Suicide attempts decreased after adding suicide care to primary care, study finds

After suicide care was integrated into routine primary care visits, researchers saw a 25% decrease in the rate of suicide attempts in the following 90 days, a new Kaiser Permanente study finds.

The study, published in the Annals of Internal Medicine, is the first to show that suicide risk screening in primary care, followed by safety planning, improved suicide prevention efforts in a health care 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 many people seek primary care prior to fatal and nonfatal suicide attempts,” said Julie Angerhofer Richards, Ph.D., MPH, the lead author of the paper and a collaborative scientist at Kaiser Permanente Washington Health Research Institute. “Many health care systems in the U.S. and abroad now routinely ask patients about suicidal thoughts, and this study provides evidence to support this practice, in combination with collaborative safety planning among people identified at risk of suicide attempt.”

Clinics implemented the integrated care model on a rolling basis starting in January 2016. Usual care data was gathered prior to implementation. After implementation, documented safety plans within 2 weeks of a primary care visit increased by 14%. Combined nonfatal 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 said they had relatively frequent thoughts about self-harm were screened further for suicide risk. Those at high risk were referred to members of the care team 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 by primary care teams including integrated mental health social workers,” Richards said. “We were lucky to partner with amazing leaders, clinicians, and staff across our organization.”