Brief Interventions Could Reduce Risk of Suicide

June 21, 2020

In the last 20 years suicide rates have increased substantially, while emergency department visits for suicidal ideation and suicide attempts have doubled.

Stephanie K. Doupnik, MD, MSHP

A single intervention could pay dividends for individuals at risk of suicide ideation, according to new data.

A team, led by Stephanie K. Doupnik, MD, MSHP, PolicyLab, Center for Pediatric Clinical Effectiveness, Division of General Pediatrics, Children’s Hospital of Philadelphia, examined whether brief interventions delivered in a single encounter to individuals at risk of suicide could improve patient outcomes.

In the systemic review and metal-analysis, the investigators identified 14 studies involving 4270 patients.

The investigators sought primary outcomes of subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up. They measured suicide attempts and linkage to follow-up using validated patient self-report measures and medical record reviews.

The investigators also pooled odds ratios and Hedges g standardized mean differences to estimate effect sizes. They measured depression symptoms 2-3 months following the encounter using validated self-report measures and pooled Hedges g standardized mean differences to estimate effect sizes.

The team found brief acute care suicide preventions interventions were linked to reduced subsequent suicide attempts, while increasing the chance of linkage to follow-up care.

The majority of interventions included multiple components, with the most common components being care coordination, safety planning, brief follow-up contacts, and brief therapeutic interventions.

Pooled-effect estimates showed that brief suicide prevention interventions were linked to a reduction in subsequent suicide attempts (OR, 0.69; 95% CI, 0.53-0.89), increased linkage to follow-up (OR, 3.04; 95% CI, 1.79-5.17).

However, they were not associated with reduced depression symptoms (Hedges g  =  0.28 [95% CI, −0.02-0.59).

“In this meta-analysis, brief suicide prevention interventions were associated with reduced subsequent suicide attempts,” the authors wrote. “Suicide prevention interventions delivered in a single in-person encounter may be effective at reducing subsequent suicide attempts and ensuring that patients engage in follow-up mental health care.”

Suicide rates have been rising in the US for the better part of 2 decades, leading to the National Action Alliance for Suicide Prevention calling for health care organizations to incorporate suicide prevention into routine practice.

Emergency department visits for suicidal ideation and suicide attempts have doubled in recent decades.

Health care organizations also play a crucial role as more than one-third of people who die by suicide have had a health care encounter within the previous week prior to death and half within a month before their death.

“Suicide prevention interventions delivered during and after a single in-person acute care encounter may be effective at reducing subsequent suicide attempts and improving patients’ odds of linkage to follow-up mental health care,” the authors wrote. “Future efforts to implement brief suicide prevention interventions in acute care are likely to reduce patients’ risk of future suicide attempts and improve their continuity of mental health care.”

The study, “Association of Suicide Prevention Interventions With Subsequent Suicide Attempts, Linkage to Follow-up Care, and Depression Symptoms for Acute Care Settings,” was published online in JAMA Psychiatry.