RomSi: Mobile Health Intervention to Enhance Suicide Prevention by Reducing Stigma and Increasing Literacy

Suicide public stigma

Public stigma will be assessed using the Spanish version of the Stigma of Suicide Scale - Short Form (SOSS-SF). This scale includes 16 adjectives that prototypically describe a person who has died by suicide. It is designed for use with the general population and identifies three distinct factors: (1) Stigma (e.g., pathetic), (2) glorification/Normalization (e.g., brave), and (3) isolation/Depression (e.g., lonely). Each item is rated on a 5-point Likert scale, where higher scores indicate stronger agreement with the adjective as a representation of a prototypical suicidal person.

Suicide literacy

The Literacy of Suicide Scale - Short Form (LOSS-SF) will be used to assess levels of suicide-related knowledge. The Spanish validation comprises 10 items divided into four domains: (1) signs and symptoms, (2) causes or nature, (3) risk factors, and (4) treatment and prevention. Responses are provided on a three-point scale ("true," "false," "don't know"). Each correct response is awarded one point, with higher scores indicating greater literacy about suicide.

Intention to seek help

The General Help-Seeking Questionnaire (GHSQ) measures the intention to seek help from various sources. Participants rate 10 items regarding their likelihood of seeking help on a 7-point scale ranging from 1 (extremely unlikely) to 7 (extremely likely) for 10 different help sources. The questionnaire provides an overall score and two subscale scores: formal help sources and informal help sources, with higher scores indicating greater help-seeking intention.

Daily assessment questionnaire protocol

Participants will be assessed daily using a brief self-report assessment to evaluate public stigma toward suicide, suicidal ideation, and help-seeking intention. Public stigma will be measured using words derived from the literature. Help-seeking intention will be assessed with a specific item, while suicidal ideation will be evaluated using the Spanish version of the Suicidal Ideation Attributes Scale (SIDAS).

Personal suicide stigma

The Personal Suicide Stigma Questionnaire (PSSQ) will be used to assess individuals' perceptions of social responses to their experiences with suicidal behaviour. It comprises 16 items rated on a 5-point Likert scale (1 = never to 5 = very often) and includes three subscales: Rejection, Minimization, and Self-Blame. The total score ranges from 16 to 80, with higher scores indicating greater experiences of suicide-related stigma.

Suicide grief experience

The Grief Experience Questionnaire (GEQ) will be used to assess feelings arising from the experience of suicide among individuals close to the deceased. The scale consists of 55 items that measure the frequency of specific reactions experienced during the two years following the loss, rated on a 5-point Likert scale (1 = never to 5 = almost always). The items are distributed across 11 subscales.

Stigma by association towards suicide.

The Stigma of Suicide and Suicide Survivor Scale (STOSASS) will be used to assess perceived stigma toward suicide and suicide survivors. The tool consists of two subscales: one for stigma toward suicide and another for stigma toward survivors, each comprising 13 items rated on a 4-point scale (1 to 4). The total score is calculated as the average of the 13-item scores, with higher total scores indicating greater perceived stigma.

Depressive symptoms

The Patient Health Questionnaire-9 (PHQ-9) will be administered. This is a nine-item scale based on the DSM-IV diagnostic criteria for major depression. Responses are recorded on a 4-point Likert scale reflecting the frequency of symptoms over the past two weeks, ranging from 0 ("Never") to 3 ("Nearly every day"). Additionally, the final question assesses the level of difficulty these issues have caused, using a 4-point Likert scale from 1 ("Not difficult at all") to 4 ("Extremely difficult"). Higher scores indicate greater severity of depressive symptoms.

Anxious symptoms

The Generalized Anxiety Disorder 7-item scale (GAD-7) will be administered to assess the presence and severity of generalized anxiety disorder. Participants will respond to 7 items regarding the frequency of their experiences over the past two weeks, using a scale ranging from 0 ("Not at all") to 3 ("Nearly every day").

Suicidal ideation

The severity of suicidal ideation will be assessed using the Suicidal Ideation Attributes Scale (SIDAS), which consists of 5 items. These items evaluate the frequency of suicidal thoughts (item 1), the ability to control them (item 2), proximity to a suicide attempt (item 3), associated distress (item 4), and interference with daily activities (item 5) over the past month. Responses are recorded on an 11-point Likert scale, with scores above 21 indicating a high risk of suicidal behavior.

Expectations and opinions on the intervention

Expectations and Opinion of Treatment Scales consist of two 5-item scales that provide a subjective measure of participants' expectations and opinions about the treatment. Items are rated on a 0-to-10 Likert scale, with higher scores indicating more positive expectations or opinions.