Clinical trial NCT02759172: Suicide Prevention Intervention for At-Risk Individuals in Transition
Official title: Suicide Risk Reduction in the Year Following Jail Release: the SPIRIT Trial (Suicide Prevention Intervention for At-Risk Individuals in Transition)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Suicide
Keywords: Suicide prevention
Jail
Lead sponsor: Michigan State University
Sponsor class: OTHER
Collaborators: name: Brown University
First posted: 2016-05-03
Enrollment: 800
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The four year SPIRIT Trial, or Suicide Prevention Intervention for at-Risk Individuals in Transition, will recruit 800 pretrial jail detainees at risk for suicide. Each participant will be randomly assigned to today's standard care or to Safety Planning Intervention (SPI) method and then followed for one year after release. Outcomes include suicide events, suicide attempts and ideation, psychiatric symptoms, functioning, treatment utilization, problem-solving, belongingness, and cost-effectiveness.

Detailed description: There were nearly 12 million admissions to US jails in 2012. Jailed individuals face a disproportionate risk for suicide. The time of arrest and jail detention represents an acute stressor that further exacerbates this risk. The epidemic of suicide during jail detention has been recognized. However, less attention has been paid to the high suicide risk and mortality in the months following jail release, as individuals re-enter their communities, are faced with financial, legal, and social stressors, and have increased access to lethal means (e.g., drugs, cars, firearms). Given that roughly 10% of all suicides in the U.S. with known circumstances occur following a recent criminal legal stressor (often arrest and jail detention), reducing suicide risk in the year after jail detention could have a noticeable impact on national suicide rates. Unlike prison, where individuals have already been sentenced and typically stay from months to years, most pretrial jail detainees are released within days. Therefore, brief interventions are required. Stanley and Brown's Safety Planning Intervention (SPI) is a brief, adjunctive suicide risk reduction intervention developed for suicidal patients presenting to urgent care settings. SPI incorporates evidence-based suicide risk reduction strategies in a low intensity, low cost intervention that can be delivered by a broad range of clinicians, making it scalable in the mental health resource-poor justice system. SPI reduces subsequent suicidal ideation and attempts among at-risk individuals in emergency rooms. However, there is no previous test of this intervention (or any other) for reducing suicidality following jail release. This RCT evaluates the effectiveness and cost-effectiveness of SPI for reducing suicide events (attempts, suicide behaviors, and suicide-related hospitalizations and emergency department visits) and attempts among 800 suicidal pretrial jail detainees from two jails in the year following jail release. It assesses critical mechanisms of suicide reduction in our target population: treatment utilization, suicide-related problem-solving, and belongingness. SPI will consist of safety planning during jail detention and follow-up phone sessions after jail release. Research with previously incarcerated individuals and with suicidal individuals in the community has shown that telephone follow-up intervention is feasible and powerful in building trust and reducing risk among these disenfranchised, isolated populations. This study will be the first randomized evaluation of a suicide prevention intervention in the vulnerable year after jail release. Beyond the human suffering and costs at an individual level, suicidal behavior incurs high economic costs in terms of health care costs and lost productivity. Jails are a catchment area for at-risk individuals at a time of high life stress and high suicide risk, providing an important opportunity for suicide prevention intervention, one that is currently being missed. This study will provide the data on costs and cost-adjusted outcomes that systems need to make informed decisions about adoption, speeding implementation. Thus, this study will contribute to knowledge about both mechanisms of action and system-level intervention effects.

Eligibility criteria: Inclusion Criteria:

* Unsentenced male and female pretrial jail detainees
* 18+ years of age
* at risk for suicide, operationalized as a response of "yes" on item 4 or greater on the initial 5 C-SSRS screening questions, indicating the presence of at least some active suicide ideation with some intent to act in the past month (i.e., individuals at higher risk, such as those who report intent with specific plan and/or suicide attempt/s in the last month, will also be included);
* speak and understand English well enough to understand questionnaires when they are read aloud.

Exclusion Criteria:

* expects to be sentenced and serve their sentence before being released to the community
* cannot provide the name and contact information of at least two locator persons
* does not have access to any telephone.

Primary outcomes:
measure: Suicide events
timeFrame: One year after jail release
Secondary outcomes:
measure: Suicide attempts
timeFrame: One year after release from jail
measure: Weeks of active suicide ideation
timeFrame: One year after release from jail
measure: Severity of suicide ideation
timeFrame: 1, 4, 8, and 12 months after release from jail
measure: Time to first suicide event
timeFrame: One year after release from jail
measure: Psychiatric Symptoms
timeFrame: 1, 4, 8, and 12 months after release from jail
measure: Functioning
timeFrame: 1, 4, 8, and 12 months after release from jail
measure: Treatment utilization
timeFrame: 1, 4, 8, and 12 months after release from jail
measure: Suicide-related problem-solving
timeFrame: 1, 4, 8, and 12 months after release from jail
measure: Belongingness
timeFrame: 1, 4, 8, and 12 months after release from jail
measure: Cost, cost-offsets, and cost-effectiveness
timeFrame: One year after release from jail
measure: Cost, cost-offsets, and cost-effectiveness
timeFrame: 1, 4, 8, and 12 months after release from jail
Other outcomes:
measure: Drug use
timeFrame: 1, 4, 8, and 12 months after release from jail
measure: Alcohol use
timeFrame: 1, 4, 8, and 12 months after release from jail
measure: Suicide deaths
timeFrame: One year after release from jail
measure: Re-arrest
timeFrame: One year after release from jail
measure: Alternate (exploratory) measure of psychiatric symptoms
timeFrame: 4 months after release from jail
Locations:
city: Flint
country: United States
facility: Genesee County Jail
state: Michigan
city: Cranston
country: United States
facility: Rhode Island Department of Corrections
state: Rhode Island
Study officials:
affiliation: Michigan State University
name: Jennifer Johnson, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Brown University
name: Lauren Weinstock, PhD
role: PRINCIPAL_INVESTIGATOR
References: