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01-07-2020 | Suicide | Original Research

Tailored Activation of Middle-Aged Men to Promote Discussion of Recent Active Suicide Thoughts: a Randomized Controlled Trial

Authors: Anthony Jerant, MD, Paul Duberstein, PhD, Richard L. Kravitz, MD, MSPH, Deborah M. Stone, ScD, MSW, MPH, Camille Cipri, BS, Peter Franks, MD

Published in: Journal of General Internal Medicine | Issue 7/2020

Abstract

Purpose

Middle-aged men are at high risk of suicide. While about half of those who kill themselves visit a primary care clinician (PCC) shortly before death, in current practice, few spontaneously disclose their thoughts of suicide during the visits, and PCCs seldom inquire about such thoughts. In a randomized controlled trial, we examined the effect of a tailored interactive computer program designed to encourage middle-aged men’s discussion of suicide with PCCs.

Methods

We recruited men 35–74 years old reporting recent (within 4 weeks) active suicide thoughts from the panels of 42 PCCs (the unit of randomization) in eight offices within a single California health system. In the office before a visit, men viewed the intervention corresponding to their PCC’s random group assignment: Men and Providers Preventing Suicide (MAPS) (20 PCCs), providing tailored multimedia promoting discussion of suicide thoughts, or control (22 PCCs), composed of a sleep hygiene video plus brief non-tailored text encouraging discussion of suicide thoughts. Logistic regressions, adjusting for patient nesting within physicians, examined MAPS’ effect on patient-reported suicide discussion in the subsequent office visit.

Results

Sixteen of the randomized PCCs had no patients enroll in the trial. From the panels of the remaining 26 PCCs (12 MAPS, 14 control), 48 men (MAPS 21, control 27) were enrolled (a mean of 1.8 (range 1–5) per PCC), with a mean age of 55.9 years (SD 11.4). Suicide discussion was more likely among MAPS patients (15/21 [65%]) than controls (8/27 [35%]). Logistic regression showed men viewing MAPS were more likely than controls to discuss suicide with their PCC (OR 5.91, 95% CI 1.59–21.94; P = 0.008; nesting-adjusted predicted effect 71% vs. 30%).

Conclusions

In addressing barriers to discussing suicide, the tailored MAPS program activated middle-aged men with active suicide thoughts to engage with PCCs around this customarily taboo topic.

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Title: Tailored Activation of Middle-Aged Men to Promote Discussion of Recent Active Suicide Thoughts: a Randomized Controlled Trial
Authors: Anthony Jerant, MD
Paul Duberstein, PhD
Richard L. Kravitz, MD, MSPH
Deborah M. Stone, ScD, MSW, MPH
Camille Cipri, BS
Peter Franks, MD
Publication date: 01-07-2020
Publisher: Springer International Publishing
Keywords: Suicide
Suicide
Published in: Journal of General Internal Medicine / Issue 7/2020
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-020-05769-3

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Abstract

Purpose

Methods

Results

Conclusions

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