This poster video is part of “Telehealth in Remote Care in a Post-Pandemic World,” the virtual conference of the UConn Center for mHealth and Social Media, May 19-20, 2022. Registration still open:

Development of a digital game intervention targeting suicide prevention in adolescents who misuse opioids

Claudia-Santi F. Fernandes, Ed.D., LPC, MCHES, NCC
Assistant Professor, Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine
Deputy Director of Mental Health & Well-Being, play2PREVENT Lab, Yale Center for Health & Learning Games, Yale University School of Medicine

Francesca Giannattasio, B.S.
Postgraduate Research Associate, play2PREVENT Lab, Yale Center for Health & Learning Games, Yale University School of Medicine

Hilary P. Blumberg, M.D.
The John and Hope Furth Professor of Psychiatric Neuroscience, Professor of Psychiatry, and Diagnostic Radiology and Biomedical Imaging, and in the Yale Child Study Center
Director, Mood Disorders Research Program, Yale University School of Medicine

Lynn E. Fiellin, M.D.
Professor of Medicine (General Medicine), Yale Child Study Center, and Public Health (Social and Behavioral Sciences)
Director, play2PREVENT Lab at the Yale Center for Health & Learning Games, Yale University School of Medicine
Chief, Fitkin Firm, Yale-New Haven Hospital

Background: Suicide is the second leading cause of death in adolescents aged 14-18 years. Adolescents who misused prescription opioids are more likely to experience suicidal thoughts and behaviors than adolescents who did not. Compelling evidence shows “serious games” (i.e., games for a purpose other than solely entertainment) can promote healthy behaviors, reduce risk factors, enhance protective factors through skill-building, and target prevention.

Objective: Our primary objective was to design and develop a digital game intervention that models the process of a safety planning intervention. We explored peer and student perceptions around potential warning signs, coping strategies, and seeking help among youth who may be at greater risk of suicide due to misuse of opioids.

Methods: We conducted eight focus groups with a total of 30 participants, including 9 high-school-aged adolescents [aged 16-18], 8 college-aged youth [aged 18-21], 13 providers, and 5 interviews with adults who have experience with opioids in their youth [aged 40-47] to inform the content of the digital game intervention. Focus groups and interviews were conducted via Zoom between February 2022 and April 2022. A semi-structured focus group/interview guide was developed, pilot tested, and used in focus groups and interviews. The guides align constructs from the intersectional ecological model to better identify how to help students cope with social and cultural stressors and how to strengthen individual and community assets. Using this lens, questions were related to potential warning signs of emotional distress, coping strategies, and seeking help to prevent suicidal thoughts and behaviors among youth who misuse opioids. Focus groups and interviews were approximately 60-90 minutes. Debrief summaries were completed after each one.
Participants received a $25 gift card and additional mental health and opioid misuse resources following the session. Focus groups and interviews were audiotaped and then transcribed.

Results: Findings will inform the development of a digital game intervention to prevent suicide among adolescents who misuse opioids. Salient themes were extracted from the focus groups and interviews. They include themes related to previous substance misuse, later diagnosis of a mental health disorder, grief, bullying, stigma, family dynamics, and the role of identity. Potential storylines will focus on improving one’s self-esteem, managing conflict at home, navigating peer influence, addressing concerns about seeking help, and increasing access to resources for seeking help based on identity. Gameplay will incorporate techniques that enhance mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance from dialectical behavioral therapy for adolescents.

Conclusions: Digital game interventions may play a critical role in preventing suicide among youth who misuse opioids. Next steps include a pilot randomized controlled trial to evaluate the user experience, acceptability, and feasibility of the intervention in Fall 2022.