Clinical trial NCT04693845: Aftercare Focus Study (AFS): A Clinical Trial to Reduce Short-Term Suicide Risk After Hospitalization
Official title: Aftercare Focus Study (AFS): A Clinical Trial to Reduce Short-Term Suicide Risk After Hospitalization
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Suicidal Ideation
Suicide, Attempted
Distress, Psychological
Quality of Life
Keywords: Suicidal Ideation
Suicide, Attempted
Distress, Psychological
Psychotherapy
Lead sponsor: University of Washington
Sponsor class: OTHER
Collaborators: name: The Catholic University of America
name: American Foundation for Suicide Prevention
First posted: 2021-01-05
Enrollment: 150
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Randomized Controlled Trial
Primary purpose: TREATMENT

Brief summary: Increasingly, the period after hospital admission is acknowledged as one of extremely high risk for suicidal patients. While it might be hoped that hospitalization would address and resolve suicide risk, a review of international studies shows the risk of suicide is up to 200 times higher among individuals recently discharged from hospitals vs. the general population. In response, some health care systems use an "urgent care" or "next-day appointment" (NDA) clinics for follow-up. NDAs serve as short-term crisis intervention at a specific appointment time and location so patients do not "fall through the cracks" in the care transition. Collaborative Assessment and Management of Suicidality (CAMS) is a potentially effective intervention to reduce short term suicidal risk in this transition from inpatient to outpatient treatment. To this end, this study has the following study aims: (1) Evaluate whether CAMS for suicidal NDA patients results in less suicidal behavior than TAU, (2) Evaluate whether CAMS for suicidal NDA patients results in less suicidal ideation and intent as well as improved mental health markers than TAU, and (3) Evaluate whether CAMS for suicidal NDA patients is more satisfactory to patients than TAU.

Detailed description: Increasingly, the period after hospital admission is acknowledged as one of extremely high risk for suicidal patients. While it might be hoped that hospitalization would address and resolve suicide risk, a review of international studies shows the risk of suicide is up to 200 times higher among individuals recently discharged from hospitals vs. the general population. In response, some health care systems use an "urgent care" or "next-day appointment" (NDA) clinics for follow-up. NDAs serve as short-term crisis intervention at a specific appointment time and location so patients do not "fall through the cracks" in the care transition. Collaborative Assessment and Management of Suicidality (CAMS) is a promising outpatient treatment framework that merits rigorous study as a potentially effective intervention to reduce short term suicidal risk in the transition from inpatient to outpatient treatment. Pilot data suggest that CAMS decreases suicidal ideation and psychological distress while increasing hope, patient satisfaction, and retention more than NDA treatment as usual (TAU). CAMS in the NDA clinic has the potential to fill three key targets highlighted in the 2012 National Strategy for Suicide Prevention: (1) prevent suicidal behavior, (2) increase clinician confidence and willingness to see suicidal patients, and (3) are sufficiently feasible, trainable, adaptable, and flexible to scale up across health systems. To this end, this study has the following study aims: (1) Evaluate whether CAMS for suicidal NDA patients results in less suicidal behavior than TAU, (2) Evaluate whether CAMS for suicidal NDA patients results in less suicidal ideation and intent as well as improved mental health markers than TAU, and (3) Evaluate whether CAMS for suicidal NDA patients is more satisfactory to patients than TAU.

Eligibility criteria: Inclusion Criteria:

1. inpatient or emergency service admission for suicidality or suicide attempt
2. lifetime suicide attempt
3. referring clinician determined that the patient did not have appropriate outpatient mental health appointment in the next two weeks (other than an NDA)
4. an NDA is an appropriate disposition plan
5. consented to all study procedures.

Exclusion Criteria:

1. under age 18
2. insufficient English to understand the study procedures and provide informed consent
3. too psychotic or manic, aggressive, or cognitively impaired such that outpatient therapy was not indicated
4. patient not stable enough to be discharged home for a minimum of 24 hours prior to study treatment
5. court-ordered to outpatient treatment
6. patient lived an impractical distance away

Primary outcomes:
measure: Suicidal behavior
timeFrame: Twelve months
measure: Suicidal ideation
timeFrame: Twelve months
measure: Suicidal intent
timeFrame: Twelve months
measure: Psychological Distress
timeFrame: Twelve months
measure: Quality of life and overall functioning
timeFrame: Twelve months
measure: Treatment Satisfaction
timeFrame: Through the end of study treatment, an average of 3 months
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
affiliation: University of Washington
name: Katherine A Comtois, PhD, MPH
role: PRINCIPAL_INVESTIGATOR
References: