  Ba c k gr o u n d  of  t he St u d y  ............................................................................................................................................. 4 -6  
4.  P artici p a nt  Selecti o n  ....................................................................................................................................................... 6 -8  
A.  I ncl usi o n a n d E xcl usi o n  Criteria  ................................................................................................................................. 6 -7  
B.  Ge n der  ............................................................................................................................................................................ 7  
C.  Ra cial/ Et h nic  Ori gi n  ...................................................................................................................................................... 7  
D.  V ul ner a ble  P o p ulati o ns  .................................................................................................................................................. 7  
E.  A ge  ................................................................................................................................................................................. 8  
F.  T otal  N u m ber  of  Partici pa nts  t o be  E nr olle d  ................................................................................................................. 8  
5.  St u d y  Desi g n  / Met h o d / Pr oce d ures ............................................................................................................................ 8 -1 3  
A.  S u m mar y  of  t he Researc h  Desi g n  ............................................................................................................................. 8 -1 1  
B.  A nal ysis  of  St u d y  Res ults  ....................................................................................................................................... 1 1 -1 2  
C.  M o nit ori n g  ................................................................................................................................................................... 1 2  
D.  St or a ge  of  Data  ........................................................................................................................................................ 1 2 -1 3  
E.  C o nfi de ntialit y  of  Data  ................................................................................................................................................. 1 3  
6.  Ris k/ Be n efit  Assess me nt  ............................................................................................................................................. 1 3 -1 7  
A.  Ris ks  ........................................................................................................................................................................ 1 3 -1 4  
B.  Pr e ve nti o n  of  Ris ks  ................................................................................................................................................. 1 4 -1 5  
C.  A d verse  E ve nts  ....................................................................................................................................................... 1 5 -1 7  
D.  Be nefits  ........................................................................................................................................................................ 1 7  
7.  P artici p a nt  Re cr uit me nt  a n d  I nf or me d C o nse nt  ...................................................................................................... 1 7 -1 9  
A.  Recr uiti n g  ..................................................................................................................................................................... 1 7  
B.  I nf or me d C o nse nt  ......................................................................................................................................................... 1 8  
C.  O btai ni n g  a n d D oc u me nti n g  C o nse nt  .......................................................................................................................... 1 8  
D.  Partici pa nt  C o m pre he nsi o n  a n d Ca pacit y  .................................................................................................................... 1 8  
E.  C osts  t o Partici pa nts  ..................................................................................................................................................... 1 8  
F.  C o m pe nsati o n  t o Partici pa nts  .................................................................................................................................. 1 8 -1 9  
8.  Refere nces  .................................................................................................................................................................... 1 9 -2 3  
A p pe n di x  1:  M o o d  Assess me nt  &  De brief  Pr ot oc ol  ..................................................................................................... 2 4 -3 2  
A p pe n di x  2:  Wise P at h  f or A d ults  De vic e  O ver vie w ..................................................................................................... 3 3 -4 1  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W  S e attl e,  W A  9 8 1 2 6  |  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
1.  T A BL E  OF C O N T E N T S  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  2  of  4 1  
 
 
 
 
Pr ot oc ol  Titl e:  Dri v ers  of  S uici d e  M o bil e  A p p  St u dy 
 
NI A A A  Pr ot oc ol  N u m b er:  R 4 4 A A 0 2 9 8 6 8 S  
 
St erli n g  I R B Pr ot oc ol  N u m b er:  1 2 6 0 3  
 
 
Pr ot oc ol  D at e  a n d  V ersi o n:  M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
 
 
S p o ns or  N a m e  &  C o nt act  I nf or m ati o n: E vi d e nc e  B as e d  Pr actic e  I nstit ut e |  2 0 6 -4 5 5 -7 9 3 4  |  r es e arc h @j as pr h e alt h.c o m 
 
 
Pri nci p al  I n v esti g at or: Li n d a Di m eff,  P h D  
 
 
Pr oj ect  P erf or m a nc e  Sit es:  
Pri m ary  l oc ati o n: 
E vi d e nc e  B as e d  Pr actic e  I nstit ut e, 7 2 4 1  3 6 t h Av e n u e  S W  S e attl e,  W A  9 8 1 2 6  
2.  C O V E R  P A G E  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  3  of  4 1  
 
 
 
 
S uici d e r e m ai ns a s eri o us p u blic h e alt h pr o bl e m i n t h e U nit e d St at es ( U. S.) as r at es h a v e ris e n n e arl y e ac h y e ar si nc e 
2 0 0 5,  fr o m 1 1. 0  p er  1 0 0, 0 0 0  t o 1 4. 8  p er  1 0 0, 0 0 0  i n 2 0 1 8,  t ot ali n g 4 8, 3 4 4  i n 2 0 1 8;  1. 4  milli o n  U. S.  a d ults  m a d e  a  s uici d e 
att e m pt, a n d a n ot h er 1 2 milli o n t h o u g ht s eri o usl y a b o ut killi n g t h e ms el v es t h at s a m e y e ar. Alc o h ol us e dis or d er ( A U D) 
ex p o n e nti ally i ncr e as es s uici d e risk a n d c a n als o i nt erf er e wit h s uici d e pr e v e nti o n i nt erv e nti o n eff orts. Di git al 
t ec h n ol o gi es c a n effici e ntl y a n d r eli a bl y h el p d eliv er s uici d e pr e v e nti o n e vi d e nc e -b as e d pr actic es a n d i ncr e as e t h e 
c o nfi d e nc e a n d c o m p et e nc e of pr ovi d ers i n tr e ati n g s uici d e, i ncl u di n g w h e n A U Ds a n d ot h er b e h avi or al pr o bl e ms  
(“ dri v ers of  s uici d e;” e. g.,  a nxi o us/ d e pr ess e d  m o o d,  sl e e p pr o bl e ms)  m a y  i nt erf er e wit h  t h es e eff orts.  
 
T his pr oj ect will t est t h e n e wl y d e v el o p e d Wis e P at h f or A d ults (“ Wis e P at h”), a r o b ust di git al t ec h n ol o g y d e v el o p e d 
u n d er NI A A A S BI R F ast -Tr ac k a w ar d ( R 4 4 A A 0 2 9 8 6 8; Drs. Di m eff & J o b es, C o -PIs) t h at is d e v el o p e d t o effici e ntl y a n d 
r eli a bl y ai d d eliv ery of r ec o m m e n d e d b est-pr actic es f or t h e tr e at m e nt of s uici d al i d e ati o n  i n a d ults, i ncl u di n g s uici d al 
i n divi d u als w h o als o mis us e alc o h ol. Wis e P at h i ncl u d es t ec h ni q u es f or pr e v e nti o n of s uici d al b e h a vi ors (i d e ati o n, 
pl a n ni n g, att e m pts) w hil e pr ovi di n g s u p p ort i n th e m o m e nt vi a a m o bil e a p p. Wis e P at h will i ncl u d e e vi d e nc e -b as e d 
pr actic es f or s uici d e pr e v e nti o n, i ncl u di n g f or t h os e w h o ar e s uici d al a n d als o ex p eri e nc e ot h er b e h avi or al h e alt h 
c o nc er ns s uc h as d e pr ess e d m o o d, sl e e p pr o bl e ms, a n d mis us e of alc o h ol. T his st u dy wil l t est Wis e P at h wit h i n di vi d u als 
w h o ar e ex p eri e nci n g t h es e pr o bl e ms a n d r ec e ntl y s o u g ht tr e at m e nt fr o m a pri m ary c ar e pr ovi d er. Wis e P at h i ncl u d es: 
psyc h o e d uc ati o n, b e h a vi or al s kills tr ai ni n g, crisis st a biliz ati o n pl a n ni n g, l et h al m e a ns m a n a g e m e n t, bri ef i nt erv e nti o ns 
f or t h e tr e at m e nt of  s uici d al i d e ati o n, d e pr ess e d  m o o d,  sl e e p pr o bl e ms,  alc o h ol  mis us e,  a n d  m ess a g es  of  h o p e,  wis d o m, 
a n d i nsi g hts fr o m p e o pl e wit h li v e d ex p eri e nc e ( PL E).  
 
W e will c o n d uct a r a n d o miz e d c o ntr oll e d tri al ( R C T; N = 1 2 0) c o m p ari n g Wis e P at h ( n = 6 0) t o a n acti v e c o ntr ol c o n diti o n 
( Virt u al H o p e  B ox  a n d  el ectr o nic  w ell n ess  r es o urc es br oc h ur e;  n = 6 0)  i n a d ults  ex p eri e nci n g  s uici d al i d e ati o n. T o  e ns ur e  a 
s uffici e nt s a m pl e of i n divi d u als w h o mis us e alc o h ol, n o f e w er t h a n 3 5 % ( n = 4 2) of t h e s a m pl e will b e c o m pris e d of 
i n divi d u als w h o ex p eri e nc e a h ar mf ul or h az ar d o us l e v el of alc o h ol us e. P artici p a nts will b e r a n d o ml y assi g n e d t o a 
c o n diti o n utilizi n g a mi ni miz ati o n r a n d o miz ati o n pr oc e d ur e t o m atc h p artici p a nts acr oss c o n diti o n o n s uici d e s e v erit y, 
d e pr essi o n  s e v erit y, a n d alc o h ol  mis us e.  P artici p a nts  will b e ass ess e d at b as eli n e, 4,  8, a n d  1 2  w e e ks.  P artici p a nts will b e 
c o m p e ns at e d $ 6 0 f or c o m pl eti o n of e ac h of t h e f oll o w -u p ass ess m e nts ( 4 -, 8-, a n d 1 2-w e e k); n o p a y m e nt will b e 
pr ovi d e d f or c o m pl eti o n of t h e b as eli n e ass ess m e nt, h o w e v er p artici p a nts will r ec ei v e a $ 6 0 b o n us f or c o m pl eti n g all 
ass ess m e nts. P artici p a nts w h o c o m pl et e e ac h ass ess m e nt (i ncl u di n g b as eli n e) wit hi n 7 2 h o urs of t h e sc h e d ul e d 
a p p oi nt m e nt will e ar n a c h a nc e t o wi n o n e of  1 3 $ 1 0 0 A m az o n gift c ar ds  ( 1 pr ovi d e d t o pil ot t est p artici p a nts, 1 2 t o R C T 
p artici p a nts) t h at will b e r affl e d at t h e e n d of t h e st u dy (i. e., t h os e w h o c o m pl et e all f o ur ass ess m e nts o n ti m e will h a v e 
f o ur r affl e e ntri es). If a p artici p a nt d eci d es t o wit h dr a w or e n d p artici p ati o n pri or t o c o m pl eti n g t h eir tri al or if t h e y ar e 
a d mi nistr ati v el y wit h dr a w n by t h e r es e arc h ers, t h e y will b e c o m p e ns at e d t h e t ot al a m o u nt f or t h e ass ess m e nts t h e y 
h av e c o m pl et e d.  
 
Pri or t o c o m m e nci n g t h e R C T, w e will  c o n d uct a s m all pil ot tri al  wit h  t ar g et e n d-us ers ( N = 2 0), usi n g i d e ntic al  pr oc e d ur es 
(i ncl u di n g i ncl usi o n a n d excl usi o n crit eri a) t h at will b e a p pli e d i n t h e R C T. T h e p ur p os e of t h e pil ot is t o m ak e n ec ess ary 
a dj ust m e nts t o b ot h st u dy pr oc e d ur es a n d Wis e P at h b ef or e t h e R C T is c o n d uct e d. W e will a d dr ess pr o bl e ms a n d  
b arri ers  d uri n g  t h e pil ot  tri al. T h e  R C T  will  b e gi n  aft er  all  iss u es t h at c o ul d a dv ers el y  i m p act t h e st u dy ar e  r es ol v e d d uri n g 
t h e pil ot. As a fi n al c h ec k of Wis e P at h, w e will ov er-r ecr uit f or t h e Wis e P at h c o n diti o n, c o m p ari n g Wis e P at h ( n = 1 5) t o 
t h e acti v e c o ntr ol ( n = 5). I n c o ntr ast t o t h e pr o p os e d 1 2-w e e k R C T, t h e pil ot st u dy will l ast 6 w e e ks a n d will i ncl u d e 3 
ass ess m e nts ( b as eli n e, 3 a n d 6 w e e ks). P artici p a nts t a ki n g p art i n t h e pil ot tri al will r ec ei v e $ 6 0 e ac h f or t h e 3 - a n d 6 - 
w e e k ass ess m e nt p oi nts t h e y c o m pl et e , as w ell as a c h a nc e t o wi n t h e A m az o n gift c ar ds as d escri b e d a b ov e ( u p t o 3 
e ntri es, d e p e n di n g o n h o w m a ny ass ess m e nts c o m pl et e d wit hi n 7 2 h o urs of t h e sc h e d ul e d ass ess m e nt).  
 
3.  I N T R O D U C TI O N 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  4  of  4 1  
 
 
A.  T y p e  of  R es e arc h  
 
T his st u dy i n v ol v es b e h a vi or al r es e arc h. T h e f oc us of t his s u m m ati v e e v al u ati o n st u dy is t o c o m p ar e Wis e P at h t o a n 
acti v e c o ntr ol c o n diti o n t o t est its eff ecti v e n ess. O ur g o al is t o t est t h e n e wl y d e v el o p e d Wis e P at h a p p d esi g n e d t o 
d eli v er  e vi d e nc e -b as e d  i nt erv e nti o ns t h at dir ectl y  tr e at a  p ers o n’s  r e as o ns f or w a nti n g  t o di e  (t h eir “ dri v ers” f or s uici d e) 
w hil e si m ult a n e o usl y a d dr essi n g alc o h ol mis us e a n d ot h er c o -occ urri n g b e h avi or al h e alt h pr o bl e ms ( e. g., m o o d, sl e e p 
pr o bl e ms) w h e n r el e v a nt.  
 
B.  P ur p os e/ O bj ecti v e  of  t h e St u d y  
 
T h e c e ntr al p ur p os e of t his pr oj ect is t o e v al u at e a n d f acilit at e e vi d e nc e -b as e d b est pr actic es f or i n divi d u als str u g gli n g 
wit h s uici d al i d e ati o n a n d c o -occ urri n g b e h avi or al pr o bl e ms, i ncl u di n g alc o h ol mis us e, a n d pr ovi d e assist a nc e t o t h e 
p ati e nts  w hil e  t h e y ar e  w aiti n g  t o r ec ei v e c ar e, as  t h e y ar e  r ec ei vi n g c ar e, a n d  aft er  t h e y r et ur n h o m e.  W hil e  Wis e P at h  is 
hi g hly i n n ov ati v e i n h o w it d eliv ers t h es e b est pr actic es, t h e c o nt e nt is w ell-est a blis h e d a n d k n o w n t o r e d uc e s uici d alit y 
a n d alc o h ol mis us e.  
 
W e  will c o n d uct a  1 2 -w e e k  i nt e nt-t o-tr e at R C T wit h 1 2 0 s uici d al a d ults 2 2 y e ars a n d ol d er w h o  m a y als o b e  ex p eri e nci n g 
alc o h ol  mis us e.  P artici p a nts  will  b e  r a n d o ml y assi g n e d  t o Wis e P at h ( n = 6 0) or  a n  acti v e  c o ntr ol c o n diti o n ( n = 6 0) i ncl u di n g 
Virt u al H o p e B ox, a w ell -r e g ar d e d s uici d e pr e v e nti o n s elf-h el p a p p, pl us a n el ectr o nic w ell n ess r es o urc es br oc h ur e 
c o nt ai ni n g li n ks t o h e alt h  a n d  w ell n ess  m at eri als,  psyc h o e d uc ati o n  a b o ut  s uici d e, d e pr essi o n,  s elf-h el p  r ec ov ery-f oc us e d 
r es o urc es ( e. g., Alc o h olics A n o n y m o us a n d ot h er 1 2-St e p pr o gr a ms, M o d er ati o n M a n a g e m e nt, etc.), a n d p h o n e/t ext 
i nf or m ati o n f or t h e 9 8 8 S uici d e & Crisis Lif eli n e. P artici p a nts will b e ass ess e d at b as eli n e, 4, 8 a n d 1 2 w e e ks. 
 
W e  h y p ot h esiz e  t h at i n c o m p aris o n t o t h e acti v e  c o ntr ol c o n diti o n, Wis e P at h  p artici p a nts  will  s h o w si g nific a ntl y b ett er 
o utc o m es fr o m b as eli n e t o t h e 4 -, 8-, a n d 1 2-w e e k ass ess m e nt p oi nts s uc h t h at:  
1.  Wis e P at h  p artici p a nts  will  r e p ort si g nific a ntl y gr e at er  d ecr e as es  i n s uici d al a n d  alc o h ol  mis us e  b e h avi ors 
c o m p ar e d t o c o ntr ols  
2.  Wis e P at h  p artici p a nts  will  r e p ort gr e at er  i ncr e as es i n s elf-effic ac y  a n d  c o pi n g wit h  s uici d al t h o u g hts a n d  distr ess, 
as w ell as us e of s uici d e pr e v e nti o n str at e gi es c o m p ar e d t o st u dy c o ntr ols  
3.  Wis e P at h  p artici p a nts  will  r e p ort a  hi g h er  d e gr e e  of  s atisf acti o n wit h  t h eir r es p ecti v e a p p  c o m p ar e d t o c o ntr ols 
 
Pri or t o c o m m e nci n g t h e R C T , w e will first c o n d uct a pil ot tri al t o e ns ur e cl arit y of r es e arc h pr ot oc ol i nstr ucti o ns, t o 
v ali d at e ti m e esti m at es t o c o m pl et e r es e arc h m e as ur es, a n d t o e ns ur e t h at all as p ects of t h e r es e arc h pr ot oc ol ar e 
s e nsiti v e t o t h e n e e ds a n d ex p eri e nc es of s uicid al i n di vi d u als, a p pl yi n g t h e s a m e r ecr uit m e nt str at e g y, p artici p a nt 
crit eri a, r es e arc h pr oc e d ur e,  a n d  o utc o m e  m e as ur es  as  will  b e  a p pli e d  i n t h e R C T.  As  a  fi n al c h ec k of Wis e P at h  a p p,  w e 
will ov er -r ecr uit f or t h e Wis e P at h c o n diti o n, c o m p ari n g Wis e P at h ( n =1 5) t o t h e acti v e c o ntr ol ( n = 5). I n c o ntr ast t o t h e 
pr o p os e d 1 2 -w e e k R C T, t h e pil ot st u dy will l ast 6 w e e ks a n d will i ncl u d e t hr e e ass ess m e nts ( b as eli n e, 3 a n d 6 w e e ks).  
 
C.  B ac k gr o u n d  of  t h e St u d y  
 
Gl o b ally,  s uici d e is a  si g nific a nt p u blic  h e alt h  pr o bl e m  acc o u nti n g  f or a p pr oxi m at el y  8 0 0, 0 0 0  d e at hs a n n u all y. 1 D e at h  b y 
s uici d e is t h e s ec o n d l e a di n g c a us e of  d e at h  f or p e o pl e  a g es  1 5  t o 2 4  w orl d wi d e 2 a n d  t h e s ec o n d l e a di n g c a us e of d e at h 
f or p e o pl e a g es 1 0-3 4 i n t h e U nit e d St at es. 3 I n a d diti o n t o t h e liv es l ost a n n u ally t o s uici d e, f ar m or e p e o pl e s eri o usl y 
t hi n k a b o ut ( 1 2. 3 milli o n), m ak e a s eri o us pl a n ( 3. 5 milli o n), or m ak e a n att e m pt a n n u ally ( 1. 7 milli o n). 4 I n a d diti o n t o 
t h e d e v ast ati n g i m p act of s uici d e o n t h os e l eft b e hi n d, 5 t h e ec o n o mic a n n u al c ost of s uici d e b et w e e n 2 0 1 5 a n d 2 0 2 0 
a v er a g e d $ 4 8 4 billi o n. 6 
 
I n divi d u als str u g gli n g wit h  s elf-i nj uri o us t h o u g hts a n d  b e h avi ors  n e e d  acc ess  t o e vi d e nc e -b as e d  r es o urc es, b ut  oft e n  d o 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  5  of  4 1  
 
 
n ot r ec ei v e it. F or c o m m u niti es wit h li mit e d b e h avi or al h e alt h r es o urc es, r ef err als t o b e h avi or al h e alt h s p eci alists f or 
m a n a g e m e nt of pr o bl e ms c o ntri b uti n g t o s uici d alit y ar e pr o bl e m atic f or a v ari et y of r e as o ns i ncl u di n g l ac k of cli nic al 
r es o urc es, e m p h asis o n st a biliz ati o n d uri n g a crisis r at h er t h a n o n g oi n g c ar e, a n d b arri ers t o p ati e nt tr e at m e nt acc ess 
a n d e n g a g e m e nt.  
 
T h er e is a w ell -est a blis h e d g a p b et w e e n t h e pr e v al e nc e of m e nt al h e alt h dis or d ers a n d a v ail a bilit y of b e h avi or al h e alt h 
pr ovi d ers i n g e n er al, 7, 8 a n d f or s uici d e i n p artic ul ar. 9 F or i nst a nc e, c urr e ntl y o nly 1 1 st at es m a n d at e s uici d e f oc us e d 
tr ai ni n g f or c o u ns el ors, t h er a pists, etc. a n d m aj orit y  of  b e h a vi or al  h e alt h pr ovi d ers d o n ot r ec ei v e  a ny  tr ai ni n g i n s uici d e 
ass ess m e nt a n d i nt erv e nti o n. 1 0 M or e o v er, m a n y pr ovi d ers ar e r el uct a nt t o tr e at s uici d al i d e ati o n i n p ati e nts b ec a us e 
t h e y d o n ot k n o w w h at t o d o, fe ar t h e y m a y m a k e t h e p ati e nt w ors e, or b e s u e d f or m al pr actic e. T h es e iss u es c a n 
c o ntri b ut e t o c o m pl et e l ac k of  a v ail a bilit y  ( p artic ul arl y i n r ur al c o m m u niti es), l o n g w aitlists,  a n d  tr e at m e nt d eli v ery  fr o m 
w ell -m e a ni n g, b ut u ntr ai n e d pr ovi d ers t h at m ay l ac k e m piric al s u p p ort.  
 
W h e n pr ovi d ers ar e a v ail a bl e, t h er e c o nti n u e t o b e c h all e n g es i n t h e d eliv ery of c ar e f or i n di vi d u als str u g gli n g wit h 
s uici d alit y a n d  c o-occ urri n g  b e h avi or al  h e alt h  pr o bl e ms.  T h e  e m p h asis  i n m a ny  s etti n gs is oft e n  o n  r e d uci n g ac ut e  cris es 
( e. g., T h e J oi nt C o m missi o n ( TJ C) r e q uir e m e nt of s af et y pl a n ni n g, l et h al m e a ns ass ess m e nt). W hil e t h es e eff orts ar e  
critic al, t h e y m a y  n ot  eff ecti v el y  a d dr ess  t h e iss u es c o ntri b uti n g t o t h e i n divi d u al’s s uici d alit y, i ncl u di n g c o m m o nly c o- 
occ urri n g b e h avi or al  h e alt h  pr o bl e ms ( e. g., alc o h ol  mis us e, d e pr ess e d  m o o d,  sl e e p pr o bl e ms). It c a n als o b e r ar e t h at 
pr ovi d ers ar e tr ai n e d i n e vi d e nc e -b as e d pr actic es f or b ot h s uici d alit y a n d t h e arr a y of c o -occ urri n g b e h avi or al h e alt h 
pr o bl e ms.  
 
Alc o h ol us e dis or d er ( A U D) is c o nsist e ntl y i m plic at e d i n s uici d al b e h avi ors a n d d e at h by s uici d e 1 1 – 1 8 a n d is ass oci at e d  
wit h  a  t e nf ol d i ncr e as e i n risk f or s uici d e. 1 9 – 2 1 Acc or di n g  t o t h e C D C,  alc o h ol  i nt oxic ati o n is i nv olv e d i n a p pr oxi m at el y  2 2 % 
of s uici d es a n d i n a p pr oxi m at el y 3 0 -4 0 % of all s uici d e att e m pts. 2 2 A m o n g p ers o ns s e e ki n g tr e at m e nt f or alc o h ol 
d e p e n d e nc e, a b o ut 4 0 % h a v e m a d e at l e ast o n e s uici d e att e m pt i n t h eir lif eti m e. 1 9, 2 3 – 2 5 I n o n e st u dy of 5 0 s uici d es, A U D 
w as t h e pri m ary di a g n osis i n 2 3 % of c as es, a n d c o -occ urr e d i n a n ot h er 3 7 % of c as es. 2 6 I n a n ot h er st u dy, 5 6 % of t h os e 
w h o di e d b y s uici d e h a d a lif eti m e hist ory of A U D. 2 7 W hil e t h e b e h avi or al m ec h a nis ms f or t h e r el ati o ns hi p ar e c o m pl ex, 
alc o h ol m a y i ncr e as e t h e risk of s uici d e  b y d ecr e asi n g i n hi biti o ns a n d i ncr e asi n g d e pr ess e d m o o d. 1 1 Ot h er f act ors f or  
s uici d e m a y  i ncl u d e alc o h ol’s  a bilit y  t o: ( 1) i ncr e as e psyc h ol o gic al  distr ess  a n d  a git ati o n;  ( 2) pr o p el  s uici d al i d e ati o n i nt o 
acti o n t hr o u g h s uici d e -s p ecific alc o h ol ex p ect a nci es ( e. g., pr ovi d es “li q ui d c o ur a g e” t o act a n d/ or m ak es t h e act its elf 
p ai nl ess); a n d ( 3) c o nstrict c o g niti o n, w hic h i n t ur n i m p airs pr o bl e m -s ol vi n g a n d us e of a d a pti v e c o pi n g str at e gi es. 2 8 
 
I n a d diti o n, t h er e ar e v ery fr e q u e ntl y si g nific a nt ot h er b arri ers t o tr e at m e nt acc ess a n d e n g a g e m e nt e v e n w h e n 
e vi d e nc e -b as e d i nt erv e nti o n d eliv ery is a v ail a bl e. S uc h b arri ers i ncl u d e str uct ur al b arri ers r el at e d t o p ati e nt r es o urc es 
( e. g., c ost, c hil dc ar e, tr a ns p ort ati o n c osts, a bilit y  t o t a k e ti m e off  w ork),  as  w ell  as  gr e at er  p erc ei v e d  sti g m a, p artic ul arl y 
wit hi n l o w er i nc o m e c o m m u niti es 2 9 a n d a m o n g mi n oritiz e d r aci al/ et h nic c o m m u niti es. 3 0 
 
Di git al  t ec h n ol o gi es c a n h el p  a d dr ess  u n m et  tr e at m e nt n e e ds.  M et a -a n alytic  eff orts  s u p p ort t h e d eli v ery  of  s elf-g ui d e d 
c o m p ut eriz e d c o g niti v e-b e h avi or al t h er a py ( C C B T) f or n u m er o us mil d t o m o d er at e b e h avi or al h e alt h pr o bl e ms, 
i ncl u di n g d e pr essi o n, p a nic, a n d a nxi et y as w ell as alc o h ol a n d s u bst a nc e us e,5 0, 5 1 A d diti o n ally, ni n e m et a -a n alys es 
c o n d uct e d w orl d wi d e h av e f o u n d t h at s uc h i nt erv e nti o ns o ut p erf or m w ait -list c o ntr ols a n d tr e at m e nt as us u al, 
pr o d uci n g s m all t o m e di u m eff ect siz es, a n d c a n p erf or m c o m p ar a bl y t o tr a diti o n al f ac e -t o-f ac e t h er a py.3 7, 3 8, 8 3 – 8 8 
M or e o v er, di git al s u p p ort t o ols  off er  m a ny  a dv a nt a g es t h at c a n h el p i m pr ov e  acc ess t o e vi d e nc e -b as e d  c ar e, i ncl u di n g 
a v ail a bilit y f or us e w h e n e v er a n d w h er e v er t h e y ar e m ost n e e d e d ( e. g., 2 4 -h o urs a d ay, r ur al ar e as), d eliv ery i n ar e as 
wit h b e h a vi or al h e alt h s h ort a g es ( e. g., r ur al a n d l o w -i nc o m e c o m m u niti es), all wit h o ut i n att e nti o n, drift, b ur n o ut, or 
c om p assi o n f ati g u e. As s uc h t h e y c a n b e a p o w erf ul t o ol i n st e p p e d c ar e m o d els (i. e., h e alt hc ar e m o d els t h at m atc h 
i nt erv e nti o n str at e g y t o s e v erit y a n d  c o urs e of  t h e pr o bl e m). 6 0, 6 1 Alt h o u g h  s o m e m o bil e  a p ps  t ar g eti n g t h es e i n divi d u al 
m e nt al a n d b e h avi or al h e alt h pr o bl e ms h a v e b e e n d e v el o p e d f or a d ults wit h pr o misi n g o utc o m es,
6 2, 6 3 n o m o bil e 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  6  of  4 1  
 
 
t ec h n ol o gi es c urr e ntl y exist  t h at a d dr ess  b ot h s uici d al  i d e ati o n a n d  c o-occ urri n g  b e h avi or al  h e alt h  c o nc er ns. M o bil e 
t ec h n ol o g y s u p p ort t o ols ar e sc al a bl e, l o w-c ost, a n d lik e d b y c o ns u m ers 6 4 w h e n t h e y ar e us e d.  
 
 
A.  I ncl usi o n a n d  E xcl usi o n  Crit eri a  
P ot e nti al  p artici p a nts  will  first c o m pl et e a n  eli gi bilit y  scr e e n t o e ns ur e  t h e y m e et  st u dy crit eri a: 
I ncl usi o n Crit eri a: 
•  
R esi d es  i n t h e U nit e d  St at es 
•  
2 2 +  y e ars  of  ag e  
•  
E n glis h  s p e a ki n g 
•  
At  risk f or s uici d e, as  e vi d e nc e d  by  at  l e ast o n e  of  t h e f oll o wi n g: 
o  O n e  or  m or e  lif eti m e s uici d e att e m pts  ( A S Q it e m 4)  
o  E n d ors e m e nt  of  a ny  AS Q  it e ms 1  -3  ( ex p a n d e d fr o m “ p ast f e w w e e ks”  i n AS Q  t o “ p ast 3 0  d a ys”  i n o ur  
m e as ur es)  
▪ 
It e m 1:  I n t h e p ast  3 0  d ays,  h av e  y o u wis h e d  y o u w er e  d e a d ?  
▪ 
It e m 2:  I n t h e p ast  3 0  d ays,  h av e  y o u f elt t h at y o u or  y o ur  f a mily w o ul d  b e  b ett er  off  if y o u  w er e 
d e a d ?  
▪ 
It e m 3:  I n t h e 3 0  d ays,  h av e  y o u  b e e n  h avi n g  t h o u g hts a b o ut  killi n g  y o urs elf ? 
•  
C urr e ntl y  h as  a  pri m ary  c ar e pr ovi d er  a n d  s o u g ht c ar e fr o m t h e m i n t h e p ast  y e ar 
•  
P oss ess es  a n d  is t h e pri m ary  us er  of  a n  A n dr oi d - or  i P h o n e-b as e d  s m art p h o n e wit h  a  d at a  pl a n  
 
Gi v e n t h at alc o h ol mis us e ex p o n e nti ally i ncr e as es t h e ris k of d e at h by s uici d e, c a n ex ac er b at e ot h er pr o bl e ms, a n d 
i nt erf er e wit h  eff ecti v e  tr e at m e nt, w e  will  ov er -r ecr uit i n divi d u als w h o  mis us e  alc o h ol  t o e ns ur e  r el e v a nc e of  t h e t o ol 
f or t h e m. N o f e w er t h a n 3 5 % of t h e s a m pl e will b e c o m pris e d of i n divi d u als w h o sc or e 8 or m or e o n t h e Alc o h ol Us e 
Dis or d ers I d e ntific ati o n T est ( A U DI T), i n dic ati n g a h ar mf ul or h az ar d o us l e v el of dri nki n g.  
 
Excl usi o n  Crit eri a:  
•  
S e v er e  d e pr essi o n  ( P H Q-9  sc or e of  2 0  or  gr e at er)  
•  
Alc o h ol  d e p e n d e nc e  ( A U DI T sc or e of  3 2  or  gr e at er)  
•  
Ac ut el y s uici d al ( affir ms it e m 5 of t h e Ask S uici d e Scr e e ni n g Q u esti o ns; Ar e y o u h a vi n g t h o u g hts of killi n g 
y o urs elf ri g ht n o w ?  F oll o w e d  by  e n d orsi n g  i nt e nt; H a v e  y o u  i nt e n d e d t o act  o n  ur g es  t o kill y o urs elf i n t h e p ast 
3 0 d a ys ? or pl a n ni n g wit hi n t h e p ast 3 0 d a ys; H a v e y o u m a d e a pl a n t o kill y o urs elf i n t h e p ast 3 0 d a ys ? ) 
•  
Si g nific a nt  dr u g  a b us e  pr o bl e ms  (sc or es 6  or  gr e at er  o n  t h e D AS T -1 0)  
•  
Pr e vi o us  p artici p ati o n  i n NI A A A  f or m ati v e r es e arc h (i. e., us e d  or  w as  ex p os e d  t o Wis e P at h  a p p)  
•  
C urr e nt  us e  of  t h e Virt u al  H o p e  B ox  a p p  
 
I n divi d u als w h o  ar e  excl u d e d  b ec a us e  of  t h e s e v erit y of  t h eir d e pr essi o n,  s uici d e ac uit y,  a n d/ or  d e gr e e  of  s u bst a nc e us e 
dis or d er will b e pr ovi d e d wit h r es o urc es (i. e., t h e S uici d e a n d Crisis Lif eli n e ( 9 8 8), S A M HS A’s N ati o n al H el pli n e) a n d 
e nc o ur a g e d t o r e ac h o ut t o t h eir pri m ary c ar e or m e nt al/ b e h avi or al h e alt h pr ovi d er.  
 
B ec a us e w e h av e ex p eri e nc e d a n u m b er of p artici p a nts i n ot h er st u di es r ecr uit e d fr o m s oci al m e di a f a ki n g t h eir i d e ntiti es 
( a n d t h us li k el y f a k e d cli nic al sy m pt o ms, hist ory) t o p artici p at e i n t h e st u dy (i. e., s ai d t h e y r esi d e d i n t h e U S, b ut l at er w e 
f o u n d t h e y act u ally w er e l oc at e d i n Afric a or ot h er c o u ntri es), w e w o ul d li ke t h e o pti o n t o v erify t h e i d e ntit y a n d/ or 
r esi d e nc y of pr os p ecti v e p artici p a nts . T his m ay i ncl u d e r e q uiri n g pr os p ecti v e p artici p a nts t o t ur n t h eir c a m er as o n d uri n g 
4.  P A R TI CI P A N T  S EL E C TI O N  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  7  of  4 1  
 
 
virt u al m e eti n gs a n d/ or aski n g t h e i n divi d u al t o v erify t h e y ar e i n t h e U S b y s h o wi n g eit h er t h eir st at e-iss u e d dri v er’s 
lic e ns e/I D c ar d or a pi ec e of m ail s h o wi n g t h eir n a m e a n d a U S m aili n g a d dr ess. A n y i n divi d u al w h o c a n n ot d e m o nstr at e 
t h eir r esi d e nc y will b e t ol d t h at t h e s essi o n c a n n ot pr oc e e d, a n d t h e y will n ot b e e nr oll e d i n t h e st u dy.  
 
B.  G e n d er  
 
T his st u dy will n ot li mit i ncl usi o n of a n y gr o u p b y s ex/ g e n d er, r ac e, a n d/ or et h nicit y. W o m e n as w ell as m e n will b e 
eli gi bl e f or all p h as es of t his st u dy. T h e r es e arc h t e a m will m ai nt ai n a f oc us e d eff ort o n e ns uri n g t h at t h e p erc e nt of 
w o m e n a n d  mi n orit y p artici p a nts r ecr uit e d f or  t his st u dy ar e r e pr es e nt ati v e of  t h e br o a d er gr o u p of  t ar g et e n d -us ers. I n 
a d diti o n t o r ecr uit m e nt fr o m c ar e cli nics ( e. g., o ut p ati e nt cli nics, pri m ary c ar e), lists ervs, a n d ot h er gr o u ps s ervi n g 
pr ovi d ers  w h o  tr e at i n divi d u als ex p eri e nci n g  s uici d alit y, w e  will  utiliz e  s oci al m e di a  pl atf or ms  ( e. g., F ac e b o o k,  I nst a gr a m) 
a n d r ef err als fr o m o ur pr of essi o n al n et w ork t o e ns ur e w e r e ac h a di v ers e p artici p a nt p o p ul ati o n.  
 
C.  R aci al/ Et h nic  Ori gi n  
 
T o e ns ur e t h at t h e s a m pl e d e m o gr a p hic r e pr es e nts t h e r aci al/ et h nic m ak e -u p of t h e U. S. p o p ul ati o n, w e m a y a u g m e nt 
o ur  r ecr uit m e nt eff orts  t o i ncl u d e r ecr uit m e nt usi n g  s oci al m e di a  a n d/ or  t hir d-p art y  r ecr uit m e nt c o m p a ni es. T his  all o ws 
us  t o r ecr uit fr o m et h nic all y  a n d  r aci ally div ers e  r e gi o ns of  t h e c o u ntry t o e ns ur e  a  m atc h  b et w e e n  t h e U. S.  et h nic/r aci al 
d e m o gr a p hic m a k e -u p wit h t h e div ersit y of o ur r es e arc h s a m pl e or t ar g et e d r ecr uit m e nt fr o m gr o u ps o n s oci al m e di a 
pl atf or m t h at i ncl u d e i n divi d u als t h at m ay b e i nt er est e d/ eli gi bl e t o p artici p at e i n t his r es e arc h.  
 
Dr. Di m eff h as s ucc essf ull y e m pl oy e d a n u m b er of a p pr o ac h es i n h er pr e vi o us r es e arc h t o r e ac h r ecr uit m e nt t ar g ets 
wit h r es p ect t o et h nic a n d r aci al mi n oriti es. If n e e d e d, w e will p urs u e t h es e a p pr o ac h es i ncl u di n g: Si g nific a ntl y 
ex p a n di n g r ecr uit m e nt eff ort s i n et h nic all y a n d r aci ally di v ers e g e o gr a p hic l oc ati o ns, t o a g e nci es s ervi n g et h nic a n d 
r aci al mi n oriti es, a n d t a ki n g a m uc h m or e acti v e, p ers o n al a p pr o ac h t hr o u g h o ut t h e r ecr uit m e nt eff ort. T his l att er 
a p pr o ac h  oft e n  i n v ol v es i d e ntifyi n g w h at  m att ers  t o t h e or g a niz ati o n  i n a dv a nc e  a n d  s e e ki n g w a ys  t o li n k o ur  r e q u est t o 
t h eir n e e ds/i nt er ests/ missi o n. 
 
D.  V ul n er a bl e  P o p ul ati o ns  
 
T h e risk  t o p artici p a nts i n t his r es e arc h is mi ni m al  w h e n a p pl yi n g  NI H  risk st a n d ar ds a n d d esi g n ati o ns. Acc or di n g  t o 
t h es e NI H g ui d eli n es,  “ mi ni m al risk t o s u bj ects m e a ns t h at t h e pr o b a bilit y a n d  m a g nit u d e  of h ar m or disc o mf ort 
a ntici p at e d  i n t h e r es e arc h ar e  n ot  gr e at er  t h a n t h os e or di n arily  e nc o u nt er e d  i n d aily  lif e or  d uri n g  t h e p erf or m a nc e  of 
r o uti n e p hysic al  a n d  psyc h ol o gic al  ex a mi n ati o ns  or  t ests a n d  t h at c o nfi d e nti alit y is a d e q u at el y  pr ot ect e d.  T his  c at e g ory 
i ncl u d es pr ot oc ols t h at p os e “ n o gr e at er t h a n mi ni m al  ris k” acc or di n g t o f e d er al r e g ul ati o ns.” 
 
T his  st u dy d o es i ncl u d e p ati e nts w h o ar e c urr e ntl y s uici d al. B y d efi niti o n  t h es e p ati e nts ar e i n h er e ntl y hi g h -risk 
p artici p a nts;  h o w e v er,  t h e q u esti o n  t o c o nsi d er f or t his r es e arc h is w h et h er  t h e st u dy pr oc e d ur es  ar e  lik el y t o m a k e  t h e 
p artici p a nts m or e s uici d al.  W e b eli e v e t h e  a ns w er is n o.  P ast r es e arc h f o u n d  t h at m a n y of t h e p ati e nt p artici p a nts 
e nj oy e d  pr ovi di n g  t h eir f e e d b ac k d uri n g  t h e i nt ervi e w s essi o ns a n d  h avi n g  t h eir o pi ni o n/ p ers p ecti v e  v al u e d.  S o m e  als o 
d escri b e d t h at f or t h e m o m e nts t h e y w er e i nt er acti n g  wit h t h e r es e arc h  t e a m, t h eir mi n d  w as off t h eir  w orri es.  
 
H o w e v er,  as  a  pr ec a uti o n,  all  p artici p a nts  will  c o m pl et e t h e d e bri ef  pr ot oc ol a n d,  i n t h e u nlik el y  e v e nt  t h at a  p artici p a nt 
ex p eri e nc es hi g h distr ess d uri n g or aft er a n i nt ervi e w, a m e m b er of o ur cli nic al st aff ( e. g., PI Dr. Li n d a Di m eff or C o - 
I nv esti g at or Dr. Allis o n R u ork) will i m m e di at el y j oi n t h e c all wit h t h e p artici p a nt a n d pr ovi d e crisis s u p p ort, i ncl u di n g 
te ac hi n g b e h avi or al s kills a n d/ or c o n n ecti o n wit h 9 8 8 crisis h otli n e.  
 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  1 2  of  4 1  
 
 
m et h o d  w e  h av e  c h os e n pr ovi d es  s e v er al o pti o ns  f or t h e h a n dli n g  of  i nc o m pl et e d at a.  Pr ef er e nc e  will  b e  gi v e n  t o t h os e 
m et h o ds f or w hic h t h e ass u m pti o ns ( e. g., Missi n g at R a n d o m) ar e pl a usi bl y m et a n d t h at h a v e t h e l e ast bi as e d 
p ar a m et er esti m at es.  
 
A n al ysis Str at e g y . W e will us e t h e G e n er aliz e d Li n e ar M o d el ( GL M), a r e gr essi o n-b as e d a p pr o ac h. It a d dr ess es 
li mit ati o ns of A N O V A  i n t h at it c a n a n alyz e  a  v ari et y  of c o m m o nly e nc o u nt er e d  o utc o m e distri b uti o ns  ( e. g., c o nti n u o us, 
c o u nt) a n d c a n c alc ul at e r o b ust st a n d ar d err ors w hic h ar e l ess s e nsiti v e t o s k e w n ess. S p ecific all y, w e will c o n d uct o ur 
r e p e at e d-m e as ur es a n al ys es usi n g  a  v ersi o n  of GL M  c all e d G e n er aliz e d Esti m ati n g  E q u ati o ns ( G E E),  w hic h  d o es n ot  r el y 
o n t h e ov erl y r estricti v e ( a n d oft e n i nc orr ect) ass u m pti o ns m a d e b y R e p e at e d M e as ur es A N O V A a b o ut t h e c ov ari a nc e 
m atrix t h at c a n l e a d t o miss p ecific ati o n. Li k e Hi er arc hic al Li n e ar M o d eli n g ( HL M), G E E c a n t est t h e us e of diff er e nt 
ass u m pti o ns of t h e c ov ari a nc e m atrix t o d et er mi n e t h e o n e t h at b est fits t h e d at a; it c a n als o i ncl u d e p artici p a nts w h o 
ar e missi n g d at a at c ert ai n ti m e p oi nts. W e will us e t h e S P S S a n d G E E f or all hy p ot h es es c o nc er ni n g o utc o m es f or 
p ar e nts a n d y o ut h. F or e ac h o utc o m e, w e will s p ecify t h e c orr ect distri b uti o n a n d c o m p ar e fit i n dic es t o i d e ntify t h e 
c ov ari a nc e m atrix  t h at b est  fits t h e d at a.  All  h y p ot h es es  r el at e t o c h a n g e ov er  ti m e, a n d  s o t h e m ulti pl e  ti m e-p oi nts  will 
b e tr e at e d i n t h e G E E a n al ys es as n est e d wit hi n t h e i n divi d u al. Als o, w e will tr e at i nt erv e nti o n c o n diti o n a n d ti m e as 
c at e g oric al, d u m my-c o d e d pr e dict ors; t h e c o ntr ol c o n diti o n a n d b as eli n e sc or es will s erv e as t h e r ef er e nc e p oi nts. T h e 
p ar a m et er of i nt er est will b e t h e Ti m e X C o n diti o n i nt er acti o n, a n d t h e Ty p e III st atistic will s erv e as a n o m ni b us t est of 
w h et h er t h e t w o c o n diti o ns diff er e d i n c h a n g e ov er ti m e.  
C.  M o nit ori n g  
 
W e h av e f or m e d a D at a a n d S af et y M o nit ori n g B o ar d ( D S M B) t o pr ovi d e ov ersi g ht of t his st u dy. T h e c o m mitt e e will 
p eri o dic all y r e vi e w a n y m o dific ati o ns t o t h e r es e arc h d esi g n a n d c o n d uct of t h e st u dy, a n d m ak e r ec o m m e n d ati o ns 
acc or di n g  t o t h e NI H/ NI A A A  p olici es  f or d at a  a n d  s af et y m o nit ori n g.  M e m b ers  of  t h e D S M B  h av e  n o  fi n a nci al st a k e wit h 
a ny m e m b er or or g a niz ati o n i n v ol v e d wit h t his pr oj ect a n d ar e fr e e of existi n g or p ot e nti al c o nflicts of i nt er est.  
 
Drs.  Di m eff  a n d  J o b es will  b e  r es p o nsi bl e f or m a n a gi n g,  st ori n g, a n d  pr ot ecti n g  st u dy d at a.  T h e y  will  w ork  cl os el y wit h 
t h e r es e arc h st aff t o m ai nt ai n c o nti n u o us, cl os e m o nit ori n g a n d pr o m ptl y r e p ort a d v ers e e v e nts t o e ac h ot h er, t h e 
D S M B, a n d t h e I R B.  
 
D.  St or a g e  of  D at a  
 
All  d at a  c oll ecti o n a n d  st or a g e will  f oll o w G o o d Cli nic al  Pr actic e  a n d  HI P A A  g ui d eli n es.  El ectr o nic  d at a  will  b e  m ai nt ai n e d 
i n a s ec ur e d, p ass w or d pr ot ect e d sit e wit h fir e w all a n d ot h er s ec urit y pr ot ecti o ns. T h e d at a fil es ar e c o d e d wit h t h e 
p artici p a nt’s st u dy i d e ntific ati o n n u m b er. W e will assi g n e ac h p artici p a nt a u ni q u e st u dy i d e ntific ati o n n u m b er, w hic h 
will b e att ac h e d t o d at a, i ncl u di n g all q u alit ati v e d at a a n d o nli n e s urv e ys. N o n a m es or p ers o n al i d e ntifyi n g i nf or m ati o n 
will b e i ncl u d e d  wit h p artici p a nts’ d a t a. O nl y o n e r ec or d  c o n n ecti n g i d e ntific ati o n n u m b ers  wit h n a m es  will  b e k e pt, a n d 
t h at will b e st or e d s e p ar at el y fr o m t h e d at a o n a s ec ur e s erv er wit h a p ass w or d r e q uir e d t o acc ess t h e r ec or d. T his 
r ec or d will b e d estr oy e d aft er six y e ars. Aft er t h e r ec or d is d estr oy e d, t h er e will b e n o w a y t o li n k p artici p a nt n a m es t o 
t h eir r es p o ns es. T h e d e-i d e ntifi e d d at a will b e r et ai n e d i n d efi nit el y. H ar d c o pi es of I nf or m e d C o ns e nt f or ms will b e 
st or e d i n a  l oc k e d c a bi n et s e p ar at e fr o m t h e d at a  or  sc a n n e d a n d s a v e d  el ectr o nic all y  i n a n  el ectr o nic  d at a b as e  s e p ar at e 
fr o m t h e d at a, w hic h is s ec ur e, p ass w or d pr ot ect e d, HI P A A-c o m pli a nt, a n d i ncl u d es fir e w all a n d ot h er s ec urit y 
pr ot ecti o ns. I nf or m e d C o ns e nt f or ms fill e d o ut el ectr o nic all y will b e st or e d i n a n el ectr o nic d at a b as e s e p ar at e fr o m t h e 
d at a, w hic h  is s ec ur e d, p ass w or d pr ot ect e d, HI P A A -c o m pli a nt, a n d i ncl u d es fir e w all a n d  ot h er s ec urit y pr ot ecti o ns.  O nl y 
t h e st u dy st aff will h a v e acc ess t o t h e el ectr o nic a n d h ar d c o p y r ec or ds. 
 
S urv e y -b as e d d at a, i ncl u di n g t h e scr e e ni n g a n d d e m o gr a p hics q u esti o n n air e, as w ell as a bri ef q u esti o n n air e t o ass ess 
acc e pt a bilit y a n d cli nic al r el e v a nc e, ar e als o st or e d i n o ur HI P A A -c o m pli a nt s urv e y s yst e m (i. e., Q u altrics), w h er e 
r es p o ns es ar e  tr a ns mitt e d usi n g  a  S ec ur e  S oc k ets  L a y er (S SL) c o n n ecti o n a n d  is als o  e ncry pt e d. S urv e y d at a  us e o nly  t h e 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  1 3  of  4 1  
 
 
st u dy i d e ntific ati o n n u m b er t o i d e ntify t h e p artici p a nt. I n m ost c as es, p artici p a nts will c o m pl et e t h e s urv e ys dir ectl y i n 
t h e s urv e y syst e m a n d/ or t h e d at a  ar e  e nt er e d  dir ectl y  by a  r es e arc h er i nt o t h e syst e m. I n t h e u nlik el y  e v e nt  of  a  p a p er - 
p e ncil m e as ur e b ei n g pr ef err e d or n ec ess ary, t h e d at a will b e i m m e di at el y e nt er e d i nt o t h e s urv e y s yst e m b y a 
r es e arc h er t h e n t h e p a p er c o p y will b e  d estr oy e d wit hi n  2 4 h o urs  vi a s hr e d di n g  or s ec ur e  dis p os al  i n a s ec ur e s hr e d di n g 
bi n  f or l at er s ec ur e dis p os al.  Acc ess  t o all  el ectr o nic  r es e arc h fil es is li mit e d t o r es e arc h st aff, w h o  ar e  r e q uir e d t o l o g i n 
wit h a u ni q u e us er n a m e a n d p ass w or d f or acc ess.  
 
E.  C o nfi d e nti alit y  of  D at a  
 
T o  pr ot ect  p artici p a nts  fr o m l oss of  c o nfi d e nti alit y, t h e f oll o wi n g pr oc e d ur es  will  b e  e m pl oy e d:  E ac h  p artici p a nt  will  b e 
assi g n e d a st u dy i d e ntific ati o n n u m b er t h at d o es n ot  c o nt ai n n u m b er el e m e nts t h at c o ul d b e li n k e d b ac k t o t h eir  
i d e ntit y. O nly  o n e  d oc u m e nt,  k n o w n  as  t h e M ast er  P artici p a nt  D oc u m e nt  ( M P D), will  li n k t h e p ati e nt’s  i d e ntit y t o t h eir 
st u dy i d e ntific ati o n n u m b er. T h e M P D fil e is st or e d s e p ar at e fr o m st u dy d at a o n a cl o u d -b as e d e ncry pt e d s erv er 
( S h ar e P oi nt) acc essi bl e o nly t o t h e r es e arc h t e a m tr ai n e d i n t h e et hic al c o n d uct of h u m a n s u bj ects’ r es e arc h. 
 
W h e n  a p plic a bl e  st u dy st aff will  s e n d e m ail  r e mi n d ers t o p artici p a nts  c o m pl eti n g s urv e y m e as ur es  o nli n e  t h at i ncl u d es a 
li n k t o t h e o nli n e s urv e y q u esti o n n air es. P artici p a nts will e nt er t h eir u ni q u e st u dy i d e ntific ati o n n u m b er r at h er t h a n 
i d e ntifyi n g i nf or m ati o n w h e n c o m pl eti n g s urv e y m e as ur es o nli n e. D at a g at h er e d vi a o nli n e s urv e ys will b e s ec ur el y 
tr a ns mitt e d a n d st or ed acc or di n g t o t h e sit e’s s ec urit y p olic y, acc essi bl e o nly t o t h e r es e arc h st aff vi a a p ass w or d - 
s ec ur e d acc o u nt. 
 
D at a will b e pr ot ect e d a n d st or e d as d escri b e d a b ov e i n St or a g e of D at a. I n a d diti o n, w e will d estr oy all fil es li n ki n g 
p artici p a nt n a m es  or  ot h er  i d e ntifyi n g i nf or m ati o n t o st u dy i d e ntific ati o n n u m b ers six  y e ars  aft er  t h e st u dy is fi nis h e d. 
 
 
A.  Ris ks  
 
W e  b eli e v e  t h e risks of  h ar m  c a us e d by  t h e st u dy t o b e l o w a n d w e  esti m at e  t h e risk t o st u dy p artici p a nts  is mi ni m al.  All 
as p ects of t h e r es e arc h pr ot oc ol a n d Wis e P at h h a v e b e e n c ar ef ull y r e vi e w e d b y o ur a d vis ors wit h li v e d ex p eri e nc e t o 
e ns ur e t h eir acc e pt a bilit y f or i n divi d u als ex p eri e nci n g s uici d alit y a n d ot h er c o nc er ns s uc h as sl e e p/ m o o d pr o bl e ms, 
alc o h ol mis us e. T o n ot e, n o k n o w n a dv ers e e v e nts h a v e occ urr e d d uri n g o ur r es e arc h t o d at e. R at h er, f e e d b ac k fr o m 
t ar g et e n d us ers ( e. g., t h os e lik e t h e p artici p a nts i n t his st u dy) h as b e e n u niv ers all y p ositi v e. H o w e v er, s h o ul d a d v ers e 
e v e nts occ ur d u ri n g t h e st u dy, w e will t h or o u g hly ass ess f act ors t h at c o ntri b ut e d t o t h e m a n d will s e e k r es ol uti o n of 
t h os e pr o bl e ms r el at e d t o t h e st u dy a n d m a k e n otify t h e a p pr o pri at e p arti es as s p ecifi e d i n  o ur D at a S af et y  M o nit ori n g 
Pl a n.  
 
S o m e p artici p a nts m ay n o n et h el ess f e el u nc o mf ort a bl e c o m pl eti n g q u esti o n n air es a b o ut n o n -s uici d al s elf-i nj uri o us 
b e h avi ors,  a n d  s uici d al b e h avi ors,  alc o h ol  a n d/ or  ot h er  s u bst a nc e mis us e,  or  a b o ut  t h eir m o o d.  W e  will  a d dr ess  t his b y 
i nf or mi n g p artici p a nts t h at t h e y h a v e t h e ri g ht t o r ef us e t o a ns w er a n y q u esti o n d uri n g t h e st u dy. 
 
A n ot h er  p ot e nti al  risk f or p artici p a nts is  t h at of  e m b arr ass m e nt  or  disc o mf ort  if a  fri e n d or  c oll e a g u e s e es a n d  i n q uir es 
a b o ut t h e a p p a n d/ or disc ov ers its p ur p os e. P artici p a nts will b e e nc o ur a g e d t o us e t h eir assi g n e d a p p o nly w h e n a n d 
w h er e  t h e y ar e  c o mf ort a bl e d oi n g  s o. R es e arc h ers  will  als o  e nc o ur a g e  p artici p a nts t o p ass w or d  pr ot ect  t h eir p h o n e  t o 
pr e v e nt ot h ers fr o m s e ei n g t h e a p p t h e y ar e assi g n e d t o or its n otific ati o ns.  
 
A n ot h er risk is t h e p ossi bilit y t h at d at a fr o m t h e m o bil e d e vic e m a y b e i nt erc e pt e d d uri n g tr a ns missi o n or acc ess e d by 
6.  RI S K/ B E N E FI T  A S S ES S M E N T  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  1 4  of  4 1  
 
 
ot h ers  s h o ul d t h e p artici p a nt  mis pl ac e  or  l os e t h eir p h o n e;  t his is a  risk t h at a p pli es t o t h e  us e  of  m o bil e  d e vic es  o v er all. 
W e h av e elicit e d t h e c o ns ult ati o n of h e alt hc ar e a d mi nistr at ors a n d pri m ary c ar e a n d ot h er cli nic a d mi nistr at ors t o 
e ns ur e t h at t h e d at a c oll ect e d b y Wis e P at h c a n n ot b e us e d a g ai nst t h e p artici p a nts i n a n y w a y.  T h e s erv er is s ec ur e d 
a n d p ass w or d pr ot ect e d a n d o nly acc essi bl e t o E B PI e n gi n e ers a n d s el ect r es e arc h st aff. T h e pr ot ecti o ns f or t h e s erv er  
ar e  si mil ar t o t h os e us e d  i n b a n ki n g  or  ot h er  c o m m erci al w e bsit es a n d  as  a n  a d d e d  pr ec a uti o n,  all  a p p -g e n er at e d  d at a  is 
st or e d o n t h e s ec ur e s erv er, n ot o n t h e m o bil e p h o n e its elf.  
 
S o m e  p artici p a nts  m a y  f e el pr ess ur e  t o p artici p at e  b ec a us e t h e y  ar e  b ei n g  r ef err e d t o t h e st u dy by  t h eir s ervic e pr ovi d er 
(i. e., pri m ary c ar e p hysici a n, m e nt al h e alt h c o u ns el or). T h er e is als o t h e p ot e nti al risk of l oss  of c o nfi d e nti alit y. St e ps  will 
b e t a k e n t o e ns ur e t h at p artici p ati o n is v ol u nt ary a n d t h at p artici p a nts’ pri v ac y a n d t h e d at a c oll ect e d fr o m t h e 
p artici p a nts ar e pr ot ect e d. P artici p a nts will b e i nf or m e d t h at r ef us al t o p artici p at e will n ot aff ect t h e s ervic es t h e y 
c urr e ntl y r ec ei v e a n d t h at w e will n ot i nf or m t h eir s ervic e pr ovi d er or ot h er pr of essi o n al w h o m ay h a v e pr ovi d e d st u dy 
i nf or m ati o n of t h eir p artici p ati o n ( or n ot) i n t his st u dy. T o f urt h er d ecr e as e t his risk, st u dy st aff will b e tr ai n e d n e v er t o 
pr ess ur e p artici p a nts t o t a k e p art i n t h e r es e arc h or ex pr ess dis a p p oi nt m e nt if c o ns e nt t o p artici p at e i n t h e st u dy is n ot 
pr ovi d e d.  All  p artici p a nts  will  b e  i nf or m e d t h at t h e y h av e  t h e ri g ht t o r ef us e t o p artici p at e  or  disc o nti n u e  p artici p ati o n  at 
a ny ti m e.  
 
N o  d ec e pti o n  will  b e  us e d  i n t his r es e arc h. B ec a us e p artici p a nts  will  h av e  hist ory  of  r ec e nt or  c urr e nt s uici d al i d e ati o n, 
t h er e is a p ossi bilit y t h at s o m e p ati e nt p artici p a nts m ay ex p eri e nc e e m oti o n al distr ess d uri n g t h e st u dy pr oc e d ur es.  
H o w e v er,  w e  h av e  n ot  r ec ei v e d a ny  r e p orts of  a dv ers e  e v e nts i n  o ur  pr e vi o us  r es e arc h t h at i ncl u d e d s uici d al o ut p ati e nts 
a n d p ati e nts i n t h e e m er g e nc y d e p art m e nt or i n p ati e nt u nit c o m pl eti n g si mil ar st u dy pr oc e d ur es.  
 
T h us, d es pit e t h e f act t h at t his st u dy i ncl u d es p artici p a nts fr o m a s e nsiti v e p o p ul ati o n, w e b eli e v e t h e risks of t h e st u dy 
t o b e l o w a n d w e esti m at e t h e risk t o st u dy p ati e nts  is mi ni m al; h o w e v er, s h o ul d  a dv ers e e v e nts  occ ur d uri n g t h e st u dy, 
w e will t h or o u g hly ass ess f act ors t h at c o ntri b ut e d t o t h e a d v ers e e v e nt, i ncl u di n g us e of Wis e P at h, a n d will s e e k 
r es ol uti o n of t h os e pr o bl e ms r el at e d t o t h e st u dy. W e will n otify t h e I R B a n d o ur D S M B a b o ut a ny a d v ers e e v e nts, 
s h o ul d t h e y occ ur, a n d s e e k t h eir r ec o m m en d ati o ns. F urt h er, aft er e ac h st u dy m e eti n g, r es e arc h ers will c o n d uct a 
d e bri ef pr ot oc ol d e v el o p e d b y M ars h a M. Li n e h a n, P h D f or us e i n st u di es i nv ol vi n g s uici d al p ati e nts t o ass ess distr ess 
a n d i m mi n e nt s uici d e risk at e n d of e ac h s essi o n. ( Pl e as e s e e A p p e n dix 1 ). P artici p a nts i n hi g h distr ess or r e p orti n g hi g h 
s uici d al i d e ati o n will b e w alk e d t hr o u g h b e h a vi or al s kills wit h a tr ai n e d r es e arc h er a n d m o o d ass ess e d a g ai n. If t h e 
distr ess/risk h as b e e n all e vi at e d aft er utiliz ati o n of t h e b e h a vi or al s kills, n o f urt h er  acti o n will b e t a k e n. If t h e 
p artici p a nt’s  distr ess/risk  d o es  n ot  all e vi at e,  or  w h e n  f urt h er s u p p ort or  risk ass ess m e nt  is r e q uir e d, w e  will  pr oc e e d  t o a 
w ar m h a n d off pr oc e d ur e a n d c o n n ect t h e p artici p a nt, if n e e d e d, t o a crisis c o u ns el or fr o m 9 8 8.  
 
Ot h er  p ot e nti al  risks ar e  mi ni m al.  S o m e  p artici p a nts  m a y  f e el disc o mf ort  pr ovi di n g  n e g ati v e  f e e d b ac k o n  t h e st u d y a p p 
as t h e y a ns w er t h e q u esti o n n air es b ec a us e t h e y ar e h esit a nt t o criticiz e. S o m e p artici p a nts m ay f e el pr ess ur e t o 
p artici p at e b ec a us e t h e y ar e b ei n g r ef err e d t o t h e st u dy b y t h eir s ervic e pr ovi d er.  
 
P h ysic al,  s oci al, ec o n o mic,  or  l e g al risks fr o m p artici p ati n g f or p ati e nts  a n d  n o n -p ati e nts  ar e  ex p ect e d  t o b e l o w t o n o n - 
exist e nt;  h o w e v er,  it is c o nc ei v a bl e t h at a  d at a  br e ac h  c o ul d l e a d t o w ork/i ns ur a nc e  discri mi n ati o n  b as e d  o n  a  p ati e nt’s 
hist ory of s uici d al b e h avi or.  
 
T h er e ar e n o k n o w n alt er n ati v e pr oc e d ur es t o ass ess t his i nf or m ati o n. T h e pri m ary alt er n ati v e t o p artici p ati n g i n t h e 
r es e arc h is t o d ecli n e t o p artici p at e  i n t h e r es e arc h, w hic h  p artici p a nts  m a y  d o  at  a ny  ti m e wit h o ut  c h a n g e t o a ny st u dy 
b e n efits t h e y h a v e e ar n e d.  
 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  1 5  of  4 1  
 
 
B.  Pr e v e nti o n  of  Ris ks  
 
All  r es e arc h ers i nt er acti n g wit h  p artici p a nts  will  b e  tr ai n e d i n pr ot ecti o n  of  h u m a n  s u bj ects, HI P A A,  a n d  will  c o m pl et e a 
c o urs e i n G o o d Cli nic al Pr actic es. All i nf or m ati o n will b e tr e at e d as c o nfi d e nti al m at eri al a n d will b e a v ail a bl e o nly t o 
st aff. 
 
All p artici p a nts will b e pr ovi d e d wit h c o m pl et e discl os ur e r e g ar di n g w h at ex plicitl y will b e ask e d of t h e m usi n g a n 
I nf or m e d C o ns e nt  pr oc e d ur e.  T h e  I nf or m e d C o ns e nt  f or m will  d escri b e  t h e pr oc e d ur es  of  t h e st u dy a n d  cl arify t h at t h e 
st u dy is c o m pl et el y v ol u nt ary  a n d  t h at t h e y m a y  d ecli n e  t o p artici p at e  at  a ny  ti m e. Alt h o u g h  p ot e nti al  p artici p a nts  m a y 
b e  i nf or m e d of  t h e st u dy by  t h eir s ervic e pr ovi d ers,  it will  b e  m a d e  cl e ar t o t h e m t h at t h e st u dy is c o m pl et el y v ol u nt ary 
a n d  will n ot  aff ect t h e s ervic es t h e y ar e r ec ei vi n g i n  a ny w a y  or  will t h e  r es e arc h ers i nf or m t h eir pr ovi d er if t h e y d eci d e 
t o p artici p at e i n t h e r es e arc h or n ot. Pr ovi d ers a n d a g e nci es w h o a gr e e t o pr ovi d e t h e st u dy i nf or m ati o n t o t h eir 
p ati e nts or w aitlist cli e nts will b e i nf or m e d t h at t h er e s h o ul d b e n o c o erci o n of p ot e nti al p artici p a nts t o t a k e p art. I n 
a d diti o n , w e will tr ai n st aff a n d pr ovi d e  all st aff  i n p art n eri n g a g e nci es wit h d et ail e d i nstr ucti o ns a n d/ or scri pts o n h o w 
t o pr ovi d e i nf or m ati o n a b o ut t his st u dy t o p ot e nti al p artici p a nts. 
 
As d escri b e d pr e vi o usl y, if r es e arc h ers c o n d ucti n g t h e f oll o w u p ass ess m e nts p erc ei v e a n y i n dic ati o n of t h e p artici p a nt 
b ei n g at i m mi n e nt risk f or s uici d e or i n n e e d of extr a s u p p ort, a w ar m h a n d off pr oc e d ur e will b e us e d t o h el p t h e 
p artici p a nt b y t e ac hi n g s kills a n d t h e r es e arc h er will c o n n ect t h e m wit h 9 8 8 S uici d e & Crisis Lif eli n e if n e e d e d ( e. g., 
m o o d  r ati n gs d o  n ot  i m pr ov e aft er  skills, p artici p a nt  r e q u ests a d diti o n al  s u p p ort) or  i n c as es of  extr e m e  distr ess  or  if t h e 
p artici p a nt r e q u ests t o t alk wit h  a crisis c o u ns el or at 9 8 8.  Dr. Di m eff will c oll a b or at e cl os el y wit h t h e I R B a n d D S M B 
t hr o u g h o ut t h e st u dy t o e ns ur e pr o p er m a n a g e m e nt of hi g h-risk sit u ati o ns, s h o ul d t h e y occ ur. 
 
F urt h er,  n o  i d e ntifyi n g i nf or m ati o n will  b e  ass oci at e d  wit h  d at a  c oll ect e d fr o m p artici p a nts. D at a  g at h er e d  vi a  o nli n e 
s urv e ys will b e s ec ur el y tr a ns mitt e d a n d st or e d acc or di n g t o t h e sit e’s s ec urit y p olic y, acc essi bl e o nly t o t h e PIs a n d 
r es e arc h st aff vi a a  p ass w or d -s ec ur e d acc o u nt. D at a  b ei n g u pl o a d e d fr o m Wis e P at h will b e  tr a ns mitt e d o n a s ec ur e,  
e ncry pt e d  c h a n n el. A p p -g e n er at e d  d at a  ex p ort e d  fr o m Wis e P at h will  b e  d e -i d e ntifi e d d uri n g  d o w nl o a d  a n d  pr ovi d e d  t o 
r es e arc h ers wit h o ut i d e ntifyi n g i nf or m ati o n. W h e n d o w nl o a d e d b y t h e E n gi n e eri n g T e a m, d at a is ex p ort e d a n d d e - 
i d e ntifi e d t o scr u b t h e d at a of p ers o n ally i d e ntifi a bl e i nf or m ati o n. O nl y t h e st aff tr ai n e d i n HI P A A a n d pr oc e d ur es f or 
c o n d uct of et hic al h u ma n s u bj ects r es e arc h will h a v e acc ess t o st u dy d at a. T h e i d e ntit y of p artici p a nts will b e k e pt 
s e p ar at e fr o m r ec or ds of t h eir r es e arc h d at a.  
 
St e ps will b e t a k e n t o e ns ur e t h at p artici p ati o n is v ol u nt ary, a n d t h at p artici p a nts’ pri v ac y a n d t h e d at a c oll ect e d fr o m 
t h e p artici p a nts ar e pr ot ect e d. P artici p a nts will b e t ol d t h at t h eir p artici p ati o n is c o m pl et el y v ol u nt ary, a n d t h at t h e y 
m a y  c h a n g e t h eir mi n ds  a n d  wit h dr a w  at  a ny  ti m e. D at a  will  b e  pr ot ect e d  a n d  st or e d as  d escri b e d  a b ov e  i n Pr ot ecti o n  of 
St u dy D at a.  
 
T o a d dr ess p ot e nti al disc o mf ort i n s h ari n g criticis m or ot h er o pi ni o ns a b o ut t h e a p p d uri n g t h e st u dy i nt ervi e w, t h e 
i nt ervi e w er will  ass ur e  t h e p artici p a nt  t h at a ny  a n d  all  f e e d b ac k, p ositi v e  a n d  n e g ati v e,  is h el pf ul.  P artici p a nts  will  b e 
i nf or m e d t h at t h e y m a y d eci d e h o w m uc h or littl e t o s h ar e. 
 
C.  A d v ers e  E v e nts  
 
F or  t his st u dy, w e  d efi n e  a n  a dv ers e  e v e nt  as  a ny u n d esir a bl e  ex p eri e nc e  ass oci at e d  wit h  t h e us e  of  a  m e dic al  d e vic e  or 
e n g a g e m e nt i n t h e r es e arc h pr oc e d ur e, i ncl u di n g:  
 
S uici d e -r el at e d A d v ers e  Ev e nts  
•  
S uici d e  att e m pts  t h at d o  n ot  r e q uir e m e dic al  att e nti o n  or  h os pit al -b as e d  c ar e 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  1 6  of  4 1  
 
 
•  
W ar m  h a n d off  t o 9 8 8  
•  
Si g nific a nt  i ncr e as e i n s uici d al i d e ati o n, d efi n e d  by:  
o  Fr e q u e nc y:  A  t w o-f ol d i ncr e as e i n SI  i n t h e p ast  3 0  d ays  b as e d  o n  t h e S elf  I nj ury T h o u g hts a n d  B e h avi ors 
I nt ervi e w ( SI T BI); or 
o  I nt e nsit y: A  t w o-p oi nt  i ncr e as e i n SI  i n p ast  3 0  d ays  b as e d  o n  SI T BI  
 
Alc o h ol -r el at e d A d v ers e  E v e nts  
•  
S elf -r e p ort of  bl ac k o uts  
•  
S elf -r e p ort of  i nj uri es t o t h e ms el v es or  ot h ers  r el at e d t o alc o h ol  
•  
≥5 -p oi nt  r a w sc or e i ncr e as e o n  P R O MI S  Alc o h ol  Us e (it e m  7 a)  O R  P R O MI S  Alc o h ol  N e g ati v e  C o ns e q u e nc es 
M e as ur e ( ≤1. 3 S D c h a n g e i n T -sc or es) 
 
S eri o us  A d v ers e  E v e nts  
•  
S uici d e  att e m pt  t h at l e a ds t o ac ut e  h os pit al -b as e d  c ar e ( e. g., visit  t o e m er g e nc y  d e p art m e nt) a n d  ar e  dir ectl y 
r el at e d t o t h e st u dy pr oc e d ur es a n d/ or us e of st u dy-assi g n e d a p p  
•  
Alc o h ol  p ois o ni n g  t h at l e a ds t o ac ut e  h os pit al -b as e d  c ar e r es ulti n g fr o m t h e st u dy pr oc e d ur es  or  st u dy-assi g n e d 
a p p us a g e  
•  
D e at h  of  p artici p a nt  
 
I n t h e e v e nt t h at a p artici p a nt h as ex p eri e nc e d a n a d v ers e e v e nt, t h e r es e arc h t e a m, u n d er t h e dir ecti o n of st u dy 
i nv esti g at ors ( Di m eff, J o b es, R u ork), will ass ess sit u ati o n gi vi n g ris e t o a n d c o ns e q u e nc e of ( e. g., ass oci at e d m e dic al 
tr e at m e nt) a n a d v ers e e v e nt. Eff ort will b e m a d e  t o d et er mi n e w h et h er a n d t h e  ext e nt  t o w hic h t h e di git al a p ps us e d i n 
t h e r es e arc h st u dy or st u dy pr oc e d ur e c a us e d or c o ntri b ut e d t o t h e a d v ers e e v e nt. C o m pl et e i nf or m ati o n  gl e a n e d fr o m 
t his ass ess m e nt will t h e n b e s h ar e d wit h t h e D S M B, i n a d ditio n t o o ur d et er mi n ati o n r e g ar di n g t h e i nv olv e m e nt of t h e 
di git al a p p a n d/ or st u dy pr oc e d ur e i n t h e a d v ers e e v e nt. T h e D S M B will b e t h e fi n al ar bit er i n d et er mi ni n g w h et h er t h e 
a dv ers e  e v e nt  w as  c a us e d or  ex ac er b at e d  by  t h e st u dy a p p  or  st u dy pr ot oc ol. If  a  s eri o us a dv ers e  e v e nt  occ urs,  it will  b e 
r e p ort e d t o D S M B a n d I R B wit hi n 7 2 h o urs. 
 
All p artici p a nts will b e pr ovi d e d wit h i nf or m ati o n a b o ut h o w t o r e p ort p ot e nti al a d v ers e e v e nts a n d i nf or m ati o n a b o ut 
p ot e nti al a d v ers e e v e nts will b e g at h er e d fr o m p artici p a nts vi a s urv e ys a n d s e mi -str uct ur e d i nt ervi e ws.. I n a d diti o n, 
p artici p a nts  will  b e  e nc o ur a g e d  t o r e p ort a ny p ot e nti al  a d v ers e  e v e nts dir ectl y  t o t h e r es e arc h ers i m m e di at el y. P ot e nti al 
a dv ers e e v e nt r e p orts will b e m o nit or e d b y st u dy st aff; t h e s urv e y s yst e m a ut o m atic all y n otifi es st u dy st aff w h e n a 
r e p ort is c o m pl et e d. B ec a us e t h e risks t o p artici p ati o n ar e l o w, t h e lik eli h o o d of a d v ers e e v e nts r el at e d t o t h e pr o p os e d 
r es e arc h is j u d g e d t o b e l o w. I n t h e e v e nt t h at a p ot e nti al a d v ers e e v e nt is r e p ort e d, t h e i nv esti g at ors ( Drs. Di m eff, 
J o b es, a n d R u ork) will b e n otifi e d i m m e di at el y. T h e y will t h e n ass ess t h e sit u ati o n a n d d et er mi n e a n a p pr o pri at e cli nic al 
a n d et hic al c o urs e of  a cti o n, i ncl u di n g r e p ort of a n a d v ers e e v e nt t o t h e I R B a n d  D S M B.  Dr.  Di m eff will w ork  cl os el y wit h 
t h e r es e arc h st aff t o m ai nt ai n c o nti n u o us, cl os e m o nit ori n g a n d pr o m pt r e p ort r e p orti n g.  
 
St o p pi n g  Crit eri a  
T h er e  ar e  t hr e e st a n d ar d st o p pi n g r ul es: e vi d e nc e  of  h ar m,  f utilit y, a n d  b e n efit.  Gi v e n  t h e bri ef  d ur ati o n  of  t his st u dy 
a n d  s m all s a m pl e siz e, w e  h av e  el ect e d  t o a p pl y t h e st o p pi n g r ul e o nly  t o h ar m c a us e d by  t h e r es e arc h pr oc e d ur es  or 
st u dy-assi g n e d a p p, a n d n ot f utilit y a n d b e n efit.  
 
T his t y p e of st o p pi n g r ul e is t y pic all y est a blis h e d by esti m ati n g ex p ect e d a d v ers e  e v e nt r at es b as e d o n pr e vi o us st u di es 
a n d/ or cli nic al d at a. If t h e act u al r at e of t h os e e v e nts exc e e ds y o ur a ntici p at e d r at e b y s o m e pr es p ecifi e d a m o u nt, t h e 
st o p pi n g r ul e is tri g g er e d. A p pr oxi m at el y 2 0-4 0 % of p ati e nts wit h r ec e nt s uici d al i d e ati o n or att e m pts will att e m pt 
s uici d e d uri n g a o n e -t o-t w o-y e ar st u dy  p eri o d. D uri n g  t his s a m e st u dy p eri o d, a n  esti m at e d  1 0 %  of p ati e nts  wit h si mil ar 
s uici d al i d e ati o n a n d att e m pt hist ory will b e h os pit aliz e d. T h er ef or e, if t h e d e vic e is s af e, t h es e w o ul d b e t h e esti m at e d 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  1 7  of  4 1  
 
 
ex p ect e d r at es f or s uici d e att e m pts a n d h os pit aliz ati o ns w e c o ul d ex p ect t o e nc o u nt er d uri n g t h e st u dy. B as e d o n 
n at ur al v ari a bilit y, r a n d o m err or, p ot e nti ally hi g h er risk s a m pl es, a n d a c a uti o n t o n ot ov er esti m at e l e v el of risk, t h e 
st o p pi n g r ul e is s et at  5 0 %  hi g h er  t h a n t h es e r at es. T h e  s a m e pri nci pl es  h av e  b e e n  a p pli e d  f or alc o h ol-r el at e d pr o bl e ms.  
 
If it is d et er mi n e d  t h at t h e t hr es h ol d f or st o p pi n g, b as e d  o n  t h e st u dy crit eri a, h as  b e e n  m et  f or o n e  or  m or e  of  t h e 
crit eri a, t h e D S M B w o ul d ex a mi n e t h e d at a t o d eci d e w h et h er t h e st u dy s h o ul d b e st o p p e d.  
 
If a n y  of  t h e f oll o wi n g crit eri a ar e  m et,  d at a  will  b e  s e nt t o D S M B  t o d et er mi n e if st u dy s h o ul d b e  st o p p e d a n d a  r e p ort 
will b e s e nt t o I R B wit hi n 7 2 h o urs of D S M B d ecisi o n:  
•  
6 0 %  of  p artici p a nts  att e m pt  s uici d e 
•  
1 5 %  of  p artici p a nts  ar e h os pit aliz e d  
•  
9 0 %  of  p artici p a nts  ex p eri e nc e  bl ac k o uts  or  i nj uri es d u e  t o alc o h ol  us e  
•  
4 %  of  p artici p a nts  ex p eri e nc e  alc o h ol  p ois o ni n g  t h at l e a ds t o h os pit al -b as e d  c ar e 
 
D.  B e n efits  
 
T h e ov er arc hi n g p ur p os e of t his r es e arc h is t o d esi g n a hi g hly eff ecti v e, e asy -t o-us e di git al t ec h n ol o g y f or us e b y 
i n divi d u als w h o  ar e  s uici d al a n d  m a y  als o  ex p eri e nc e  c o-occ urri n g  c o nc er ns ( e. g., sl e e p/ m o o d pr o bl e ms,  alc o h ol  mis us e) 
t o h el p f acilit at e acc ess t o e vi d e nc e-b as e d c ar e at t h e p oi nt of n e e d. B y p artici p ati n g i n t his pr oj ect, p e o pl e c a n h el p 
e ns ur e t h at t h os e w h o ar e s uici d al h a v e acc ess t o r o b ust s uici d e -s p ecific c ar e. 
 
 
A.  R ecr uiti n g  
 
P artici p a nts  will  b e  r ecr uit e d o n  a  first-c o m e, first-s erv e d b asis  t h o u g h s o m e p artici p a nts  will  b e  str at e gic all y r ecr uit e d t o 
e ns ur e t h e r el e v a nc e of Wis e P at h  f or i n di vi d u als w h o mis us e alc o h ol; n o f e w er t h a n 3 5 % of t h e s a m pl e will b e 
c o m pris e d of i n divi d u als  w h o r e p ort a  h ar mf ul  or h az ar d o us l e v el  of dri nki n g  (sc or e 8  or  m or e  o n t h e A U DI T). F urt h er,  t o 
e ns ur e c ult ur al r el e v a nc e, r ecr uit m e nt eff orts will als o pri oritiz e et h nic a n d r aci al di v ersit y o v er first -c o m e, first s erv e d 
r ecr uit m e nt. 
P artici p a nts will b e r ecr uit e d t hr o u g h w or d -of -m o ut h, r ef err als fr o m or g a niz ati o ns, pri m ary c ar e cli nics, m e nt al h e alt h 
a n d o ut p ati e nt cli nics, ot h er pr of essi o n al c o n n ecti o ns, a n d t hr o u g h 3 r d p art y r ecr uit m e nt pl atf or ms ( e. g., CI N T, Us er 
I nt ervi e ws). W e m a y als o us e t ar g et e d vi a s oci al m e di a a d v ertis e m e nt ( e. g., F ac e b o ok, I nst a gr a m) p ost e d i n cl os e d 
gr o u ps. W e will r e q u est t h at a d mi nistr ati v e st aff a n d pr o vi d ers at p art n eri n g cli nics a n d or g a n iz ati o ns distri b ut e st u dy 
r ecr uit m e nt m at eri als (fl y er) dir ectl y t o p ati e nts a n d/ or h a v e it acc essi bl e i n cli nic l o b bi es. R ecr uit m e nt m at eri als will 
c o nt ai n a n e m ail a d dr ess  a n d p h o n e n u m b er  t h at pr os p ecti v e p artici p a nts c a n  c o nt act if i nt er est e d i n p artici p ati ng, a n d 
a li nk a n d/ or Q R c o d e t o a w e bsit e or dir ectl y t o t h e o nli n e eli gi bilit y scr e e n. P ot e nti al p artici p a nts will i n dic at e t h eir 
i nt er est i n l e ar ni n g m or e a b o ut t h e st u dy b y c o nt acti n g st u dy st aff dir ectl y vi a p h o n e, t ext, or e m ail or b y dir ectl y 
p r oc e e di n g t o t h e o nli n e eli gi bilit y scr e e n. Pr ovi d ers a n d ot h ers distri b uti n g r es e arc h r ecr uit m e nt m at eri als will b e 
i nstr uct e d t o e m p h asiz e t h e v ol u nt ary n at ur e of t h e r es e arc h f or all p artici p a nts a n d t o d escri b e t h e r es e arc h 
o p p ort u nit y i n  w a ys  t h at mi n i miz e act u al a n d p erc ei v e d c o erci o n. St u dy st aff  will  b e tr ai n e d n e v er  t o pr ess ur e p ot e nti al 
p artici p a nts  t o t a k e p art  i n t h e r es e arc h or  ex pr ess  dis a p p oi nt m e nt  if c o ns e nt t o p artici p at e  i n t h e st u dy is n ot  pr ovi d e d.  
As d escri b e d a b ov e, w e m a y als o ask pr os p ecti v e p artici p a nts t o v erify t h eir i d e ntit y a n d/ or r esi d e nc y, i ncl u di n g 
r e q uiri n g pr os p ecti v e p artici p a nts t o t ur n t h eir c a m er as o n d uri n g virt u al m e eti n gs a n d/ or aski n g t h e pr os p ecti v e 
p artici p a nt t o v erify t h e y a r e i n t h e U S b y s h o wi n g eit h er t h eir st at e-iss u e d dri v er’s lic e ns e/I D c ar d or a pi ec e of m ail 
s h o wi n g t h eir n a m e a n d a U S m aili n g a d dr ess. A n y i n divi d u al w h o c a n n ot d e m o nstr at e t h eir r esi d e nc y will b e t ol d t h at 
t h e s essi o n c a n n ot pr oc e e d, a n d t h e y will n ot b e e nr oll e d i n t h e st u dy.  
7.  P A R TI CI P A N T  R E C R UI T M E N T  A N D  I NF O R M E D C O N S E N T  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  1 8  of  4 1  
 
 
B.  I nf or m e d C o ns e nt  
 
All p artici p a nts will b e pr ovi d e d wit h c o m pl et e discl os ur e r e g ar di n g w h at ex plicitl y will b e ask e d of t h e m f or 
p artici p ati o n  usi n g  I nf or m e d C o ns e nt  pr oc e d ur es.  T h e  I nf or m e d C o ns e nt  f or ms will  d escri b e  t h e st u dy pr oc e d ur es  a n d 
cl arify t h at t h e st u dy is c o m pl et el y v ol u nt ary a n d t h at p artici p a nts m ay d ecli n e t o p artici p at e at a n y ti m e.  
 
O nc e i niti al eli gi bilit y is d et er mi n e d, p ot e nti al p artici p a nts will b e gi v e n a bri ef d escri pti o n of t h e st u dy a n d ask e d f or 
t h eir v er b al c o ns e nt t o pr oc e e d wit h t h e I nf or m e d C o ns e nt disc ussi o n. P artici p a nts will first c o m pl et e a n o m ni b us 
c o ns e nt f or m t h at d escri b es t h e st u dy i n d et ail, i ncl u di n g t h at t h e y will b e ask e d t o us e a m o bil e a p p d uri n g t h e st u dy, 
b ut  d o es  n ot  i ncl u d e d et ail e d  i nf or m ati o n a b o ut  t h e m o bil e  a p ps  us e d  i n t h e st u dy. Aft er  t h e p artici p a nt  is r a n d o miz e d 
t o c o n diti o n, t h e y will  b e  ask e d  to  si g n a n  i nf or m e d c o ns e nt f or m a d d e n d u m  wit h  i nf or m ati o n a b o ut  t h e st u dy c o n diti o n 
(i. e., t h e m o bil e a p p) t o w hic h t h e y w er e all oc at e d. 
 
T h e I nf or m e d  C o ns e nt pr oc ess will  t a k e pl ac e i n p ers o n or r e m ot el y ( e. g., Z o o m, t el e p h o n e, e m ail)  wit h a  r es e arc h er. All 
p ot e nti al p artici p a nts ar e i nf or m e d d uri n g t h e I nf or m e d C o ns e nt pr oc e d ur e t h at p artici p ati o n is c o m pl et el y v ol u nt ary 
a n d  t h at t h e y m a y  wit h dr a w fr o m  t h e st u dy at a n y ti m e wit h n o n e g ati v e  c o ns e q u e nc es. Eli gi bl e p artici p a nts will r ec ei v e 
a  c o p y of  t h e I nf or m e d C o ns e nt  F or m  (vi a h ar d  c o p y, o nli n e,  or  e m ail).  P artici p a nts  will  h av e  t h e o p p ort u nit y  t o r e a d a n d 
r e vi e w t h e c o ns e nt f or m wit h t h e r es e arc h st aff, o n t h eir o w n, a n d/ or r e vi e w it wit h fri e n ds a n d f a mily if d esir e d. St u dy 
st aff will b e a v ail a bl e t o a ns w er a n y q u esti o ns or c o nc er ns t h e p artici p a nts m ay h a v e pri or t o si g ni n g a n d r et ur ni n g t h e 
c o ns e nt for m.  
 
C.  O bt ai ni n g  a n d  D oc u m e nti n g  C o ns e nt  
 
P artici p a nts will pr ovi d e c o ns e nt b y si g ni n g t h e p a p er I nf or m e d C o ns e nt F or m or el ectr o nic all y b y t y pi n g t h eir n a m e or 
a d di n g  t h eir el ectr o nic si g n at ur e t o a n o nli n e  v ersi o n/ P D F  of  t h e I nf or m e d C o ns e nt F or m. W e will pr ovi d e a  c o p y of  t h e 
I nf or m e d C o ns e nt  F or m f or  t h e p artici p a nt  t o k e e p  f or t h eir r ec or ds. T h e  si g n e d c o ns e nt f or ms will  b e  st or e d o n  HI P A A - 
c o m pli a nt S h ar e P oi nt. If a p artici p a nt si g ns a p a p er c o p y of t h e I nf or m e d C o ns e nt F or m, a r es e arc h er will sc a n si g n e d 
h ar d c o pi es a n d s a v e el ectr o nic c o pi e s ( e. g., as a P D F) o n S h ar e P oi nt. 
 
D.  P artici p a nt  C o m pr e h e nsi o n  a n d  C a p acity  
 
All  eff orts  will  b e  m a d e  t o e ns ur e  p ot e nti al  p artici p a nts  u n d erst a n d  t h e i nf or m ati o n pr es e nt e d  i n t h e I nf or m e d C o ns e nt 
F or m. T hr o u g h o ut t h e I nf or m e d C o ns e nt pr oc ess es, t h e r es e arc h er will ask if t h e p artici p a nt h as a n y q u esti o ns.  
P artici p a nts will h a v e t h e o p p ort u nit y t o r e a d a n d r e vi e w t h e c o ns e nt/ ass e nt f or m o n t h eir o w n a n d r e vi e w it wit h 
fri e n ds a n d  f a mily if d esir e d.  Dr.  Di m eff  a n d  t h e st u dy st aff will  b e  a v ail a bl e  t o a ns w er  a ny  q u esti o ns  or  c o nc er ns t h e 
p artici p a nts m ay h a v e pri or t o si g ni n g t h e c o ns e nt f or m.  
 
E.  C osts  t o P artici p a nts  
 
T h er e  ar e  n o  c osts t o p artici p a nts  f or t a ki n g p art  i n t his st u dy. 
 
F.  C o m p e ns ati o n  t o P artici p a nts  
 
All p a y m e nts will b e distri b ut e d wit hi n 3 0 d a ys aft er p artici p ati o n is c o m pl et e. P artici p a nts m ay c h o os e t o r ec ei v e 
p ay m e nt  i n t h e f or m of  a  c h ec k i n t h e m ail  or  a  gift  c ar d ( A m az o n, Kr o g er,  T ar g et)  by  m ail. If  a  p artici p a nt  d eci d es  t o 
wit h dr a w or e n d p artici p ati o n pri or t o c o m pl eti n g t h eir tri al ( or if t h e y ar e a d mi nistr ati v el y wit h dr a w n by t h e 
r es e arc h ers), t h e y will b e c o m p e ns at e d t h e t ot al a m o u nt f or t h e ass ess m e nts t h e y h a v e c o m pl et e d.  
 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  2 0  of  4 1  
 
 
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M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
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P a g e  2 1  of  4 1  
 
 
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M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
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M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
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P a g e  2 3  of  4 1  
 
 
c o nti n g e nc y m a n a g e m e nt  i n a n  i n n er-city s u bst a nc e us e  dis or d er  o ut p ati e nt  pr o gr a m.  J o ur n al of  S u bst a nc e  A b us e 
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Tr e ati n g t h e S uici d al P ers o n i n Pri m ary C ar e. 3 6 , 1 . 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
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P a g e  2 4  of  4 1  
 
 
A P P E N DI X  1  
M o o d  Assess me nt  &  De bri ef  Pr ot oc ol  
A d a pt e d  fr o m M ars h a  Li n e h a n’s S uici d e  Ris k/ Distr ess  Ass ess m e nt  Pr ot oc ol  
P U R P OS E:  
W hil e  t h e risk is d e e m e d  l o w f or t his r es e arc h, t h e i nt e nt of  t his M o o d  I n d ucti o n Pr ot oc ol  is t o e ns ur e  t h at p artici p a nts 
ar e n ot i n gr e at er distr ess t h a n at t h e st art of t h e i nt ervi e w d u e t o t h e i nt ervi e w pr oc ess.  
P R O C E D U R E:  
T h e  i nt e nt of  t his pr oc e d ur e  is t o e ns ur e  t h at p artici p a nts  w h o  m a y  b ec o m e  e m oti o n ally  distr ess e d  d uri n g  or  aft er 
t h e i nt ervi e w r ec ei v e h el pf ul s u p p ort f oll o wi n g  c o m pl eti o n of t h e  i nt ervi e w a n d e nc o ur a g e m e nt t o r e ac h o ut f or 
s u p p ort, if n e e d e d. 
 
T w o  v ersi o ns  of  t h e b asic  pr oc e d ur e ar e  d escri b e d  b el o w:  t h e first f oc us es o n s u p p orti n g t h e p artici p a nt  d uri n g t h e 
c o urs e of  t h e st u dy a p p oi nt m e nt  s h o ul d t h e y b ec o m e  distr ess e d;  t h e s ec o n d f oc us es o n  ass essi n g  a n d  pr ovi di n g  as - 
n e e d e d s u p p ort f oll o wi n g t h e c o m pl eti o n of t h e i nt ervi e w.  
D uri n g  St u dy  A p p oi nt m e nt:  
If p artici p a nt  a p p e ars  e m oti o n all y  distr ess e d  d uri n g  t h e c o urs e of  t h e i nt er vi e w or  o nli n e  s urv e ys, as k: 
“J ust w a nt e d t o t a k e a m o m e nt t o c h ec k i n a n d s e e h o w y o u ar e d oi n g. S o m eti m es j ust t alki n g a b o ut or 
r efl ecti n g o n a r e ally u ps etti n g ti m e i n y o ur lif e c a n bri n g st uff u p.” P a us e a n d list e n.  
 
➢ If p artici p a nt  c o m m u nic at es t h e y ar e  ok a y:  “ Ok ay. W e’ll  k e e p  m o vi n g  al o n g  t h e n. B ut  if y o u  w a nt 
t o p a us e or st o p at a n y p oi nt, j ust l et m e k n o w. S o u n d g o o d ?” P a us e, all o w r es p o ns e, a n d 
pr oc e e d.  
 
➢ If t h e p artici p a nt  st at es t h e y ar e  distr ess e d a n d/ or  it is a p p ar e nt t o i nt er vi e w er t h at t h e y c o ul d 
b e n efit  fr o m a  s h ort br e ak  a n d/ or  pr actici n g  a  b e h a vi or al  s kill, as k:  “W o ul d  it b e  h el pf ul  t o t ak e a 
mi ni  br e a k ? Or  if y o u’r e u p f or it, w e c o ul d als o d o a littl e  d e e p br e at hi n g or w al ki n g ( or a n ot h er 
s kill t h e p ati e nt r e a dily us es wit h s ucc ess) t o g et h er. 
T h e  i nt ervi e w er s h o ul d t h e n d o  w h at  is n e e d e d  a n d/ or  as k e d  f or: pr actici n g  a  skill (s uc h as  p ac e d 
br e at hi n g or distr acti o n t ec h ni q u e, TI P P) a n d/ or t a ki n g a s h ort br e a k.  
 
F oll o wi n g  a  bri ef  br e a k,  as k:  “Is it o k ay  t o c o nti n u e, or  w o ul d  y o u  pr ef er  t o t a k e a  p a us e or  c all it a  d a y ?”  
I nt er vi e w er s h o ul d t h e n pr oc e e d  i n r e q u est e d w ay.  
•  If p artici p a nt  wis h es  t o pr oc e e d,  r e mi n d p artici p a nt  t h at t h e y ar e  fr e e t o t a k e a  br e a k 
w h e n e v er t h e y wis h.  
•  If t h e y wis h  t o e n d t h e i nt er vi e w, t h a nk t h e m a n d ask t h e m w h at will  b e h el pf ul  f or t h e m t o d o  t o 
r e d uc e t h eir e m oti o n al  distr ess  aft er  t h e y l e a v e. E nc o ur a g e  c o n n ecti o n wit h  a  9 8 8  S uici d e  &  Crisis 
Lif eli n e c o u ns el or a n d p erf or m a w ar m h a n d off if t h e y a gr e e t o b e c o n n ect e d, as k: “Is t h er e 
s o m e o n e y o u c all f or s u p p ort s h o ul d y o u n e e d it l at er t o d a y ? Or I c a n c o n n ect y o u wit h t h e  
c o u ns el ors pr o vi di n g  s u p p ort f or t his r es e arc h.” 
o  If t h e p artici p a nt is extr e m el y u ps et a n d/ or ex p eri e nci n g a n ac ut e crisis,  t h e i nt er vi e w er 
will i m m e di at el y p erf or m a w ar m h a n d off t o 9 8 8 ( S e e M a n a gi n g a n Ac ut e Crisis S ecti o n  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  2 5  of  4 1  
 
 
b el o w)  a n d  c o nt act Dr.  Di m eff  2 0 6 -3 8 4 -7 3 7 1,  Dr.  R u or k  7 0 7 -8 8 8 -7 2 9 2,  a n d  A n g el a  K ell e y - 
Bri m er 2 5 3 -2 7 9 -8 6 5 9 (t ext a n d e m ail).  
E n d  of  St u dy A p p oi nt m e nt:  
U nl ess  t er mi n ati n g t h e a p p oi nt m e nt  mi d -s essi o n at  p artici p a nt’s  r e q u est (s e e a b ov e),  c o m pl et e t h e m o o d  
ass ess m e nt  b el o w  e v e n  if y o u h av e  alr e a d y  c h ec k e d i n wit h  t h e p artici p a nt.  I n ot h er  w or ds,  t h e m o o d  ass ess m e nt 
m ust b e c o m pl et e d at t h e e n d of all st u dy a p p oi nt m e nts.  
If t h e p artici p a nt  r e p orts a  sc or e of  3  or  gr e at er  o n  t h e m o o d  ass ess m e nt  q u esti o n,  t h e i nt ervi e w er will  m ov e  o n  t o 
t h e M o o d I n d ucti o n Pr ot oc ol. 
If t h e p artici p a nt is extr e m el y u ps et a n d/ or ex p eri e nci n g a n ac ut e crisis, t h e i nt ervi e w er will p erf or m a 
w ar m  h a n d off  t o 9 8 8  i m m e di at el y a n d  c o nt act Dr.  Di m eff  2 0 6 -3 8 4 -7 3 7 1,  Dr.  R u or k  7 0 7 -8 8 8 -7 2 9 2,  a n d 
A n g el a K ell e y -Bri m er 2 5 3 -2 7 9 -8 6 5 9 (t ext a n d e m ail).  
M O O D AS S ES S M E N T:  
O p e n  t h e M o o d  Ass ess m e nt  a n d  D e bri ef  Pr ot oc ol  S urv e y  f or R es e arc h ers  t o c o m pl et e a n d  r ec or d all  p artici p a nt  a ns w ers 
a n d acti o ns t a k e n d uri n g t h e m o o d ass ess m e nt a n d d e bri ef pr ot oc ol.  
 
Scri pt: 
T h a n k  y o u  s o m uc h  f or s h ari n g wit h us  t o d ay. B ef or e  w e  e n d  o ur  s essi o n, I j ust w a nt  t o c h ec k i n t o m a k e 
s ur e y o u  ar e  i n g o o d  s h a p e o nc e  y o u  l e a v e. 
 
O n  a  sc al e of  0 -7 , h o w  w o ul d  y o u  r at e y o ur e m oti o n al  distr ess  ri g ht n o w, w h er e 0  is L o w/ n o n-exist e nt 
a n d  7 is t h e hi g h est i m a gi n a bl e ?” 
 
O n  t h at s a m e sc al e, w h at  is y o ur ur g e  t o us e dr u gs or alc o h ol ri g ht  n o w ?  
 
O n  t h e sc al e of 0-7 , w h at  is y o ur ur g e  t o h ar m  y o urs elf  ri g ht n o w ?   
 
O n  t h at s a m e sc al e, w h at  is y o ur i nt e nt t o kill y o urs elf ri g ht n o w ? 
 
< <If  p artici p a nt  a ns w ers  0 -4  o n  all  q u esti o ns,  t h a n k p artici p a nt  a g ai n  a n d  e n d  t h e s essi o n h er e. > >  
 
< <If  p artici p a nt  a ns w ers  5  or  hi g h er,  c o nti n u e t o t h e r e m ai ni n g pr ot oc ol. > >  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  2 6  of  4 1  
 
 
M O O D I N D U C TI O N: 
1.  V ali d at e ex p eri e nc e : Y o u m e nti o n e d o n t h at m o o d r ati n g t h at y o u ar e f e eli n g < <i ns ert w h at p ers o n 
e n d ors e d, e. g., “li k e killi n g y o urs elf” or “li k e h ar mi n g y o urs elf” > > . I j ust w a nt t o m a k e s ur e t h at y o u’r e 
i n g o o d  s h a p e b ef or e  w e  h a n g  u p.  W o ul d  it b e  ok a y  wit h  y o u  if w e  t a k e a  f e w m o m e nts  t o s e e if w e  c a n 
g et  y o ur m o o d  u p  a  bit  b ef or e  w e  h a n g  u p ?  (if r e ally distr ess e d,  s ki p t o M a n a gi n g  a n  Ac ut e  Crisis  s ecti o n) 
2.  I nvit e Assist a nc e : D o  y o u  f e el at  all  li k e y o u  c o ul d b e n efit  fr o m a d diti o n al  s u p p ort at  t h e m o m e nt,  or  is 
it o n e of t h os e t hi n gs t h at y o u c a n ex p ect will p ass wit h ti m e ? If it w o ul d b e h el pf ul t o y o u, w e c o ul d 
t hi n k t hr o u g h a f e w s kills y o u mi g ht fi n d h el pf ul t o bri n g d o w n y o ur distr ess or s ort of distr act fr o m 
d et ails  t h at ar e  u ps etti n g  (list e n). T h e  i nt ervi e w er s h o ul d t h e n d o  w h at  is n e e d e d  a n d/ or  as k e d  f or: s e e 
Pr actici n g a S kill  s ecti o n b el o w, if p artici p a nt is i nt er est e d. 
If P artici p a nt Is R el uct a nt t o E n g a g e i n Pr o bl e m S ol vi n g Eff orts t o C h a n g e M o o d: I d o w a nt t o m a k e 
s ur e y o u’r e o k ay b ef or e w e h a n g u p. Is t h er e s o m et hi n g els e t h at mi g ht b e g oi n g o n f or y o u ri g ht n o w 
t h at mi g ht  b e  h el pf ul  t o t al k a b o ut  f or a  f e w mi n ut es?  I c a n h el p  y o u  c o n n ect wit h  h el pf ul  c o u ns el ors at 
t h e 9 8 8 S uici d e & Crisis Lif eli n e or w o ul d it b e h el pf ul t o try o ut a s kill ? If t h e y d o n ot wis h t o, m ov e t o 
I d e ntif y S u p p ort T h e y C a n C all if N e e d e d. 
3.  O P TI O N AL:  I d e ntif y S u p p ort  T h e y  C a n  C all  if N e e d e d : If r el e v a nt/ a p plic a bl e ( e. g., distr ess  is hi g h  a n d 
n ot  f ull y r es ol vi n g, r ef usi ng tr a nsf er t o 9 8 8),  as k:  “I w o n d er  if it mi g ht b e h el pf ul t o i d e ntify a  p ers o n 
w h o y o u mi g ht c all aft er y o u l e a v e h er e if y o u’r e still f e eli n g pr etty distr ess e d a n d j ust n e e d a bit of 
s u p p ort ? Or I c a n c o n n ect y o u k n o w wit h a c o u ns el or d e dic at e d t o s u p p orti n g ot h ers i n t h es e 
sit u ati o ns.” 
a. List e n a n d  i n q uir e if t h e y h a v e  t h at p ers o n’s  n u m b er  e asil y  a v ail a bl e.  
4.  C o pi n g  A h e a d  Aft er  H a n gi n g  U p : 
➢ I d e ntif y a  Pl a n.  B ef or e  w e  e n d  t his c all, I w a nt  t o m a k e  s ur e y o u’r e s et a n d  i n g o o d  s h a p e. W o ul d  
t h at b e  o k a y ?  ( P a us e) 
< <If  p artici p a nt  w a nts  t o t er mi n at e c all b ef or e  c o m pl eti n g t his st e p, s ki p t o St e p  5 > >  
W h at  i d e as d o  y o u  h a v e  f or w h at  y o u  mi g ht  d o  if y o u  st art f e eli n g distr ess e d  a g ai n ?  
< <If  n o  i d e as, r e mi n d p artici p a nt  of  s kills pr actic e d  t o d a y or  if n o  s kills, s u g g est o n e  or  t w o s kills t h e y 
c o ul d us e a n d off er t o pr actic e t o g et h er. Als o r e mi n d p artici p a nt t h at t h e y c a n c all or t ext 9 8 8 at 
a ny ti m e > >  
➢ I d e ntif y W h o t h e y C a n C all if N e e d e d. W o ul d it b e h el pf ul f or us t o fi g ur e o ut w h o m y o u mi g ht c all 
if y o u n e e d a bit m or e s u p p ort l at er ? D o y o u h a v e s o m e o n e y o u us u ally c all w h e n y o u’r e f e eli n g 
d o w n ? ( P a us e) 
< <if  n e e d e d > > W h at  a b o ut  t h e s uici d e lif eli n e at  9 8 8 ?  Is t h at s o m e o n e y o u  mi g ht  r e ac h o ut  t o? 
5.  C o ncl u di n g t h e C all : T h a n k y o u f or w orki n g wit h m e t o d a y. I t hi n k w e’v e g ot a g o o d pl a n i n pl ac e. D o 
y o u w a nt t o j ust s a y b ack t o m e w h at t h e pl a n is j ust t o m a k e s ur e y o u h a v e it ? If i m p ort a nt d et ails 
o mitt e d, fill i n.  
< <If  n e e d e d,  s u m m ariz e t h e pl a n > >  
T h at’s  ok a y.  L et m e  s u m m ariz e it f or y o u.  W o ul d  y o u li k e t o writ e  it d o w n  j ust s o y o u  h a v e  it ? Di d I g et 
it ri g ht ? ( P a us e) Gr e at. S o c a n w e a gr e e t h at’s w h at y o u’r e g oi n g t o d o if it’s n e e d e d aft er w e h a n g 
u p?  
C o ncl u d e  t h e C all.  T h a nk  y o u  a g ai n  f or t a ki n g t h e ti m e. All  my  b est  t o y o u. G o o d by e.  
 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  2 7  of  4 1  
 
 
M A N A GI N G  A N  A C U T E  C RI SI S  
 
F or  us e  w h e n  p artici p a nt  is extr e m el y  u ps et.  
 
I c a n t ell y o u  ar e still h a vi n g  a  h ar d  ti m e. I w a nt t o m a k e s ur e t h at y o u  ar e o k ay a n d  s af e aft er w e h a n g 
u p.  I a m  w orri e d  a b o ut  y o u  a n d  I’ d li k e t o g et  h el p  fr o m a  c o u ns el or at  t h e 9 8 8  S uici d e &  Crisis  Lif eli n e. I 
a m g oi n g t o c o nf er e nc e us i nt o t h e 9 8 8 h otli n e a n d h a v e t h e m j oi n o ur c all. Pl e as e h ol d o n w hil e I g et 
t h e m o n  t h e li n e wit h  us.  It’s i m p ort a nt y o u  d o n’t  h a n g  u p  w hil e  I a m  g etti n g  t h e c o u ns el or o n  t h e li n e. 
O nc e p artici p a nt is o n wit h 9 8 8, m ut e y o ur p h o n e a n d Z o o m a n d t ur n y o ur c a m er a off o n Z o o m t h e n 
c o nt act Dr.  Di m eff  2 0 6 -3 8 4 -7 3 7 1,  Dr.  R u or k  7 0 7 -8 8 8 -7 2 9 2,  a n d  A n g el a  K ell e y -Bri m er  2 5 3 -2 7 9 -8 6 5 9  (t ext a n d 
e m ail).  
S h o ul d  a n  e m er g e nc y  occ ur,  d o  n ot  h esit at e  t o c all Dr. Di m eff  aft er  i niti ati n g a  w ar m  h a n d off or  at  a n y 
ti m e. 
 
P R A C TI CI N G  A  S KILL  
 
C h o os e  a  s kill t o pr actic e  wit h  t h e p artici p a nt  or  d escri b e  t h e s kill a n d  l et t h e p artici p a nt  c h o os e: 
TI P P S kills  
S elf -S o ot h e 
Distr act:  Wis e  Mi n d  A C C E P T S  
I M P R O V E t h e M o m e nt 
T hi nki n g of Pr os & C o ns  
 
Aft er  t e ac hi n g 1  or  2 s kills,  r e ass ess m o o d.  
 
If m o o d  r ati n gs ar e  b el o w  t hr es h ol d ( 0-4),  c o nti n u e t o St e p  4: C o pi n g  A h e a d . 
 
E m ail Li n d a Di m eff (li n d a. di m eff @j as pr h e alt h.c o m) a n d A n g el a K ell e y -Bri m er 
( a n g el a. bri m er @j as pr h e alt h.c o m) t h at extr a  s u p p ort w as  pr ovi d e d  t o t h e p artici p a nt.  
 
If m o o d  r ati n gs ar e  still a b ov e  t hr es h ol d ( 5-7),  as k  p artici p a nt  if t h e y w a nt  t o tr y a n ot h er  s kill (t h e n 
r e ass ess m o o d) or pr oc e e d t o w ar m h a n d off t o 9 8 8 S uici d e & Crisis Lif eli n e. 
> > If w ar m h a n d off: I w a nt t o m a k e s ur e t h at y o u ar e o k ay a n d s af e aft er w e h a n g u p. I a m w orri e d 
a b o ut y o u a n d I’ d li k e t o g et h el p fr o m a c o u ns el or at t h e 9 8 8 S uici d e & Crisis Lif eli n e. I a m g oi n g t o 
c o nf er e nc e us  i nt o t h e 9 8 8  h otli n e  a n d  h a v e  t h e m j oi n o ur  c all. Pl e as e  h ol d  o n  w hil e  I g et t h e m o n  t h e 
li n e wit h us. It’s i m p ort a nt y o u d o n’t h a n g u p w hil e I a m g etti n g t h e c o u ns el or o n t h e li n e. 
O nc e p artici p a nt is o n wit h 9 8 8, m ut e y o ur p h o n e a n d Z o o m a n d t ur n y o ur c a m er a off o n Z o o m t h e n 
c o nt act Dr.  Di m eff  2 0 6 -3 8 4 -7 3 7 1,  Dr.  R u or k  7 0 7 -8 8 8 -7 2 9 2,  a n d  A n g el a  K ell e y -Bri m er  2 5 3 -2 7 9 -8 6 5 9  (t ext a n d 
e m ail).  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  2 8  of  4 1  
 
 
TI P P  S kills  
T e ac h  S kills  b el o w  or  w atc h  li n k e d vi d e o  t o g et h er wit h  p artici p a nt  
 
➢ T E M P E R A T U R E  C H A N G E:  
Vi d e o  t o w atc h  wit h  p artici p a nt:  htt ps:// n o w m att ers n o w. or g/s kill/c ol d -w at er  
I m m ers e y o ur f ac e  i n Ic e or  C ol d  W at er.  T a ki n g  a  h ot  b at h  or s h o w er  m a y  als o b e  eff ectiv e.  
Fill a si n k wit h  c ol d w at er a n d a d d s o m e ic e. If y o u d o n’t h a v e ic e,  b e cr e ativ e.  A d d a p ac k of c ol d p e as or 
s o m et hi n g icy t h at will l o w er t h e t e m p er at ur e of t h e w at er ev e n m or e. If y o u d o n’t h a v e a si n k, fill a bi g 
mixi n g  b o wl.  N o w y o u’r e g oi n g  t o h ol d  y o ur br e at h  a n d  d u n k  y o ur f ac e a n d  h e a d  i n f or as l o n g as y o u  c a n 
h ol d y o ur br e at h. T h e n c o m e u p, ex h al e, i n h al e a n d d u n k a g ai n.  R e p e at as m a n y ti m es as y o u n e e d t o 
u ntil  y o u  f e el q uit e  a  bit  c al m er. * D O  N O T  U S E  T H E  I C E T E C H NI Q U E  I F Y O U  H A V E  A  H E A R T  C O N DI TI O N  O R 
H A V E H A D A H E A R T A T T A C K *  
 
 
➢ IN T E N S E  P H Y SI C AL  E X E R CI S E:  
Vi d e o  t o w atc h  wit h  p artici p a nt:  htt ps:// w w w. y o ut u b e.c o m/ w atc h ?v = RcI X k e G 9 0t 0  
R u n ni n g  ar o u n d  t h e bl ock,  d oi n g  j u m pi n g j acks, t ur ni n g o n  a  s o n g a n d  d a nci n g  ar o u n d  f or a  littl e 
w hil e … all  of  t h es e t hi n gs c a n us e  u p  s o m e of t h e e n er g y  t h at is f u eli n g distr ess.  
 
 
➢ P A C E D  B R E A T HI N G:  
Vi d e o  t o w atc h  wit h  p artici p a nt:  htt ps:// n o w m att ers n o w. or g/s kill/ p ac e d -br e at hi n g  
Br e at h e  i n a n d  o ut  n or m all y,  sli g htl y l e n gt h e ni n g t h e o ut  br e at h.  St arti n g  wit h  9  a n d  d ecr e asi n g  t o 0,  l a b el 
e ac h of t h e o ut br e at hs wit h a n u m b er, i. e. I n.. O ut ( 9) …. I n.. O ut ( 8) …. I n.. O ut ( 7) …. If y o u n otic e y o ur 
mi n d w a n d eri n g, g e ntl y bri n g y o ur att e nti o n b ack t o t h e c o u nti n g of t h e br e at hs. Tr y t o f oc us o n t h e 
n u m b ers a n d br e at hi n g, a n d n ot hi n g els e. W h e n y o u r e ac h z er o, st art c o u nti n g d o w n a g ai n. T his ti m e 
d o n’t st art  wit h  t h e n u m b er  9; st art wit h  t h e n u m b er  8.  W or k  y o ur  w a y  d o w n  t o 0 a g ai n.  W h e n  y o u r e ac h 
0, c o nti n u e st arti n g t h e c o u nts a g ai n, e ac h ti m e d ecr e asi n g t h e st arti n g n u m b er by o n e, u ntil y o u h a v e 
r e ac h e d z er o a g ai n. W h e n y o u h a v e fi nis h e d, if y o u n e e d t o, st art a g ai n at 9, a n d r e p e at u ntil y o u ar e 
f e eli n g m or e r e g ul at e d. 
 
 
➢ P R O G R ES SI V E  M U S CL E  R EL A X A TI O N:  
Vi d e o  t o w atc h  wit h  p artici p a nt:  htt p:// w w w. y o ut u b e.c o m/ w atc h ?v =i h O 0 2 w Uz g kc  
T h er e ar e m a ny w a ys of d oi n g pr o gr essi v e r el ax ati o n, b ut i n a n uts h ell, y o u ar e g oi n g t hr o u g h y o ur b o d y 
a n d mi n df ull y r el axi n g o n e ar e a at a ti m e. If y o ur distr ess is v er y hig h, y o u m a y w a nt t o s q u e ez e all t h e 
m uscl es  i n e ac h  ar e a  v er y ti g htl y f or a  f e w s ec o n ds a n d  t h e n r el e as e. D o n’t f or g et y o ur  f ac e! Scr u nc h it u p 
ti g htl y, a n d  r el e as e. D o n’t  gi v e  u p  o n  it if it d o es n’t  w or k  o nc e - tr y it a  f e w ti m es. Y o u c a n als o  fi n d g ui d e d 
pr o gr essi v e r el ax ati o n vi d e os o n Y o u T u b e.  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  2 9  of  4 1  
 
 
S elf -S o ot h e  
T hi n k  of  s o ot hi n g e ac h  of  y o ur  fi v e s e ns es 
 
Vi d e o  t o w atc h  wit h  p artici p a nt:  htt ps:// w w w. y o ut u b e.c o m/ w atc h ?v = C w n H ez 9 T C 6c  
 
➢ VI SI O N : B uy o n e b e a utif ul fl o w er, m a k e o n e s p ac e i n a r o o m pr ett y, li g ht a c a n dl e a n d w atc h t h e 
fl a m e. S et a pr ett y pl ac e at t h e t a bl e, usi n g y o ur b est t hi n gs f or a m e al. G o t o a m us e u m wit h 
b e a utif ul art. G o sit i n t h e l o b by of a b e a utif ul ol d h ot el. L o ok at n a t ur e ar o u n d y o u. G o o ut i n t h e 
mi d dl e  of  t h e ni g ht a n d  w atc h  t h e st ars. W al k  i n a  pr ett y  p art of  t h e t o w n. Fix  y o ur  n ails  s o t h e y l o ok 
pr ett y.  L o ok at  b e a utif ul  pict ur es  i n a  b o ok.  G o  t o a  b all et  or  ot h er  d a nc e  p erf or m a nc e,  or  w atc h  o n e 
o n T V. B e mi n df ul of e ac h si g ht t h at p ass es i n fr o nt of y o u, n ot li n g eri n g o n a ny.  
➢ H E A RI N G : List e n t o b e a utif ul  or  s o ot hi n g m usic,  or  t o i nvi g or ati n g a n d  exciti n g  m usic.  P a y  att e nti o n  t o 
s o u n ds of n at ur e li k e w a v es, bir ds r ai nf all, r ustli n g l e a v es. Si n g y o ur f av orit e s o n gs, h u m a s o ot hi n g 
t u n e, l e ar n t o pl a y a n i nstr u m e nt. C all 8 0 0 or ot h er i nf or m ati o n n u m b ers t o h e ar a h u m a n v oic e. B e 
mi n df ul of a ny s o u n ds t h at c o m e y o ur w a y, l etti n g t h e m g o i n o n e e ar a n d o ut t h e ot h er.  
➢ S M ELL : Us e y o ur f a v orit e p erf u m e or l oti o ns, or tr y t h e m o n i n t h e st or e, s pr a y fr a gr a nc e i n t h e air, 
li g ht a sc e nt e d c a n dl e. P ut l e m o n oil o n y o ur f ur nit ur e. P ut p ot p o urris i n a b o wl i n y o ur r o o m. B oil 
ci n n a m o n, b a k e  c o oki es, c a k e or  br e a d.  S m ell  t h e r os es. W al k  i n a  w o o d e d  ar e a  a n d  mi n df ull y  br e at h e 
i n t h e fr es h s m ells of n at ur e. 
➢ T A S T E : H a v e  a  g o o d  m e al,  h a v e  a  f a v orit e s o ot hi n g dri nk,  s uc h as  h er b al  t e a or  h ot  c h oc ol at e ( b ut n o 
alc o h ol). Tr e at y o urs elf t o a d ess ert. P ut w hi p p e d cr e a m o n y o ur c off e e. S a m pl e fl a v ors at a n ic e 
cr e a m st or e. S uck  o n a  pi ec e of  p e p p er mi nt c a n dy.  C h e w y o ur  f a v orit e g u m. G et a  littl e bit of s p eci al 
f o o d y o u d o n't us u ally s p e n d t h e m o n e y o n, s uc h as fr es h s q u e ez e d or a n g e j uic e or or g a nic 
v e g et a bl es. R e all y t ast e t h e f o o d y o u e at, e ati n g o n e t hi n g mi n df ull y a n d f oc usi n g o n its t ast e.  
➢ T O U C H : Ex p eri e nc e  w h at e v er  y o u  ar e  t o uc hi n g, n otic e  t h at t h e t o uc h is s o ot hi n g. T a k e  a  b u b bl e  b at h, 
p ut cl e a n s h e ets o n t h e b e d, p et y o ur d o g or c at, h a v e a m ass a g e, s o a k y o ur f e et, p ut cr e a my l oti o n 
o n y o ur w h ol e b o dy. P ut a c ol d c o m pr ess o n y o ur f or e h e a d, si nk i nt o a r e all y c o mf ort a bl e c h air i n a 
h ot el l o b by or i n y o ur h o m e, p ut o n a sil k y bl o us e , dr ess, or sc arf. Tr y o n f ur-li n e d gl ov es. Br us h y o ur 
h air f or a l o n g ti m e. H u g s o m e o n e.  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  3 0  of  4 1  
 
 
Distr act  
Wis e  Mi n d  A C C E P T S  
 
Vi d e o  t o w atc h  wit h  p artici p a nt:  htt ps:// n o w m att ers n o w. or g/s kill/ distr acti o n  
 
➢ A C TI VI TI ES:  
Acti viti es h el ps y o u t o f e el b ett er, a n d as y o u f e el b ett er a n d pr o d ucti v e, y o ur s elf est e e m ris es a n d 
e n d or p hi n’s  ar e  r el e as e d. D o  s o m et hi n g p hysic al  li k e ex ercis e,  h o b bi es,  cl e a ni n g, g o  t o a  c o m m u nit y 
e v e nt,  c all or  visit  a  fri e n d, g o  w al ki n g,  w or k,  pl a y,  p artici p at e  i n s p orts, g o  o ut  t o a  m e al,  h a v e  d ec af 
c off e e or t e a, g o fis hi n g, c h o p w o o d, d o g ar d e ni n g, pl a y pi n b all. D o w h at e v er w or ks f or y o u.  
➢ C O N T RI B U TI N G:  
C o ntri b ut e  t o s o m e o n e, d o  v ol u nt e er  w or k;  gi v e  s o m et hi n g t o s o m e o n e els e,  m a k e  s o m et hi n g nic e  f or 
s o m e o n e els e, d o a s ur prisi n g, t h o u g htf ul t hi n g. 
➢ C O M P A RIS O N S:  
W atc h  dis ast er  m ovi es,  w atc h  s o a p o p er as, visit  a n  E R  w aiti n g  r o o m, or  a  h os pit al  w aiti n g  r o o m, c o m p ar e 
y o urs elf t o p e o pl e c o pi n g t h e s a m e as y o u or l ess w ell t h a n y o u.  
➢ E M O TI O N S  
( O p p osite E m oti o ns): Be s ure w hat y o u d o will cre at e t he o p p osit e e m oti o n t o w hat y o u are fe eli n g.  Y o u c o ul d 
watc h  c o me di es  li ke "I L o ve  L uc y"  or  " Car ol B ur nett"  or  watc h  e m oti o nal m o vies  or  liste n t o e m oti o nal  m usic. 
Rea d e m oti o nal b o o ks or st ories.  
➢ P U S HI N G  A W A Y  
( us e t his s kill l ast - as a t u ni n g o ut): P us h t h e sit u ati o n a w a y by l e a vi n g it f or a w hil e, l e a v e t h e sit u ati o n 
m e nt all y. B uil d a n i m a gi n ar y w all b et w e e n y o urs elf a n d t h e sit u ati o n or p us h t h e sit u ati o n a w a y by 
bl ocki n g  it o ut  of  y o ur  mi n d.  C e ns or  r u mi n ati n g. R ef us e  t o t hi nk a b o ut  t h e p ai nf ul  as p ects  of  t h e sit u ati o n. 
P ut t h e p ai n o n a s h elf. B ox it u p a n d p ut it a w a y f or a w hil e.  
➢ T H O U G H T S  
( ot h er t h o u g hts): C o u nt  t o 1 0;  c o u nt c ol ors i n a  p ai nti n g  or  tr e e or  o ut  t h e wi n d o w.  D o  a nyt hi n g,  w or k 
p uzzl es, w atc h T V, r e a d.  
➢ S E N S A TI O N S  
( ot h er i nt e ns e s e ns ati o ns): H ol d  ic e i n y o ur  h a n d,  s q u e ez e a  r u b b er b all  v er y  h ar d,  t a k e a  h ot  s h o w er, 
list e n t o l o u d m usic, s ex, s n a p a r u b b er b a n d o n y o ur wrist, s uck o n a l e m o n. 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  3 1  of  4 1  
 
 
I M P R O V E t h e M o m e nt  
 
Vi d e o  t o w atc h  wit h  p artici p a nt:  htt ps:// w w w. y o ut u b e.c o m/ w atc h ?v = n w 5 m o Y A Ej Y 8  
 
➢ IM A G E R Y:  
I m a gi n e v er y r el axi n g sc e n es or s ol di ers fig hti n g a n d wi n ni n g. I m a gi n e a s ecr et r o o m wit hi n y o urs elf, 
s e ei n g h o w it is d ec or at e d. G o i nt o t h e r o o m w h e n e v er y o u f e el t hr e at e n e d. Cl os e t h e d o or o n 
a nyt hi n g t h at c a n h urt y o u. I m a gi n e e v er yt hi n g g oi n g w ell. I m a gi n e c o pi n g w ell. M a k e u p a f a nt as y 
w orl d  t h at is c al mi n g a n d  b e a utif ul  a n d  l et y o ur  mi n d  g o  wit h  it. I m a gi n e h urtf ul  e m oti o ns  dr ai ni n g  o ut 
of y o u li k e w at er o ut of a pi p e.  
➢ M E A NI N G:  
(cr e at e a tr ack r ec or d of e n d ur a nc e) Fi n d or cr e at e s o m e p ur p os e, m e a ni n g or v al u e i n p hysic al or 
e m oti o n al p ai n. R e m e m b er, list e n t o, or r e a d a b o ut s pirit u al v al u es. F oc us o n w h at e v er p ositiv e 
as p ects  of  a  p ai nf ul  sit u ati o n y o u  c a n fi n d. R e p e at  t h e m ov er  a n d  ov er  i n y o ur  mi n d.  M a k e  l e m o n a d e 
o ut of l e m o ns.  
➢ P R A Y E R:  
( w al k & t al k o ut l o u d or k n e el a n d pr a y t o y o ur hi g h er p o w er, t o G o d, G o d d ess, w h o e v er) O p e n y o ur 
h e art t o a s u pr e m e b ei n g wit h gr e at wis d o m, w h at e v er t h at m e a ns t o y o u. It c o ul d b e G o d or y o ur 
o w n  wis e  mi n d  f or i nst a nc e. As k  f or t h e str e n gt h t o b e ar  t h e p ai n  i n t his m o m e nt.  T ur n  t hi n gs ov er  t o 
G o d or a hi g h er b ei n g.  
➢ R EL A X A TI O N:  
Fi n d  h u m or  a n d  l a u g h. Tr y  r el axi n g e ac h  l ar g e m uscl e  gr o u p,  st arti n g wit h  y o ur  h a n ds  a n d  ar ms,  g oi n g 
t o t h e t o p of y o ur h e a d,  a n d t h e n w or ki n g  d o w n.  List e n t o a r el ax ati o n t a p e, ex ercis e  h ar d,  t ak e a  h ot 
b at h, or sit i n a h ot t u b.  Dri nk h ot mil k, m ass a g e y o ur n eck a n d sc al p, or y o ur c al v es a n d f e et, g et i n a 
t u b fill e d wit h v er y c ol d or h ot w at er a n d st a y i n it as l o n g as y o u c a n t ol er at e. Br e at h e d e e pl y, h alf - 
s mil e, c h a n g e y o ur f aci al ex pr essi o n 
➢ O N E  T HI N G  I N T H E  M O M E N T:  
F oc us  y o ur  e ntir e  att e nti o n  o n  j ust w h at  y o u  ar e  d oi n g  ri g ht n o w.  K e e p  y o urs elf  i n t h e v er y  m o m e nt 
y o u ar e i n i n t h e pr es e nt. F oc us y o ur e ntir e att e nti o n o n p hysic al s e ns ati o ns t h at acc o m p a ny 
n o nj u d g m e nt al t as ks. ( e. g. w al ki n g, w as hi n g, d oi n g dis h es, cl e a ni n g, fixi n g). B e a w ar e of h o w y o ur 
b o dy m ov es d uri n g e ac h t as k. D o a w ar e n ess ex ercis es.  
➢ V A C A TI O N:  
Gi v e y o urs elf a  bri ef v ac ati o n. F or i nst a nc e, fr o m  2 p. m.  t o 4 p. m., g et i n b e d a n d p ull  t h e c ov ers ov er 
y o ur h e a d f or 2 0 mi n ut es. R e nt a m ot el r o o m at t h e b e ac h or i n t h e w o o ds f or a d a y or t w o. U n pl u g 
y o ur p h o n e f or a d a y, or l et y o ur a ns w eri n g m ac hi n e scr e e n y o ur c alls. T a k e a 1 h o ur br e at h er fr o m 
w or k  t h at n e e ds  t o b e  d o n e.  L o ok at  a  m a g azi n e,  b u n dl e  u p  i n a  c h air, e at  sl o wl y. All o w  y o urs elf  t o b e 
a ki d a g ai n - t a k e a br e a k fr o m a d ult h o o d. 
➢ E N C O U R A G E M E N T:  
C h e er  l e a d y o urs elf. R e p e at  ov er  a n d  ov er:  “I c a n st a n d it. T his  w o n't  l ast f or e v er. I will  m a k e  it o ut  of 
t his. I' m d oi n g t h e b est I c a n. I c a n d o it. I a m O K.” 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  3 2  of  4 1  
 
 
T hi n ki n g  of Pr os  &  C o ns  
 
Vi d e o  t o w atc h  wit h  p artici p a nt:  htt ps:// vi m e o.c o m/ 8 3 6 2 6 2 2 2 7/ 8 9 3 b 0 6 d 0 6 3?s h ar e =c o p y  
 
M a k e  a  list of  t h e pr os  a n d  c o ns of  t ol er ati n g t h e distr ess . 
M a k e  a n ot h er  list of  t h e pr os  a n d  c o ns of n ot  t ol er ati n g t h e distr ess  - t h at is, of  c o pi n g by  d oi n g 
s o m et hi n g i m p ulsi v e. 
F oc us  o n  l o n g-t er m g o als , t h e li g ht at  t h e e n d  of  t h e t u n n el. R e m e m b er  ti m es w h e n  y o ur  disc o mf ort  h as 
e n d e d.  
T hi nk  of  t h e p ositiv e  c o ns e q u e nc es of  t ol er ati n g t h e distr ess.  I m a gi n e i n y o ur  mi n d  h o w  g o o d  y o u  will  f e el 
if y o u ac hi e v e y o ur g o als, if y o u d o n't act i m p ulsi v el y. 
T hi nk  of  all  of  t h e n e g ati v e  c o ns e q u e nc es of  n ot  t ol er ati n g y o ur  c urr e nt distr ess.  R e m e m b er  w h at  h as 
h a p p e n e d  i n t h e p ast w h e n y o u h a v e act e d i m p ulsi v el y t o esc a p e t h e m o m e nt. 
As k  y o urs elf,  “Will  t his ev e nt  t h at is distr essi n g  m e  g oi n g  t o m att er  i n 5  y e ars ?” 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  3 3  of  4 1  
 
 
A P P E N DI X  2  
Wise P at h  f or A d ults  De vi ce  O ver vie w  
C o nsiste nt wit h ot h er c o u ntries w here di gital t o ols ar e wi del y use d as a first i nt er ve nti o n i n a ste p p e d car e 
m o del, 1 t h e i nt e nt of t his pr o d uct is t o i ncrease acc ess t o e vi de nc e-base d res o urces f or s uici dal i deati o n ( SI) 
w hile als o a d dr essi n g ot her be ha vi oral h ealt h pr o ble ms t hat c a n c o -oc c ur a n d/ or e x acer b ate ris k of s uici d e. 
We  f oc us s pecific all y o n  d e presse d  m o o d,  alc o h ol  mis use,  a n d slee p pr o ble ms.  W hile  a p ps  e xist  f or s o me of 
t hese be ha vi oral h ealt h pr o ble ms i n di vi d uall y, we k n o w of n o di gital a p p a vaila ble o n t he mar ket t hat is 
desi g ne d t o a d dr ess SI al o n g wit h t he ot her c o -oc c urri n g pr o ble ms. F urt her m ore, we k n o w of n o a p p f or 
t hese c o n diti o ns t hat is c urre ntl y a p pr o ve d b y t he F D A. 
 
Wise Pat h  is n ot  f or use  i n e mer g e nc y  sit uati o ns (e. g., ac ut e s uici de ris k) a n d l a beli n g wit hi n  t he a p p will 
ma ke t his cle ar a n d i ncl u de ref erral t o 9 1 1 or 9 8 8 if crisis care is i n dicate d.  
 
Wise Pat h will pr o vi de t he esse ntial ke y p erf or ma n ce ele m e nts f or eac h r ec o m me n de d e vi de n ce -base d 
practi ce i n Ta ble 1: crisis sta bilit y pla n ni n g, let hal m ea ns safet y, as well as sta n dar di ze d assess me nt a n d 
pr o gress m o nit ori n g, a n d ot her  rec o m me n de d r es o urces: ps yc h oe d uc ati o n wit h be ha vi or al s kills trai ni n g, 
st ories b y  pe o pl e  wit h  li ve d e x perie nce,  a n d  acti vities  f or ma na gi n g  alc o h ol mis use,  de presse d  m o o d,  a n d 
slee p pr o ble ms. 
 
Ta ble  1:  Rec o m me n d e d  E vi de nce -B ase d  Practi ces  ( E B Ps) t hat Wise Pat h  Di gitizes  f or t he User  
Rec o m m e n de d  E B P  
R oa d ma p  t o Di gitiz ati o n i n  t he Wise Pat h A p plicati o n  
 
 
Let h al  Me a ns  S afet y  
Wise Pat h  di giti zes  self-re p ort of  assessi n g  a n d pla n ni n g  f or 
let hal me a ns safet y i ncl u di n g i de ntif yi n g let hal mea ns t he 
patie nt  c urre ntl y  has  a vaila ble t o t he m (i n cl u di n g fir e ar ms); 
orie nti n g t he patie nt t o t h e c o ncer n a b o ut ha vi n g ac c ess t o 
let hal me a ns d uri n g a peri o d of h ei g ht e ne d s uici dalit y; a n d 
de vel o pi n g  a pl a n  f or ma na gi n g acc ess  t o let hal mea ns.  
As  Descri be d  I n 
Br ya n, C. J., St o ne, S. L., & R u d d, M. D. ( 2 0 1 1). A pra cti cal, e vi de nce -base d a p pr oac h f or m ea ns -restricti o n 
c o u nseli n g wit h  s uici dal patie nts.  Pr ofessi o n al  Psyc h ol o gy:  Rese arc h  a n d  Pr acti ce , 4 2 ( 5), 3 3 9 -3 4 6. 
d oi: 1 0. 1 0 3 7/a 0 0 2 5 0 5 1  
Refere nces  
Ma n n,  J. J., & Mic hel,  C.  A.  ( 2 0 1 6). Pre ve nti o n  of  Fire ar m  S ui ci de  i n t he U nite d  States:  W hat  W or ks  a n d W hat 
Is P ossi ble. A meric a n J o ur n al of Psyc hi atry , 1 7 3 ( 1 0), 9 6 9-9 7 9. d oi: 1 0. 1 1 7 6/a p pi. aj p. 2 0 1 6. 1 6 0 1 0 0 6 9  
Bet z,  M.  E.,  Ka utz ma n,  M.,  Se gal,  D.  L.,  Miller,  I., Ca mar g o,  C.  A.,  Jr, B o u drea u x,  E.  D.,  &  Ari as,  S.  A.  ( 2 0 1 8). 
Fre q ue nc y  of  let hal mea ns  assess me nt  a m o n g e m er ge nc y de part m e nt  pati e nts  wit h  a  p ositi ve  s ui ci de ris k 
scre e n. Psyc hi atry Rese arc h , 2 6 0 , 3 0– 3 5. d oi: 1 0. 1 0 1 6/j. ps yc hres. 2 0 1 7. 1 1. 0 3 8  
 
Crisis  S afet y/ St a bilit y  Pl a n ni n g  
Wise Pat h di giti zes t he d e vel o p me nt of a crisis safet y pla n. 
Patie nts ar e g ui de d t hr o u g h i de ntif yi n g t heir war ni n g si g ns, 
pe o ple  t h e y c a n call w he n  i n a s uici de crisis, be h a vi oral  s kills 
t he y ca n use  t o get  t hr o u g h e m oti o n al distress,  practi cal  wa ys 
t he y ma k e t heir e n vir o n me nt safe, a n d t heir reas o ns f or 
li vi n g. 
As  Descri be d  I n 
St a nle y,  B.,  &  Br o w n,  G.  K.  ( 2 0 1 2). Safet y  Pla n ni n g  I nt er ve nti o n: A  Bri ef  I nt er ve nti o n t o Miti gat e  S uici de  Ris k.  
C o g nitive  a n d  Be h avi or al  Pr actice , 1 9 ( 2), 2 5 6 – 2 6 4.  d oi: 1 0. 1 0 1 6/j. c b pra. 2 0 1 1. 0 1. 0 0 1  
 
1  Si m m o n ds -B uc kle y,  M.,  B e n ni o n,  M.  R.,  Kellett,  S.,  Milli n gs,  A.,  Har d y,  G.  E.,  &  M o or e,  R.  K.  ( 2 0 2 0). Acce pta bilit y  a n d eff ecti ve ness of  N H S -r ec o m me n de d e- 
t her a pies f or de pr essi o n, a n xiet y, a n d str ess: Meta-a nal ysis. J o ur n al of M e dic al I nter net R ese arc h , 2 2 ( 1 0), e 1 7 0 4 9 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  3 4  of  4 1  
 
 
Refere nces  
A n dre ass o n, K., Kr o g h, J., Bec h, P., Fra n dse n, H., B u us, N., St a nle y, B., Ker k h of, A., N or de nt oft, M., & 
Erla n gse n,  A.  ( 2 0 1 7). M Y P L A N  – m o bile  p h o ne  a p pli cati o n t o m a na ge  crisis of  pers o ns  at  ris k of  s uici de: 
st u d y pr ot oc ol f or a ra n d o mize d c o ntr olle d tri al. Tri als , 1 8 ( 1), 1 7 1. d oi: 1 0. 1 1 8 6/s 1 3 0 6 3-0 1 7 -1 8 7 6 -9  
Br ya n,  C.J.  ( N. D.). Crisis  Res p o nse  Pla n ni n g  f or S ui ci dal  Pati e nts  [ We bi nar]. T he  U ni versit y  of  Ut a h. 
htt p:// h o pe 4 uta h.c o m/ w p -c o nte nt/ u pl oa ds/ 2 0 1 6/ 1 2/ Crai g -Br ya n. p df  
J o bes, D.  A.  ( 2 0 1 7). Cli nical  assess me nt a n d treat m e nt of  s ui ci dal ris k: A criti q ue  of  c o nt e m p orar y c are  a n d 
C A M S as a p ossi ble re me d y. Pr actice I n n ov ati o ns , 2 ( 4), 2 0 7-2 2 0. d oi: 1 0. 1 0 3 7/ pri 0 0 0 0 0 5 4  
TJ C,  Patie nt  Safet y  G oal  E P 6  - E vi de nce -base d  res o urc es f or safet y pl a n ni n g,  a n d f oll o w u p  c are u p o n  disc har ge 
htt ps:// w w w.j oi ntc o m missi o n. or g/res o urces/ patie nt -safet y-t o pi cs/s uici de-pre ve nti o n/  
Assess me nt  a n d  Pr o gress 
M o nit ori n g  
Wise Pat h di giti zes t he d eli v er y of self -re p ort assess me nt 
meas ures  rel e va nt t o SI  a n d  its dri vers  as  well  as  pr o vi di n g 
vis ualiz ati o ns of t h ese dat a a n d i nt er pret ati o n i nf or m ati o n.  
As  Descri be d  I n 
Ka z di n,  A.  E.  ( 2 0 0 8). E vi de nce -base d  tre at me nt a n d practic e:  ne w  o p p ort u niti es  t o bri d ge  cli nic al rese arc h a n d 
pra ctice, e n ha nce t he k n o wle d ge base, a n d i m pr o ve patie nt care.  A meric a n psyc h ol o gist , 6 3 ( 3), 1 4 6. 
L a n g kaas,  T.  F.,  Wa m p ol d,  B.  E.,  &  H offart,  A.  ( 2 0 1 8). Fi ve  t y pes of  cli nic al differe nce  t o m o nit or  i n 
pra ctice. Psyc h ot her a py , 5 5 ( 3), 2 4 1. 
W a m p ol d,  B.  E.  ( 2 0 1 5). R o uti ne  o utc o me  m o nit ori n g:  C o mi n g  of  a ge — Wit h  t he us ual  de vel o p m e ntal 
c halle n ges. Psyc h ot her a py, 5 2 ( 4), 4 5 8– 4 6 2. htt ps:// d oi. or g/ 1 0. 1 0 3 7/ pst 0 0 0 0 0 3 7  
Refere nces  
Bic k ma n , L. ( 2 0 0 8). A meas ure me nt fe e d bac k s yst e m ( M F S) is nec essar y t o i m pr o ve m e nt al healt h 
o utc o mes.  J o ur n al  of  t he A meric a n  Ac a de my  of  C hil d  a n d  A d ol esc e nt  Psy c hi atry , 4 7 ( 1 0), 1 1 1 4.  
de  J o n g, K.,  Ti m ma n,  R.,  Ha k kaart -Va n  R oije n,  L.,  Ver m e ule n,  P.,  K o oi ma n,  K.,  Passc hier,  J., &  B ussc h ba c h,  J. 
V.  ( 2 0 1 4). T he  effect  of  o utc o me  m o nit ori n g  fe e d ba c k t o cli ni ci a ns a n d patie nts  i n s h ort a n d l o n g-t er m 
ps yc h ot hera p y: A ra n d o mize d c o ntr olle d trial. Ps yc h ot hera p y Rese arc h, 2 4( 6), 6 2 9 -6 3 9.  
de  J o n g, K.,  C o nij n,  J. M.,  Galla g her,  R.  A.,  Res het ni k o va,  A.  S.,  Heij,  M.,  &  L utz,  M.  C.  ( 2 0 2 1). Usi n g  pr o gress 
fe e d bac k t o i m pr o ve o utc o mes a n d re d uce dr o p-o ut, treat me nt d urati o n, a n d deteri orati o n: A m ultil e vel 
m et a -a nal ysis. Cli nic al Psyc h ol o gy Revie w , 8 5 , 1 0 2 0 0 2. 
Har m o n,  C.,  Ha w ki ns, E. J.,  La m bert, M. J.,  Sla de,  K.,  & W hi p pl e, J. S. ( 2 0 0 5). I m pr o vi n g o ut c o m es f or  p o orl y 
res p o n di n g clie nts: T he  use  of  cli nical s u p p ort t o ols a n d fe e d ba c k t o cli e nts. J o ur nal of  cli nic al ps yc h ol o g y, 
6 1( 2), 1 7 5 -1 8 5.  
L a n g kaas,  T.  F.,  Wa m p ol d,  B.  E.,  &  H offart,  A.  ( 2 0 1 8). Fi ve  t y pes of  cli ni c al  differe nc e  t o m o nit or  i n 
pra ctice. Psyc h ot her a py , 5 5 ( 3), 2 4 1. 
W a m p ol d,  B.  E.  ( 2 0 1 5). R o uti ne  o utc o me  m o nit ori n g:  C o mi n g  of  a ge — Wit h  t he us ual  de vel o p m e ntal 
c halle n ges. Psyc h ot her a py, 5 2 ( 4), 4 5 8– 4 6 2. htt ps:// d oi. or g/ 1 0. 1 0 3 7/ pst 0 0 0 0 0 3 7  
I nter ve nti o n P at h w a ys  f or M ulti - 
pr o ble m Prese nt ati o ns  
Wise Pat h  di giti zes t he i n di vi d u al pat h wa ys f or patie nts 
str u g gli n g wit h  SI  a n d m ulti ple  dri v ers  of  s uici de. Pat h wa ys  i n 
Wise Pat h ar e deri ve d fr o m pri nci ples re g ar di n g h o w tar get 
hierarc hies are de v el o pe d i n Dial ectical Be ha vi or T h era p y 
( D B T) i n t he tr eat me nt of SI a n d m ulti ple c o-o cc urri n g 
pr o ble ms.  
Refere nces  
De C o u,  C.  R.,  C o mt ois,  K.  A.,  &  La n des,  S.  J. ( 2 0 1 9). Dial ecti cal  be ha vi or  t hera p y is effe cti ve f or t he tre at m e nt 
of s uici dal be ha vi or: A meta -a nal ysis. Be h avi or t her a py , 5 0 ( 1), 6 0-7 2.  
H of ma n n,  S.  G.,  &  Ha yes,  S.  C.  ( 2 0 1 9). T he  f ut ure of  i nter ve nti o n sci e nc e: Pr oc ess -base d  t hera p y. Cli ni c al 
Psyc h ol o gic al Scie nce , 7 ( 1), 3 7-5 0.  
Pers o ns,  J. B.  ( 2 0 2 2). Case  f or m ulati o n. C o g nitive  a n d  B e h avi or al  Pr actic e , 2 9 ( 3), 5 3 7 -5 4 0.  
Ri per,  H.,  A n derss o n,  G.,  H u nter, S. B., de  Wit, J., Ber ki n g, M.,  & C uij pers, P. ( 2 0 1 4).  Tre at m e nt of c o m or bi d 
alc o h ol use  dis or ders  a n d de pressi o n  wit h  c o g niti ve‐ be ha vi o ural  t hera p y a n d  m oti vati o nal  i nt er vie wi n g: A 
meta‐a nal ysis. A d dicti o n , 1 0 9 ( 3), 3 9 4-4 0 6.  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  3 5  of  4 1  
 
 
 
 
Ps yc h oe d uc ati o n/ 
Be h a vi or al  S kills  Tr ai ni n g  
Wise Pat h  di giti zes  a n d c o ns oli dat es  a wi de  ra n ge of  be ha vi oral  s kills 
i nte n de d t o i m pr o v e e m oti o n re g ulati o n a n d distress t olera n ce. 
Be ha vi oral  s kills are  deri ve d  fr o m Diale cti cal  Be h a vi or  T hera p y 
( D B T). Wise Pat h ori e nts patie nts t o w hat t he s kill is, w h y it is 
usef ul, a n d h o w t o use it.  
As  Descri be d  I n 
Li ne ha n  M.  ( 2 0 1 5). D B T  Skills  Tr ai ni n g  M a n u al.  G uilf or d  P u blicati o ns.  
Barl o w,  D. H.,  Ellar d,  K. K.,  &  Fair h ol me,  C. P.  ( 2 0 1 0) U nifie d  pr ot oc ol  f or tr a ns di a g n osti c tre at me nt of  e m oti o n al 
dis or ders: W ork b o ok. O xf or d U ni versit y Press.  
Refere nces  
A nestis,  M.  D.,  Pe n ni n gs,  S.  M.,  La ve n der,  J. M.,  T ull,  M.  T.,  &  Gratz,  K.  L.  ( 2 0 1 3). L o w distress  t ol era nce as a n 
i n dire ct ris k fa ct or f or s uici dal be ha vi or: C o nsi deri n g t he e x pl a nat or y r ole of n o n-s ui ci dal self-i nj ur y. 
C o m pre he nsive  Psyc hi atry , 5 4 ( 7), 9 9 6 -1 0 0 2.  d oi: 1 0. 1 0 1 6/j.c o m p ps yc h. 2 0 1 3. 0 4. 0 0 5  
B us h, N. E., D o bsc ha, S. K., Cr u m pt o n, R., De n nes o n , L. M., H off m a n, J. E., Crai n, A., Cr o m er, R., & Ki n n, J. T. 
( 2 0 1 4). A  Virt ual  H o pe  B o x  S mart p h o ne  A p p  as a n Ac cess or y  t o T hera p y:  Pr o of -of -C o nc e pt  i n a Cli ni c al  Sa m ple 
of Vetera ns. S uici de a n d Life -T hre ate ni n g Be h avi or , 4 5 ( 1), 1-9. d oi: 1 0. 1 1 1 1/slt b. 1 2 1 0 3  
Gre p mair, L., Mitterle h ner, F., L oe w, T., Bac hler, E., R ot her, W., & Ni c kel, M. ( 2 0 0 7). Pr o m oti n g Mi n df ul ness i n 
Ps yc h ot hera pists i n Trai ni n g I nfl ue nces t he Tre at m e nt Res ults of T heir Pati e nts: A Ra n d o mi z e d, D o u ble -Bli n d, 
C o ntr olle d St u d y. Psyc h ot her a py a n d Psyc h os o m ati cs , 7 6 ( 6), 3 3 2– 3 3 8. d oi: 1 0. 1 1 5 9/ 0 0 0 1 0 7 5 6 0  
L u xt o n,  D. D,  J u ne, J. D., &  C hal ker,  S. A.  ( 2 0 1 5). M o bil e  Healt h  T e c h n ol o gi es  f or S ui ci de  Pre ve nti o n:  Fe at ure  Re vie w 
a n d Rec o m me n dati o ns f or Use i n Cli nical Care. C urre nt Tre at me nt O pti o ns i n Psy c hi atry , 2 ( 4), 3 4 9-3 6 2. 
d oi: 1 0. 1 0 0 7/s 4 0 5 0 1 -0 1 5 -0 0 5 7 -2  
Mc Ca ul,  K.  D.,  S ol o m o n,  S.,  &  H ol mes,  D.  S.  ( 1 9 7 9). Effe cts  of  pa c e d  res pirati o n a n d e x pe ctati o ns o n  p h ysi ol o gi c al 
a n d ps yc h ol o gical res p o nses t o t hreat. J o ur n al of P ers o n ality a n d S oci al Psyc h ol o gy , 3 7 ( 4), 5 6 4– 5 7 1. 
d oi: 1 0. 1 0 3 7// 0 0 2 2 -3 5 1 4. 3 7. 4. 5 6 4  
Z eif ma n,  R.  J., B oritz,  T.,  Bar n hart,  R.,  La bris h,  C.,  &  Mc Mai n,  S.  F.  ( 2 0 2 0). T he  i n de pe n de nt r oles of  mi n df ul ness  
a n d distress  t olera nce i n tre at me nt o utc o mes  i n di ale cti c al  be ha vi or  t hera p y s kills trai ni n g. P ers o n alit y  Dis or ders: 
T he ory, Rese arc h, a n d Tre at me nt , 1 1 ( 3), 1 8 1– 1 9 0. d oi: 1 0. 1 0 3 7/ per 0 0 0 0 3 6 8  
 
Ps yc h oe d uc ati o n/  
Pe o ple  wit h  Li ve d  E x perie nce  
Wise Pat h i n cl u des vi d e os b y pe o ple wit h li v e d e x perie nce (s ui ci de 
atte m pt s ur vi v ors a n d ot h ers w h o ha ve li ve d wit h s ui ci dal i deati o n) 
w h o pr o vi de practical i nf or mati o n (e. g., t he i m p orta n ce of see ki n g 
a n d e n ga gi n g  i n tre at me nt, strat e gies f or ma n a gi n g  i nte nse e m oti o ns) 
a n d h o pe f or t he f ut ure.  
Refere nces  
Pisa ni, A. R.,  W y ma n,  P.  A.,  G ur ditta, K., Sc h meel k -C o ne, K.,  A n ders o n,  C.  L.,  & J u d d, E. ( 2 0 1 8). M o bil e P h o ne 
I nter ve nti o n t o Re d uce  Y o ut h  S uici de  i n R ural  C o m m u niti es:  Fi el d  T est.  J MI R Me nt al  He alt h , 5 ( 2), e 1 0 4 2 5. 
d oi: 1 0. 2 1 9 6/ 1 0 4 2 5  
Nasl u n d,  J. A.,  Gra n de,  S.  W.,  Asc h bre n ner,  K.  A.,  & El w y n,  G.  ( 2 0 1 4). Nat urall y  Occ urri n g  Peer  S u p p ort  t hr o u g h 
S ocial Me dia: T he E x perie nces of I n di vi d uals  wit h Se vere  Me nt al Ill ness Usi n g  Y o u T u be. P L o S  O N E , 9 ( 1 0): 
e 1 1 0 1 7 1. d oi: 1 0. 1 3 7 1/j o ur nal. p o ne. 0 1 1 0 1 7 1  
Ga y, Bar b. ( 2 0 1 5, A u g ust 1 5). E n g a gi n g S uici de Att e m pt S urvi v ors [ Vi de o]. S uici de Pre ve nti o n Res o urc e Ce nter. 
htt ps:// w w w.s prc. or g/ vi de o/atte m pt -s ur vi v ors 
 
 
Acti vities  f or M a n a gi n g 
De presse d M o o d  
Wise Pat h  di giti zes t he d eli v er y of t hera p y acti vities i nte n de d t o 
i m pr o ve de pr essi ve s y m pt o ms. Acti vities are deri ve d fr o m 
Be ha vi oral  Acti vati o n  ( B A), i ncl u di n g i de ntifi cati o n of  pre vi o usl y  
e nj o ye d a cti viti es,  val u es -c o nsiste nt acti vities,  a n d s u bse q ue nt 
acti vit y sc he d uli n g.  
As  Descri be d  I n 
L e n uez, C. W., H o p k o, D. R., Acier n o, R., Da u g hters, S. B., & Pa g ot o, S. L. ( 2 0 1 1). T e n year re visi o n of t he brief 
be ha vi oral  acti vati o n treat me nt f or de pressi o n:  Re vise d  tre at m e nt m a n ual.  Be h avi or  M o dific ati o n.  3 5 ( 2), 1 1 1 - 
1 6 1.  
Refere nces  

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  3 6  of  4 1  
 
 
A d dis,  M.  E.,  &  Martell,  C.  R.  ( 2 0 0 4). Overc o mi n g  de pressi o n  o ne  st e p at  a  ti me: T he  ne w  be h avi or al  acti v ati o n 
a p pr o ac h t o getti n g y o ur life b ack . Ne w Har bi n ger P u bli cati o ns, I nc or p orat e d. 
C uij pers,  P.,  va n  Strate n,  A.,  &  War mer da m,  L.  ( 2 0 0 7). Be ha vi oral  a cti vati o n treat m e nts of  de pressi o n:  A  met a - 
a nal ysis. Cli nic al Psyc h ol o gy Revie w , 2 7 ( 3), 3 1 8– 3 2 6. d oi: 1 0. 1 0 1 6/j. c pr. 2 0 0 6. 1 1. 0 0 1  
E kers,  D.,  We bster,  L.,  Va n  Strate n,  A.,  C uij pers,  P.,  Ric har ds,  D.,  &  Gil b o d y,  S.  ( 2 0 1 4). Be ha vi o ural  a cti vati o n f or 
de pressi o n; a n u p date of meta -a nal ysis of effe cti ve ness a n d s u b gr o u p a nal ysis.  Pl o S o ne , 9 ( 6), e 1 0 0 1 0 0. 
Ri beir o, J. D., H ua n g, X., F o x, K. R., & Fra n kli n, J. C. ( 2 0 1 8). De pressi o n a n d h o pel ess ness as ris k fact ors f or s ui ci de 
i deati o n, atte m pts a n d deat h:  meta -a nal ysis of  l o n git u di nal st u di es. T he  Britis h  J o ur n al  of  Psy c hi atry , 2 1 2 ( 5), 2 7 9 - 
2 8 6.  
St ei n, A. T., Carl, E., C uij pers, P., Kar y ota ki, E., & S mits, J. A. ( 2 0 2 1). L o o ki n g be y o n d de pressi o n: A m et a -a nal ysis 
of  t he effect  of  be ha vi oral  acti vati o n o n  de pressi o n,  a n xi et y, a n d a cti vati o n.  Psy c h ol o gi c al  Me di ci ne , 5 1 ( 9), 1 4 9 1 - 
1 5 0 4.  
Acti vities  f o r M a n a gi n g  Al c o h ol 
Use  
Wise Pat h di giti zes t he d eli v er y of t hera p y acti vities i nte n de d t o 
re d uce pr o ble ms  relate d t o alc o h ol use.  Partic ularl y  strate gies rel ate d 
t o m o derati n g  alc o h ol use a n d re d uci n g i nt o xicati o n. 
As  Descri be d  I n 
U S De part me nt of Healt h a n d H u ma n Ser vices. Ret hi n ki n g Dri n ki n g: Alc o h ol a n d Y o ur Healt h. Ti ps t o Tr y. 
htt ps:// w w w.ret hi n ki n g dri n ki n g. niaaa. ni h. g o v/t hi n ki n g -a b o ut -a -c ha n ge/strate gies -f or-c utti n g -d o w n/ti ps -t o- 
tr y.as p x 
E pstei n,  E.  E.,  &  Mc Cra d y,  B.  S.  ( 2 0 0 9). Overc o mi n g  alc o h ol  use  pr o bl e ms:  A  c o g niti ve -be h avi or al  tre at me nt pr o gr a m . 
O xf or d  U ni versit y  Press.  
Dal e y,  D.  C.,  &  Marlatt,  G.  A.  ( 2 0 0 6). Overc o mi n g  y o ur al c o h ol  or  dr u g  pr o bl e m:  Eff e cti ve  re c ov ery str at e gi es. O xf or d 
U ni versit y Press.  
 
Refere nces  
A miri,  S.,  &  B e h nez ha d,  S.  ( 2 0 2 0). Alc o h ol  us e  a n d ris k of  s uici de: a  s yste matic re vie w a n d M eta -a nal ysis.  J o ur n al of  a d dictive 
dis e as es , 3 8 ( 2), 2 0 0-2 1 3.  
Is aacs, J. Y.,  S mit h,  M.  M.,  S herr y,  S.  B.,  Se n o,  M.,  M o ore,  M.  L.,  &  Ste wart,  S.  H.  ( 2 0 2 2). Alc o h ol  us e  a n d deat h  b y  s uici de: 
A meta‐a nal ysis of 3 3 st u dies. S uici de a n d Life‐ T hr e ate ni n g Be h avi or , 5 2 ( 4), 6 0 0-6 1 4.  
K ue h n,  B.  M.  ( 2 0 0 9). R et hi n ki n g  Dri n ki n g.  J A M A, 3 0 1 ( 1 6), 1 6 4 7 -1 6 4 7.  
Witt,  K.,  C hitt y,  K.  M.,  War d ha ni,  R.,  Vär ni k,  A.,  De  Le o,  D.,  &  K ol ves,  K.  ( 2 0 2 1). Effect  of  alc o h ol i nter ve nti o ns o n  s uici dal 
i deati o n a n d be ha vi o ur: A s yste matic re vie w a n d meta-a nal ysis. Dr u g a n d alc o h ol de pe n de nce, 2 2 6, 1 0 8 8 8 5.  
 
Acti vities  f or M a n a gi n g Slee p  
Wise Pat h  di gitiz es  a n d deli v ers  ps yc h oe d ucati o n  a n d  acti vities  t o 
i m pr o ve sle e p h y gie n e. C o nte nt is deri ve d fr o m C o g niti ve 
Be ha vi oral T her a p y f or I ns o m nia ( C B T -I). 
As  Descri be d  I n: 
E di n ger  J D, Mea ns  M K:  C o g niti ve -be ha vi oral  t hera p y f or pri m ar y  i ns o m nia. Cli n  Ps yc h ol  Re v.  2 0 0 5,  2 5:  5 3 9 -5 5 8.  
1 0. 1 0 1 6/j. c pr. 2 0 0 5. 0 4. 0 0 3.  
 
Refere nces  
Ber nert,  R.  A.,  &  J oi ner, T.  E.  ( 2 0 0 7). Slee p  dist ur ba nc es  a n d s ui ci de ris k: a re vie w of  t he lit erat ure. Ne ur o psy c hi atric 
dise ase a n d tre at me nt , 3 ( 6), 7 3 5-7 4 3.  
 
Wise Pat h  di giti zes alr ea d y -e xisti n g e vi d e nce -b ase d r es o urces a n d acti vities t o ma ke it easi er f or a d ult users 
t o ac cess  t o ols t o fa cilitate ma na g e me nt  of  t heir s uici dal t h o u g hts, de presse d  m o o d,  alc o h ol  mis use,  a n d sl ee p 
pr o ble ms, as well as s u p p orti n g t he m wit h ps yc h oe d ucati o n/ be ha vi oral s kills trai ni n g a n d i nsi g ht fr o m  
pe o ple wit h li ve d e x perie n ce (s hare d st ories), see T a ble 2. T his is i m p orta nt bec a use t hese re c o m m e n de d 
acti viti es are ofte nti mes n ot deli vere d d u e t o ge o gr a p hical li mitati o ns (e. g., r ural areas), staff s h ort a ges, 
i ns ufficie nt trai ni n g i n t he nec essar y e vi de n ce-base d pr ot oc ols t o a d dr ess m ulti ple pr o bl e ms, la c k of 
res o urces t o acc ess  treat me nt, a n d  c o m m u nit y  sti g m a re gar di n g me ntal  healt h  treat me nt. Wise  Pat h  fa cilitates 
deli ver y of E B Ps b y a ut o mati n g self -re p ort me as ures a n d acc ess t o ot her hel pf ul res o urces. 

M arc h 2 0 , 2 0 2 5  |  V ersi o n  2  
E vi d e n c e - B a s e d  Pr a cti c e  I n stit ut e |  7 2 4 1  3 6t h  A v e n u e  S W,  S e attl e,  W A  9 8 1 2 6|  2 0 6 - 4 5 5 - 7 9 3 4  |  r e s e ar c h @j a s pr h e alt h. c o m 
P a g e  4 1  of  4 1  
 
 
Psyc h oe d uc ati o n/ S h are d  St ories  
Wise Pat h  pr o vi des  a ccess  t o peer  vi de os.  W hil e  t h e state of  scie n ce is nasce nt,  e vi de nc e s h o ws t hat list e ni n g 
t o pe o ple wit h li v e d e x perie nce wit h s uici d e o n el ectr o nic me dia has be e n hel pf ul f or i n di vi d u als t o e x pl ore 
feeli n gs a n d t o pics t h at t h e y mi g ht ot her wise be u n c o mf orta bl e wit h. S uc h c o nte nt re pr ese nts a l ar gel y 
u nta p pe d res o urc e t hat ca n be le ve r a ge d t o i m pr o ve o utc o mes f or users. 

St atistic al A n al ysis Pl a n  
W e  will u s e t h e G e n er aliz e d Li n e a r M o d el ( G L M),  a r e gr e s si o n- b a s e d 
a p pr o a c h.  It a d dr e s s e s li mit ati o n s of A N O V A  i n t h at it c a n a n alyz e a v ari et y of c o m m o nly 
e n c o u nt er e d o ut c o m e di stri b uti o n s ( e. g., c o nti n u o u s, c o u nt)  a n d c a n  c al c ul at e r o b u st 
st a n d ar d err or s w hi c h ar e l e s s s e n sitiv e t o s k e w n e s s.  S p e ci ti c all y, w e will c o n d u ct o ur 
r e p e at e d- m e a s ur e s a n aly s e s u si n g a v er si o n of G L M c all e d G e n er aliz e d E sti m ati n g 
E q u ati o n s ( G E E).  Li k e Hi er ar c hi c al Li n e a r M o d eli n g ( H L M),  G E E c a n i n cl u d e p arti ci p a nt s 
w h o ar e mi s si n g  d at a  at  c ert ai n  ti m e p oi nt s a n d t e st a s s u m pti o n s a b o ut t h e c ov ari a n c e 
m atrix t o d et er mi n e t h e o n e  t h at b e st  tit s  t h e d at a.   W e will u s e t h e S P S S st ati sti c al 
p a c k a g e v er si o n 3 1  a n d  G E E f o r all hy p ot h e s e s c o n c er ni n g r e p e at e d m e a s ur e s o ut c o m e s. 
All hy p ot h e s e s r el at e t o c h a n g e ov e r ti m e, a nd s o t h e m ulti pl e ti m e- p oi nt s will b e tr e at e d i n 
t h e G E E  a n aly s e s a s n e st e d wit hi n t h e i n divi d u al.  Al s o, w e will tr e at i nt er v e nti o n c o n diti o n 
a n d  ti m e a s c at e g ori c al, d u m m y- c o d ed pr e di ct or s; t h e c o ntr ol c o n diti o n a n d b a s eli n e 
s c or e s will s er v e a s t h e r ef er e n c e p oi nt s. W e will a n alyz e hy p ot h e si s 3 ( s ati sf a cti o n wit h 
t h e Wi s e P at h a p p) d e s cri ptiv ely a n d c o m p ar e t o t h e c o ntr ol a p p u si n g t-t e st s .  
O v er all Pl a n  
1.
C hi- S q u ar e a n d t-t e st s t o C o n tir m Gr o u p E q uiv al e n cy b et w e e n C o ntr ol a n d
Wi s e P at h C o n diti o n s f or d e m o gr a p hi c s a n d r a n d o miz ati o n v ari a bl e s
2.
D e m o gr a p hi c Fr e q u e n ci e s
3.
D e s cri ptiv e s f or All A n alyti c V ari a bl e s
4.
D at a Str u ct uri n g f or G E E
a.
Ex a mi n e c orr el ati o n a n d c ov ari a n c e, al o n g wit h v ari a bl e di stri b uti o n t o
i nf or m m o d el p ar a m et er s
5.
G E E M o d el s ( s e e b el o w) a n d t-t e st s
M e a s ur e s a n d it e m s t o b e i n cl u d e d i n a n al y s e s  
1.
H 1: Wi s e P at h p arti ci p a nt s will r e p ort si g ni ti c a ntly gr e at er d e cr e a s e s i n s ui ci d al a n d
al c o h ol mi s u s e b e h avi or s c o m p ar e d t o st u d y c o ntr ol s.
a.
S ui ci d al b e h avi or s
i. I nt e n sit y a n d d ur ati o n m o st li k ely t o b e s e n sitiv e t o c h a n g e
ii. Still l o o k at P a st 3 0- d ay fr e q u e n cy , wit h u n d er st a n di n g t h at it i s l e s s
s e n siti v e t o c h a n g e i n ot h er st u di e s
iii. F or e c a sti n g v ari a bl e s ( e. g., p er c eiv e d li k eli h o o d of f ut ur e att e m pt s)
b.
P R O MI S Al c o h ol U s e, N e g ativ e C o n s e q u e n c e s

2.
H 2: Wi s e P at h  p arti ci p a nt s will r e p ort si g ni ti c a ntly gr e at er i n cr e a s e s i n s elf -e tii c a cy
a n d c o pi n g wit h s ui ci d al t h o u g ht s a n d di str e s s, a s w ell a s u s e of s ui ci d e pr e v e nti o n
str at e gi e s c o m p ar e d t o st u d y c o ntr ol s.
a.
S ui ci d e R el at e d C o pi n g S c al e
b.
P R O MI S S elf -E tii c a cy of M a n a gi n g E m oti o n s
3.
H 3: S ati sf a cti o n will b e ev al u at e d u si n g d e s cri pti v e s f or i n divi d u al it e m s a n d t -t e st s
f or ov er all s ati sf a cti o n a n d av er a g e it e m s ati sf a cti o n
4.
C ov ari at e s
a.
N o a pri ori c ov ari at e s pl a n n e d
b.
Will d et er mi n e ti n al li st of c ov ari at e s aft er ex a mi ni n g d e m o gr a p hi c s, gr o u p
e q uiv al e n cy c hi -s q u ar e, a n d a ny ot h er b a s eli n e v ari a bl e s  d e s cri ptiv e s of
i nt er e st