Primary Care’s Vital Role in Suicide Prevention Efforts

NIMH-Funded Research Demonstrates Effective Strategies for Reducing Suicide Attempts in Adult Primary Care Settings

December 30, 2024
• Research Highlight

Suicide remains a leading cause of death in the United States, posing a significant challenge to public health initiatives. Previous studies have revealed that proactively identifying and assisting individuals at risk for suicide during routine healthcare visits can be crucial in prevention efforts. Primary care clinics play a pivotal role in this endeavor, as over 40% of individuals who died by suicide had visited such facilities in the month leading up to their deaths. This stark statistic underscores the importance of integrating preventive measures within these healthcare settings.

A groundbreaking study funded by the National Institute of Mental Health (NIMH) has demonstrated that incorporating targeted suicide care practices into routine visits can lead to a remarkable 25% reduction in suicide attempts within three months following the visit. This research not only emphasizes the vital function that primary care clinics can serve in suicide prevention but also encourages healthcare systems to adopt and implement these crucial practices in everyday clinical care.

Understanding the Research Methodology and Implementation of Suicide Prevention Strategies

During most patient visits, primary care clinicians routinely screen for depression, which often includes inquiries about suicide risk. Previous NIMH-supported studies have established that screening for suicidal thoughts and behaviors, followed by effective safety planning, can significantly diminish the risk of suicide attempts. This study aimed to ascertain whether embedding these suicide care practices into standard adult primary care visits could effectively mitigate future suicide attempts.

Led by Dr. Julie Angerhofer Richards at the Kaiser Permanente Washington Health Research Institute, the research team sought to evaluate the impact of integrated suicide care within routine adult primary care visits on subsequent suicide attempts. The study utilized secondary data derived from a comprehensive investigation into the National Zero Suicide Model, which is recognized as the first U.S. program demonstrating a significant decline in suicides among behavioral health patients.

Prior to the intervention, participating providers followed standard care protocols that did not encompass systematic screening for suicide risk or appropriate follow-up measures. A total of 22 clinics participated in the study, with staggered implementation dates for the suicide care practices over a two-year period. Throughout the study, over 333,593 patients attended more than 1.5 million primary care visits, providing a substantial data set for analysis.

The suicide care intervention included several key components:

• Depression Screening: All patients underwent a brief two-question depression screener, followed by an extensive depression symptom scale for those who indicated positive responses.
• Depression Symptom Scale: Patients who scored positively on the initial screener were further assessed using a comprehensive depression symptom scale.
• Suicide Risk Assessment: Individuals expressing thoughts of self-harm or suicide completed a detailed assessment of suicidal thoughts and behaviors.
• Suicide Safety Planning: Patients revealing intentions or plans to commit suicide in the previous month were promptly referred to designated care staff, including mental health social workers, for immediate safety planning. This collaborative safety planning involved identifying warning signs, developing coping strategies, and establishing a safe environment to effectively manage a suicidal crisis.

The intervention was bolstered by three critical strategies:

• Expert facilitators provided training sessions at each clinic and maintained ongoing support to address challenges and offer solutions.
• Clinical decision support tools, such as pre-visit reminders and visit prompts, were integrated into the clinics’ electronic medical record systems.
• Regular performance monitoring of medical records provided insights into clinicians’ rates of screening and assessment.

The research team conducted a comparative analysis between clinics implementing suicide care and those adhering to standard care practices, focusing on:

• Documentation rates of suicide risk assessments and safety planning within two weeks following an at-risk patient’s primary care visit.
• Incidence rates of suicide attempts or suicides within 90 days post-primary care visit.

Key Findings: The Impact of Integrating Suicide Care in Primary Care Settings

The study revealed that incorporating suicide care into routine adult primary care visits resulted in significantly higher rates of suicide risk screening, thorough assessments, and collaborative safety planning. Notably, the intervention led to a 25% decrease in suicide attempts within 90 days following a primary care visit compared to clinics that provided standard care. These findings suggest that integrating suicide prevention strategies into adult primary care not only increases the number of individuals screened for suicidal thoughts and behaviors but also contributes to a reduction in suicide attempts following their clinic visits.

These results align with NIMH’s emphasis on suicide prevention within healthcare environments, ultimately aiming to lower the suicide rate across the United States. This study outlines crucial next steps for healthcare providers and care teams in addressing suicidal concerns during clinical interactions, thereby playing an essential role in saving lives.

Reference for Further Reading on This Study

Richards, J. A., Cruz, M., Stewart, C., Lee, A. K., Ryan, T. C., Ahmedani, B. K., & Simon, G. E. (2024). Effectiveness of integrating suicide care in primary care: Secondary analysis of a stepped-wedge, cluster randomized implementation trial. Annals of Internal Medicine, 177(11), 1471–1482. https://doi.org/10.7326/M24-0024

Immediate Help Resources for Those in Crisis

If you or someone you know is experiencing suicidal thoughts or crises, please do not hesitate to reach out for help. You can call or text the 988 Suicide and Crisis Lifeline at 988 or engage in a chat at 988lifeline.org . In emergency situations, please call 911.

Explore Additional Resources on Suicide Prevention

Important Disclaimer Regarding the Zero Suicide Framework

The Zero Suicide framework was developed by the Education Development Center (EDC) as part of federally funded initiatives, including the Suicide Prevention Resource Center and the National Action Alliance for Suicide Prevention. The information and branding associated with Zero Suicide are freely accessible through the Zero Suicide Toolkit^SM , which is managed by EDC. There is no official endorsement by EDC intended or implied.