Inpatient Cognitive-Behavioral Therapy to Reduce Suicide Risk Post-Discharge

Although inpatient treatment provides immediate stabilization and crisis management for suicidal patients, the risk of suicide post-discharge is substantial, with approximately one third of all suicides by individuals with mental disorders occurring in the 90 days following hospitalization. These data highlight the importance of establishing an empirically-supported inpatient treatment for suicide prevention. Cognitive behavioral therapy (CBT) is a strong candidate, given that CBT reduces risk in suicidal outpatients. In addition, an open trial was completed that 1) adapted the strongest outpatient CBT protocol for an inpatient setting, 2) demonstrated high levels of feasibility and acceptability, and 3) obtained preliminary estimates of efficacy. The objective here is to conduct a largescale randomized controlled trial (RCT) comparing CBT (n = 100) to treatment as usual (TAU, n = 100) to firmly establish efficacy and collect pilot data on treatment implementation metrics. This study aims to determine the efficacy of inpatient CBT on suicidal behavior, suicidal ideation/intent, and readmission post-treatment and over a 6-month follow-up period. The central hypothesis, based on strong outpatient data, is that inpatient CBT will reduce suicidal behavior, suicidal ideation/intent, and inpatient readmission over 6 months post-discharge, compared to TAU. Participants will be recruited after inpatient admission following a suicide attempt. An Independent Evaluator (IE) will conduct a clinical assessment that includes diagnostic/symptom assessments, assessment of suicide risk, and an Implicit Association Test (IAT), and participants complete self-report measures on substance use, clinical traits, and symptoms. Participants will receive four CBT sessions and will be assessed by the IE again within 24 hours prior to discharge. Participants will receive a questionnaire and IAT on a monthly basis for 6 months postdischarge. The proposed study will inform best practices treatment for hospitalized suicidal patients by establishing for the first time, and ultimately disseminating, an empirically-validated inpatient treatment for suicide prevention.

Inpatient Cognitive-Behavioral Therapy to Reduce Suicide Risk Post-Discharge

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