Validation of the Spanish ASQ translation: Screening pediatric patients for suicide-risk in Argentina.

BACKGROUND: The high frequency of suicide risk in adolescents necessitates the development and validation of specific tools for systematic screening. To date, there are translated, but not validated suicide risk screening tools in Spanish. OBJECTIVE: To validate the Spanish version of the Ask Suicide-Screening Questions (ASQ) for suicide risk screening in pediatric patients in Argentina. METHOD: Using a cross-sectional multicenter design, a convenience sample of pediatric patients aged 10 to 18 years old were recruited from outpatient/inpatient medical settings and private psychiatric clinics. The Spanish version of the Suicidal Ideation Questionnaire (SIQ) assessment tool was used as a standard criterion to validate the ASQ. RESULTS: A total of 301/380 pediatric patients were screened for suicide risk. Twentyeight percent of the entire sample (83/301) of youth screened positive on the ASQ, and 21% (62/301) screened positive on the SIQ/SIQ-JR and were considered "at risk" for suicide. Compared with the SIQ, the Spanish ASQ yielded a sensitivity of 96.8% (95% Confidence Interval [CI]: 88.8-99.6%), specificity of 90.4% (95% CI: 85.9-93.8%), positive predictive value of 72.3% (95 CI: 61.4-81.6%), and negative predictive value of 99.1% (95% CI: 96.7-99.9%). The positive Likelihood Ratio (LR) was 10.1 (95% CI: 6.1-14.0), and the negative LR was 0.03 (95% CI: -0.01-0.09). Kappa was 0.77 (95% CI: 0.69-0.86), and the Area Under the Curve was 0.94 (95% CI: 0.91-0.97). CONCLUSION: The Spanish language ASQ demonstrated strong psychometric properties, providing initial evidence that it is a valid tool for identifying Spanish-speaking youth at risk for suicide.

A randomized 3-month, parallel-group, controlled trial of CALMA m-health app as an adjunct to therapy to reduce suicidal and non-suicidal self-injurious behaviors in adolescents: study protocol.

Background: Suicidal and non-suicidal self-injurious behaviors are among the leading causes of death and injury in adolescents and youth worldwide. Mobile app development could help people at risk and provide resources to deliver evidence-based interventions. There is no specific application for adolescents and young people available in Spanish. Our group developed CALMA, the first interactive mobile application with the user in Spanish, which provides tools based on Dialectical Behavioral Therapy to manage a crisis of suicidal or non-suicidal self-directed violence with the aim of preventing suicide in adolescents and youth. Methods: To test the effectiveness, safety and level of engagement of the CALMA app in people aged 10 to 19 who are treated in mental health services of two public hospitals, we will conduct a parallel-group, two-arm randomized controlled trial. Participants will be assessed face-to-face and via video call at four timepoints: day-0 (baseline), day-30, day-60, and day-90. A total of 29 participants per group will be included. Change in the frequency of suicidal and non-suicidal self-injurious behaviors will be compared between groups, as well as the level of emotional dysregulation, level of app engagement and time of psychiatric admission during the follow-up period. Discussion: This study is particularly relevant to young people given their widespread use of mobile technology, while there are currently no available smartphone app-based self-guided psychological strategies in Spanish that attempt to reduce suicidal behavior in adolescents who are assisted in the public health sector from low and middle-income countries in Latin America. Clinical trial registration: https://clinicaltrials.gov/, NCT05453370.

Eficacia y seguridad de una app para la reducción de las pensamientos y conductas autolesivas en adolescentes / Efficacy and safety of an app to reduce self-injurious thoughts and behaviors in teenagers

En Argentina, el suicidio en adolescentes se ha incrementado en los últimos 15 años y, actualmente, es la segunda causa de mortalidad. A pesar de la existencia de intervenciones eficaces, un aspecto crucial para su efectividad en la práctica es la accesibilidad. Debido a las características en la distribución de los recursos humanos en Salud Mental en Argentina, muchas veces estos tratamientos no están accesibles en el momento de la crisis. Este escenario nos lleva a buscar nuevas plataformas para brindar intervenciones basadas en la evidencia de forma universal, económica y rápida. En este contexto, los teléfonos inteligentes se presentan como una buena alternativa. Nuestro grupo de investigación ha desarrollado una aplicación para la prevención del suicidio, a través del manejo de los pensamientos y conductas autolesivas denominada CALMA. En este proyecto diseñamos un Ensayo Clínico Aleatorizado y Controlado con un seguimiento a 3 meses, que contó con ramas paralelas una control, en la que los participantes recibieron el Tratamiento Usua (TAU) y otra intervención, en la que recibieron el Tratamiento Usual más CALMA (TAU  CALMA). Ensayo clínico ha sido registrado en ClinicalTrials.gov (NCT05453370) y en el RENIS (N°: IS003529). Los resultados muestran que, en esta instancia del ensayo clínico, CALMA no ha demostrado ser fectiva para la reducción de los pensamientos y conductas autolesivas en adolescentes asistidos en Hospitales Públicos del AMBA. CALMA tampoco demostró reducir la desregulación emocional y las reinternaciones por conductas autolesivas durante el seguimiento. Por otro lado, CALMA mostró ser una aplicación segura y presentar buenos niveles de aceptabilidad por parte de los usuarios, lo que es fundamental para seguir trabajando en estrategias que permitan mejorar su efectividad como por ejemplo las técnicas de gamificación.