Suicide Prevention Interventions for Suicide Risk Management

Not currently recruiting at 1 trial location

Overseen By Monika Lohani, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Utah

Disqualifiers: Outside U.S.

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to find effective ways to manage and reduce the risk of suicide by testing four different treatment approaches. Participants will be assigned to one of the following combinations: a structured interview with either a safety plan or a crisis response plan, or a narrative assessment with either a safety plan or a crisis response plan. Each method involves talking with a clinician to develop strategies to cope with suicidal thoughts and behaviors. The trial seeks individuals clinically diagnosed with suicidal thoughts and a history of suicide attempts. As an unphased trial, this study offers participants the opportunity to contribute to important research that could lead to better suicide prevention strategies.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that treatments studied for managing suicide risk are generally safe and well-tolerated. The Safety Plan, used in several studies, has effectively reduced suicidal thoughts and behaviors. One study found that people using a digital Safety Plan were 50% less likely to return to the emergency room. Another study noted that the quality of the Safety Plan can affect its effectiveness, although most plans could still be improved.

The Crisis Response Plan also has strong safety evidence. It quickly reduces suicidal thoughts and attempts. For example, one study found that soldiers using the Crisis Response Plan were 76% less likely to attempt suicide in the next six months compared to those who received standard care. Additionally, more frequent use of the Crisis Response Plan was linked to fewer suicidal thoughts and more positive feelings.

Both methods appear effective and safe for managing suicide risk, with studies supporting their use to help reduce suicidal thoughts and behaviors. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these interventions for suicide risk management because they offer personalized and innovative approaches to prevention. Unlike standard treatments that often focus on medication or generalized therapy, these methods emphasize tailored strategies such as the Crisis Response Plan and the Safety Plan, which equip individuals with specific coping mechanisms and resources. The Narrative Assessment provides a unique opportunity for individuals to share their personal stories, potentially uncovering underlying factors and fostering a deeper understanding between clinician and patient. These interventions aim to provide immediate, actionable support, which could lead to more effective and timely prevention of suicide attempts and ideation.

What evidence suggests that this trial's interventions could be effective for suicide risk management?

This trial will compare different interventions for managing suicide risk. Studies have shown that safety plans, detailed lists of coping strategies, effectively reduce suicidal thoughts and behaviors. In this trial, some participants will receive a structured interview and safety plan, while others will receive a structured interview and Crisis Response Plan (CRP). Research indicates that structured interviews, where clinicians ask specific questions, can increase the detection of suicidal thoughts by 600% and reduce attempts by up to 80%. CRPs, which provide immediate steps to prevent suicide, have been linked to fewer suicide attempts and less suicidal thinking. Additionally, narrative assessments, where individuals share their crisis story, combined with either safety plans or CRPs, are also being tested in this trial and have shown promise in lowering suicidal thoughts. Overall, these approaches have demonstrated promising results in managing suicide risk. ^{5 6 7 8 9}

Who Is on the Research Team?

Monika Lohani, PhD

Principal Investigator

University of Utah

Are You a Good Fit for This Trial?

This trial is for individuals in the U.S. with a clinical diagnosis of suicidal ideation or those who have attempted suicide before. It's not open to people living outside the U.S.

Inclusion Criteria

You have been diagnosed with having thoughts of harming yourself.

You have attempted suicide in the past.

Exclusion Criteria

Geographic location outside the U.S.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants are randomly assigned to one of four interventions and assessed before and after the intervention

2 weeks

Follow-up

Participants are monitored for changes in suicide relevant thoughts and behaviors

1 month

What Are the Treatments Tested in This Trial?

Interventions

• Crisis Response Plan
• Narrative Assessment
• Safety Plan
• Structured interview

Trial Overview The study tests four different interventions: Safety Plan, Crisis Response Plan, Structured Interview, and Narrative Assessment. Participants are sorted into these groups based on gender and history of suicide attempts.

How Is the Trial Designed?

Group I: Structured interview and Safety Plan Active Control 2 Interventions

In the structured interview approach, clinicians ask a series of predetermined questions and/or assess a specified set of risk and protective factors, typically using a checklist-based approach. The safety plan is a written, prioritized list of coping strategies and resources for reducing suicide risk.

Group II: Structured interview and Crisis Response Plan Active Control 2 Interventions

In the structured interview approach, clinicians ask a series of predetermined questions and/or assess a specified set of risk and protective factors, typically using a checklist-based approach. Crisis response planning intervention teaches a range of coping strategies and provides support that can reduce suicide attempts and ideation.

Group III: Narrative assessment and Safety Plan Active Control 2 Interventions

In the narrative assessment approach, clinicians ask patients to "tell the story" of their suicidal crisis. The safety plan is a written, prioritized list of coping strategies and resources for reducing suicide risk.

Group IV: Narrative assessment and Crisis Response Plan Active Control 2 Interventions

In the narrative assessment approach, clinicians ask patients to "tell the story" of their suicidal crisis. Crisis response planning intervention teaches a range of coping strategies and provides support that can reduce suicide attempts and ideation.

Who Is Running the Clinical Trial?

University of Utah

Lead Sponsor

Trials

1,169

Recruited

1,623,000+

Ohio State University

Collaborator

Trials

891

Recruited

2,659,000+

Published Research Related to This Trial

The Safety Planning Intervention (SPI) is a structured six-step action plan designed to help individuals at risk of suicide by enhancing their coping strategies and social support, and by removing access to means of self-harm.

Research shows that SPI is highly effective in reducing suicidal behavior, making it a valuable tool in various settings such as emergency rooms and outpatient clinics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[SAFETY PLANNING INTERVENTION FOR SUICIDE PREVENTION]. Perlstein, J., Katzir, N., Lotan, A., et al.[2022]

A self-administered, Web-based safety planning application was developed and tested with 30 suicidal patients, showing strong usability ratings and enabling 90% of participants to complete at least 5 out of 6 safety planning steps.

Participants reported a significant decrease in suicidal ideation intensity after using the application, with pre-application scores averaging 5.11 and post-application scores averaging 4.46, indicating the potential effectiveness of this tool in enhancing coping abilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing. Boudreaux, ED., Brown, GK., Stanley, B., et al.[2023]

A systematic review of 22 studies found that suicide safety planning (SSP) is effective in reducing suicidal behavior and ideation, highlighting its importance as a suicide prevention strategy.

SSP can be delivered in various formats, including standard, enhanced, and electronically, but more research is needed to explore its impact on mental illness symptoms and resilience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Suicide Safety Planning Interventions: A Systematic Review Informing Occupational Therapy. Marshall, CA., Crowley, P., Carmichael, D., et al.[2023]

A 1-hour virtual training significantly improved clinicians' knowledge and self-efficacy in using electronic safety plans for suicide prevention, with lasting effects observed at a 6-month follow-up.

Among clinicians working with suicidal youth, 81% attempted to use the electronic safety plan template, and 63% completed it, indicating that this training can enhance the implementation of safety planning in community settings despite some challenges like technology issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of a Virtual Suicide Safety Planning Training on Clinician Knowledge, Self-Efficacy, and Use of Safety Plans in Community Mental Health Clinics. Whitmyre, ED., Esposito-Smythers, C., Goldberg, DG., et al.[2023]

The study successfully implemented the Safety Planning Intervention (SPI) for adolescent suicidality in emergency services, showing that training significantly improved providers' attitudes and knowledge about the intervention.

Collaboration with stakeholders and brief training were effective strategies for integrating structured safety planning into pediatric emergency settings, which is crucial for enhancing care for suicidal youths.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety Planning Intervention for Adolescents: Provider Attitudes and Response to Training in the Emergency Services Setting. Bettis, AH., Donise, KR., MacPherson, HA., et al.[2022]

The Safety Planning Intervention (SPI) is effective in reducing suicidal ideation and behavior, as well as improving depression and treatment engagement among adults experiencing suicide-related distress, based on a systematic review of 26 studies.

The SPI is adaptable and can be delivered in various formats (in-person or online) and as a standalone or combined intervention, making it a flexible tool in suicide prevention practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. Ferguson, M., Rhodes, K., Loughhead, M., et al.[2022]

The article reviews various ultra-brief and brief suicide-specific interventions, highlighting their potential to quickly stabilize individuals at risk of suicide, which is crucial given the rising suicide rates.

Several interventions, such as the Safety Planning Intervention and Cognitive Therapy for Suicide Prevention, have shown promising evidence for effectiveness, indicating a need for continued research to optimize these approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Brief and Ultra-Brief Suicide-Specific Interventions. Stanley, B., Brodsky, B., Monahan, M.[2023]

A qualitative study involving experienced suicide researchers revealed significant challenges in defining and reporting adverse events (AEs) and serious adverse events (SAEs) in suicide prevention trials, which complicates safety evaluations.

Participants emphasized the urgent need for clear and consistent definitions and reporting standards for AEs and SAEs to improve the comparability of studies and enhance safety monitoring in at-risk populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Variability in the definition and reporting of adverse events in suicide prevention trials: an examination of the issues and a proposed solution. Oquendo, MA., Feldman, S., Silverman, E., et al.[2022]

Citations

1. sciencedirect.com sciencedirect.com/science/article/abs/pii/S2468171724000164

The narrative crisis model of suicide as a framework for ... The Narrative Crisis Model of Suicide (NCM) is an iterative, dynamic, diathesis-stress model that conceptualizes individuals' progression to suicidal behavior.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12429010/

Comparing the Impacts of Crisis Response Plan and Self‐ ... More frequent CRP use was linked with lower risk of suicidal ideation and greater positive affect. This may reflect better plan use due to ...

3. personalizedmedpsych.com personalizedmedpsych.com/article/S2468-1717(24)00016-4/abstract

The narrative crisis model of suicide as a framework for ... The Narrative Crisis Model of Suicide (NCM) is an iterative, dynamic, diathesis-stress model that conceptualizes individuals' progression to suicidal behavior.

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0165032724009145

A randomized controlled trial of patient-clinician ... Narrative assessment paired with a Crisis Response Plan reduces suicidal thoughts. •. Collaborative risk assessments can enhance safety ...

5. psychiatryonline.org psychiatryonline.org/doi/full/10.1176/appi.focus.20220072

Suicide Risk Assessment, Management, and Mitigation in ... Screening helps to identify the few people at risk within a large group. Assessment seeks to decide whether a specific individual is at significant risk.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10189833/

Effectiveness of Suicide Safety Planning Interventions Evidence across a range of studies indicates that SSP is effective for reducing suicide behavior (SB) and ideation (SI).

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0887618523001627

Crisis response planning rapidly reduces suicidal ideation ... Crisis response planning (CRP), a brief safety planning-type intervention, has been shown to rapidly reduce suicidal ideation and suicide attempts.

8. msrc.fsu.edu msrc.fsu.edu/blog/msrc-common-data-elements-cde/

Crisis Response Plan (CRP) Results indicated Soldiers who received a CRP were 76% less likely to attempt suicide during the next six months as compared to Soldiers who received standard ...

9. bmchealthservres.biomedcentral.com bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-11739-w

insights from a randomized control trial of crisis response plan ... Both Crisis Response Plan and self-guided Safety Planning were found to lower suicidality after receiving them via telehealth services.