Suicide Prevention, Suicide Risk | Patient
Conditions
Brief summary
The goal of this pilot study is to learn whether the use of suicide risk prediction algorithms in primary care can help identify people who may benefit from extra mental health monitoring. Specifically, this study aims to measure how use of the suicide risk prediction algorithm to prompt extra mental health monitoring among adult primary care patients impacts proportions of patients identified at risk of suicide and engaged in safety planning. Secondarily, we plan to measure proportions of patients identified at risk of suicide via mental health monitoring (irrespective of engagement in safety planning).
Interventions
OTHERSuicide risk prediction algorithm
Use of a suicide risk prediction algorithm, developed by the Mental Health Research Network (MHRN), will be used to prompt additional mental health monitoring. Mental health monitoring will include asking patients about suicidal thoughts (via the ninth question of the Patient Health Questionnaire-9, PHQ-9), followed by suicide risk assessment (via use of a brief self-administered version of the Columbia Suicide Risk Severity Rating Scale, C-SSRS), followed by Safety Planning with a designated member of the primary care team.
Sponsors
Kaiser Permanente
National Institute of Mental Health (NIMH)
University of Washington
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Retrospective pre-post design
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Any type of adult primary care visit/encounter at Kaiser Permanente Washington (KPWA) between 3/5/25-10/5/25 (pre-period) and 10/6/25-4/30/26 (post-period or implementation period).
Exclusion criteria
Primary care visit/encounter among people under 18 years old.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Suicide Risk Safety Plan Documentation | Rates for primary care encounters will be compared before and after implementation, during the 13 month study period 3/05/2025-4/05/2026 (implementation launch 10/6/2025) | Indicator for whether a patient was identified at risk of suicide (using the PHQ-9 and C-SSRS) and had a safety planning intervention documented in the EMR on the day of, or in the following 14 days of a primary care encounter, using a standardized template based on the brief suicide risk safety plan intervention developed by Drs. Stanley \& Brown to mitigate risk |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Suicidal ideation symptom assessment | Rates of assessment for primary care encounters will be compared before and after implementation, during the 13 month study period 3/05/2025-4/05/2026 (implementation launch 10/6/2025) | Indicator for whether a patient completed the Patient Health Questionnaire-9 (PHQ-9) Question 9 for primary care encounter |
| Prior month intent/planning for suicide attempt | Rates for primary care encounters will be compared before and after implementation, during the 13 month study period 3/05/2025-4/05/2026 (implementation launch 10/6/2025) | Indicator for whether a patient indicated prior-month intent or planning for suicide attempt (C-SSRS score ≥3, on the C-SSRS assessment for the primary care encounter (range 0-6; higher scores confer greater risk) |
| Suicide risk assessment | Rates for primary care encounters will be compared before and after implementation, during the 13 month study period 3/05/2025-4/05/2026 (implementation launch 10/6/2025) | Indicator for whether a patient completed the Columbia Suicide Risk Severity Rating Scale (C-SSRS) for the primary care encounter |
| Frequent suicidal ideation reported (in prior 2-weeks) | Rates for primary care encounters will be compared before and after implementation, during the 13 month study period 3/05/2025-4/05/2026 (implementation launch 10/6/2025) | Indicator for whether a patient reported suicidal ideation "more than half the days" or "nearly every day" (PHQ-9 Q9 score 2 or 3), on the assessment documented in the electronic medical record (EMR) for the primary care encounter (range 0-3, higher scores indicate more frequent suicidal ideation) |
Countries
United States
Outcome results
None listed