Suicide Attempt
Conditions
Keywords
prevention of suicidality
Brief summary
Suicide is one of the leading causes of premature death and a prioritized public health concern. Safety Planning Intervention (SPI) is a method with strong international research support for reducing suicidal behaviour by enhancing individuals' strategies for crisis management and improving access to support. SPI is a single-session intervention lasting approximately 45 minutes, which any healthcare provider can deliver after a brief training. Despite promising results, the implementation of SPI in Swedish healthcare remains limited. This project examines how SPI can be integrated into various healthcare settings and evaluates its impact on suicide-related emergency visits, psychiatric hospitalizations, and healthcare utilization. Data and Methods Stepped-Wedge implementation study in specialist psychiatry, where SPI is gradually introduced in psychiatric units. This study design allows for a robust evaluation of effects while ensuring all units eventually receive the intervention. As part of this study, a survey among healthcare professionals will be conducted to assess their experiences with feasibility, usability, and implementation barriers. Data will be collected from QlikView healthcare utilization data. Poisson regression models with mixed effects will be used to analyze the impact of SPI on emergency visits and psychiatric hospitalizations. A health economic analysis will be conducted to evaluate the cost-effectiveness of SPI. Societal Relevance and Impact The project contributes to Sweden's national suicide prevention strategy by: 1. Scientifically evaluating the feasibility and effects of SPI in Swedish healthcare. 2. Developing training programs for healthcare professionals in suicide prevention. 3. Informing policy decisions and national guidelines. 4. Analyzing the cost-effectiveness of SPI from a societal perspective. Implementation The research team includes experts in suicide prevention, psychiatry, epidemiology, patient safety, and health economics, creating a strong multidisciplinary foundation. The Stepped-Wedge design ensures an ethically and methodologically sound evaluation of SPI. Gradual implementation allows for time-based comparisons, minimizes selection bias, and ensures all patients receive the intervention. The project is conducted in close collaboration with healthcare providers and policymakers to ensure that research findings can be integrated into clinical practice and strengthen suicide prevention efforts in Sweden.
Interventions
BEHAVIORALSafety Planning Intervention (SPI)
Safety Planning Intervention (SPI), developed by Stanley \& Brown (12), is a brief, structured suicide preventive intervention designed to help individuals identify warning signs, develop coping strategies, and establish emergency contact pathways. SPI is a single-session intervention that typically lasts approximately 45 minutes and is delivered in clinical or emergency care settings. It is designed to help individuals identify warning signs, develop coping strategies, and establish a concrete plan for seeking support during a suicidal crisis. Unlike traditional risk assessments that focus on predicting suicide risk, SPI actively engages individuals in managing crises before they escalate. The intervention consists of six core steps.
Sponsors
Region Skane
Forte
Study design
Allocation
NA
Intervention model
SEQUENTIAL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients presenting to psychiatric services with suicidal ideation, suicidal planning, or a suicide attempt Patients receiving care in participating adult psychiatric emergency or inpatient units
Exclusion criteria
Age under 18 years
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Monthly rate of emergency visits for suicide attempts | Monthly measurements throughout the 45-month study period | Monthly number of emergency department visits for suicide attempts identified using ICD-10 codes X60-X84 and events of undetermined intent (Y10-Y34), obtained from aggregated healthcare utilization data from psychiatric clinics in Region Skåne. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Monthly rate of psychiatric inpatient admissions for suicide attempts | Monthly measurements throughout the 45-month study period | Monthly number of psychiatric inpatient admissions with ICD-10 diagnoses indicating suicide attempts (X60-X84) or events of undetermined intent (Y10-Y34), obtained from aggregated healthcare utilization data. |
| Emergency department revisits following suicide attempts | Monthly measurements throughout the 45-month study period | Monthly number of emergency department revisits due to suicide attempts or events of undetermined intent within 30 days, 6 months, or 12 months after a previous visit. |
| Psychiatric inpatient readmissions following suicide attempts | Monthly measurements throughout the 45-month study period | Monthly number of psychiatric inpatient readmissions due to suicide attempts or events of undetermined intent within 30 days, 6 months, or 12 months after a previous admission. |
| Incremental cost-effectiveness of SPI implementation | Assessed over the 45-month implementation period | Incremental cost-effectiveness ratio comparing the Safety Planning Intervention (SPI) with usual care based on healthcare utilization costs and suicide-related healthcare events. |
Countries
Sweden
Contacts
CONTACTSara Lindström, Associate professor
Outcome results
None listed