In the Journals

Intervention with follow-up reduces suicidal behavior after ED discharge

Barbara Stanley

Patients presenting to the ED with suicide-related concerns who received the Safety Planning Intervention with structured follow-up via telephone were less likely to show suicidal behavior and more likely to attend mental health treatment after discharge than those who received usual care, according to findings published in JAMA Psychiatry.

“The suicide rate in the U.S. is increasing dramatically, but development of effective interventions has not kept pace,” Barbara Stanley, PhD, professor of medical psychology, department of psychiatry, Columbia University, and director, Suicide Prevention Training Implementation & Evaluation, Center for Practice Innovations, New York State Psychiatric Institute, told Healio Psychiatry. “Many suicidal individuals do not seek treatment following an ED visit for suicide-related concerns. Others do not have the resources or access to care even if they desire it.”

Researchers examined whether the administration of the Safety Planning Intervention, with structured follow-up telephone contact, to adult patients visiting ED for a suicide-related reason helped lessen suicidal behavior and improve outpatient treatment engagement during the high-risk, 6-month period after discharge. They used a cohort comparison design at nine Veterans Health Administration hospital EDs (five intervention and four control sites).

“Brief interventions like the one we developed and tested are important to provide in acute care settings because it may be the only treatment received,” Stanley explained to Healio Psychiatry. “Also, even if patients want to have treatment, there is often a delay between referral and appointment while the patients are at heightened risk for further suicidal crises.”

The Safety Planning Intervention, a brief clinical intervention often used in health systems, combines evidence-based strategies that offer prioritized coping strategies, including lethal means counseling, to decrease suicidal behavior. During follow-up, social workers or psychologists who were trained and supervised by senior project staff contacted patients via phone at least twice to check suicide risk, review the intervention and support treatment engagement.

Of 1,640 patients overall, 1,186 received the intervention (88.5% men) and 454 were in the comparison group (88.1% men). The Safety Planning Intervention with follow-up telephone contact was linked with 45% fewer suicidal behaviors (OR = 0.56; 95% CI, 0.33-0.95; P = .03).

“Our research shows that the [safety planning intervention] and follow-up by telephone is effective in reducing suicidal behavior and in increasing treatment attendance post ED discharge,” Stanley said.

Adults who received the intervention plus follow-up were less likely to engage in suicidal behavior compared with those who received usual care during 6-month follow-up (3.03% vs. 5.29%). Furthermore, patients receiving the intervention had more than two times the odds of attending at least one outpatient mental health visit (OR = 2.06; 95% CI, 1.57-2.71; P < .001).

“Using the low-burden intervention in this project and others was associated with about the same reduction in suicidal behavior as more intensive and costly psychosocial interventions,” Stanley and colleagues wrote in the full study. “If implemented broadly, [Safety Planning Intervention plus follow-up] has the potential to reduce suicidal behavior and enhance behavioral health treatment engagement, particularly during high-risk periods following ED discharge. This strategy may help decrease suicide risk in the long-term.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.

Barbara Stanley
 

Patients presenting to the ED with suicide-related concerns who received the Safety Planning Intervention with structured follow-up via telephone were less likely to show suicidal behavior and more likely to attend mental health treatment after discharge than those who received usual care, according to findings published in JAMA Psychiatry.

“The suicide rate in the U.S. is increasing dramatically, but development of effective interventions has not kept pace,” Barbara Stanley, PhD, professor of medical psychology, department of psychiatry, Columbia University, and director, Suicide Prevention Training Implementation & Evaluation, Center for Practice Innovations, New York State Psychiatric Institute, told Healio Psychiatry. “Many suicidal individuals do not seek treatment following an ED visit for suicide-related concerns. Others do not have the resources or access to care even if they desire it.”

Researchers examined whether the administration of the Safety Planning Intervention, with structured follow-up telephone contact, to adult patients visiting ED for a suicide-related reason helped lessen suicidal behavior and improve outpatient treatment engagement during the high-risk, 6-month period after discharge. They used a cohort comparison design at nine Veterans Health Administration hospital EDs (five intervention and four control sites).

“Brief interventions like the one we developed and tested are important to provide in acute care settings because it may be the only treatment received,” Stanley explained to Healio Psychiatry. “Also, even if patients want to have treatment, there is often a delay between referral and appointment while the patients are at heightened risk for further suicidal crises.”

The Safety Planning Intervention, a brief clinical intervention often used in health systems, combines evidence-based strategies that offer prioritized coping strategies, including lethal means counseling, to decrease suicidal behavior. During follow-up, social workers or psychologists who were trained and supervised by senior project staff contacted patients via phone at least twice to check suicide risk, review the intervention and support treatment engagement.

Of 1,640 patients overall, 1,186 received the intervention (88.5% men) and 454 were in the comparison group (88.1% men). The Safety Planning Intervention with follow-up telephone contact was linked with 45% fewer suicidal behaviors (OR = 0.56; 95% CI, 0.33-0.95; P = .03).

“Our research shows that the [safety planning intervention] and follow-up by telephone is effective in reducing suicidal behavior and in increasing treatment attendance post ED discharge,” Stanley said.

Adults who received the intervention plus follow-up were less likely to engage in suicidal behavior compared with those who received usual care during 6-month follow-up (3.03% vs. 5.29%). Furthermore, patients receiving the intervention had more than two times the odds of attending at least one outpatient mental health visit (OR = 2.06; 95% CI, 1.57-2.71; P < .001).

“Using the low-burden intervention in this project and others was associated with about the same reduction in suicidal behavior as more intensive and costly psychosocial interventions,” Stanley and colleagues wrote in the full study. “If implemented broadly, [Safety Planning Intervention plus follow-up] has the potential to reduce suicidal behavior and enhance behavioral health treatment engagement, particularly during high-risk periods following ED discharge. This strategy may help decrease suicide risk in the long-term.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.