Panelists presented 2 studies comparing evidence-based strategies to improve patient outcomes.
The Patient-Centered Outcomes Research Institute (PCORI) hosted a virtual panel on youth and young adult suicide prevention, led by U.S. Representatives Ashley Hinson (R-Iowa) and Jamie Raskin (D-Maryland).
PCORI, an independent nonprofit organization sanctioned by Congress in 2010, hosted the panel to present the current state of suicide prevention in this patient population and to discuss 2 ongoing studies funded by PCORI that offer evidence-based strategies and initiatives to help prevent suicide. Presented by Hinson, Raskin and PCORI Executive Director Nakela L. Cook, MD, MPH, the panel shared alarming statistics on suicide: suicide is the second leading cause of death among 15-24 year olds; overall suicide rates have increased by more than 30% since 2001; approximately 1 in 4 youth and young adults worldwide suffer from clinically severe depression; and 1 in 5 young people experience clinically elevated anxiety, double the pre-pandemic rate. “These disturbing statistics demonstrate a dire need for more evidence on effective suicide prevention strategies to help clinicians care for those at risk,” Nakela said.1
After the keynote, Jill Harkavy-Friedman, PhD, vice president of research at the American Foundation for Suicide Prevention, discussed the social, psychosocial, biological and environmental factors that often contribute to suicidal ideation in young people. and young adults. “What we’ve learned from most of the research is that [individuals who die by suicide] have trouble shifting gears and struggle to see strategies for coping,” Harkavy-Friedman said. “Essentially, they are in tremendous pain. They feel helpless, they feel hopeless, and they feel like they can be a burden on people and nothing will ever change.1
Harkavy-Friedman added that these people do not have access to their normal coping mechanisms when in crisis, also noting that factors contributing to suicide risk are not static and there is never a single cause of suicide. “I think it’s important for people to understand that 60% of people who die by suicide die the first time,” she said. “So we actually have to reach people before they get to the point of being aggressive or engaging in suicidal behavior.”1
In order to reach these people earlier and more effectively, PCORI has funded research, including 2 ongoing studies that were presented to the panel. Anna Radin, DrPH, MPH, an applied researcher in the St. Luke’s Health System Applied Research Division, presented a study that compared 2 types of follow-up support for adolescents and adults who tested positive for the risk of suicide in primary care clinics and emergency departments (ED). Interventions reviewed include Safety Planning Intervention+ (SPI+), which involves support via phone calls, and Caring Contacts (CC), which involves support via a phone call and subsequent text or email. In both cases, people receive personalized and non-demanding support in connection with a safety plan that they developed while they were still in the hospital or clinic. Compared to patients who received usual care, those who received SPI+ were half as likely to engage in suicidal behavior and twice as likely to undergo outpatient treatment, and those who received CC intervention were 44% less likely to have suicidal thoughts and 48% less likely to attempt suicide.2
“I think the most important thing we’ve seen so far is the very high level of satisfaction with both interventions so far,” said Radin, who is also the study’s principal investigator. “Of those who completed an interim satisfaction rating, 99% of our participants said that the follow-up phone calls they received for either intervention were helpful and would recommend them to a friend, and 95% of our attendees said the text messages they received were also helpful.1
The panel ended with a discussion of the second study – presented by Joan R. Asarnow, PhD, ABPP, professor of psychiatry and biobehavioral sciences at UCLA and director of the UCLA Youth Stress and Mood Program – which also compared 2 evidence-based interventions to reduce suicide attempts. This study focuses on Safety-Acute (A), which is an emergency room crisis therapy session focused on patient safety (formerly known as Family Intervention for Suicide Prevention [FISP]), and the SAFETY-A+ Coping Long-term with Active Suicide Program (CLASP), which is a series of brief therapeutic follow-up contacts that occur after discharge from the ER or hospital. Including 1,516 young people between the ages of 15 and 24 who presented to the emergency room with suicidal ideation and/or behavior in the study, the researchers randomly assigned participants to SAFETY-A or SAFETY-A+ FERMOIR, then performed assessments at the 3-, 6-, and 12-month marks. The objectives of the study are to improve the continuity of care within this patient population; identify patients who would benefit from a treatment approach that provides therapeutic contact both while in the ED and after discharge; and help guide decision-makers in developing the services that will most effectively improve patient outcomes and achieve national suicide prevention goals.3
“Research confirms that we have effective suicide prevention strategies – and when we implement these strategies in our community settings, we see a reduction in deaths,” said Asarnow, who is also the study’s lead researcher. “While we can’t eliminate all suicides, we can reduce them, and we can also reduce suicide attempts. But the problem is that proven suicide prevention strategies are too often inaccessible to young people…in our communities.1
1. PCORI Virtual Information Session on Youth and Young Adult Suicide Prevention. Patient-Centered Outcomes Research Institute. Presentation of the panel. February 23, 2022.
2. Radin AK, et al. Comparison of two ways to provide follow-up safety planning support for adults and adolescents at risk of suicide. Patient-Centered Outcomes Research Institute. In progress.
3. Asarnow J, et al. Young Partners in Care for Suicide Prevention (YPIC-SP). Patient-Centered Outcomes Research Institute. In progress.