Breakthrough study shows model that reduces suicide rates 25%, and authors hope for more
Over the last two decades, suicide rates in the United States have increased by more than 36%, as part of a larger mental health crisis. But Monday, top researchers indicated they have cracked the code to turning that around.
They're so confident they call it the zero-suicide model.
Researchers from Henry Ford Health and Kaiser Permanente released the results of data collected over eight years — and ideas refined since 2001 — in the Journal of American Medical Association. The new body of research suggests that by adopting this zero-suicide protocol, health care systems across the country and beyond can reduce suicide rates among their patients by 25%.
"We don't want to be satisfied with a 5% reduction, or even a 25% reduction that we've seen in this study," said Brian Ahmedani, lead author of the study, who also serves as the director of research for behavioral health services at Henry Ford Health in Michigan. "We want to keep moving forward so that we can do everything we can to prevent every single suicide."
One of the confounding issues with suicide is that, while it is one of the leading causes of death across every age group in the United States, it is 100% preventable.
Here's what the research shows.
More than 80% of people who died by suicide, and more than 90% of people who attempted suicide, visited a doctor's office in the weeks or months leading up to their deaths or suicide attempts.
The idea behind the zero-suicide model is that when patients sit down with their primary care providers, they're given a suicide risk screening. The screening involves filling out what's called a PHQ-9, a nine-question patient health questionnaire, which is typically administered as a screening for depression.
The point of focus is question nine, which asks how often, over the course of the last two weeks, have you had thoughts that you would be better off dead, or of hurting yourself. The response scale ranges from "Not at all" to "Nearly every day."
Depending on the severity of the response, physicians conduct a suicide risk assessment. Then, a safety plan is put into place.
That safety plan includes asking whether the patient has easy-to-access firearms and, if so, to go over safe and secure storage. It includes having care teams reach out semi-regularly in the coming days to assess how the patient is doing and help navigate outpatient care options. The patient is also, if needed, connected with intensive psychotherapy approaches geared specifically to suicide prevention.
Between January 2012 and December 2019, researchers collected data from millions of patients in six health systems across California, Oregon, Michigan, Colorado and Washington.
An important element to the zero-suicide model, Ahmedani said, was ensuring that it could apply across different populations and regions. It tried to answer the question of whether the model worked among Black patients, LGBTQ+ patients, rural patients, low-income patients, and other groups.
The research showed it can. The protocol is shaped by the locality of the clinic, the resources available and, importantly, the staff that administers the model.
"It's really important that, when you do this work, it's done in a way that we know that it can actually be implemented, rather than trying to stick to a really structured approach," Ahmedani said.
Ahmedani said that level of global training and support has already started across other states and around the world.
As a trial run for how this model can be used across different health care systems, Michigan established a program called "My Mind" that works in partnership between Henry Ford Health and Blue Cross Blue Shield, the largest insurer in the state.
Staff from My Mind are equipping providers across the state with training and support of the zero-suicide model. Along the way, those providers are working with researchers on data and quality improvement to better tailor the model to them.
Although the data overwhelming shows the vast majority of people who attempt or die by suicide see their primary care provider prior to their deaths, researchers are thinking about creative strategies for that other 27% of the population that does not regularly go to the doctor.
For example, 21% of people who die by suicide have had some interaction with the criminal justice system in the year before they died. So researchers are applying the zero-suicide model to people who have recently been released from prison.
Another high-risk period occurs shortly after someone is discharged from the emergency department or inpatient hospital for behavioral health conditions.
Finding interventions for children and adolescents also is critical at a time when, in Wisconsin, more than 60% of students said they felt anxious, depressed or suicidal in the last year. Researchers have developed the zero-suicide model in schools to create what Ahmedani described as a cross-community partnership.
Ahmedani and other researchers believe the solution to achieving zero suicides will come from such cross-community collaborations. In the same way that public health departments collaborated with barber shops and churches to help build vaccine trust in communities that don't have positive experiences with the medical world, the same can be done to help those struggling with suicidal ideation.
"We're building those bridges at Henry Ford right now and testing those models," Ahmedani said. "And I believe that in the next few years, we're certainly going to have those kinds of approaches seeping into the community."
This article originally appeared on Milwaukee Journal Sentinel: Groundbreaking study shows model that can reduce suicide rates by 25%
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