Implementation of Suicide Risk Models in Health Systems

NCT06060535 | Enrolling By Invitation DMC

• 2 other identifiers: R01MH1305481R01MH130548-01
• Study Type: interventional
• Target: 394,000
• Locations: 1 country
• Sites: 3

Brief Summary

The goal of this clinical trial is to evaluate a suicide risk model in patients receiving behavioral health care treatment. The main question it aims to answer is: Does the implementation of the suicide risk model reduce suicide attempts? Researchers will compare the outcomes of patients identified by the model to those in a usual care group.

Conditions

Suicide, Attempted; Suicide, Fatal

Keywords

Suicide Prevention

Outcome Measures

Primary Outcomes (1)

• Suicide attempt, 90 days post-index encounter

  The number and proportion of visits followed by any suicide attempt (ICD-10 diagnosis codes) occurring within 90 days of an index visit.

  90 days post-index encounter

Secondary Outcomes (4)

• Identification

  Through study completion, an average of 18 months

• Recognition

  Through study completion, an average of 18 months

• Evidence-based suicide care

  Through study completion, an average of 18 months

• Any 14-day follow-up care in behavioral health

  14 days post-index encounter

Study Arms (2)

Usual Care

ACTIVE COMPARATOR

Usual care suicide prevention pathway

Behavioral: Suicide Attempt Risk Model Care Pathway

Intervention

EXPERIMENTAL

Implementation of the suicide risk model

Behavioral: Suicide Attempt Risk Model Care Pathway

Interventions

Suicide Attempt Risk Model Care Pathway BEHAVIORAL

The suicide attempt risk model uses documented histories of medical and psychiatric diagnoses, medications, and health service utilization to predict risk of a suicide attempt in the 90 days following an outpatient visit in behavioral health clinics.

Intervention; Usual Care

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• + years old
• + visit to a behavioral health clinic at participating sites

You may not qualify if:

• None

Sponsors & Collaborators

• Henry Ford Health System: collaborator
• HealthPartners Institute: collaborator
• National Institute of Mental Health (NIMH): collaborator
• Kaiser Permanente: lead

Study Sites (3)

Henry Ford Health System

Detroit, Michigan, 48202, United States

Location

HealthPartners

Bloomington, Minnesota, 55425, United States

Location

Kaiser Permanente Center for Health Research

Portland, Oregon, 97227, United States

Location

Related Publications (11)

• Ahmedani BK, Simon GE, Stewart C, Beck A, Waitzfelder BE, Rossom R, Lynch F, Owen-Smith A, Hunkeler EM, Whiteside U, Operskalski BH, Coffey MJ, Solberg LI. Health care contacts in the year before suicide death. J Gen Intern Med. 2014 Jun;29(6):870-7. doi: 10.1007/s11606-014-2767-3. Epub 2014 Feb 25.

  PMID: 24567199 BACKGROUND

• Simon GE, Johnson E, Lawrence JM, Rossom RC, Ahmedani B, Lynch FL, Beck A, Waitzfelder B, Ziebell R, Penfold RB, Shortreed SM. Predicting Suicide Attempts and Suicide Deaths Following Outpatient Visits Using Electronic Health Records. Am J Psychiatry. 2018 Oct 1;175(10):951-960. doi: 10.1176/appi.ajp.2018.17101167. Epub 2018 May 24.

  PMID: 29792051 BACKGROUND

• Hedegaard H, Curtin SC, Warner M. Increase in Suicide Mortality in the United States, 1999-2018. NCHS Data Brief. 2020 Apr;(362):1-8.

  PMID: 32487287 BACKGROUND

• Yarborough BJH, Ahmedani BK, Boggs JM, Beck A, Coleman KJ, Sterling S, Schoenbaum M, Goldstein-Grumet J, Simon GE. Challenges of Population-based Measurement of Suicide Prevention Activities Across Multiple Health Systems. EGEMS (Wash DC). 2019 Apr 12;7(1):13. doi: 10.5334/egems.277.

  PMID: 30993146 BACKGROUND

• Rossom RC, Richards JE, Sterling S, Ahmedani B, Boggs JM, Yarborough BJH, Beck A, Lloyd K, Frank C, Liu V, Clinch SB, Patke LD, Simon GE. Connecting Research and Practice: Implementation of Suicide Prevention Strategies in Learning Health Care Systems. Psychiatr Serv. 2022 Feb 1;73(2):219-222. doi: 10.1176/appi.ps.202000596. Epub 2021 Jun 30.

  PMID: 34189931 BACKGROUND

• Simon GE, Shortreed SM, Johnson E, Rossom RC, Lynch FL, Ziebell R, Penfold ARB. What health records data are required for accurate prediction of suicidal behavior? J Am Med Inform Assoc. 2019 Dec 1;26(12):1458-1465. doi: 10.1093/jamia/ocz136.

  PMID: 31529095 BACKGROUND

• Simon GE, Rutter CM, Peterson D, Oliver M, Whiteside U, Operskalski B, Ludman EJ. Does response on the PHQ-9 Depression Questionnaire predict subsequent suicide attempt or suicide death? Psychiatr Serv. 2013 Dec 1;64(12):1195-202. doi: 10.1176/appi.ps.201200587.

  PMID: 24036589 BACKGROUND

• Yarborough BJH, Stumbo SP. Patient perspectives on acceptability of, and implementation preferences for, use of electronic health records and machine learning to identify suicide risk. Gen Hosp Psychiatry. 2021 May-Jun;70:31-37. doi: 10.1016/j.genhosppsych.2021.02.008. Epub 2021 Mar 4.

  PMID: 33711562 BACKGROUND

• Coleman KJ, Stewart CC, Bruschke C, et al. Identifying people at risk for suicide: Implementation of screening for the Zero Suicide Initiative in large health systems. Advances in Psychiatry and Behavioral Health. 2021;1(1):67-76.

  BACKGROUND

• National Action Alliance for Suicide Prevention. A prioritized research agenda for suicide prevention: An action plan to save lives. Rockville, MD. 2014.

  BACKGROUND

• Stumbo SP, Hooker SA, Rossom RC, Miley K, Ahmedani BK, Lockhart E, Yeh HH, Yarborough BJH. Study protocol for a stepped-wedge, randomized controlled trial to evaluate implementation of a suicide risk identification model among behavioral health patients in three large health systems. BMC Psychiatry. 2025 Apr 8;25(1):344. doi: 10.1186/s12888-025-06760-0.

  PMID: 40200191 DERIVED

Related Links

• A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives

MeSH Terms

Conditions

Suicide, Attempted; Suicide, Completed; Suicide Prevention

Condition Hierarchy (Ancestors)

Suicide; Self-Injurious Behavior; Behavioral Symptoms; Behavior

Study Officials

• Bobbi Jo Yarborough, PsyD

  Kaiser Permanente

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Clinics are the unit of randomization, all behavioral health clinics will be randomized, over the course of three waves, to cross over from usual care to intervention (implementation of the suicide risk model).

Study Record Dates

• First Submitted: August 13, 2023
• First Posted: September 29, 2023
• Study Start: October 4, 2022
• Primary Completion: January 1, 2026
• Study Completion: January 1, 2026
• Last Updated: December 15, 2025

Record last verified: 2025-10

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: Materials will be shared, upon request, to interested researchers beginning 6 months after publication of the main analyses for up to one year.
• Access Criteria: Materials will be shared with interested researchers through the MHRN website, data may be shared for secondary analyses through a secure file transfer site.

Locations

US (3)