Background: Suicide is a significant global public health concern. Individuals with suicidal behaviors often seek help in emergency departments (ED), making mental health providers critical to suicide prevention. Brief interventions such as safety planning are essential in these settings. However, there is a limited understanding of how mobile digital safety planning apps can aid in secondary suicide prevention. Objective: This study evaluated the effectiveness of a digital safety plan, delivered through the MeMind app, in reducing ED visits associated with suicidal behavior (ie, suicidal ideation or attempt). Methods: A one-year follow-up was conducted for individuals who presented to the ED for an index event of suicidal behavior (N=78). Participants were provided with a digital safety plan on their mobile devices and instructed to activate it during future suicidal crises. Results: At follow-up, participants who activated the digital safety plan showed a 50% lower likelihood of returning to the ED, when compared to those who did not activate it. Conclusions: These findings suggest that digital safety planning may serve as a scalable and accessible intervention with the potential to significantly contribute to suicide prevention efforts.

Background: Esketamine has been shown to produce a major antidepressant response in patients with treatment-resistant depression (TRD). We evaluated the factors associated with achieving remission in these individuals. Methods: The study was carried out across four psychiatry departments in Madrid, Spain. Patients aged over 18 years were included if they received esketamine as an augmentation treatment for TRD. Standard esketamine protocol included an induction phase (4 weeks) and a maintenance phase (5 to 8 weeks). Subsequent treatment continuation was proposed. Clinical data and scores at the Clinical Global Impression scales were measured following each esketamine administration. Results: Sixty-five patients initiated the treatment, and 45 patients (69.2%) completed the standard protocol. The median number of esketamine administrations was 19. The mean age was 53.09 and 52.3% of the patients were females. Out of the whole sample, 36 (55%) of the patients achieved remission over the follow-up. Remission rates elevated to 67% in those who completed the standard protocol, and to 70% in those having received more than 19 esketamine administrations. Achieving remission over the follow-up was associated with the absence of dissociative symptoms, and with completing the standard esketamine protocol (OR = 0.229, p = 0.045; and OR = 4.538, p = 0.025, respectively). Receiving more than 19 esketamine administrations was associated with remission over the follow-up (OR = 6.513, p = 0.006). Conclusions: Our results suggest that extending the numbers of esketamine administration may increase the chances to obtain remission. Adverse effects did not impact the treatment course.

Background: Treatment-resistant depression (TRD) poses a major clinical challenge, particularly when accompanied by suicidal behavior. Intranasal esketamine has demonstrated rapid antidepressant effects in TRD, but real-world comparative evidence remains limited. Methods: We conducted a six-month naturalistic prospective cohort study in two Spanish mental health centers, including 62 TRD patients with high suicide risk undergoing fourth-line treatment. Thirty patients received intranasal esketamine and thirty-two alternative pharmacological interventions. Suicidal ideation (C-SSRS), depressive symptoms (HAM-D-17) and functional status (FAST) were assessed at baseline and at 1-, 3- and 6-month follow-ups. Results: Both groups showed significant improvement during follow-up; however, esketamine-treated patients exhibited a faster and greater reduction in suicidal ideation and depressive symptoms than those receiving alternative pharmacological strategies. The number needed to treat to prevent one case of high suicide risk was 1.35. Functional improvement was comparable between groups. Conclusions: In real-world clinical settings, intranasal esketamine was associated with a faster and greater reduction in suicidal ideation and depressive symptoms among TRD patients with high suicide risk, supporting its role as a rapid-acting therapeutic option within comprehensive and closely monitored care.