Increasing Safety Plan Use and Reducing Suicidal Ideation Among Emerging Adults: A Pilot Randomized Trial of the STARS Intervention

Abstract

Introduction: Emerging adult sexual and gender minorities (EA-SGM) experience disproportionately high rates of suicide. The Safety Planning Intervention can reduce suicide risk, but its effectiveness for this population may be limited without additional support. The Supporting Transitions to Adulthood to Reduce Suicide (STARS) program was developed to address this gap by integrating a mobile application and peer mentorship to promote consistent Safety Plan use.

Methods: Participants (n = 64) were randomized to receive either SPI alone or SPI plus STARS. Participants were followed for 6 months.

Results: STARS was highly acceptable and associated with significantly greater use of the Safety Plan at 2 months compared to SPI alone. While both groups demonstrated significant reductions in suicidal ideation over time, participants in STARS showed sustained nonsignificant improvements through 6 months, whereas SPI alone experienced a slight increase after 4 months. STARS participants used their Safety Plan significantly more frequently than SPI alone (39% vs. 15% for monthly use) at 2 months.

Conclusions: STARS is a feasible and acceptable intervention that enhances Safety Plan engagement and longer-term reductions in suicidal ideation among EA-SGM. These promising findings provide preliminary support for a fully powered effectiveness trial to evaluate STARS' outcomes.

Trial registration: ClinicalTrials.gov identifier: NCT05018143.

Keywords: LGBTQ+; eHealth; emerging adults; mental health; suicide prevention.