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| Name | Class |
|---|---|
| Forte | INDUSTRY |
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Suicide is one of the leading causes of premature death and a prioritized public health concern.
Safety Planning Intervention (SPI) is a method with strong international research support for reducing suicidal behaviour by enhancing individuals' strategies for crisis management and improving access to support. SPI is a single-session intervention lasting approximately 45 minutes, which any healthcare provider can deliver after a brief training. Despite promising results, the implementation of SPI in Swedish healthcare remains limited. This project examines how SPI can be integrated into various healthcare settings and evaluates its impact on suicide-related emergency visits, psychiatric hospitalizations, and healthcare utilization. Data and Methods Stepped-Wedge implementation study in specialist psychiatry, where SPI is gradually introduced in psychiatric units. This study design allows for a robust evaluation of effects while ensuring all units eventually receive the intervention. As part of this study, a survey among healthcare professionals will be conducted to assess their experiences with feasibility, usability, and implementation barriers.
Data will be collected from QlikView healthcare utilization data. Poisson regression models with mixed effects will be used to analyze the impact of SPI on emergency visits and psychiatric hospitalizations. A health economic analysis will be conducted to evaluate the cost-effectiveness of SPI. Societal Relevance and Impact
The project contributes to Sweden's national suicide prevention strategy by:
Gradual implementation allows for time-based comparisons, minimizes selection bias, and ensures all patients receive the intervention. The project is conducted in close collaboration with healthcare providers and policymakers to ensure that research findings can be integrated into clinical practice and strengthen suicide prevention efforts in Sweden.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Safety Planning Intervention for suicide prevention | Experimental | Stepped wedge design with four areas being added to the study on at a time |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Safety Planning Intervention (SPI) | Behavioral | Safety Planning Intervention (SPI), developed by Stanley & Brown (12), is a brief, structured suicide preventive intervention designed to help individuals identify warning signs, develop coping strategies, and establish emergency contact pathways. SPI is a single-session intervention that typically lasts approximately 45 minutes and is delivered in clinical or emergency care settings. It is designed to help individuals identify warning signs, develop coping strategies, and establish a concrete plan for seeking support during a suicidal crisis. Unlike traditional risk assessments that focus on predicting suicide risk, SPI actively engages individuals in managing crises before they escalate. The intervention consists of six core steps. |
| Measure | Description | Time Frame |
|---|---|---|
| Monthly rate of emergency visits for suicide attempts | Monthly number of emergency department visits for suicide attempts identified using ICD-10 codes X60-X84 and events of undetermined intent (Y10-Y34), obtained from aggregated healthcare utilization data from psychiatric clinics in Region Skåne. | Monthly measurements throughout the 45-month study period |
| Measure | Description | Time Frame |
|---|---|---|
| Monthly rate of psychiatric inpatient admissions for suicide attempts | Monthly number of psychiatric inpatient admissions with ICD-10 diagnoses indicating suicide attempts (X60-X84) or events of undetermined intent (Y10-Y34), obtained from aggregated healthcare utilization data. | Monthly measurements throughout the 45-month study period |
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Inclusion Criteria:
Patients presenting to psychiatric services with suicidal ideation, suicidal planning, or a suicide attempt
Patients receiving care in participating adult psychiatric emergency or inpatient units
Exclusion Criteria:
Age under 18 years
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sara Lindström, Associate professor | Contact | +46702823770 | sara.lindstrom@med.lu.se |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Region Skåne, psychiatric services | Not yet recruiting | Helsingborg | Skåne County | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35048835 | Background | Nuij C, van Ballegooijen W, de Beurs D, Juniar D, Erlangsen A, Portzky G, O'Connor RC, Smit JH, Kerkhof A, Riper H. Safety planning-type interventions for suicide prevention: meta-analysis. Br J Psychiatry. 2021 Aug;219(2):419-426. doi: 10.1192/bjp.2021.50. |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 4, 2025 | Mar 7, 2026 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D013406 | Suicide, Attempted |
| ID | Term |
|---|---|
| D013405 | Suicide |
| D016728 | Self-Injurious Behavior |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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| Emergency department revisits following suicide attempts |
Monthly number of emergency department revisits due to suicide attempts or events of undetermined intent within 30 days, 6 months, or 12 months after a previous visit. |
| Monthly measurements throughout the 45-month study period |
| Psychiatric inpatient readmissions following suicide attempts | Monthly number of psychiatric inpatient readmissions due to suicide attempts or events of undetermined intent within 30 days, 6 months, or 12 months after a previous admission. | Monthly measurements throughout the 45-month study period |
| Incremental cost-effectiveness of SPI implementation | Incremental cost-effectiveness ratio comparing the Safety Planning Intervention (SPI) with usual care based on healthcare utilization costs and suicide-related healthcare events. | Assessed over the 45-month implementation period |
| Region Skåne, psychiatric services | Not yet recruiting | Kristianstad | Sweden |
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| Region Skåne, psychiatric services | Recruiting | Lund | Sweden |
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| Region Skåne, psychiatric services | Recruiting | Malmö | 22736 | Sweden |
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