Population-based suicide care program yielded 25% reduction in suicide attempts
A primary care-based program that combined care for mental health issues and substance use with safety planning reduced suicide attempts within 90 days of a primary care visit.
Suicide reduction measures integrated into primary care resulted in 25% fewer suicide attempts within 90 days of a primary care visit when implemented alongside a substance use care program, a study found.
Of persons who die by suicide, more than 40% have seen a primary care clinician within a month and 75% within a year of their death, reported the authors of a secondary analysis of a trial to evaluate the effectiveness of a population-based suicide care program. In the study, 19 primary care practices in a large health care system in Washington State were selected to test a program that combined care for both mental health issues, like depression, and substance use.
Patients were screened annually using a short survey to assess depression, alcohol, and drug use, and clinicians used this information for early identification and treatment. Practice facilitators, electronic medical record (EMR) clinical decision support, and performance monitoring were used to support implementation of depression screening, suicide risk assessment, and safety planning. Primary outcomes included documented safety planning after population-based screening and suicide risk assessment and suicide attempts or deaths (with self-harm intent) within 90 days of a visit. The findings were published Oct. 1 by Annals of Internal Medicine.
The study compared 255,789 patients who made 953,402 primary care visits under usual care and 228,255 patients making 615,511 visits during the suicide care period. The rate of safety planning was higher in the suicide care group than in the usual care group (38.3 vs. 32.8 per 10,000 patients; rate difference, 5.5 [95% CI, 2.3 to 8.7]), and suicide attempts within 90 days were lower in the suicide care group than in the usual care group (4.5 vs. 6.0 per 10,000 patients; rate difference, −1.5 [95% CI, −2.6 to −0.4]).
Researchers attributed the decline to key elements of their Zero Suicide model, such as depression screening, risk assessment, and safety planning. According to the researchers, their findings may provide vital evidence for health care teams considering how to respond to patient-reported suicidality during routine primary care encounters, as well as for organizational leaders considering the value of integrating clinical practices in primary care to support suicide prevention.
“Clinical implications of these findings support use of primary care-based practices for suicide prevention—specifically, population-based suicide risk identification followed by collaborative safety planning,” the authors wrote. “These findings also underscore the importance of using robust implementation strategies. Specifically, the combination of skilled practice facilitators, EMR-based clinical decision support, and routine performance monitoring supported this integration over a 2-year period. This effort required resources and active participation of primary care leaders and teams, including registered nurses and integrated clinical social workers, who were responsible for engaging patients at risk for suicide in collaborative safety planning.”