Title: Impact of a Distress Brief Intervention on Suicidal Ideation, Suicide Attempts and Self-harm in the immediate, short and longer term.
Funder: Department of Health and Social Care

Abstract: The aim of this study is to understand whether and how the Distress Brief Intervention (DBI) Programme in Scotland makes a difference to people who have thoughts and feelings of suicide and helps to prevent suicide. Since the 1990’s suicide rates in Scotland have been higher than in the rest of the UK; with 784 deaths by suicide in Scotland in 2018. Suicide attempts are most common amongst young and middle-aged adults, but middle-aged men and women are most likely to die by suicide. Young adults are most likely to self-harm. Young people’s mental health is getting worse and evidence suggests that mental distress has increased among UK adults since Covid-19. Mental distress is experienced by everyone affected by suicide or self-harm. Understanding how NHS and voluntary organisations can help people in distress and prevent suicide is very important. However, doing research studies that provide this learning on a large scale is difficult. _x000D_ _x000D_ The DBI programme began in 2017 in response to the Scottish Government’s Mental Health and Suicide Prevention Strategy which identified a need to improve support for adults in distress in Scotland. Some people who received support from DBI told us they felt DBI may have stopped them from attempting suicide. This research proposal is inspired by them. Through this research we want to find out more about whether and how DBI helps people in distress deal with thoughts and feelings of suicide and whether it prevents people from attempting suicide. We also want to find out how DBI might improve the way it helps people with these problems. _x000D_ _x000D_ There are two levels of DBI. L1: trained staff (e.g. police, A&E, ambulance, primary care and NHS24) provide a compassionate response to individuals who present to them in distress. If they would like further support, they are referred to the DBI service with a promise of contact within the next 24 hours to start L2. At L2 people are offered a recommended 14 consecutive days (although only 55% are finished within 14 days; others are seen for up to a month or more when needed) of community-based support from trained staff. This includes compassionate problem solving, wellness and distress management planning, supported connections and signposting on to other suitable services._x000D_ _x000D_ People who have received support from DBI informed this proposal and will be involved in all aspects of the research. We will collect the following information:_x000D_ • Questionnaires with service users at four stages (immediately before and after receiving LL2 DBI, 3-4 months and 1 year after DBI intervention)_x000D_ • Qualitative interviews with people who have received support from DBI at three stages (1 month, 3-4 months and 1 year after DBI intervention)_x000D_ • Focus groups with DBI staff _x000D_ • Linking information collected from service users via questionnaires to information collected about them by DBI staff. _x000D_ • We will also compare the way that DBI service users use health services in an unplanned way because of their distress against people who had experienced distress before DBI started. _x000D_ _x000D_ Study updates will be shared with the DBI service, those using the service and policy makers. DBI services can use the findings to improve their service. At the end of the study, a final report will be put on the DBI website and a learning event will be held to share findings. People who have received support from DBI will also produce a creative output. Journal articles will also be written.

Lay abstract: This study asks ‘does DBI help people who present in crisis and distress with current or previous suicidal ideation, suicide attempts, self-harm achieve better outcomes in the immediate, short and longer term?’_x000D_ Suicide is a key UK challenge, with Scottish rates highest in the UK. Most who die from suicide have health service contact in the year before, almost half unscheduled. Understanding if suicidal behaviour can be prevented by NHS and partner intervention is crucial but difficult to evidence. In 2017 the Distress Brief Interventions Programme (DBI) was piloted in Scotland. In DBI Level 1 (L1) front-line staff (e.g. Primary Care, Police, Ambulance, A&E and NHS24) offer a compassionate response to those in distress and refer to Level 2 (L2) DBI who within 24hrs offer 14 days of problem-solving support. There is little evidence of the effectiveness of brief interventions on suicidality, but previous evaluation suggests DBI may prevent self-harm or suicidality. _x000D_ This study aims to understand whether and how DBI can reduce suicidal ideation, suicidal behaviour and self-harm among those presenting to front line services in distress. Key objectives are: to understand intervention mechanisms that contribute to these outcomes and why, to focus on risk groups of young and middle-aged adults, to inform the continued improvement of DBI and the wider service system._x000D_ The study has a mixed-method evaluation design grounded within the IMV (https://suicideresearch.info/the-imv/) with a strong PPI element. For 1 year survey data using validated scales will be collected from 1350 DBI service users immediately pre- and post DBI and interview data at 1 month, with follow-up data collection at 3-4 months and 1 year. Key outcomes measured will be suicidal ideation and behaviour, self-harm, resilience, self-stigma. Survey data will be linked to routine DBI data. A comparator group of those contacting NHS 24 for mental health reasons (including self-harm and suicidality) from Jan to June 2020 and who were not referred to DBI because their contact was prior to roll out of DBI to NHS24, will be identified. Use of unscheduled care before and after calling NHS 24 for the comparator group and DBI service users will be analysed to identify whether unscheduled care use in the year after is lower for DBI service users. For DBI service users, we will also compare changes in rates of unscheduled care use post-intervention between those referred for reasons of suicidality or self-harm and those who were not. An economic evaluation will cost and compare DBI service user health and social care resource use for the year following DBI and alternative care pathways used by GPs. _x000D_ Descriptive statistics, crosstabs and logistic regression will be used to analyse survey data and linked data. Qualitative data will be summarised, charted and coded using QSR NVivo 11 and analysed using framework matrix. Difference between DBI users and the comparator group in unscheduled care use will be assessed by doubly robust estimation adjusted for unscheduled care received in the preceding year. Secondary analyses using counts as dependent variables (e.g. length of hospital stay) will be analysed using Poisson regression. Data synthesis will be undertaken. _x000D_ Findings and policy and practice recommendations will be shared with stakeholders and the public. Final reports, journal articles, conference papers and an accessible PPI creative output will be published.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH