This case study was submitted by the Oregon Clinical & Translational Research Institute (OCTRI), a CTSA at Oregon Health and Science University (OHSU).
This research has community, economic, and policy implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.
The goal of this work is to create technology that uses physiological measures to help adolescents identify symptoms of stress dysregulation associated with worsening suicidal ideation (SI). This will allow early identification and interventions to prevent emergency department visits and suicide attempts (SA). Dr. Sheridan and his team, via a pilot study and clinical trial,1 are in the process of testing technology that will be available in wearable devices such as smartwatches. This technology measures activity, sleep, and heart rate variability in adolescents with acute suicidality. Additionally, algorithms will be set so that patients receive timely feedback in order to implement their own coping strategies. This feedback loop will help prevent SI/SA because patients are informed of their biological responses and empowered to act in order to prevent their own potential SI.
The research, scheduled to be completed in 2022, will collect data to refine the technology and assess the ability of therapeutic interventions to modify these physiologic parameters. This technology has the ability to be incorporated into existing technology around 2025.
David Sheridan (primary contact), Assistant Professor, Pediatric Emergency Medicine; Co-Director Emergency Medicine Clinical Innovation
OHSU/Doernbecher Children’s Hospital
This project was motivated by a substantial increase in suicidal patients presenting in the emergency room, especially adolescents. Suicide is the second leading cause of death in youth ages 10-24 .2 Emergency Department (ED) visits of suicidal adolescents has doubled in the past nine years, with estimated annual visits for SA/SI between 2007 and 2015 increasing from 580,000 to 1.12 million.3 Additionally, there is an economic cost to suicide in the United States. In 2013, the Centers for Disease Control estimated that the United States lost $50.8 billion dollars in medical and work loss costs.4
Demonstrated benefits are those that have been observed and are verifiable.
Potential benefits are those logically expected with moderate to high confidence.
Development of wearable device technology that measures physiological responses. Demonstrated.
Development of wearable device technology that provides feedback to patients and families on patient physiological stress. Demonstrated.
Development of new procedure whereby wearable device signals patients and families to act on stress levels. Potential.
Data from wearable device can help prevent SI/SA, a public health issue. Potential.
Support for access to mental healthcare by providing essential data direct to patient. Potential.
Reduction of SI/SA by notifying patients to implement coping skills in times of stress. Potential.
Establishment of an intellectual property license for the algorithms and the technology. Demonstrated.
Fewer SI/SA-related ED visits in adolescents. Potential.
Fewer SI/SA-related ED visits in adolescents. Potential.
Development of a start-up to develop and manufacture wearable device technology. Potential.
Patents and copyrights will be filed for the technology. Potential.
Lives saved due to fewer suicides. Potential.
This research has clinical, community, and economic implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.5
Clinical: Sheridan and his team have developed wearable device technology to monitor the physiological responses of adolescents with acute suicidality. Research results will help determine the accuracy of the physiological data gathered from the technology as well as its associations with reported suicide severity scores. From these results, algorithms will be set to have the wearable device signal the patient and their family when to act on stress levels. There are no current physiological standards for SI/SA.
Once the technology is fine-tuned for wider distribution, it can be incorporated into already-existing wearable devices. This technology will create physiological analytics that can be monitored by the patient and their family to create a therapeutic window to address precursors to SI.
Community: Levels of stress and dysregulation will be monitored by the patient in a community setting to diagnose stressful times that can lead to SI/SA. By providing patients with data they can act on with coping skills, this can decrease the need for mental health providers that aren’t always available due to large caseloads, patient costs, insurance coverage, or geographic availability.
Another benefit is that the algorithms used to signal the patient are designed to help prevent, rather than react to, acute suicidality. Suicide is a public health concern given its high economic and social costs. This device has the potential to signal dysregulation and stress in a patient so they can act to prevent SI. This, in turn, can improve quality of life for not only the patient but those around them.
Economic: Shorter-term economic benefits include license agreements and patents to protect the intellectual property of both the algorithms and the technology itself. Once the technology is refined, a start-up company will be developed to manufacture wearable technology.
Longer-term economic benefits include cost savings and effectiveness; this may occur through a reduction in the 1.2 million annual ED visits due to SI/SA. Therefore, this technology has the potential to save both money and lives.
- ClinicalTrials.gov. National Library of Medicine (U.S.). (2017, January 25 – ). Wearable Suicidal Early Warning System for Adolescents. Identifier NCT03030924. Retrieved March 18, 2020 from: https://clinicaltrials.gov/ct2/show/NCT03030924CT03030924.
- National Institute of Mental Health. Suicide. Accessed online at https://www.nimh.nih.gov/health/statistics/suicide.shtml on December 17, 2019.
- Burstein, B., Agostino, H., Greenfield, B. (2019). Suicidal attempts and ideation among children and adolescents in US emergency departments, 2007-2015. JAMA Pediatrics, 173, 598-600.
- Florence, C., Simon, T., Haegerich, T., Luo, F., & Zhou, C. Estimated Lifetime Medical and Work Loss Costs of Fatal Injury. United States 2013. Morbidity and Mortality Weekly Report 2015; 64(38), 1078-1082.
- Institute of Clinical & Translational Sciences at Washington University in St. Louis. Translational Science Benefits Model website. https://translationalsciencebenefits.wustl.edu. Published February 1, 2019. Accessed March 18, 2020.