NIMH-funded study used universal screening, risk assessment, and safety planning to reduce suicide attempts among adult primary care patients
• Research Highlight
Suicide is a leading cause of death in the United States and a major public health problem. Previous research has shown that identifying and helping people at risk for suicide during regular care visits can help prevent it. Primary care clinics are particularly important in this regard, as research has shown that more than 40% of people who die by suicide They were seen in this setting a month before his death.
A recent study funded by the National Institute of Mental Health (NIMH) found that when primary care clinics added suicide care practices to routine visits, suicide attempts decreased by 25% in the 3 months following the visit . The findings highlight the impact it can have for primary care clinics to take an active role in suicide prevention and help empower health systems to integrate those practices into clinical care.
What did the researchers do in the study?
Primary care doctors screen for depression during most care visits, and depression screenings often include questions about suicide risk. Previous NIMH Supported Research found that screening for suicidal thoughts and behaviors followed by brief safety planning can reduce the risk of suicide attempts.
Researchers led by Julie Angerhofer Richards, Ph.D., M.P.H. at the Kaiser Permanente Health Research Institute in Washington, aimed to see whether integrating suicide care into routine adult primary care visits could prevent subsequent suicide attempts.
This study analyzed secondary data from a larger integrated study of the National Zero Suicide Model . The comprehensive Zero Suicide approach is the first US program linked to a substantial decrease in suicides among behavioral health patients. The research team previously examined this model in a NIMH-funded independent study in six health systems in the United States.
Before the intervention, providers provided usual care, which did not include population-based suicide screening and follow-up. The 22 participating clinics were randomly assigned to begin providing suicide care on staggered dates (4 months apart) over a 2-year period. During the study, 333,593 patients were seen in more than 1.5 million primary care visits.
Suicide care consisted of:
- Depression screening: All patients completed a brief two-question depression screening questionnaire, followed by a longer depression symptom scale for those who scored positively on either question.
- Depression Symptom Scale: The rater was followed by a longer depression symptom scale for patients who scored positively on any of the questions.
- Suicide risk assessment: Patients with thoughts of self-harm or suicide completed a measure of suicidal thoughts and behaviors.
- Suicide Safety Planning: Patients who reported suicide intentions or plans in the past month were referred to designated care staff, including mental health social workers, for same-day suicide safety planning. Safety planning was a collaborative process between patients and providers that involved identifying warning signs, listing coping strategies and supports, and creating safe environments to manage a suicidal crisis.
Three key strategies supported the intervention:
- Trained facilitators led training at each clinic and met with staff on an ongoing basis to offer support and resolve issues.
- Clinical decision support, including previsit reminders and visit prompts, came from the clinics’ electronic medical records system.
- Regular monitoring of medical record performance informed physicians’ screening and assessment rates.
The researchers compared clinics that provide suicide care with clinics that provide usual care in:
- Rates of providers documenting suicide risk assessment and safety planning in the medical record within 2 weeks of an at-risk patient’s primary care visit
- Rates of suicide attempts or death by suicide among patients within 90 days of visiting primary care
What did the results of the study show?
Integrating suicide care into routine adult primary care visits resulted in significantly higher rates of suicide risk screening, assessment, and collaborative safety planning. The intervention, in turn, resulted in a 25% decrease in suicide attempts in the 90 days following a primary care visit compared to usual care clinics. Taken together, the results demonstrate that integrating suicide prevention practices into adult primary care leads to more people being screened for suicidal thoughts and behaviors and fewer suicide attempts once they leave the clinic.
These findings support NIMH Priority on Suicide Prevention in Health Care Settings with the ultimate goal of reducing the suicide rate in the United States. The study provides critical next steps for providers and care teams to respond to suicidal concerns during clinical practice, helping to save lives in the process.
Reference
Richards, JA, Cruz, M., Stewart, C., Lee, AK, Ryan, TC, Ahmedani, BK, and Simon, GE (2024). Effectiveness of integrating suicide care into primary care: secondary analysis of a cluster-randomized and stepped implementation trial. Annals of internal medicine, 177(11), 1471-1482. https://doi.org/10.7326/M24-0024
Funds
If you or someone you know is struggling or having suicidal thoughts, call or text the Suicide and Crisis Lifeline 988 at 988 or chat on 988lifeline.org . In life-threatening situations, call 911.
For more information on suicide prevention, see:
Disclaimer
The Zero Suicide Framework was developed at the Educational Development Center (EDC) through the federally funded Suicide Prevention Resource Center and the National Suicide Prevention Action Alliance. Zero Suicide information and branding is freely available at Zero Suicide. Tool KitYE managed by EDC. No official endorsement by EDC is intended or should be inferred.
