A research team led by Dr. Joan Asarnow from the UCLA Youth Stress and Mood Program at UCLA's Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, has been approved to lead a $13 million funding award by the Patient-Centered Outcomes Research Institute (PCORI) to compare two evidence-based interventions for reducing suicide attempts and improving patient outcomes for youth presenting to emergency departments 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.
"Suicide is currently the second leading cause of death for youths ages 15 to 24 in the United States, responsible for more deaths than any major illness," said Joan Asarnow, PhD, Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine and Director of the Youth Stress and Mood Program at UCLA, who will lead the study. "Young people with serious suicidal behavior or thoughts often present to emergency departments (EDs), particularly youth who make potentially deadly suicide attempts. While current evidence indicates benefits of some tested interventions for reducing later suicide attempts and improving the likelihood that youth will receive needed mental health treatment after discharge, it is not yet known whether it is sufficient to provide a safety and stabilization focused intervention in the ED, or whether additional therapeutic follow-up contacts are needed to improve youth 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 Dr. 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 over 1500 youth drawn from 5 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: UCLA led by Dr. Asarnow and Dr. Naser Ahmadi who will be leading a site at Olive View-UCLA Medical Center; Duke University Medical Center in North Carolina led by Dr. David Goldston, the other project principal investigator; Brown University Alpert Medical School in Rhode Island led by Dr. Anthony Spirito and Dr. Ivan Miller III; and 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. Suicide rates in the U.S. have been increasing during the past two decades, and increasing rates of youth presenting with mental health related ED visits, and visits for suicidal ideation and behavior, have raised concerns that the effects of the COVID-19 pandemic on mental health could lead to a further rise in suicide rates.
"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 is available at pcori.org/research-results/2021/youth-partners-care-suicide-prevention-ypic-sp and on the website for the Center for Trauma Informed Adolescent Suicide, Self-Harm, and Substance Misuse Treatment and Prevention, led by Drs. Asarnow & Goldston asapnctsn.org.