A better approach to prevent teen suicide deaths

New grant funds crucial work to test effectiveness of teen suicide prevention in primary care

With a new $680,000 grant from the National Institutes of Mental Health, Kaiser Permanente Washington Health Research Institute (KPWHRI) will lead the first known study to test whether integrating suicide prevention in primary care reduces suicide-related events among teens. The research will provide important evidence for suicide prevention and could guide more widespread adoption of an approach that is already in use at Kaiser Permanente Washington.

“Our study takes advantage of the fact that we have data from primary care clinics that implemented a suicide prevention program for teens, and we can compare the before and after,” said Gwen Lapham, PhD, MPH, MSW, an assistant investigator at KPWHRI and lead researcher on the grant. “We’re also able to look at the impact of providing confidential care, which is important because concerns about confidentiality are a primary reason why teens don’t disclose suicide risk.”

Suicide is a leading cause of death for teens, and in 2021, approximately 1 in 5 high school students said that they had seriously considered suicide. The U.S. Preventive Services Task Force recently concluded that there is not enough available evidence to recommend regular suicide risk screening for teens during primary care visits, because no study has previously compared outcomes for teens with and without suicide risk screening and follow-up.

Beginning in the spring of 2022, Kaiser Permanente Washington implemented a specialized teen suicide prevention approach in 30 clinics that see approximately 8,200 teens ages 13 to 17 for preventive visits per year. In the new study, researchers will use data from those clinics to compare 4 years of usual care prior to implementation with 3 years of usual care after the launch of the suicide prevention program.

Suicide risk screening has always been part of usual care but was prompted by a positive depression screen rather than being standard for every visit. Parents often completed the screen, and there was no standardized approach for confidential screening with just the teen.

The intervention involves suicide risk screening at every teen preventive care visit, follow-up screening to determine the severity of suicide risk if identified, and safety planning with teens who screen for high risk. The safety plan has 6 steps and includes talking about coping strategies, crisis support, and risk mitigation. Preventive care visits last 40 minutes, instead of 20 minutes, and there are standardized processes in place for protecting confidentiality and making it possible for teens to talk directly with their care team. Lapham led the development and pilot testing of this approach as part of her work with KPWHRI’s Center for Accelerating Care Transformation (ACT Center).

“Our team worked with Kaiser Permanente Washington on a similar program for adults,” Lapham said, “and the success of that approach prompted us to adapt it for teens. We interviewed teens and guardians about what they needed and what they preferred as far as the key elements of the program, and that informed the choices we made and how it was integrated into regular health care visits.”

The research team will look at several outcomes for the study. One primary outcome is the percentage of teens engaged in safety planning, which reduces immediate risk and provides tools for navigating suicidal thoughts in the future. The second is reduction of suicide-related events after primary care visits. Suicide-related events include suicide deaths, suicide attempts, and hospitalization or emergency room visits for self-harm or suicidal ideation. Finally, they will look at time alone with a clinician and confidential documentation, in order to understand whether confidential care increases safety planning.

Secondary outcomes include the percentage of teens screened for suicide risk and acute suicide risk, new mental health treatment within 30 days of a primary care visit, and documentation of confidential care.

“Suicide among teens is a public health crisis, and we have a real opportunity to understand how we can bring those numbers down,” Lapham said. “These clinics serve a diverse set of teens, and we think the results will be applicable to most primary care settings and could inform changes nationwide to better support this age group and prevent more suicide deaths.”

By Amelia Apfel