Device Helps Reduce Suicide Risk in Schizophrenia Patients

A telehealth monitoring system, utilizing a home-based telephone device that serves as an interface between patients and hospital staff, appears to help reduce suicidal symptoms in patients with schizophrenia recently discharged from the hospital.

In a poster presented at the April meeting of the International Congress on Schizophrenia Research in Colorado Springs, Colo., John Kasckow, M.D., Ph.D., said the main finding from the small pilot study was that the group that used the telehealth device had a higher probability of improvement in suicidal symptoms compared with a control group of patients who received intensive case management but not the telehealth intervention.

Kasckow is staff psychiatrist with the VA Pittsburgh Healthcare System Mental Illness Research, Education, and Clinical Center (MIRECC), VA Behavioral Health Service, and Western Psychiatric Institute and Clinic.

The monitoring system is called Health Buddy, a device that patients take home with them and prompts them with daily questions about symptoms of suicide and depression using scripted dialogues. Responses are downloaded daily to the hospital staff and read every four hours, seven days a week; when patients' responses indicate an increase in suicidal symptoms, they are contacted by clinical staff.

Kasckow and Gretchen Haas, Ph.D., the director of VA Pittsburgh's MIRECC, developed the system in collaboration with the nursing staff at VA Pittsburgh Healthcare System. They have had a longstanding research interest in managing suicidal behavior in patients with schizophrenia—a leading cause of premature death in patients with psychosis—using an integrated psychosocial and pharmacological approach.

"We were interested in creating a psychosocial intervention using telehealth as a strategy to target high-risk patients who have a hard time getting to the hospital because of barriers like transportation," Kasckow told Psychiatric News.

In the study, 19 patients were randomized to receive the Health Buddy home telehealth intervention, and 19 were randomized to a control group. Patients in both groups received intensive case management over six months with twice weekly phone calls using the Suicide Symptom Inventory and Personal Health Questionnaire scales, and weekly face-to-face assessments with the Calgary Depression Rating Scale and the Clinical Global Impressions scale.

At three months, the group that received the Health Buddy intervention had significantly reduced suicidal symptoms compared with the control group, which received only the intensive case management.

Kasckow told Psychiatric News that the pilot study is not adequately powered to examine exactly how the system is producing effects. But he said that the improved monitoring and expedited clinical attention to patients with worsening symptoms, plus the psychoeducation and support provided by the device itself are likely factors.

"It allows us to monitor suicidal ideation in a more in-depth manner and to monitor depression, a risk factor for suicide," he said. "In this way we think we are able to capture someone before their symptoms escalate. In addition, it addresses another risk factor—social isolation—by facilitating communication.

"But the dialogues used with the device probably also contribute by offering support to patients," Kasckow said. "If their symptoms get worse, it tells patients to contact their physician. And if patients are having suicidal ideation, it will instruct them to call a 1-800 suicide hotline and to contact their physician.

"Our goal now is to improve the system," Kasckow continued. "We would like to optimize the dialogue scripts and add something to detect early warning signs of psychosis. And we want to test the dialogues in the same population of patients to optimize acceptability and usability, then perform an additional field test for making final improvements prior to launching a large-scale intervention study.

"We are optimistic about expanding this, since our preliminary studies indicate it reduces suicidal behavior and possibly has important impacts on other behaviors associated with patients with schizophrenia."