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Research Highlight: Brief Suicide Prevention Interventions in Acute Care Settings May Reduce Subsequent Suicide Attempts

Suicide is the tenth leading cause of death in the United States, and rates of suicide have been rising in each of the last 15 years. Research has shown that more than one-third of people who die by suicide had a health care encounter in the week before their death, and half within a month before their death. Because of this, health care organizations are well positioned to provide suicide prevention interventions during patient visits. However, clinical teams require evidence-based interventions to address suicide risk directly and ensure that patients transition to ongoing mental health care.

In a research project led by Stephanie K. Doupnik, M.D., and supported by the National Institute of Mental Health, researchers conducted a systematic review of studies (called a meta-analysis) on clinical trials of brief suicide prevention interventions to determine how effective these interventions might be in acute care settings, such as hospitals, emergency departments, and urgent care centers. Their findings were published in JAMA Psychiatry.

The team included 14 studies in the meta-analysis, representing a total of 4,270 patients. The three primary outcomes they examined were: subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up.

The included studies evaluated brief suicide prevention interventions to promote ongoing mental health care and reduce subsequent suicide attempts. The researchers identified studies that included four main components in their interventions: brief contact interventions, care coordination, safety planning interventions, and other brief therapies.

  • Brief contact interventions included telephone calls, postcards, and letters.
  • Care coordination included scheduling outpatient mental health appointments, mobile crisis response team evaluations, as well as outpatient mental health appointments and collaborating with patients’ families to reduce barriers to attending appointments.
  • Safety planning interventions included components such as identifying family, friends, and social places that can distract from suicidal thoughts; identifying individuals who can help during a suicidal crisis; and listing mental health professionals and urgent care services to contact during a suicidal crisis.
  • Brief therapeutic interventions included other interventions that used a variety of therapeutic techniques to reduce a patient’s likelihood of self-harm.

Looking at the primary outcomes of the studies together, the researchers found that brief suicide prevention interventions were associated with reduced subsequent suicide attempts and increased linkage to follow-up care. The researchers found that the brief suicide prevention interventions in these studies were not associated with statistically significant reductions in depression symptoms. The most common component among the interventions in the studies was promoting connectedness via engagement with health care clinicians and with the patient’s community.

An important future research direction, the researchers wrote, is to identify and test implementation strategies for brief suicide prevention interventions in acute care settings. To do this, the authors suggest that health care settings need robust systems to identify patients with suicide risk, and that clinical teams require access to mental health professionals with skills and expertise to provide brief interventions. They also suggested future research could investigate implementing these kinds of interventions in acute care settings outside of traditional health care, like jails and crisis homeless shelters.

References

Doupnik, S. K., Rudd, B., Schmutte, T., Worsley, D., Bowden, C. F., McCarthy, E., Eggan, E., Bridge, J. A., & Marcus, S. C. (2020). Association of Suicide Prevention Interventions with Subsequent Suicide Attempts, Linkage to Follow-up Care, and Depression Symptoms for Acute Care Settings. JAMA Psychiatry. DOI:10.1001/jamapsychiatry.2020.1586

Grants:

K23MH115162; T32MH109433; R01MH107452

Research Highlight