Suicide risk management: development and analysis of a telephone-based approach to patient safety
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Research-based queries about patients’ experiences often uncover suicidal thoughts. Human subjects review requires suicide risk management (SRM) protocols to protect patients, yet minimal information exists to guide researchers’ protocol development and implementation efforts. The purpose of this study was to examine the development and implementation of an SRM protocol employed during telephone-based screening and data collection interviews of depressed primary care patients. We describe an SRM protocol development process and employ qualitative analysis of de-identified documentation to characterize protocol-driven interactions between research clinicians and patients. Protocol development required advance planning, training, and team building. Three percent of screened patients evidenced suicidal ideation; 12% of these met protocol standards for study clinician assessment/intervention. Risk reduction activities required teamwork and extensive collaboration. Research-based SRM protocols can facilitate patient safety by (1) identifying and verifying local clinical site approaches and resources and (2) integrating these features into prevention protocols and training for research teams.
Supplementary Material (0)
- Pearson, J. L., Stanley, B., King, C. A., & Fisher, C. B. (2001). Intervention research with persons at high risk for suicidality: Safety and ethical considerations. The Journal of Clinical Psychiatry, 62(sup 25), 17–26.
- Vannoy, S., Whiteside, U., & Unützer, J. (2010). Current practices of suicide risk management protocols in research. Crisis, 31, 7–11. CrossRef
- Jacobs, D. G., Brewer, M., & Klein-Benheim, M. (1999). Suicide assessment: An overview and recommended protocol. In D. G. Jacobs (Ed.), The Harvard Medical School Guide to Suicide Assessment and Intervention (pp. 3–39). San Francisco: Josey-Bass.
- McIntosh, J. L. (for the American Association of Suicidology). U.S.A. suicide 2007: Official final data. Washington, DC: American Association of Suicidology, dated May 23, 2010. Retrieved 02 February 2011 from http://www.suicidology.org.
- Rudd, M. D., Berman, A. L., Joiner, T. E., et al. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide & Life-Threatening Behavior, 36, 255–262. CrossRef
- Mann, J. J. (2002). A current perspective of suicide and attempted suicide. Annals of Internal Medicine, 136, 302–311.
- Hall, R. C. W., Platt, D. E., & Hall, R. C. W. (1999). Suicide risk assessment: A review of risk factors for suicide in 100 patients who made severe attempts. Psychosomatics, 40, 18–27.
- Goldberg, J. F., Singer, T. M., & Garno, J. L. (2001). Suicidality and substance abuse in affective disorders. The Journal of Clinical Psychiatry, 62(suppl 25), 35–43.
- Sareen, J., Cox, B. J., Afifi, T. O., et al. (2005). Anxiety disorders and risk for suicidal ideation and suicide attempts: A population-based longitudinal study of adults. Archives of General Psychiatry, 62, 1249–1257. CrossRef
- Oquendo, M. A., Friend, J. M., Halberstam, B., et al. (2003). Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior. The American Journal of Psychiatry, 160, 580–582. CrossRef
- Seedat, S., Stein, M. B., & Forde, D. R. (2005). Association between physical partner violence, posttraumatic stress, childhood trauma, and suicide attempts in a community sample of women. Violence and Victims, 20, 87–98. CrossRef
- Goodwin, R. D., Kroenke, K., Hoven, C. W., et al. (2003). Major depression, physical illness, and suicidal ideation in primary care. Psychosomatic Medicine, 65, 501–505. CrossRef
- Tang, N. K., & Crane, C. (2006). Suicidality in chronic pain: A review of the prevalence, risk factors and psychological links. Psychological Medicine, 36, 575–586. CrossRef
- Joiner, T. (2005). Why people die by suicide. Cambridge: Harvard University Press.
- Pope, K. S., & Vasquez, M. J. T. (2007). Responding to suicidal risk. In K. S. Pope & M. J. T. Vasquez (Eds.), Ethics and psychotherapy and counseling, 3rd ed. (pp. 258–279). San Francisco: Josey-Bass.
- Mościcki, E. K. (1999). Epidemiology of suicide. In D. G. Jacobs (Ed.), The Harvard Medical School Guide to Suicide Assessment and Intervention (pp. 40–51). San Francisco: Josey-Bass.
- Brown, G. K., Beck, A. T., Steer, R. A., & Grisham, J. R. (2000). Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 68, 371–377. CrossRef
- American Psychiatric Association (2003). Practice guideline for the assessment and treatment of patients with suicidal behaviors. Retrieved 3 February 2011 from http://www.psychiatryonline.com/pracGuide/pracguideChapToc_14.aspx.
- Sánchez, H. G. (2001). Risk factor model for suicide assessment and intervention. Professional Psychology, Research and Practice, 32, 351–358. CrossRef
- Esposito, E., Wang, J. L., Adair, C. E., et al. (2007). Frequency and adequacy of depression treatment in a Canadian population sample. Canadian Journal of Psychiatry, 52, 780–789.
- Fortney, J. C., Pyne, J. M., Edlund, M. J., et al. (2007). A randomized trial of telemedicine-based collaborative care for depression. Journal of General Internal Medicine, 22, 1089–1093. CrossRef
- Unützer, J., Katon, W., Callahan, C. M., et al. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA, 288, 2836–2845. CrossRef
- Joiner, T., Kalafat, J., Draper, J., et al. (2007). Establishing standards for the assessment of suicide risk among callers to the National Suicide Prevention Lifeline. Suicide and Life-Threatening Behavior, 37, 353–365. CrossRef
- Fortney, J. C., Pyne, J. M., Edlund, M. J., Robinson, D. E., Mittal, D., & Henderson, K. L. (2006). Design and implementation of the Telemedicine-Enhanced Antidepressant Management Study. General Hospital Psychiatry, 28, 18–26. CrossRef
- Nutting, P. A., Gallagher, K., Riley, K., White, S., Dickinson, W. P., Korsen, N., et al. (2008). Care management for depression in primary care practice: Findings from the RESPECT-Depression Trial. Annals of Family Medicine, 6, 30–37. CrossRef
- Solberg, L. I., Glasgow, R. E., Unützer, J., et al. (2010). Partnership research: A practical trial design for evaluation of a natural experiment to improve depression care. Medical Care, 48, 576–582. CrossRef
- Unützer, J., Katon, W., Williams, J. W., Jr., et al. (2001). Improving primary care for depression in late life: The design of a multicenter randomized trial. Medical Care, 39, 785–799. CrossRef
- Schulberg, H. C., Bruce, M. L., Lee, P. W., Williams, J. W., Jr., & Dietrich, A. J. (2004). Preventing suicide in primary care patients: The primary care physician's role. General Hospital Psychiatry, 26, 337–345. CrossRef
- Schulberg, H. C., Lee, P. W., Bruce, M. L., et al. (2005). Suicidal ideation and risk levels among primary care patients with uncomplicated depression. Annals of Family Medicine, 3, 523–528. CrossRef
- Bonner, L., Felker, B., Chaney, E., et al. (2005). Suicide risk response: Enhancing patient safety through development of effective institutional policies. In K. Henriksen, J. B. Battles, E. Marks, & D. I. Lewin (Eds.), Advances in patient safety: From research to implementation, 3 (pp. 507–519). Rockville: Agency for Healthcare Research and Quality.
- Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16, 606–613. CrossRef
- Prins, A., Ouimette, P., Kimmerling, R., et al. (2003). The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Prim Care Psychiatry., 9, 9–14. CrossRef
- Bush, K. R., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158, 1789–1795. CrossRef
- Kazis, L. E., Ren, X. S., Lee, A., et al. (1999). Health status in VA patients: Results from the Veterans Health Study. American Journal of Medical Quality, 14, 28–38. CrossRef
- Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277–1288. CrossRef
- Bradley, K. A., DeBenedetti, A. F., Volk, R. J., Williams, E. C., Frank, D., & Kivlahan, D. R. (2007). AUDIT-C as a brief screen for alcohol misuse in primary care. Alcoholism, Clinical and Experimental Research, 31, 1208–1217. CrossRef
- Corson, K., Gerrity, M. S., & Dobscha, S. K. (2004). Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item. Am J Manag Care, 10, 839–45.
- Hailey, D., Roine, R., & Ohinmaa, A. (2008). The effectiveness of telemental health applications: A review. Canadian Journal of Psychiatry, 58, 767–778.
- Kennedy, G. J. (2008). Targets for telephone-based behavioral health interventions. Primary Psychiatry, 15, 35–39.
- Bisconer, S. W., & Gross, D. M. (2007). Assessment of suicide risk in psychiatric hospital. Professional Psychology, Research and Practice, 38, 143–149. CrossRef
- Gilbody, S., Bower, P., Fletcher, J., et al. (2006). Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine, 166, 2314–2321. CrossRef
- Lee, M. L., Yano, E. M., Wang, M., et al. (2002). What patient population does visit-based sampling in primary care settings represent? Medical Care, 40, 761–770. CrossRef
About this Article
- Suicide risk management: development and analysis of a telephone-based approach to patient safety
Translational Behavioral Medicine
Volume 1, Issue 3 , pp 372-383
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Patient safety
- Primary care
- Research participants
- Collaborative care
- Author Affiliations
- 1. Department of Psychology, University of Montana, Missoula, MT, USA
- 12. 32 Campus Dr., Missoula, MT, 59812, USA
- 2. Department of Veterans Affairs, Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA
- 3. Department of Veterans Affairs, Geriatrics Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
- 4. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- 5. Department of Human Development, Washington State University-Vancouver, Vancouver, WA, USA
- 6. Department of Veterans Affairs, Mental Health Service, VA Puget Sound Health Care System, Seattle, WA, USA
- 7. VA New York Harbor Healthcare System, New York, NY, USA
- 8. New York University School of Medicine, New York, NY, USA
- 10. Los Angeles School of Medicine, University of California, Los Angeles, CA, USA
- 11. RAND Health Program, Santa Monica, CA, USA
- 9. Department of Veterans Affairs, Health Services Research and Development Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA