Suicide Attempt Rates Are Reduced by Integrating Suicide Care into Primary Care

Integrating population-based suicide care into primary care in combination with a substance us program reduced suicide attempts by 25% within 90 days of the primary care visit, according to study findings published in Annals of Internal Medicine.

Researchers conducted a secondary analysis of a stepped-wedge, cluster randomized implementation trial (ClinicalTrials.gov Identifier: NCT02675777) at 19 primary care practices in Washington State, US to assess the outcomes of integrating population-based suicide care for suicide attempt prevention into primary care. Adults who had a primary care visit between January 2015 and July 2018 were eligible for inclusion and received either usual care or the intervention. The intervention included the administration of an annual 7-item screening, which comprised the 2-item Patient Health Questionnaire for depression, 3-item Alcohol Disorders Identification Test-Consumption, a cannabis use frequency question, and a question regarding the frequency of illegal drug or nonmedical use of prescription medications; the self-administered Columbia-Suicide Severity Rating Scale, which assessed suicide risk; and same-day safety planning. Primary outcomes included safety planning after screening and suicide risk assessment, as well as suicide attempts or deaths within 90 days of a primary care visit. Mixed-effects logistic models were used in statistical analysis.

A total of 255,789 patients (mean age, 49.3; women, 58.5%; White non-Hispanic/Latinx, 71.8%) made 953,402 primary care visits during the usual care period and 228,255 patients (mean age, 50.2; women, 59.3%; White non-Hispanic/Latinx, 70.3%) made 615,511 visits during the suicide care period.

The median number of visits across both the usual and suicide care periods for patients with and without suicidal thoughts during any visit was 3 and 2, respectively. 

The suicide vs usual care group demonstrated significantly higher rates of safety planning (38.3 vs 32.8 per 10,0000 patients; rate difference, 5.5; 95% CI, 2.3-8.7) and lower suicide attempts in the 90 days post-primary care visits (4.5 vs 6.0 per 10,000 patients; rate difference, -1.5; 95% CI, -2.6 to -0.4).

In all, 84.5% and 19.9% of patients in the suicide and usual care groups, respectively, were screened via the Alcohol Use Disorders Identification Test-Consumption w for alcohol misuse. In the suicide and usual care groups, a positive test result was yielded by 21.7% and 19.9% of patients, an alcohol use disorder diagnosis was received by 0.67% and 0.79% of patients, and brief alcohol counseling was received by 0.51% and 0.14% of patients, respectively.

Study limitations included the joint implementation of suicide care and substance use disorder treatment, relevance of results since the COVID-19 pandemic, reliance on self-reported suicidality screening tools, and reduced generalizability of results to the entire US population.

“Future work might consider examining both the independent and bundled effects of clinical practices supporting care for depression, suicidality, alcohol, cannabis, and other drug use,” the study authors concluded.