Office Hours Recap: Research spotlight and our top takeaways

Structural Racism and Suicide Prevention

• Article: Structural racism and suicide prevention for ethnoracially minoritized youth: A conceptual framework and illustration across systems (Alvarez, Polanco-Roman, Breslow, & Molock, 2022) 
• Takeaway: Structural racism in society is likely to be one of the factors driving suicide risk for youth of colour. Even if an individual system can’t reform society at large, it can work proactively to improve health equity and address racial disparities, as well as routinely address race-based stress and trauma with those they serve. This article offers several strategies for consideration.  

Prediction in Suicide Prevention

• Article: The role of prediction in suicide prevention (Large, 2018)
• Takeaway: We tend to think we are much better than we actually are at predicting suicide risk. Categorising and stratifying people by risk results in missing many people who die by suicide and many false positives. That's why the SafeSide Framework focuses on planning, rather than prediction. Large recommends routinely planning for what might happen with all patients rather than narrowing our focus predicting what will happen with a more narrow group. This is why when creating an initial plan with someone, we recommend being certain to include identifying two foreseeable changes and making a contingency plan for each.
• Article: Evaluation of the Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment suicide risk modeling clinical program in the Veterans Health Administration (McCarthy, Cooper, Dent, et al., 2021)
• Takeaway: While humans are not good at prediction, machine learning algorithms working with big data are making some first steps toward progress in this area. This article is the first to show positive engagement and improved prevention outcomes – including reduced suicide attempts – from using predictive technology to reach out to veterans identified as being in a high-risk period based on their health record data.
• Articles: Local implementation evaluation of a suicide prevention predictive model at a large VA health care system (Du Pont, Stanley, Pruitt, Reger, 2022); Evaluating clinician attitudes after local implementation of the Veterans Affairs predictive model for suicide prevention (Piccirillo, Pruitt, Reger, 2022)
• Takeaway: While new technological solutions like the REACH VET initiative may help with prediction, important questions remain about what individual clinicians should do with risk data and how this should be applied to individual cases.

 Non-Demand Caring Contacts

• Article: Implementation strategy to increase clinicians’ use of the caring letters suicide prevention intervention (Reger, Jegley, Shelan, et al., 2022)
• Takeaway: Non-demand caring contacts – letters or messages sent out to maintain a connection with someone who has been in contact with a system for suicide risk – are a powerful prevention tool supported by excellent evidence. Having a centralised systems-level method for sending out caring contacts makes it easier for clinicians to make this happen. 

Note: This is one of the recaps from our monthly Office Hours sessions where SafeSide members can ask questions and share their experiences. Members also have access to Community of Practice with the full library of recaps, newsletters and resources.