Comparison of the Safety Planning Intervention with Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department

On Monday, 30^th July at 10am (GMT) we had our monthly online journal club session and we discussed the paper:

Stanley B, Brown GK, Brenner LA, et al. (2018). Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department. JAMA Psychiatry. Published online July 11, 2018. doi:10.1001/jamapsychiatry.2018.1776

Here are some notes from thoughts shared in our discussion.

1. Overview

The paper adds to growing evidence base regarding the efficacy of safety planning, and follow up contact interventions.

Study in a veteran population which was predominantly male. Although other studies have shown efficacy in samples with a higher percentage of women.
Would be interested to see how effective this intervention is for people being discharged from inpatient into the community.

Members of the group were unfamiliar with the use of propensity score as a method to adjust for identified differences between control and intervention samples.
Would have also liked to know if there was any association with follow up calls and treatment engagement.

Discussions largely focused around avenues for future research which seek to:

Identify the critical components and mechanisms. Would have been useful to have further brake down of the control group, and intervention to understand whether the reduction in suicidal behaviours appears to be due to SPI versus follow up contact, and then further what elements of the SPI are the critical components.
How important is delivery mechanism? Psychosocial assessments are associated with reduced rates of repeat self-harm, leading to speculation that the act of talking to someone, acknowledging and validating their experiences may have a therapeutic impact. Be interested to see if participants valued the clinical collaboration which leads to the development of the SPI, or whether alternative mechanisms such as digital apps could be used to create safety plans.
To what extent did people use the safety plan, and what impact did this have on coping with crisis? Considered whether the use of the plan could be tracked alongside monitoring of psychological factors and mechanisms as identified by models such as the Integrated Motivational-Volitional Model (IMV).
Another point was the scope for an EMA type study to assess the psychological mechanisms involved in the decision to use the safety plan, as well as other psychosocial variables that may play a role in the intervention.

And here is an interview with Barbara H. Stanley, one of the authors of the study: Interview audio.