Suicide ranks 10th among all causes of mortality in the United States, accounting for more than 40,600 deaths in 2012. Suicide attempts result in 600,000 emergency room visits and nearly 200,000 hospitalizations each year. Reducing this potentially preventable morbidity and mortality is a public health priority. Recent developments create an opportunity to evaluate population-based, selective prevention programs for suicidal behavior. First, increasing use of standard depression severity measures allows timely and efficient identification of people at risk for suicidal behavior. Second, efficient and scalable interventions have shown promise for reducing risk of suicide attempt in at-risk populations. Third, the NIMH-funded Mental Health Research Network has established a nationwide infrastructure large enough to test prevention programs.
This large pragmatic trial will test treatments intended to reach large groups of adult patients who have serious thoughts of suicide. Patients at risk will be identified and followed through medical records. The research team will test two treatment programs: The first program, a care management approach, draws on two previous efforts, a collaborative care for depression strategy plus an approach developed at the Henry Ford Health System. The second program is an online skills training method designed to help people manage painful emotions and stressful situations.
To determine the impact of the two prevention strategies, patients will be compared with another group of patients receiving usual care. This 5-year study is designed to enroll 19,500 patients. In addition to its large scope and the significant problem that it will address, this study is groundbreaking because the study design and intervention programs were developed in collaboration with people with “lived experience,” those who have experienced suicidal thoughts or survived suicide attempts themselves.