Funds awarded by the Patient-Centered Outcomes Research Institute
A research team co-led by David Goldston, PhD, Associate Professor of Psychiatry and Behavioral Sciences in the Duke University School of Medicine, and Joan Asarnow, PhD, Professor of Psychiatry and Biobehavioral Sciences in the David Geffen School of Medicine at UCLA, has been approved for a $13 million funding award by the Patient-Centered Outcomes Research Institute (PCORI).
Through this project, the team will compare two evidence-based interventions for reducing suicide attempts and improving patient outcomes for youth presenting to emergency departments (EDs) with suicidal episodes.
The project features partnerships among researchers, patients, parents, family members, health and mental health care providers, administrators, payers and policy makers to ensure that results are informed by and important to youth, family members, clinicians and other stakeholders.
“From 2003 to 2018, the rates of suicide among young people in the United States ages 12 to 17 doubled, and the rate of suicide in 2018 among adolescent girls was the highest in 20 years,” said Goldston, who serves as the Director of the Duke Center for the Study and Prevention of Suicide. “Rates of suicide attempts are also high, with nearly 19 percent of high school students reporting that they seriously considered suicide and nine percent of students reporting that they attempted suicide in the last year.”
He notes that many youth who present to EDs with suicidal episodes do not receive evidence-based care in in that setting, and often they do not receive follow-up care for suicidal risk or behaviors after their ED visit.
“Brief interventions have the potential to help reduce later suicide attempts and help young people access treatment after discharge from the emergency department,” Goldston said. “It is not known, however, whether interventions in the ED are sufficient to promote safety, or whether additional brief therapeutic contacts and check-ins with young people help improve outcomes.”
To help answer this question, the project team will compare Safety-Acute (A), a crisis therapy session in the ED focused on enhancing safety (previously called the Family Intervention for Suicide Prevention, FISP); and SAFETY-A + Coping Long-Term with Active Suicide Program (CLASP), comprised of brief therapeutic follow-up contacts after discharge from the ED/hospital. Evidence supports benefits of both interventions individually.
“Our study’s results will clarify whether the additional resources needed to provide therapeutic follow-up calls following an ED intervention lead to improved outcomes, and which patient subgroups are most likely to benefit from a treatment approach that provides therapeutic contact both during the ED visit and after discharge,” said Asarnow. “This information can guide decision-makers regarding how to best develop services and service systems to improve patient outcomes and achieve national suicide prevention goals, including for diverse groups to improve equity.”
A large and diverse sample of more than 1,500 youth drawn from five sites will participate. By assessing intervention benefits for youth who are racial or ethnic minorities, from rural and frontier communities, and socioeconomically disadvantaged, the study aims to inform efforts to improve health equity.
Study sites include:
- Duke University Medical Center in North Carolina, led by Dr. David Goldston
- UCLA, led by Dr. Asarnow and Dr. Naser Ahmadi, who will be leading a site at Olive View-UCLA Medical Center
- Brown University Alpert Medical School in Rhode Island, led by Dr. Anthony Spirito and Dr. Ivan Miller III
- University of Utah School of Medicine and Intermountain Healthcare, led by Dr. Brooks Keeshin and Tammer Attallah MBA, MSW
The study was selected for funding through a PCORI funding announcement specifically focused on comparing the effectiveness of brief interventions to prevent suicide among adolescents and young adults, and addresses our national goal of reducing youth suicide.
“This study was selected for PCORI funding for its potential to fill an important gap in our understanding of how best to use brief interventions to reduce the immediate risk of suicide in young people and direct them to appropriate longer-term care,” said PCORI Executive Director Nakela L. Cook MD, MPH. “We look forward to following the study’s progress and working with the project team to share the results.”
The award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.
PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. Additional information about this study is available on the PCORI website.