Thursday, October 28, 2021

‘Recovery-based’ Suicide Prevention Program Lowers Hospital Readmissions, Suicidality

Patients previously hospitalized for suicidality who took part in a comprehensive, recovery-based suicide prevention program in upstate New York were less likely to be rehospitalized and reported fewer suicidal thoughts six months after discharge than patients who received usual care, according to a study published Wednesday in Psychiatric Services in Advance.

To date, suicide prevention efforts have focused largely on screening, education, and brief interventions rather than on the treatment of underlying vulnerabilities, senior author Robert Gregory, M.D., director of the Psychiatry High Risk Program (PHRP) and a professor at Upstate Medical University, told Psychiatric News. In contrast, PHRP emphasizes transformative healing through specialized psychotherapy and aims to strengthen personal and relational capacities, thereby building resilience that leads to recovery, he said.

Gregory and colleagues compared the outcomes of 32 adults aged 18 to 40 who participated in PHRP following discharge from an adult inpatient psychiatry unit with 32 matched adults referred to mental health clinics, therapists, and/or other treatment programs (usual care). Participants in the PHRP group received weekly individual dynamic deconstructive psychotherapy (DDP), a treatment originally developed to treat borderline personality that focuses on remediating deficits in social cognition and emotion processing as well as fostering self-acceptance. The entire treatment team was trained in DDP to improve team cohesion and provide patients with a unified message, the authors noted. PHRP participants also received pharmacotherapy as needed.

The researchers compared the participants’ Patient Health Questionnaire-9 (PHQ-9) scores as well as psychiatric rehospitalization rates and emergency department visits over the course of the six-month study.

PHRP participants’ PHQ-9 scores dropped from an average of 20 at intake to 13 at 180 days postdischarge; item 9 response on the PHQ-9, which measures suicidal ideation, dropped from an average of 2.00 at intake to 0.75 at 180 days postdischarge. PHRP participants had a total of three emergency department visits, and none were readmitted; those in the usual care group had a total of 14 emergency department visits, and 34% were readmitted.

“[T]he study provides preliminary evidence that a recovery-based model of suicide prevention can be feasible, sustainable, and effective in reducing suicide risk and inpatient stays. Future research is needed to establish cost-effectiveness and replicability of this model in other health care systems,” wrote Gregory and colleagues.

“There is nothing about our program that can’t be replicated in other regions of the country to lower [emergency department] and hospital utilization, and to save lives,” Gregory said. “DPP is a manual-based therapy, and training is available for clinicians. Alternative specialized treatments, such as dialectical behavior or cognitive-behavioral therapy, could be substituted in a high-risk program and might be just as effective. Other elements of the program could also be reproduced, such as the tight quality assurance, multidisciplinary and multimodal team-based approach with a cohesive treatment philosophy, and help with transitions in care.”

For related information, see the Psychiatric News article “Innovative Suicide Prevention Program Using Psychotherapy Shows Early Success.”

(Image: iStock/kentarus)

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