Journal Article Epublish 1 citation
PubMed: 41212557 DOI: 10.1001/jamanetworkopen.2025.43156
Safety Planning vs Standard Care for Suicide Prevention After Pretrial Jail Detention: A Randomized Clinical Trial.
JAMA Netw Open 8(11):e2543156
Authors: Lauren M Weinstock, Richard N Jones, Ted R Miller, Gregory K Brown, Sarah A Arias, Hannah R Graves, Ivan W Miller, Louis Cerbo, Julie Rexroth, Holly Fitting, Danis Russell, Sheryl Kubiak, Michael D Stein, Christopher Matkovic, Shirley Yen, Brandon A Gaudiano, Jennifer E Johnson
Affiliations
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, Rhode Island.
- Pacific Institute for Research and Evaluation, Silver Spring, Maryland.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
- Psychosocial Research Program, Butler Hospital, Providence, Rhode Island.
- Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, State of Rhode Island, Cranston.
- Genesee County Jail, Flint, Michigan.
- Family Reentry, Community Resources for Justice, Bridgeport, Connecticut.
- Genesee Health System, Flint, Michigan.
- School of Social Work, Wayne State University, Detroit, Michigan.
- Boston University School of Public Health, Boston, Massachusetts.
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, Rhode Island. Psychiatry Emergency Service, Rhode Island Hospital, Providence.
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint.
Abstract
IMPORTANCE
In the US, 1 in 5 adult suicide decedents has spent at least 1 night in jail in the year prior to death.
OBJECTIVE
To evaluate the effectiveness of the Safety Planning Intervention (SPI) with telephone follow-up as an adjunct to enhanced standard care (ESC) compared with ESC alone for reducing suicide events in the 12 months following release from pretrial jail detention.
DESIGN, SETTING, AND PARTICIPANTS
This randomized clinical trial included individuals with past 30-day suicide risk (suicide ideation with intent and/or suicide attempt) in pretrial jail detention who were recruited from 2 jails from May 11, 2016, to November 13, 2018, with a 12-month follow-up after release. Data analysis was completed from April 2023 to May 2025.
INTERVENTIONS
All participants received ESC. The SPI included a safety planning session in jail followed by 4 to 8 telephone calls 6 months after jail release.
MAIN OUTCOMES AND MEASURES
The primary outcome was the number of suicide events (a composite of suicide attempts and behaviors, suicide-related hospitalizations, and suicide deaths). Secondary outcomes included the number of suicide attempts, weeks and severity of active suicidal ideation, time to first suicide event, psychiatric symptoms, functioning, and hypothesized mediators. Suicidal ideation and behaviors were assessed using the Columbia-Suicide Severity Rating Scale, the Longitudinal Interval Follow-Up Evaluation, and record reviews from area hospitals. Deaths were identified through hospital, state, and national death records. Hospitalizations were measured with the Treatment History Interview and hospital records.
RESULTS
Of 800 participants randomized in jail, 655 (mean [SD] age, 33.0 [10.4] years; 473 males [72%]) were released to the community and included in analyses. Of those, 593 (91%) completed at least 1 follow-up interview. Medical records were available for all 655 participants (100%). Per person-year of follow-up over 12 months, those in the SPI group compared with those in the ESC group had 42% fewer suicide events (mean [SE], 1.82 [0.18] vs 3.11 [0.32]; mean [SE] difference, -1.30 [0.37]; P < .001), 55% fewer suicide attempts (mean [SE], 1.06 [0.14] vs 2.35 [0.33]; mean [SE] difference, -1.33 [0.38]; P < .001). Differences in weeks of suicidal ideation were not statistically significant (mean [SE], 10.39 [0.78] vs 12.86 [1.02]; mean [SE] difference, -2.47 [1.28]; P = .06). There were no other observed differences in outcomes.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial of the SPI compared with ESC, those in the SPI group experienced reduced suicide risk by 42% in the year after jail release. These results suggest that SPI is effective for reducing suicide risk during this high-risk period.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02759172.
MeSH
Telephone, Safety, Clinical Medicine, Records, Suicidal Ideation, Suicide, Attempted, Jails, Suicide, Suicide Prevention