Telehealth in preventing suicide (TIPS) for Suicide

1
Effectiveness
1
Safety
UMass Chan Medical School, Worcester, MA
Suicide+1 More
Telehealth in preventing suicide (TIPS) - Other
Eligibility
18+
All Sexes
Eligible conditions
Suicide

Study Summary

This study is evaluating whether a telephone intervention can improve access to behavioral health care for people who are suicidal in the emergency department.

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Eligible Conditions

  • Suicide
  • Suicide Risk

Treatment Effectiveness

Effectiveness Estimate

1 of 3

Study Objectives

This trial is evaluating whether Telehealth in preventing suicide (TIPS) will improve 3 primary outcomes and 13 secondary outcomes in patients with Suicide. Measurement will happen over the course of 24 months.

24 months
Door to Behavioral Health Evaluation Time
Emergency Department Psychiatric Boarding Hours for Admitted Patients
In-situ intentional self-injury
Intervention Targets - Behavioral Health Appointments
Intervention Targets - Behavioral Health Evaluations
Intervention Targets - Observations
Intervention Targets - Post Visit Contacts
Intervention Targets - Safety Plans (Overall Quality)
Intervention Targets - Safety Plans (Total Number)
Intervention Targets - Suicide Risk Assessments
Percentage of Patients Admitted to Inpatient Psychiatric Treatment
Percentage of Patients Stratified as High/Imminent Risk
Suicide composite outcome
Total Length of Stay
Transfer for psychiatric evaluation
Unintentional injury death

Trial Safety

Trial Design

3 Treatment Groups

No intervention, Treatment as Usual
TIPS Alone

This trial requires 44000 total participants across 3 different treatment groups

This trial involves 3 different treatments. Telehealth In Preventing Suicide (TIPS) is the primary treatment being studied. Participants will be divided into 2 treatment groups. There is no placebo group. The treatments being tested are not being studied for commercial purposes.

TIPS Alone
Other
The TIPS synchronous telehealth protocol will consist of (a) two-way televideo evaluation with enhanced suicide risk components, performed by a Masters-level evaluator from Community HealthLink, and (b) telephone consultation and, in some cases, televideo evaluation by a psychiatrist for patients the evaluator judges should be admitted. The primary evaluation will gather data form the ED providers, patient, and any other collateral sources available. The core of the evaluation itself will consist of Community HealthLink's existing standard adult emergency mental health evaluation, which is a semi-structured evaluation focused primarily on informing a disposition decision on whether to admit the patient to a psychiatric unit. The evaluators will use this same evaluation to guide the telehealth evaluation.
TIPS and ED-SAFEHalf of the ED discharged patients with suicide risk will also be invited to receive post-discharge telephone counseling originally developed by Principal Investigator in a previous study, "Emergency Department Safety Assessment and Follow-up Evaluation" (ED-SAFE). The participant will receive three calls, clustered within three months of the index visit, with some flexibility to continue beyond that if desired. These coaching calls will still follow the original structure and content from ED-SAFE, with modifications guided by study investigators.
No intervention, Treatment as Usual
Other
No study related intervention, just monitoring of current practices used to provide suicide-related care in the non-intervention EDs.

Trial Logistics

Trial Timeline

Approximate Timeline
Screening: ~3 weeks
Treatment: Varies
Reporting: 24 months
This trial has the following approximate timeline: 3 weeks for initial screening, variable treatment timelines, and roughly 24 months for reporting.

Who is running the study

Principal Investigator
E. B.
Prof. Edwin Boudreaux, Professor
University of Massachusetts, Worcester

Closest Location

UMass Chan Medical School - Worcester, MA

Eligibility Criteria

This trial is for patients born any sex aged 18 and older. There are 3 eligibility criteria to participate in this trial as listed below.

Mark “yes” if the following statements are true for you:
The study only looked at residents of Massachusetts. show original
An individual who is 18 years of age or older. show original
Adults who present to the ED and are considered to be at risk for suicide will either have a mental health evaluation or will complete a suicide risk screener. show original

Patient Q&A Section

Please Note: These questions and answers are submitted by anonymous patients, and have not been verified by our internal team.

What is suicide?

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From the medical perspective, suicide is the act of intentionally causing one's own death by one's own means—in particular by taking one's own life (in contrast to homicide, which is non-suicidal death caused by an external perpetrator, not by the suicidal individual themselves). It is the seventh leading cause of death in the United States and currently affects about 40 in 100,000 men and women each year. As the most commonly used method of suicide, suicide is the most commonly studied means of suicide. Suicide has been studied extensively all over the world. It is recognized as one of the world's leading public health crises with a global impact on human social behavior.

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How many people get suicide a year in the United States?

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At least 1 in 5 suicides involved alcohol intake. In the suicide population, 1.1% of patients had major depression, and 0.7% had a history of substance use disorder.

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Can suicide be cured?

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Even if we try to eradicate this problem, there does not appear to be a cure. The question of if life is worth living must be asked before the dilemma is to suicide or not, which may have to be informed to family/friends.

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What are common treatments for suicide?

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The most commonly used treatments for death by suicide are a combination of medications and an active surveillance approach. However, these methods may not help everyone and are not free of side effects, which may be a matter of discussion in patients with comorbidities. The benefits of using medications in suicide attempts in the treatment of depression seem to be questionable. Although there is no difference from placebo in the benefits of using antipsychotics for depression, the use of mood-stabilizers, antidepressants, and anticonvulsants increase the risk of suicide attempts. Therefore, treatments with antidepressants and mood stabilizers should be limited to those who are currently suicidal.

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What causes suicide?

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There was a significant correlation between suicidal ideation and psychiatric comorbidity. However, correlation was only seen in the bipolar group. The main reasons for non-fatal suicidal behaviour in the survey were personal problems (50%), social factors (28.9%), depressive disorder (23.3%), psychiatric comorbid disease and/or drug misuse (7.7%), and somatic illnesses (3.7%). Bipolar patients with previous history of suicidal behaviour had less severity of depression, but they had more severe social problem and higher rate of other psychopathology than the patients who had no previous suicidal behaviour.

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What are the signs of suicide?

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Early signs of suicide include changes in behaviour such as indecision and lack of interest. Aspirin may be a good indicator of depression, and there is potential risk of suicide as the disease progresses.

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Does telehealth in preventing suicide (tips) improve quality of life for those with suicide?

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A short telephone consultation did not improve the quality of life of people with suicidal thoughts or plans among those with no previously tried means of suicide.

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What is the average age someone gets suicide?

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The suicide rate in Japan has been on the rise since the mid-1970s, especially in rural areas. While suicide rate has remained low in rural and urban areas alike, it has been on the rise in Tokyo-Yokohama-Nagoya (an urban and cosmopolitan area) since 2010. The suicide rate in rural areas in Japan has always been lower than that of urban areas and this trend has continued since the mid-1970s. The suicide rate in rural areas in Japan seems to have been increasing in the past few years, although this is still considerably lower than that of urban areas.

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What are the common side effects of telehealth in preventing suicide (tips)?

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The common side effects of telehealth are a common sense knowledge among clinicians and the public, but many patients still suffer from adverse psychosocial consequences of this technology.

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How does telehealth in preventing suicide (tips) work?

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The study shows that the use of phone calls reduces the use of all lethal means of suicide, even more so in high-age groups where the reduction in suicides is relatively lower.

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Has telehealth in preventing suicide (tips) proven to be more effective than a placebo?

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The two experimental conditions have no effect on the suicidal behaviour but the telehealth programme has been proven to be effective. Thus telehealth may be seen as another option for eliminating the risks associated with suicide while also providing information and support to those at risk. Data from a recent study could give some encouragement while further work is being undertaken on the prevention of suicide using telehealth and telemedicine.

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What is the primary cause of suicide?

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Although suicidality is a complex and sometimes controversial issue, the primary cause of a suicidal person's behavior is, in the majority of cases, either emotional or environmental factors. The primary factors of the patient's risk status should be assessed to better target the treatments appropriately.

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