{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:51:58Z","timestamp":1791993118969,"version":"4.4.0"},"reference-count":49,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Young adults in the United States experience high rates of suicidal thoughts and behaviors (STB) but low engagement with traditional care, highlighting the need for accessible and scalable digital interventions. Self-guided digital safety planning interventions (SPIs) can expand access to support but introduce important decisions about what content to deliver, when systems should intervene, and how users retain control over system actions. Personalization, defined as system-initiated adaptation, and customization, defined as user-initiated control, may offer complementary approaches to these decisions. However, how they should be coordinated to preserve autonomy and reduce burden during periods of distress remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to identify key decision points in self-guided digital SPIs and characterize what, when, how, and by whom (system or user) safety planning functions should be controlled. We further examined how personalization and customization can jointly support autonomy, reduce burden, and promote safety.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Nine young adults (ages 18\u201024) with lived experience of suicidal thoughts and behaviors were recruited from an asynchronous remote community comprising individuals who had engaged with the Mental Health America (MHA) website. Participants completed semistructured individual interviews via Zoom. Three coders analyzed interview transcripts using codebook thematic analysis. One coder open-coded all transcripts to develop a preliminary codebook. Two additional coders then applied the codebook to overlapping transcripts, after which all coders revised the codebook and resolved discrepancies by consensus before coding the remaining transcripts. Themes were interpreted using the 5W1H (Who, What, Where, When, Why, and How) framework as an organizing lens for identifying and structuring decision points.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Participants identified 3 classes of decision points for self-guided digital SPIs: (1) system-level decisions about what content and actions are automatically provided; (2) user-level decisions about when and at what pace safety planning unfolds; and (3) shared decisions requiring coordination between users and the system. Participants favored system personalization of decision aids, coping suggestions, brainstorming prompts, example messages for contacting trusted others, affirmations, and relevant resources. In contrast, participants wanted control over the timing and pacing of safety planning and the representation and organization of their safety plans. Participants also emphasized that systems should obtain explicit permission before taking safety-relevant actions, such as contacting trusted others or connecting users with crisis counselors in response to increases in detected risk.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Personalization and customization can function as complementary mechanisms for allocating decision authority within self-guided digital SPIs. The findings support a model of permissioned automation in which systems reduce cognitive and emotional burden through adaptive support while users retain control over safety-relevant actions. This decision-point framework provides a foundation for designing and evaluating self-guided suicide prevention technologies that balance adaptation, autonomy, and safety.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/95930","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:42:49Z","timestamp":1791992569000},"page":"e95930-e95930","source":"Crossref","is-referenced-by-count":0,"title":["Key Decision Points for Personalization and Customization in Self-Guided Digital Suicide Prevention: Qualitative Interview Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2366-1402","authenticated-orcid":false,"given":"Zhiying","family":"Quan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5367-6984","authenticated-orcid":false,"given":"Catherine","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2457-9377","authenticated-orcid":false,"given":"Sarah A","family":"Popowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9218-3198","authenticated-orcid":false,"given":"Theresa","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1637-5943","authenticated-orcid":false,"given":"Kevin","family":"Rushton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6330-3637","authenticated-orcid":false,"given":"Madhu","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5443-7596","authenticated-orcid":false,"given":"David C","family":"Mohr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9439-401X","authenticated-orcid":false,"given":"Kimberly A","family":"Van Orden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5149-7959","authenticated-orcid":false,"given":"Jonah","family":"Meyerhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"R1","unstructured":"Key substance use and mental health indicators in the United States: results from the 2024 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA); 2025. HHS Publication No. PEP25-07-007, NSDUH Series H-60. URL: https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/reports\/rpt56287\/2024-nsduh-annual-national-report.pdf [Accessed 07-10-2026]"},{"key":"R2","unstructured":"National Action Alliance for Suicide Prevention: Transforming Health Systems. Recommended standard care for people with suicide risk: making health care suicide safe. Education Development Center, Inc; 2018. URL: https:\/\/theactionalliance.org\/sites\/default\/files\/action_alliance_recommended_standard_care_final.pdf [Accessed 01-10-2026]"},{"issue":"18","key":"R3","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17186444","article-title":"Suicide safety planning: clinician training, comfort, and safety plan utilization","volume":"17","author":"Moscardini","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"R4","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.cbpra.2011.01.001","article-title":"Safety planning intervention: a brief intervention to mitigate suicide risk","volume":"19","author":"Stanley","journal-title":"Cogn Behav Pract"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2017.08.008","article-title":"The construct and measurement of suicide-related coping","volume":"258","author":"Stanley","journal-title":"Psychiatry Res"},{"issue":"8","key":"R6","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1017\/S0033291710002291","article-title":"Barriers to mental health treatment: results from the National Comorbidity Survey Replication","volume":"41","author":"Mojtabai","journal-title":"Psychol Med"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1007\/s11121-018-0875-8","article-title":"Young adult mental health: a prospective examination of service utilization, perceived unmet service needs, attitudes, and barriers to service use","volume":"20","author":"Cadigan","journal-title":"Prev Sci"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-10-113","article-title":"Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review","volume":"10","author":"Gulliver","journal-title":"BMC Psychiatry"},{"issue":"3","key":"R9","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1007\/s00127-022-02361-4","article-title":"Autonomy versus support: self-reliance and help-seeking for mental health problems in young people","volume":"58","author":"Ishikawa","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"10","key":"R10","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1001\/jamapsychiatry.2019.1231","article-title":"Leveraging digital health and machine learning toward reducing suicide-from panacea to practical tool","volume":"76","author":"Torous","journal-title":"JAMA Psychiatry"},{"issue":"4","key":"R11","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1080\/00332747.2022.2092828","article-title":"Just-in-time adaptive interventions for suicide prevention: promise, challenges, and future directions","volume":"85","author":"Coppersmith","journal-title":"Psychiatry"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-11739-w","article-title":"Suicide prevention via telemental health services: insights from a randomized control trial of crisis response plan and self-guided safety planning approaches","volume":"24","author":"Lohani","journal-title":"BMC Health Serv Res"},{"issue":"6","key":"R13","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1016\/j.beth.2025.03.006","article-title":"A comparison of in-person and digital suicide safety planning quality: a randomized controlled trial of three safety planning administration methods","volume":"56","author":"Hendley","journal-title":"Behav Ther"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2024.115748","article-title":"Digital safety plan effectiveness and use: findings from a three-month longitudinal study","volume":"333","author":"Rainbow","journal-title":"Psychiatry Res"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1080\/13811118.2018.1489319","article-title":"Stakeholder perspectives on using and developing the MYPLAN suicide prevention mobile phone application: a focus group study","volume":"24","author":"Buus","journal-title":"Arch Suicide Res"},{"issue":"6","key":"R16","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1080\/15374416.2024.2395271","article-title":"Accessibility and utility of an electronic self-guided safety plan for adolescents","volume":"53","author":"Methi","journal-title":"J Clin Child Adolesc Psychol"},{"key":"R17","doi-asserted-by":"crossref","unstructured":"Shin HD Durocher K Kassam I et al. Barriers and facilitators to using an app-based tool for suicide safety planning in a psychiatric emergency department: a qualitative descriptive study using the theoretical domains framework and COM-B model. Research Square. Preprint posted online on May 21, 2024. [doi: 10.21203\/rs.3.rs-4390525\/v1]","DOI":"10.21203\/rs.3.rs-4390525\/v1"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.2196\/52763","article-title":"Translating suicide safety planning components into the design of mHealth app features: systematic review","volume":"11","author":"Gryglewicz","journal-title":"JMIR Ment Health"},{"key":"R19","unstructured":"Han J Kim J Lee S . 5W1H-based expression for the effective sharing of information in digital forensic investigations. arXiv. Preprint posted online on Oct 26, 2020. [doi: 10.48550\/arXiv.2010.15711]"},{"issue":"3","key":"R20","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1111\/j.1468-2958.2010.01377.x","article-title":"Personalization versus customization: the importance of agency, privacy, and power usage","volume":"36","author":"Sundar","journal-title":"Hum Commun Res"},{"key":"R21","unstructured":"Looti M . Personalization: the psychology of tailored experiences. Encyclopedia of psychology. Aug 29, 2026. URL: https:\/\/encyclopedia.arabpsychology.com\/personalization\/ [Accessed 01-10-2026]"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1145\/3411764.3445771","article-title":"Designing for emotional well-being: integrating persuasion and customization into mental health technologies","author":"Zhang","journal-title":"Proc CHI Conf Hum Factors Comput Syst"},{"issue":"6","key":"R23","doi-asserted-by":"publisher","DOI":"10.2196\/16317","article-title":"Engaging children and young people in digital mental health interventions: systematic review of modes of delivery, facilitators, and barriers","volume":"22","author":"Liverpool","journal-title":"J Med Internet Res"},{"issue":"3","key":"R24","doi-asserted-by":"publisher","DOI":"10.2196\/24387","article-title":"Barriers to and facilitators of user engagement with digital mental health interventions: systematic review","volume":"23","author":"Borghouts","journal-title":"J Med Internet Res"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.2196\/69602","article-title":"Automated digital safety planning interventions for young adults: qualitative study using online co-design methods","volume":"9","author":"Meyerhoff","journal-title":"JMIR Form Res"},{"key":"R26","doi-asserted-by":"crossref","unstructured":"Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013. [doi: 10.1176\/appi.books.9780890425596]","DOI":"10.1176\/appi.books.9780890425596"},{"issue":"10","key":"R27","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1037\/pas0001043","article-title":"Psychometric properties of the Depressive Symptom Index-Suicidality Subscale (DSI-SS) in an adult psychiatric sample","volume":"33","author":"Stanley","journal-title":"Psychol Assess"},{"key":"R28","unstructured":"Beck AT Steer RA Brown GK . Manual for the Beck Depression Inventory-II. Psychological Corporation; 1996. URL: https:\/\/www.scienceopen.com\/document?vid=9feb932d-1f91-4ff9-9d27-da3bda716129 [Accessed 01-10-2026]"},{"issue":"9","key":"R29","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","journal-title":"J Gen Intern Med"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1145\/3491102.3501976","article-title":"\u201cI wanted to see how bad it was\u201d: online self-screening as a critical transition point among young adults with common mental health conditions","volume":"2022","author":"Kruzan","journal-title":"Proc SIGCHI Conf Hum Factor Comput Syst"},{"issue":"2","key":"R31","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","journal-title":"J Biomed Inform"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","journal-title":"J Biomed Inform"},{"key":"R33","doi-asserted-by":"crossref","unstructured":"Braun V Clarke V . Thematic analysis. In: Cooper H Coutanche MN McMullen LM Panter AT Rindskopf D Sher KJ , editors. APA Handbook of Research Methods in Psychology: Research Designs: Quantitative, Qualitative, Neuropsychological, and Biological. 2nd ed. American Psychological Association; 2023:65-81. [doi: 10.1037\/0000319-004]","DOI":"10.1037\/0000319-004"},{"key":"R34","unstructured":"Dedoose. 2018. URL: https:\/\/www.dedoose.com\/ [Accessed 01-10-2026]"},{"issue":"12","key":"R35","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1176\/appi.ajp.2011.10111704","article-title":"The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults","volume":"168","author":"Posner","journal-title":"Am J Psychiatry"},{"issue":"2","key":"R36","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1080\/13811118.2016.1182094","article-title":"A pilot study of the acceptability and usability of a smartphone application intervention for suicidal adolescents and their parents","volume":"21","author":"McManama O\u2019Brien","journal-title":"Arch Suicide Res"},{"issue":"2","key":"R37","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1080\/23794925.2020.1759469","article-title":"The Safety Planning Assistant: feasibility and acceptability of a web-based suicide safety planning tool for at-risk adolescents and their parents","volume":"5","author":"Hill","journal-title":"Evid-Based Pract Child Adolesc Ment Health"},{"issue":"10","key":"R38","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1037\/ccp0000978","article-title":"Pilot microrandomized trial of a brief digital intervention for suicidal thoughts","volume":"93","author":"Bentley","journal-title":"J Consult Clin Psychol"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.2196\/41422","article-title":"ReachCare mobile apps for patients experiencing suicidality in the emergency department: development and usability testing using mixed methods","volume":"7","author":"Larkin","journal-title":"JMIR Form Res"},{"issue":"4","key":"R40","doi-asserted-by":"publisher","DOI":"10.1145\/3699761","article-title":"MindScape study: integrating LLM and behavioral sensing for personalized AI-driven journaling experiences","volume":"8","author":"Nepal","journal-title":"Proc ACM Interact Mob Wearable Ubiquitous Technol"},{"key":"R41","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00759","article-title":"What works and what doesn\u2019t work? A systematic review of digital mental health interventions for depression and anxiety in young people","volume":"10","author":"Garrido","journal-title":"Front Psychiatry"},{"issue":"4","key":"R42","doi-asserted-by":"publisher","DOI":"10.2196\/25847","article-title":"Evidence on digital mental health interventions for adolescents and young people: systematic overview","volume":"8","author":"Lehtimaki","journal-title":"JMIR Ment Health"},{"key":"R43","unstructured":"Bell MJ . More mental health resources for the moments you need them. News from Google. May 15, 2023. URL: https:\/\/blog.google\/innovation-and-ai\/technology\/health\/mental-health-awareness-month-2023\/ [Accessed 01-10-2026]"},{"key":"R44","doi-asserted-by":"publisher","DOI":"10.2196\/47178","article-title":"Developing suicide prevention tools in the context of digital peer support: qualitative analysis of a workshop with multidisciplinary stakeholders","volume":"7","author":"Cliffe","journal-title":"JMIR Form Res"},{"issue":"5","key":"R45","first-page":"17","volume":"14","author":"Horvitz","journal-title":"IEEE Intell Syst"},{"key":"R46","doi-asserted-by":"publisher","DOI":"10.1145\/3290605.3300233","article-title":"Guidelines for human-AI interaction","author":"Amershi","journal-title":"Conf Hum Factors Comput Syst"},{"issue":"2","key":"R47","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1002\/wps.21299","article-title":"The evolving field of digital mental health: current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality","volume":"24","author":"Torous","journal-title":"World Psychiatry"},{"issue":"1","key":"R48","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s00787-024-02386-x","article-title":"Barriers to and facilitators of user engagement with web-based mental health interventions in young people: a systematic review","volume":"34","author":"Ho","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"1","key":"R49","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1146\/annurev-clinpsy-080822-051119","article-title":"Intervention optimization: a paradigm shift and its potential implications for clinical psychology","volume":"20","author":"Collins","journal-title":"Annu Rev Clin Psychol"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:42:57Z","timestamp":1791992577000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e95930"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":49,"URL":"https:\/\/doi.org\/10.2196\/95930","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]},"article-number":"v10i18e95930"}}