Please select the eligibility criteria that correspond to the clinical trial below.
Title: UH3 Pragmatic Trial of Population-based Programs to Prevent Suicide Attempt
Brief Summary: This pragmatic clinical trial will evaluate the effectiveness of two population-based outreach programs for preventing suicide attempts among patients identified as at-risk. The study will be conducted at Kaiser Permanente (KP) Washington (the lead site) and at HealthPartners, KP Colorado and KP Northwest. Electronic health records will be used to identify outpatients aged 18 or older who respond to a routinely administered PHQ depression questionnaire by reporting thoughts of death or self-harm "most of the days" or "nearly every day". This trial will be limited to patients receiving care from one of the four participating health systems. Eligible patients will be automatically assigned to continue in usual care (1/3) or to either of the two intervention programs (1/3 each). Those assigned to usual care will not be contacted at all by study staff and will continue to receive usual care from treating primary care and mental health providers. Both intervention programs involve outreach by Epic secure messaging (with optional telephone outreach for those not reading messages). The Care Management intervention includes routine outreach to assess ongoing risk of suicide attempt and care management to monitor and facilitate ongoing engagement in outpatient follow-up. The Care Manager will coordinate care with treatment by primary and behavioral health care providers using Epic Staff Messaging (or telephone contacts if necessary). The Skills Training intervention uses an online skills training program to support patients in developing and using self-management skills for emotion regulation and crisis management. A Coach will monitor each participant's use of the program and send periodic messages (using Epic secure messaging) to encourage and support use of the program and practice of program skills. Each intervention continues for up to one year. In all three groups (Usual Care, Care Management, and Skills Training) virtual data warehouse data will be used to identify likely suicide attempts over 18 months following randomization. Analyses will compare risk of suicide attempt among all those randomized, regardless of response to the initial invitation or level of participation in the intervention programs. Comparison of all those randomized is the only scientifically valid method for assessing the overall impact of either program on population-level risk of suicide attempt.


Options:
A: Inclusion Criteria:

* The patient has been correctly informed
* The patient must have given his/her informed and signed consent
* The patient must be insured or beneficiary of a health insurance plan
* French speaking adults (18 years or older) freely hospitalized (in centres or via emergency services) for prevention of suicide and who have a medium or high suicide risk score according to a Mini International Neuropsychiatric Interview structured interview
* Presence of suicidal ideation according to the Beck Suicide Ideation Scale (score \> 3)
* Prior (or recent) suicide attempt within the last three month
* The patient is able to understand the study and capable of giving his/her informed consent
* The patient is available during the weekly time slots proposed by the investigator

Exclusion Criteria:

* The patient is participating in another study that may interfere with the results or conclusions of this study
* Within the past three months, the patient has participated in another study that may interfere with the results or conclusions of this study
* The patient is in an exclusion period determined by a previous study
* The patient is under judicial protection, or is an adult under guardianship
* The patient refuses to sign the consent, or it is impossible to correctly inform the patient
* Emergency situations preventing proper study conduct
* History of schizophrenia or other psychotic troubles
* Presence of psychotic symptoms at initial interview
* Serious cognitive impairment
* Medical incapacity to participate
B: Inclusion Criteria:

Participants recruit adults who:

1. Discharge from an emergency department of a teaching hospital after attempt suicide
2. Aged above 18 years old
3. Agree to provide written inform consent.

Exclusion Criteria:

1. Patients were too ill to be interviewed
2. Patients have immediate and severe suicide risk.
C: Inclusion Criteria:

We propose to include all patients at the participating sites who:

* Complete PHQ questionnaire and respond to item 9 (regarding thoughts of death or self-harm) "more than half the days" or "nearly every day"
* Are currently enrolled in one of the four participating health systems
* Are age 18 or older
* Recent use of Epic Secure Messaging

Exclusion Criteria:

* Recorded diagnosis of dementia or developmental delay
* Previously invited to participate in the UH2 pilot trial
* Non-English speaker
D: Inclusion Criteria:

* Consumers aged 16 years and above residing in the Gold Coast catchment area
* Presenting to the Gold Coast Hospital with a recent suicide attempt and then placed on the Suicide Prevention Pathway.

Exclusion Criteria:

* Refusal of, or inability to, consent
* People who are already receiving specialised psychological interventions (such as CBT) will be excluded due to the potential confounding effect, but not people taking psychotropic medication

Answer: C