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ViewAttendees 4

Symposia

Suicide and Self-Injury

Reducing Suicide Reattempts in Hospitalized Patients: The Institute of Living Suicide Prevention Project

1 - (SYM 105) Brief Cognitive-behavioral Therapy for Suicidal Inpatients: A Randomized Clinical Trial

Saturday, November 16, 2024
4:30 PM – 6:00 PM EST
Location: Grand Ballroom K/L, Level 5, Downtown Marriott
Abstract Body
Optimizing suicide prevention care during inpatient stays is crucial given that the post-discharge period is one of the highest risk times for suicide attempt and death. Brief Cognitive-Behavioral Therapy (BCBT) has demonstrated efficacy for reducing suicide attempts in outpatients. The aim of the current study was to determine whether adding an inpatient version of BCBT (BCBT-I) to treatment as usual (TAU) reduced post-discharge suicide attempts, suicidal ideation, and psychiatric readmissions. Given that substance use disorder (SUD) is associated with elevated suicide risk, this study also tested the moderating effect of SUD. Inpatients (n = 200) admitted following a suicidal crisis (past week suicide attempt or ideation with plan on admission and attempt within previous two years) were included. Most participants identified as women (52.0%, [10.0% identified as gender diverse]), White (61.5%), not Hispanic (70.5%), not married or living together (78.5%), not working (60.5%), and with annual household income < $30,000/year (51.0%). A sizable minority reported being houseless (23.5%). Sixty percent were diagnosed with a current SUD. Participants were randomized (blocked by SUD status) to TAU (n = 106) or to TAU plus BCBT-I (n = 94). BCBT-I consisted of up to four individual sessions (depending on time to discharge) which included narrative assessment and review of suicide attempt stories, crisis response plan, inventorying reasons for living, creation of a hope kit, reducing access to lethal means, and relapse prevention. Follow-up assessments were completed monthly for six months post-discharge. Suicide attempts and readmissions were assessed via blind interviews and medical record review. Suicidal ideation was assessed via self-report. Results indicated that adding BCBT-I to TAU reduced the odds of occurrence of suicide attempt over 6 months post-discharge by 60% [Odds Ratio estimate=0.40, 95% CI: (0.20, 0.80)] in the entire patient group, and the rate of psychiatric readmissions by 71% [Rate Ratio estimate=0.29, 95% CI: (0.09, 0.90)] in those without a SUD. The effect of treatment condition on suicidal ideation was less clear, although post-hoc analyses indicated less severe suicidal ideation following BCBT-I versus TAU at one and two months post-discharge. These data provide strong support for BCBT-I as an efficacious inpatient suicide prevention treatment. Additional research is needed to facilitate treatment implementation, determine cost-effectiveness, and optimize outcomes for individuals with SUD.