For a study, researchers sought to compare two low-intensity outreach programs with standard treatment to prevent suicidal conduct in outpatients who have recently had frequent suicidal thoughts. Outpatients with frequent suicide thoughts were detected using regular Patient Health Questionnaire depression screening at four US integrated health systems in a pragmatic randomized clinical study. Between March 2015 and September 2018, a total of 18,882 participants were randomized, and results were tracked through March 2020. Patients were randomly assigned to one of three interventions: care management (n=6230), which included systematic outreach and care, skills training (n=6227), which introduced four dialectical behavior therapy skills (mindfulness, mindfulness of current emotion, opposite action, and paced breathing), or usual care (n=6187). Interventions lasted up to 12 months and were designed to enhance ongoing mental health care. The primary result was the time it took to commit nonfatal or fatal self-harm for the first occasion. Nonfatal self-harm was determined using health-care records, while fatal self-harm was determined using state death statistics. Secondary outcomes included more severe self-harm (resulting in death or hospitalization) and a broader definition of self-harm (selected injuries and poisonings not originally coded as self-harm).
A total of 18,644 patients (9009 [48%] aged 45 years or older, 12,543 [67%] female, 9,222 [50%] from mental health specialist clinics, and the remaining from general care) provided at least one day of follow-up data and were included in analyses. Around 31% of participants received care management, and 39% received skill training while actively participating in intervention programs. Over the 18 months following randomization, 540 patients experienced a self-harm event (including 45 fatalities related to self-harm and 495 nonfatal self-harm events): About 172 (3.27%) in care management, 206 (3.92%) in skills training, and 162 (3.27%) in normal care. Over 18 months, the risk of fatal or nonfatal self-harm did not change substantially between the care management and usual care groups (hazard ratio [HR], 1.07; 97.5% confidence interval [CI], 0.84-1.37) but was considerably greater in the skills training group than in the usual care group (HR, 1.29; 97.5% CI, 1.02-1.64). Care management vs. normal care had an HR of 1.03 (97.5% CI, 0.71-1.51); skills training vs. usual care had an HR of 1.34 (97.5% CI, 0.71-1.51). (97.5% CI, 0.94-1.91). Care management vs. usual care had an HR of 1.10 (97.5% CI, 0.92-1.33); skills training vs. normal care had an HR of 1.17 (97.5% CI, 0.92-1.33). (97.5% CI, 0.97-1.41).
Compared to standard treatment, delivering care management did not substantially lower the risk of self-harm in adult outpatients with recurrent suicidal thoughts, while offering short dialectical behavior therapy skills training significantly raised the risk of self-harm. The study’s conclusions did not support the deployment of the programs examined.