Brief suicide prevention interventions may reduce subsequent suicide attempts
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Incorporation of brief suicide prevention interventions into routine acute care practice may reduce subsequent suicide attempts, according to results of a systematic review and meta-analysis published in JAMA Psychiatry.
“National suicide prevention best practices recommend that individuals identified as being at risk [for] suicide receive treatment specifically directed to reduce their risk [for] suicide and services to ensure they remain engaged in mental health care,” Stephanie K. Doupnik, MD, MSHP, of Roberts Center for Pediatric Research at University of Pennsylvania, and colleagues wrote. “To achieve these goals, clinical teams need evidence-based interventions to directly address suicide risk and to ensure that patients transition to ongoing, longitudinal mental health care. Brief interventions are used in acute care to identify and provide initial management for a number of mental health and other problems and offer several practical advantages.”
These advantages include delivery in a single time-limited encounter by trained professionals, as well as the potential for some interventions to be augmented by care coordination or follow-up after a patient’s acute encounter, according to the researchers.
Doupnik and colleagues aimed to assess the association between acute care suicide prevention interventions and patients’ subsequent suicide attempts, follow-up care linkage and depression symptoms at follow-up, all of which served as the primary outcomes of the meta-analysis. They conducted a systematic review of clinical trials, published between January 2000 and May 2019, of brief suicide prevention interventions that were delivered via a single in-person encounter, some of which involved telephone follow-up. Included trials promoted continuity of mental health care, directly addressed suicide risk or did both. The researchers measured primary outcomes using validated self-report measures and medical records.
Among 14 studies representing outcomes of 4,270 patients, pooled-effect estimates showed associations between brief suicide prevention interventions and reduced subsequent suicide attempts (pooled OR = 0.69; 95% CI, 0.53-0.89) and increased linkage to follow-up (pooled OR = 3.04; 95% CI, 1.79-5.19); however, they showed no association with reduced depression symptoms (Hedges g = 0.28; 95% CI, 0.02 to 0.59).
“Even during a short ED visit or a medical hospitalization, there are brief interventions that can prevent repeat suicide attempts and help people at risk of suicide connect with mental healthcare.,” Doupnik told Healio Psychiatry. “EDs and hospitals can implement these interventions with the confidence that they can improve patient outcomes.”
In a related editorial, Nadine M. Melhem, PhD, and David Brent, MD, both of the department of psychiatry at University of Pittsburgh School of Medicine, contextualized these findings in relation to the COVID-19 pandemic.
“As the world is now grappling with [the coronavirus pandemic] and its potential effects on mental health and the suicide epidemic in the United States, we need to be prepared with brief suicide preventive interventions that every clinician could deliver face to face or through telemedicine,” they wrote. “This contribution by Doupnik [and colleagues] could not be more timely. It shows us that available brief interventions do work and can potentially save lives.”