Tailored Activation of Middle-Aged Men to Promote Discussion of Recent Active Suicide Thoughts: a Randomized Controlled Trial

Abstract

Purpose

Middle-aged men are at high risk of suicide. While about half of those who kill themselves visit a primary care clinician (PCC) shortly before death, in current practice, few spontaneously disclose their thoughts of suicide during the visits, and PCCs seldom inquire about such thoughts. In a randomized controlled trial, we examined the effect of a tailored interactive computer program designed to encourage middle-aged men’s discussion of suicide with PCCs.

Methods

We recruited men 35–74 years old reporting recent (within 4 weeks) active suicide thoughts from the panels of 42 PCCs (the unit of randomization) in eight offices within a single California health system. In the office before a visit, men viewed the intervention corresponding to their PCC’s random group assignment: Men and Providers Preventing Suicide (MAPS) (20 PCCs), providing tailored multimedia promoting discussion of suicide thoughts, or control (22 PCCs), composed of a sleep hygiene video plus brief non-tailored text encouraging discussion of suicide thoughts. Logistic regressions, adjusting for patient nesting within physicians, examined MAPS’ effect on patient-reported suicide discussion in the subsequent office visit.

Results

Sixteen of the randomized PCCs had no patients enroll in the trial. From the panels of the remaining 26 PCCs (12 MAPS, 14 control), 48 men (MAPS 21, control 27) were enrolled (a mean of 1.8 (range 1–5) per PCC), with a mean age of 55.9 years (SD 11.4). Suicide discussion was more likely among MAPS patients (15/21 [65%]) than controls (8/27 [35%]). Logistic regression showed men viewing MAPS were more likely than controls to discuss suicide with their PCC (OR 5.91, 95% CI 1.59–21.94; P = 0.008; nesting-adjusted predicted effect 71% vs. 30%).

Conclusions

In addressing barriers to discussing suicide, the tailored MAPS program activated middle-aged men with active suicide thoughts to engage with PCCs around this customarily taboo topic.

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Acknowledgments

We are indebted to the primary care offices, PCCs, and patients who participated in the trial. We are also grateful to the following individuals: Peach Dounias, BS, Sherry Hao, BA, Lauren Walker, MSW, and Zachary Weiss, BA, who facilitated the patient recruitment and participation; Simon Dvorak, BA, Charles Turner, PhD, and Robert Burnett, MA, who programmed the MAPS and control interventions; the actors who performed in videos incorporated in MAPS, overseen, and trained by Lynn Baker-Nauman, MA; and the analysts at the University of California Davis Clinical and Translational Science Center, for the administrative support in conducting the trial.

Funding

This work was supported by cooperative agreement U01CE002664 (Jerant, Duberstein) from the National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention (CDC). Additional funding was provided by the UCD Behavioral Health Center of Excellence (Jerant) and the Department of Family and Community Medicine (Jerant). The CDC participated in the design and conduct of the study. Neither the CDC nor the other funders had a role in the collection, management, analysis, or interpretation of the data or in the decision to submit the manuscript for publication.

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Correspondence to Anthony Jerant MD.

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Jerant, A., Duberstein, P., Kravitz, R.L. et al. Tailored Activation of Middle-Aged Men to Promote Discussion of Recent Active Suicide Thoughts: a Randomized Controlled Trial. J GEN INTERN MED 35, 2050–2058 (2020). https://doi.org/10.1007/s11606-020-05769-3

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