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Internet Interv. 2018 May 5;13:16-23. doi: 10.1016/j.invent.2018.04.005. eCollection 2018 Sep.

Smartphone-based safety planning and self-monitoring for suicidal patients: Rationale and study protocol of the CASPAR (Continuous Assessment for Suicide Prevention And Research) study.

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Department of Clinical Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.
Department of Psychiatry, Amsterdam Public Health research institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, The Netherlands.
Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
113 Suicide Prevention, Amsterdam, The Netherlands.
Delfland Mental Health Centre, Delft, The Netherlands.
Parnassia Psychiatric Institute, The Hague, The Netherlands.
Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.



It remains difficult to predict and prevent suicidal behaviour, despite growing understanding of the aetiology of suicidality. Clinical guidelines recommend that health care professionals develop a safety plan in collaboration with their high-risk patients, to lower the imminent risk of suicidal behaviour. Mobile health applications provide new opportunities for safety planning, and enable daily self-monitoring of suicide-related symptoms that may enhance safety planning. This paper presents the rationale and protocol of the Continuous Assessment for Suicide Prevention And Research (CASPAR) study. The aim of the study is two-fold: to evaluate the feasibility of mobile safety planning and daily mobile self-monitoring in routine care treatment for suicidal patients, and to conduct fundamental research on suicidal processes.


The study is an adaptive single cohort design among 80 adult outpatients or day-care patients, with the main diagnosis of major depressive disorder or dysthymia, who have an increased risk for suicidal behaviours. There are three measurement points, at baseline, at 1 and 3 months after baseline. Patients are instructed to use their mobile safety plan when necessary and monitor their suicidal symptoms daily. Both these apps will be used in treatment with their clinician.


The results from this study will provide insight into the feasibility of mobile safety planning and self-monitoring in treatment of suicidal patients. Furthermore, knowledge of the suicidal process will be enhanced, especially regarding the transition from suicidal ideation to behaviour.The study protocol is currently under revision for medical ethics approval by the medical ethics board of the Vrije Universiteit Medical centre Amsterdam (METc number 2017.512/NL62795.029.17).


Ecological momentary assessment; Feasibility; Mobile health; Safety planning; Suicide prevention

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