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ViewAttendees 4

Symposia

Suicide and Self-Injury

Session: Suicide Prevention as a Platform for Social Connection: Innovations in the Stanley & Brown Safety Planning Intervention

1 - (SYM 136) Quality over Completeness: Higher Quality Safety Plans Predict a Decrease in Suicide Attempts Among Psychiatrically Hospitalized Military Veterans

Sunday, November 19, 2023
10:30 AM – 12:00 PM PST
Location: Kachess (405), Level 4

Background: The period of time immediately following discharge from an inpatient psychiatry hospitalization is a period of elevated risk for suicide. Safety plans (SPs) are a brief intervention that may mitigate this risk, although there is relatively little information about the effectiveness of SPs for Veterans hospitalized for suicide risk during this high-risk transition period.

Methods: Participants were 132 Veterans (M age=45.64; 89.39% male) hospitalized for suicide risk and recruited as part of a randomized controlled trial to test the efficacy of motivational interviewing on suicide ideation (SI). We used a previously developed coding system to examine if SP quality (i.e., greater personal relevance) and completeness scores predicted a decreased likelihood of suicide attempts during the six-month follow-up period. We also examined if SP quality and completeness scores were related to the likelihood of SP usage during the follow-up. All effects were tested unadjusted and then replicated controlling for the impact of baseline SI.

Results: Of the 132 veterans, 123 had a SP. SP Quality issues were common, with 98% of plans containing at least 1 quality issue (M=4.7/plan). Furthermore, in survival analyses SP quality but not SP completeness predicted a decreased likelihood of suicide attempt (Adjusted HR [95%CI]=0.78 [0.65, 0.94]). Examining quality at the step-level, Step 1 (warning signs; AHR=0.51 [0.29, 0.91]) Step 4 (social support; AHR=0.60 [0.36, 1.00]) predicted a decreased likelihood of attempt. When examining actual SP usage over the six-month period, quality, but not completeness predicted patterns of SP usage. SP quality predicted greater initial odds of SP usage (AOR=1.37 [1.00, 1.87]) though this effect diminished as time progressed (AOR=0.91 [0.84, 0.98]). Further examination at the step-level highlighted a key role for Step 5 (professional support), which after controlling for SI, predicted marginal increase in SP usage (AOR=2.56 [0.89-7.34]) that had diminished benefit over time (AOR=0.74 [0.57, 0.96]).

Discussion: Together, these findings highlight the importance of developing high quality SPs, most notably for steps pertaining to identifying warning signs and contacting supports. In addition, we will also discuss results of a streamlined two-item coding system which assesses the presence of potential protective and harmful items on SPs.