Refining a digital phenotyping app for measurement of suicidal behavior among minoritized youth and caregivers in a community health system.

Background: Youth from racial and ethnic minoritized groups have experienced an increase in suicidal thoughts and behaviors (STBs) in recent years. Mobile health technology (mHealth) and digital phenotyping hold promise as means to measure STBs and related risk factors in these groups. Such tools are more likely to be successful when designed with input from the youth and caregivers who will use the technology. This study aimed to refine a digital phenotyping smartphone application, GeoMood, customized to measure STBs and relevant risk factors, such as family conflict and experiences of discrimination. The app was designed to collect passive data from smartphones (e.g., location, phone usage), as well as short-response survey data via ecological momentary assessments (EMAs) to further understand digital phenotypes of STBs.

Methods: We conducted semi-structured qualitative interviews with five youths of color and five caregivers to obtain feedback and refine the smartphone application, GeoMood. The ultimate goal of the interviews was to assess the app's potential acceptability from the two sets of users for whom the app was developed. Both youth and caregivers reviewed the youth version, which differs from the caregiver version content by the inclusion of items addressing suicidal behavior. Interviews were analyzed using a qualitative manifest analytic approach.

Results: Youth found the app to be an acceptable tool for measuring STBs. Caregivers were concerned about assessing self-injury explicitly.

Conclusions: Youth and caregiver feedback confirms openness by participating youth to using mHealth tools for measurement of STBs, but caregivers experience hesitation with the direct questions of such tools. Feedback was useful in refining the mobile tool and suggests multimodal assessment (text and emoji prompts) may appeal to users. Results from this study may improve the acceptability of future apps designed to measure and address disparities among particularly vulnerable groups of youth.