Brief Suicide Prevention Interventions May Reduce Subsequent Attempts

A meta-analysis of 14 studies found that brief suicide prevention interventions for patients at risk of suicide are associated with reduced subsequent suicide attempts and increased linkage to follow-up care, but not with reduced depression symptoms. The findings were published yesterday in JAMA Psychiatry.

“All of these studies show that we have evidence-based treatments in our arsenal to fight the suicide epidemic that work in different settings and different populations,” wrote Nadline M. Melhem, Ph.D., and David Brent, M.D., of the University of Pittsburgh School of Medicine in an accompanying editorial. “What we need to do next is to implement them at the appropriate point of contact in the health care system and train clinicians to deliver them.”

Stephanie K. Doupnik, M.D., M.S.H.P., of the University of Pennsylvania and colleagues conducted a review of clinical trials that involved brief suicide prevention interventions that could be delivered in a single encounter. They searched databases including Ovid MEDLINE, Scopus, CINAHL, PsychINFO, and Embase for studies published between 2000 and 2019. The studies were eligible for inclusion if they examined an intervention delivered in a single in-person encounter to patients with identified suicide risk, included a comparison group, measured patient outcomes, and were available in English.

The authors ultimately evaluated 14 studies representing outcomes for 4,270 patients. Seven of these studies measured suicide attempts, nine measured linkage to follow-up care, and six measured depression symptoms. The researchers identified four main components of interventions: brief contact interventions, including phone calls, postcards, and letters; care coordination, such as scheduling an outpatient mental health appointment; safety planning interventions, such as identifying internal coping strategies to distract from suicidal thoughts and urges; and other therapeutic interventions, such as motivational interviewing and therapies focused on improving problem-solving skills.

Brief suicide interventions were associated with a 3.5% reduction in subsequent suicide attempts, while the rate of linkage to follow-up care increased by 22.5%. Reduction in depression symptoms at follow-up was not statistically significant, however.

In their editorial, Melhem and Brent noted that it is not surprising that brief interventions did not reduce depression symptoms, which is an important predictor of suicide attempts. “However, interventions including more than a single encounter are needed to result in a sustained reduction in depression symptoms,” they wrote.

They concluded: “As the world is now grappling with the coronavirus disease 2019 pandemic and its potential effects on mental health and the suicide epidemic in the United States, we need to be prepared with brief suicide preventive interventions that every clinician could deliver face to face or through telemedicine.”

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