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Research Trends

Current Practices of Suicide Risk Management Protocols in Research

Published Online:March 02, 2010https://doi.org/10.1027/0227-5910/a000004

Abstract

Background: Participant safety is an important concern in mental-health-oriented research. Investigators conducting studies in the United States that include potentially suicidal individuals are often required to develop written suicide risk management (SRM) protocols. But little is known about these protocols. It is possible that such protocols could serve as templates for suicide risk management in clinical settings. Aims: To elucidate common (best) practices from mental health intervention researchers. Methods: We conducted a systematic descriptive analysis of written SRM protocols. A convenience sample of studies funded by the United States’ National Institute of Mental Health in 2005 were scanned to discover projects in which investigators were likely to identify and take responsibility for suicide risk in their participant pool. Qualitative methodology was used to create a checklist of tasks perceived to be operationally significant for insuring the safety of suicidal participants. The checklist was applied to all protocols to determine the variability of patient safety tasks across protocols. Results: We identified 45 candidate studies, whereof 38 investigators were contacted, resulting in the review of 21 SRM protocols. Three main categories emerged: overview, entry/exit, and process. Overall, 19 specific tasks were identified. Task frequency varied from 7% to 95% across protocols. Conclusions: The SRM checklist provides a framework for comparing the content of SRM protocols. This checklist may assist in developing SRM protocols in a wide range of settings. Developing guidelines and standard methodologies is an important step to further development of suicide prevention strategies. More research is necessary to determine the impact of SRM protocols on participant safety.

References

  • Beck, A.T. , Brown, G.K. , Steer, R.A. , Dahlsgaard, K.K. , Grisham, J.R. (1999). Suicide ideation at its worst point: A predictor of eventual suicide in psychiatric outpatients. Suicide and Life Threatening Behavior, 29, 1–9. First citation in articleMedline, Google Scholar

  • Brown, G.K. , Beck, A.T. , Steer, R.A. , Grisham, J.R. (2000). Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 68, 371–377. First citation in articleCrossref Medline, Google Scholar

  • Brown, G.K. , Ten Have, T. , Henriques, G.R. , Xie, S.X. , Hollander, J.E. , Beck, A.T. (2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. Journal of the American Medical Association, 294, 563–570. First citation in articleCrossref Medline, Google Scholar

  • Department of Health & Human Services, U.S . (2000). Healthy people 2010: Understanding and improving health. Washington, DC: U.S. Government Printing Office. First citation in articleGoogle Scholar

  • Glaser, B.G. , Strauss, A.L. (1968). The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine Publishing Company. First citation in articleGoogle Scholar

  • Hepp, U. , Wittmann, L. , Schnyder, U. , Michel, K. (2004). Psychological and psychosocial interventions after attempted suicide: An overview of treatment studies. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 25, 108–117. First citation in articleLink, Google Scholar

  • Kessler, R.C. , Berglund, P. , Borges, G. , Nock, M. , Wang, P.S. (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. Journal of the American Medical Association, 293, 2487–2495. First citation in articleCrossref, Google Scholar

  • Kung, H.C. , Hoyert, D.L. , Xu, J. , Murphy, S.L. (2008). Deaths: Final data for 2005. National Vital Statistics Report, 56(10), 9. First citation in articleGoogle Scholar

  • Linehan, M.M. , Comtois, K.A. , Murray, A.M. , Brown, M.Z. , Gallop, R.J. , Heard, H.L. et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766. First citation in articleCrossref Medline, Google Scholar

  • Mann, J.J. , Apter, A. , Bertolote, J. , Beautrais, A. , Currier, D. , Haas, A. et al. (2005). Suicide prevention strategies: A systematic review. Journal of the American Medical Association, 294, 2064–74. First citation in articleCrossref Medline, Google Scholar

  • McGinn, T. , Wyer, P.C. , Newman, T.B. , Keitz, S. , Leipzig, R. , Guyatt, G. et al. (2004). Tips for learners of evidence-based medicine: 3. Measures of observer variability (κ statistic). Canadian Medical Association Journal, 171, 1369–1373. First citation in articleCrossref, Google Scholar

  • Nierenberg, A.A. , Trivedi, M.H. , Ritz, L. , Burroughs, D. , Greist, J. , Sackeim, H. et al. (2004). Suicide risk management for the sequenced treatment alternatives to relieve depression study: Applied NIMH guidelines. Journal of Psychiatric Research, 38, 583–589. First citation in articleCrossref Medline, Google Scholar

  • Oquendo, M.A. , Stanley, B. , Ellis, S.P. , Mann, J.J. (2004). Protection of human subjects in intervention research for suicidal behavior. American Journal of Psychiatry, 161, 1558–1563. First citation in articleCrossref Medline, Google Scholar

  • Pearson, J.L. , Stanley, B. , King, C. , Fisher, C. (2005). Issues to consider in intervention research with persons at high risk for suicidality. Retrieved April 1, 2008, from the National Institute of Mental Health website www.nimh.nih.gov/suicideresearch/highrisksuicide.cfm First citation in articleGoogle Scholar

  • Pearson, J.L. , Stanley, B. , King, C.A. , Fisher, C.B. (2001). Intervention research with persons at high risk for suicidality: Safety and ethical considerations. Journal of Clinical Psychiatry, 62(Suppl. 25), 17–26. First citation in articleMedline, Google Scholar

  • Rudd, M.D. , Joiner, T.E. , Rajab, M.H. (2001). Treating suicidal behavior: An effective, time-limited approach. New York: Guilford. First citation in articleGoogle Scholar

  • Satcher, D. (1999). The surgeon general’s call to action to prevent suicide. Washington DC: US Public Health Service. First citation in articleGoogle Scholar

  • Starks, H. , Brown Trinidad, S. (2007). Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qualitative Health Research, 17, 1372–1380. First citation in articleCrossref Medline, Google Scholar

  • World Health Organization . (1996). Prevention of suicide: Guidelines for the formulation and implementation of national strategies. Geneva, Switzerland: WHO. First citation in articleGoogle Scholar

  • Yang, B. (2007). Recalculating the economic cost of suicide. Death Studies, 31, 351–361. First citation in articleCrossref Medline, Google Scholar