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Suicide Risk Management Protocol for Patients With Ischemic CVD Who Report Hopelessness
Quick Takes
- As part of a larger clinical trial examining the impact of a motivational intervention on hopelessness in patients with ischemic heart disease, investigators described the development and preliminary testing of a suicide risk management protocol for identifying, referring, and reporting suicide risk in patients.
- The suicide risk management protocol developed for this trial can serve as a model in the development of suicide risk management protocols for future research in acute care, community, or home-based settings.
Study Questions:
What are the preliminary findings of use of a suicide risk management protocol developed for a randomized controlled trial testing the impact of a motivational intervention to reduce feelings of hopelessness among adult patients with ischemic cardiovascular disease who have moderate to severe levels of hopelessness?
Methods:
Adults patients with ischemic heart disease who met the moderate to severe state of hopelessness inclusion criterion (i.e., 1.8 score or higher on the State-Trait Hopelessness Scale) were enrolled in the clinical trial. The Columbia-Suicide Severity Rating Scale and its affiliated Clinical Triage Guidelines were used to screen research participants’ levels of suicide risk and guided triage activities in the hospital and home follow-up settings, as well as during unscheduled contacts if suicidal ideations were expressed. Suicide risk scores were calculated in real time using the REDcap database system to support protocol-based researcher screening and triage activities, as well as reporting to project leaders for data safety and monitoring, treatment referral. and outcome tracking.
Results:
Of the 98 hospitalized patients who have been screened for hopelessness so far, 51 reported a moderate to severe state of hopelessness. Of these, 43 patients scored at a safe level, and 8 patients scored at a low suicide-risk level. To date, 35 patients have been enrolled in the clinical trial and have had follow-up home visit data collected. Of these, 3 instances of low suicide-risk level and 1 instance of moderate suicide-risk level were identified and triaged using the protocol.
Conclusions:
In this ongoing clinical trial, preliminary data show that use of the suicide risk management protocol has been effective in identifying participants (adults with ischemic heart disease who report hopelessness) as safe or at risk for suicide in both hospital and home settings. Feelings of hopelessness have been associated with increased suicide risk among persons living with cardiovascular disease, and research on interventions to address hopelessness need to include suicide risk protocols for assessment of suicide ideation and its severity, surveillance monitoring, and treatment referral.
Perspective:
Suicide is a major public health concern and is the 10th leading cause of death in the United States, with an age-adjusted suicide increase of 30% between 2000 and 2016. Discovery of suicide ideations in research is common, especially among patients with ischemic cardiovascular disease who experience hopelessness. Researchers conducting studies with participants who might be at risk for suicide are obligated to implement suicide risk protocols, but literature guidance on suicide risk management protocol development is sparse. As part of a larger clinical trial examining the impact of a motivational intervention on hopelessness in patients with ischemic heart disease, investigators described the development and preliminary testing of a suicide risk management protocol for identifying, referring, and reporting suicide risk in patients. This protocol was designed for effective use with patients participating in research in a variety of contexts, as well as in clinical practice.
Clinical Topics: Stable Ischemic Heart Disease, Prevention
Keywords: Suicidal Ideation, Emotions, Cardiovascular Diseases, Ischemia, Risk Management, Clinical Protocols, Referral and Consultation, Controlled Clinical Trial, Motivation
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