5 - (SYM 39) Longitudinal Risk of Suicidal Behaviors in People with Severe Mental Illness Following an Emergency Department Visit with versus Without Suicide Prevention Treatment

Individuals with severe mental illness (SMI), including schizophrenia-spectrum disorders (SSD) and bipolar disorder (BD), are at high risk for suicide (e.g., Palmer et al., 2005; Saha et al., 2007). However, suicide research often excludes individuals with SMI (Villa et al., 2020), limiting our understanding of risk for suicidal behaviors (SBs) over time and the efficacy of suicide prevention treatments among people with these diagnoses. Therefore, the aims of this research were to examine: 1) differences in SBs over the course of 52 weeks between people with and without SSD and BD diagnoses following an emergency department (ED) visit, and 2) the effects of the Coping Long Term with Active Suicide Program (CLASP) intervention in reducing SBs among people with SSD and BD diagnoses. Participants were 1,235 adults recruited from 8 different EDs across the United States who presented with recent suicidality. Using a quasi-experimental, interrupted time series design, participants were followed for 52-weeks with or without subsequent provision of CLASP. A total of 33% (n = 456) of the sample had BD, 11% (n = 149) had SSD, and 46% (n = 630) had another psychiatric diagnosis (OPD).

 First, survival analyses showed that, over the course of follow-up, participants in the SSD group had a significantly shorter mean time to SBs (41 weeks) than participants in the OPD group (44 weeks; p = .04), as did participants in the BD group (40 weeks; p = .003). Second, among participants with BD, those who received the CLASP intervention had a significantly longer time to SBs (44 weeks) compared with those who did not receive CLASP (40 weeks; p = .04). However, among those with SSD, there was no significant difference in time to SBs in those receiving CLASP (41 weeks) vs not receiving CLASP (41 weeks; p = .86). Cox regressions, which included relevant covariates, demonstrated the same pattern of results. 

 These findings suggest that, among adults at high-risk for suicide identified in the ED, SMI diagnosis is a critical indicator of prospective suicide risk. The study also shows that CLASP reduces subsequent suicide risk in those with BD but not necessarily in those with SSD. This work has considerable clinical implications, highlighting the importance of providing people with SMI with additional treatment that addresses their unique needs. In addition, the ED may be a particularly useful setting in which to identify those at risk and administer suicide interventions as part of follow-up care.