How to Reduce Suicide in Primary Care

Written by Babatunde Carew

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A cluster randomized implementation trial integrating suicide care same-day strategies into a primary care clinic reduced 90-day suicide attempts by 25% in patients with frequent thoughts of self-harm.

Synopsis
This secondary analysis of a stepped-wedge, cluster-randomized trial evaluated the effectiveness of integrating suicide care (SC) into primary care across 19 practices within a U.S. health system, focusing on suicide attempt prevention. The study found that SC implementation significantly reduced suicide attempts within 90 days of visits (4.5 vs. 6.0 per 10,000 patients; rate difference: -1.5, 95%CI -2.6 to -0.4) and increased safety planning documentation (38.3 vs. 32.8 per 10,000 patients; rate difference: 5.5, 95%CI 2.3 to 8.7). Secondary findings included improved suicide risk identification but modest psychotherapy uptake. The study demonstrates the potential of population-based SC integration to enhance primary care-driven suicide prevention efforts. (AI-generated)

Primary care steps up – suicide risk steps down
The authors open the study with a harrowing statistic, noting that more than 40% of people who die by suicide see a PCP in the month before death and more than 75% see a PCP in the year before. The USPSTF recommends screening patients for depression, though there is no consensus on how to respond when patients have suicidal thoughts. The SC strategy in this study utilized the PHQ-2, PHQ-9, and Columbia-Suicide Severity Rating Scale to identify patients with frequent thoughts of self harm; such patients were then given same-day safety planning by a licensed clinical social worker. This resulted in a 25% reduction in suicide attempt rate in the 90 days after primary care visit. While this study highlights an important potential strategy in patients with suicidal ideation, a major limitation to real-world adoption is the shortage of trained providers available to implement safety planning in at risk patients. Future studies to identify streamlined safety planning strategies that can be widely adopted by care teams without regular access to trained social workers are needed to be able to make SC a standard part of primary care practices.

Source
Effectiveness of Integrating Suicide Care in Primary Care : Secondary Analysis of a Stepped-Wedge, Cluster Randomized Implementation Trial. Ann Intern Med. 2024 Nov;177(11):1471-1481. doi: 10.7326/M24-0024. Epub 2024 Oct 1. PMID: 39348695