Adolescent, Adult, Ambulatory Care, Continuity of Patient Care, Crisis Intervention, Depression, Depressive Disorder, Emergency Service, Hospital, Loneliness, Mental Disorder, Mental Health, Mental Health Services, Outpatient Clinics, Hospital, Outpatients, Patient Care Planning, Secondary Prevention, Social Support, Suicidal Ideation, Suicide, Suicide, Attempted
Conditions
Keywords
Brief Interventions, Caring Contacts, Care Transitions, Follow-up, Emergency Department, Primary Care, Safety Planning Intervention, Safety Plan, Suicide, Suicide Prevention, Adult, Adolescent, Brief Contact Intervention
Brief summary
Randomized controlled trial to determine the best brief suicide prevention intervention for adults and adolescents who screen positive for suicidal ideation or behavior in emergency departments or primary care clinics. Aim 1: Compare the effectiveness of two brief suicide prevention interventions (safety planning intervention plus structured phone-based follow-up from a suicide prevention hotline (SPI+), versus safety planning intervention plus caring contacts (CC)) to (a) reduce suicidal ideation and behavior, (b) reduce loneliness, (c) reduce return to care for suicidality, and (d) increase uptake of outpatient mental healthcare services over 12 months among adult and adolescent patients screening positive for suicide in emergency departments (EDs) and primary care clinics. Aim 2: Assess the acceptability of connection and support planning and the safety planning intervention, with or without follow-up among providers and clinical staff in EDs and primary care clinics. Aim 3: Assess the acceptability of SPI+ and SP+CC among adult and adolescent patients.
Interventions
BEHAVIORALSPI+
Suicide prevention hotline follow-up specialists will call participants to (1) conduct a brief suicide risk assessment; (2) review and discuss the participant's connection and support plan or safety plan; and (3) provide referrals to social services or other support with treatment engagement, if indicated. Participants will receive at least one and optional additional phone calls, generally delivered according to the following schedule: days 3, 7, 14, 30, 60, 90. Modifications may be made to the schedule due to weekends, holidays, or participant availability, and additional calls may be scheduled as desired by the participant. The follow-up will stop once the participant is successfully engaged in outpatient treatment or does not desire further follow-up support.
BEHAVIORALSP+CC (Caring Contacts)
SP+CC follow-up includes one phone conversation with a suicide prevention hotline follow-up specialist and a series of personalized caring messages sent over the course of 12 months via text or email (based on participant preference). Caring contacts will generally be sent according to the following schedule: 3 in the first week, 6 weekly, 6 bi-weekly, 4 monthly; 2 bi-monthly, and one each for the participant's birthday, Thanksgiving, Christmas, and New Year's (total of 25 over 12 months). Slight variation in the schedule is allowed. There is no expectation that participants respond to the text messages; if they do, follow-up specialists reply to any incoming texts. Replies are individually-tailored and caring.
Sponsors
Patient-Centered Outcomes Research Institute
Idaho Crisis & Suicide Hotline
University of Washington
Columbia University
University of Pennsylvania
St. Luke's Health System, Boise, Idaho
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Individual-level randomization to one of two treatment arms
Eligibility
Sex/Gender
ALL
Age
12 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient at St. Luke's Health System Emergency Department or Primary Care Clinic * 12-17 years old (adolescents) or 18+ years old (adults) * Screened positive for suicide risk on C-SSRS (any response of yes) during current visit, or current visit is related to a suicide attempt * Access to a phone for the duration of the study with the ability to receive calls * The ability to send and receive email messages (required) and text messages (optional) * English or Spanish speaking and reading
Exclusion criteria
* Unable or unwilling to provide informed consent to participate * Inappropriate for study participation based on the clinical judgment of provider
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Suicidal Ideation & Behavior; measured using the Columbia Suicide Severity Rating Scale (C-SSRS) since-last-contact screener (self-assessment) | 6 months | 6-item questionnaire with yes/no response options. Scores range from 0 (no risk) to 6 (high risk) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Loneliness; measured using the NIH Toolbox Emotion Batteries Loneliness Scale | 6 months | 5-item questionnaire with Likert scale response options (1=never, 5=always). Scores range from 5 (no loneliness) to 25 (high levels of loneliness). |
| Utilization of Emergency Department for Suicidality | 6 months | Measured through self-report |
| Attendance at Outpatient Behavioral Health Appointments | 6 months | Measured through self-report |
| Suicidal Ideation & Behavior; measured using the Columbia Suicide Severity Rating Scale (C-SSRS) since-last-contact screener (self-assessment) | 12 months | 6-item questionnaire with yes/no response options. Scores range from 0 (no risk) to 6 (high risk) |
Countries
United States
Outcome results
None listed