The goal of this pilot study is to learn whether the use of suicide risk prediction algorithms in primary care can help identify people who may benefit from extra mental health monitoring. Specifically, this study aims to measure how use of the suicide risk prediction algorithm to prompt extra mental health monitoring among adult primary care patients impacts proportions of patients identified at risk of suicide and engaged in safety planning. Secondarily, we plan to measure proportions of patients identified at risk of suicide via mental health monitoring (irrespective of engagement in safety planning).
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
500,000
Use of a suicide risk prediction algorithm, developed by the Mental Health Research Network (MHRN), will be used to prompt additional mental health monitoring. Mental health monitoring will include asking patients about suicidal thoughts (via the ninth question of the Patient Health Questionnaire-9, PHQ-9), followed by suicide risk assessment (via use of a brief self-administered version of the Columbia Suicide Risk Severity Rating Scale, C-SSRS), followed by Safety Planning with a designated member of the primary care team.
Kaiser Permanente Washington Health Research Institute
Seattle, Washington, United States
Suicide Risk Safety Plan Documentation
Indicator for whether a patient was identified at risk of suicide (using the PHQ-9 and C-SSRS) and had a safety planning intervention documented in the EMR on the day of, or in the following 14 days of a primary care encounter, using a standardized template based on the brief suicide risk safety plan intervention developed by Drs. Stanley \& Brown to mitigate risk
Time frame: Rates for primary care encounters will be compared before and after implementation, during the 13 month study period 3/05/2025-4/05/2026 (implementation launch 10/6/2025)
Suicidal ideation symptom assessment
Indicator for whether a patient completed the Patient Health Questionnaire-9 (PHQ-9) Question 9 for primary care encounter
Time frame: Rates of assessment for primary care encounters will be compared before and after implementation, during the 13 month study period 3/05/2025-4/05/2026 (implementation launch 10/6/2025)
Prior month intent/planning for suicide attempt
Indicator for whether a patient indicated prior-month intent or planning for suicide attempt (C-SSRS score ≥3, on the C-SSRS assessment for the primary care encounter (range 0-6; higher scores confer greater risk)
Time frame: Rates for primary care encounters will be compared before and after implementation, during the 13 month study period 3/05/2025-4/05/2026 (implementation launch 10/6/2025)
Suicide risk assessment
Indicator for whether a patient completed the Columbia Suicide Risk Severity Rating Scale (C-SSRS) for the primary care encounter
Time frame: Rates for primary care encounters will be compared before and after implementation, during the 13 month study period 3/05/2025-4/05/2026 (implementation launch 10/6/2025)
Frequent suicidal ideation reported (in prior 2-weeks)
Indicator for whether a patient reported suicidal ideation "more than half the days" or "nearly every day" (PHQ-9 Q9 score 2 or 3), on the assessment documented in the electronic medical record (EMR) for the primary care encounter (range 0-3, higher scores indicate more frequent suicidal ideation)
Time frame: Rates for primary care encounters will be compared before and after implementation, during the 13 month study period 3/05/2025-4/05/2026 (implementation launch 10/6/2025)
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