UH3 Project: Suicide Prevention Outreach Trial (SPOT)

UH3 Project: Suicide Prevention Outreach Trial (SPOT)

Principal Investigator:

Sponsoring Institution: Kaiser Permanente Washington Health Research Institute

Collaborators:

  • HealthPartners Institute for Education and Research

  • Kaiser Permanente Colorado

  • Kaiser Permanente Northwest
  • Kaiser Permanente Washington

NIH Institute Providing Oversight: National Institute of Mental Health (NIMH)

Program Official: Matthew Rudorfer, MD (NIMH)

Project Scientist: Jane Pearson, PhD (NIMH)

ClinicalTrials.gov Identifier: NCT02326883

Trial Status: Completed

Study Snapshot

Trial Summary

Study question and significance: People at risk of self-harm or suicidal behavior can be accurately identified, but effective prevention will require effective scalable interventions. The objective of this study was to compare 2 low-intensity outreach programs with usual care for prevention of suicidal behavior among outpatients who report recent frequent suicidal thoughts.

Design and setting: Pragmatic, randomized clinical trial with 18,882 outpatients reporting frequent suicidal thoughts identified using routine Patient Health Questionnaire depression screening at 4 US integrated healthcare systems between March 2015 and September 2018, with follow-up continued through March 2020.

Intervention and methods: The study compared 2 low-intensity outreach programs—care management and dialectical behavior therapy skills training—to usual care. The primary outcome was time to first nonfatal or fatal self-harm event. Secondary outcomes included more severe self-harm (leading to death or hospitalization) and a broader definition of self-harm (selected injuries and poisonings not originally coded as self-harm).

Findings: The percentage of fatal or nonfatal self-harm events was 3.1% for those receiving usual care, 3.3% for patients offered care management, and 3.9% for patients offered dialectical behavior therapy skills training. The risk of self-harm varied with patients’ level of intervention participation. In both intervention groups, patients who actively declined intervention services had the lowest risk of self-harm. Patients who did not respond to the invitation to participate or who actively participated for more than 3 months had intermediate risk. Patients who initially participated in the intervention but continued for less than 3 months had the highest risk.

Conclusions and relevance: Offering care management to adult outpatients experiencing suicidal ideation did not reduce their risk of self-harm compared to usual care. Patients offered dialectical behavior therapy skills training had significantly greater risk of self-harm compared to usual care.

NIH Project Information

Data and Resource Sharing

VIEW ALL Resources

News and Interviews

Publications

Presentations

Back to top