Suicide attempts decreased after adding suicide care to primary care, research shows

After suicide care was integrated into routine primary care visits, researchers saw a 25% drop in suicide attempts over the next 90 days, according to a new study from Kaiser Permanente.

The study, published in the Annals of Internal Medicineis the first to demonstrate that screening for suicide risk in primary care, followed by safety planning, has improved suicide prevention efforts in a healthcare setting. The trial took place at Kaiser Permanente clinics in Washington state, using data from January 2015 to July 2018.

“Our findings are important because we know that many people seek primary care prior to fatal and nonfatal suicide attempts,” said Julie Angerhofer Richards, Ph.D., MPH, the paper’s lead author and a collaborating scientist at Kaiser Permanente Washington Health Research . Institute. “Many healthcare systems in the US and abroad now routinely ask patients about suicidal ideation, and this study provides evidence to support this practice, along with collaborative safety planning among people identified as at risk for a suicide attempt.”

Clinics progressively implemented the integrated care model starting in January 2016. Usual care data were collected prior to implementation. After implementation, the number of documented safety plans increased by 14% within two weeks of a primary care visit. Combined non-fatal suicide attempts and suicide deaths decreased by 25%. Overall, more people were screened and assessed for suicide risk, depression, and alcohol and drug use after implementation, compared to usual care.

The integrated care model included screening for all adult patients using the Patient Health Questionnaire (PHQ-9). Patients who reported having thoughts about self-harm relatively often were further screened for suicide risk. Those at high risk were referred to health care team members for safety planning.

Practice facilitation, clinical decision support tools in the electronic medical record, and regular performance monitoring were used to support implementation.

“This work required strong leadership support and active participation from primary care teams, including integrated mental health social workers,” Richards said. “We were fortunate to work with great leaders, physicians and employees across our organization.”