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:

* Adolescents between the ages of 12 and 18
* Adolescents endorse severe suicidal ideation (SIQ-JR \> 31) and moderate depression (BDI-II \> 20) at two time points (1 to 3 days)
* At least one primary parent or caregiver must participate in the assessment and treatment. This could be a biological parent, stepparent, grandparent, other relative, or a foster parent, who has at least frequent contact with the subject. When possible both parents will participate in the assessment and treatment. Legal custody is always considered (e.g., divorced parents). Having all family members present at every session is not required. Many individual meetings with the subject or the parent are planned in both treatments.

Exclusion Criteria:

* Evidence of imminent risk of harm to self or others that cannot be safely treated on an outpatient basis
* Evidence of psychotic features \[as reported on the Diagnostic Interview Schedule for Children; Voice Diagnostic Interview Schedule for Children (VDISC)\]
* Evidence of suffering from severe cognitive impairment (e.g., mental retardation, severe developmental disorders) as evidenced by educational records, parental report and/or clinical impression).
* Subjects taking antidepressant medication for depression for less than 6 weeks prior to the screening.
B: Inclusion Criteria:

* To be at least 18 years old
* To use a smartphone as a personal phone
* To have consulted in the context of a suicidal crisis within the last 7 days
* To be able to understand the nature, purpose and methodoly of the study.
* To be in a minimal treatment phase (according to the clinician's judgment).
* To accept participating to the study and the 6 months follow-up and to have signed the informed consent

Exclusion Criteria:

* Refusal of participation
* Subject protected by law (guardianship)
* Deprived of liberty Subject (by judicial or administrative decision)
* Diagnosis of a current hypomanic, manic or mixed episode, or a diagnosis of schizoaffective disorder or schizophrenia.
* No affiliation to the social safety system
* Exclusion period in relation to another protocol
* 65 years old patients and older with an MMSE score \< 24 at baseline
C: Inclusion Criteria:

* Attempted suicide
* At least 12 years old

Exclusion Criteria:

* Psychotic disorder
* Severe dementia
* Institutionalised or hospitalised for more than 2 weeks at psychiatric department
D: 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

Answer: D