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Enduring Materials

Welcome to the education module on Suicide Prevention Tips for Physicians, Clinical Staff and Their Patients provided by TMF Health Quality Institute. For assistance, contact Behavioral Health staff at 1-866-439-6863 or BehavioralHealth@tmf.org.

Suicide Prevention Tips for Physicians, Clinical Staff and Their Patients

Credit Hours: 1.0 CE

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  • Overview
  • Accreditation
  • Disclosures
  • References

The purpose of this education activity is to enhance the knowledge and understanding of participating physicians and health care providers of suicide and suicide prevention and improving the focus on care for patients at risk.

Learning objectives

After participating in this activity the participant will be able to:

  • Identify rates and trends of suicide
  • Discuss clinical steps to prevent suicide
  • Identify suicide risk factors
  • Explain suicide-specific treatment interventions
  • Identify physician suicide risk and prevention approaches
  • Explain suicide risk factors from a survivor’s perspective for the clinical provider

Release Date: Nov. 14, 2018
Expiration Date: Nov. 14, 2019

Target Audience

This enduring material is designed for health professionals who would like to increase their knowledge of suicide prevention, the patients at risk and for physicians who may identify patients at risk for suicide.

Accreditation Statement

TMF Health Quality Institute is accredited by the Texas Medical Association to provide continuing medical education (CME) for physicians.

TMF Health Quality Institute designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

TMF Health Quality Institute designates this CME activity for a maximum of 1.0 2A credits for Osteopathic physicians (DOs).

This CME activity has been designated by TMF Health Quality Institute for a maximum of 1.0 hours of education in medical ethics and/or professional responsibility.

Disclosures

The TMF Continuing Education Planning Committee and the presenter/authors of this module have no relevant financial relationships to disclose.

Planners: Terri Watson, Caitlin Moore, Allison Crotty
Presenters: Christine Moutier, Leah Patterson

Policies and standards of the Texas Medical Association, the Accreditation Council for Continuing Medical Education and the American Medical Association require that speakers/authors and planners for continuing medical education activities disclose any relevant financial relationships they may have with commercial interests whose products, devices or services may be discussed in the content of a CME activity.

Notice of Requirements for Successful Completion of Continuing Education Activity:

To receive contact hours for this continuing education activity, the participant must:

  • Attend the session in its entirety to be eligible for continuing education credit. Click the "Start" button above to access the training video.
  • Upon completion of the training, provide a unique identifier (birth day and month).
  • Complete and submit the online Educational Activity Evaluation Form for this session.

Once successful completion has been verified, a “Certificate of Successful Completion” will be awarded for 1.0 contact hours.

The TMF web-based Continuing Education has received no commercial support.

Glossary of Terms

Commercial Interest: Any entity producing, marketing, re-selling or distributing health care goods or services consumed by, or used on, patients.

Conflict of Interest: The Accreditation Council for Continuing Medical Education considers financial relationships to create conflicts of interest in Continuing Medical Education (CME) when individuals have both a financial relationship with a commercial interest and the opportunity to affect the content of CME about the products or services of that commercial interest. The potential for maintaining or increasing the value of the financial relationship with the commercial interest creates an incentive to influence the content of the CME—an incentive to insert commercial bias.

Enduring Material: An activity that endures over a specified time and does not have a specific time or location designated for participation; rather, the participant determines whether and when to complete the activity. Examples: online interactive educational module, recorded presentation, podcast.

Relevant Financial Relationships: Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria for promotional speakers’ bureau, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds) or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership and other activities from which remuneration is received, or expected. See also “conflict of interest.” Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Estimated Time to Complete this Educational Activity: 1 hour

References

CDC https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf

Clinical Care Recommended Standards
National Action Alliance for Suicide Prevention: Transforming Health Systems Initiative Work Group. (2018). Recommended standard care for people with suicide risk: Making health care suicide safe. Washington, DC: Education Development Center, Inc
https://theactionalliance.org/sites/default/files/action_alliance_recommended_standard_care_final.pdf

Joint Commission Sentinel Event Alert 56
https://www.jointcommission.org/assets/1/18/SEA_56_Suicide.pdf

Related Resources
SAFE-T Suicide assessment five-step evaluation and triage (SAFE-T) pocket card
http://www.sprc.org/resources-programs/suicide-assessment-five-step-evaluation-and-triage-safe-t-pocket-card

Beck AT, Steer, RA. Manual for the Beck Scale for Suicide Ideation. San Antonio, TX: The Psychological Corporation; 1993b.

McDowell, Lineberry, Bostwick 2011 Practical Suicide Risk Assessment for Primary Care Settings. Mayo Clinic Proceedings
https://www.jointcommission.org/assets/1/18/SEA_56_Suicide.pdf

McDowell, A, Lineberry, TW, and Bostwick, JM. Practical Suicide-Risk Management for the Busy Primary Care Physician.
Mayo Clin Proc. 2011 Aug; 86(8): 792–800.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146379/
 

Kelly, KT, Knudson, MP. Are No-Suicide Contracts Effective in Preventing Suicide in Suicidal Patients Seen by Primary Care Physicians? Archives of Family Medicine, 2000, 9 (10): 1119-21.

Stanford, EJ, Goetz, RR, Bloom, JD. The No Harm Contract in the emergency assessment of suicidal risk. Journal of Clinical Psychiatry. 1994 8 (55): 344-348.  https://ohsu.pure.elsevier.com/en/publications/the-no-harm-contract-in-the-emergency-assessment-of-suicidal-risk-2

Impact of Follow-up Contact:
Luxton DD, June JD, & Comtois KA. Can postdischarge follow-up contacts prevent suicide and suicidal behavior? A review of the evidence. Crisis 2013;34(1): 32-41

Studies of Lethal Means Reduction:
Gunnell D, Fernando R, Hewagama M, et al. The impact of pesticide regulations on suicide in Sri Lanka. International J Epid. 2007; 36:1235-1242.

Kreitman N. The coal gas story: United Kingdom suicide rates 1960-71. Brit J Prev Soc Med. 1976; 30:86-93.

Lubin G, Werbeloff N, Halperin D, et al. Decrease in suicide rates after a change of policy reducing access to firearms in adolescents: a naturalistic epidemiological study. Suicide Life Threat Behav. 2010; 40:421-424.

Timing, Suicidal Process and Attempts:
Fawcett J, Scheftner WA, Fogg L, Clark DC, Young MA, et al. (1990) Time-related predictors of suicide in major affective disorder. The American Journal of Psychiatry 147: 1189–1194.

Deisenhammer EA, Ing CM, Strauss R, et al. The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? J Clin Psychiatry. 2009; 70:19-24.

Owens D, Horrocks J, House A. Fatal and non-fatal repetition of self-harm: systematic review. Br J Psychiatry.  2002; 181:193-199.

Safety Planning:
Stanley B, Brown GK. Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice. 2011; 19:256-264.

Stanley, B., & Brown, G. K. (2008b). Safety planning intervention: Brief instructions. Washington, D.C.: United States Department of Veterans Affairs. http://www.suicidesafetyplan.com/uploads/Safety_Planning_-_Cog___Beh_Practice.pdf

Lethal Means Counseling:
Bryan CJ, Stone SL, Rudd MD. A practical, evidence-based approach for means-restriction counseling with suicidal patients. Professional Psychology: Research and Practice. 2011; 42(5):339-346.

More on Lethal Means Counseling
https://www.hsph.harvard.edu/means-matter/lethal-means-counseling/

DBT:
Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psych. 2006; 63:757-766.

Linehan, M.M. (2014). DBT® Skills Training Manual, Second Edition. New York: Guilford Press.

Linehan, MM, Tutek, DA, Heard, HL, Armstrong, HE. Interpersonal outcome of cognitive behavioral treatment for chronically suicidal bor­derline patients. American Journal of Psychiatry, 1994, 151, 1771–1776.

CBT:
CBT for Suicide Prevention
http://www.nimh.nih.gov/news/science-news/2009/new-approach-to-reducing-suicide-attempts-among-depressed-teens.shtml  

Brown GK, Ten Have T, Henriques GR, et al. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA.  2005; 294:563-570.

Stanley, B, Brown, G, Brent, D, Wells, K, Poling, K, Curry, J, Kennard, BD, Wagner, A, Cwik, M, Brunstein Klomek, A, Goldstein, T, Benedetto, V, Barnett, S, and Hughes, J. Cognitive Behavior Therapy for Suicide Prevention (CBT-SP): Treatment Model, Feasibility and Acceptability. J Am Acad Child Adolesc Psychiatry. 2009 Oct; 48(10): 1005–1013.

CAMS:
Jobes DA. The CAMS approach to suicide risk: philosophy and clinical procedures. Suicidology. 2009; 14:1-5.

Jobes DA, Wong SA, Conrad AK, Drozd JF, Neal-Walden T. The collaborative assessment and management of suicidality versus treatment as usual: A retrospective study with suicidal outpatients. Suicide & Life-threatening Behavior. 2005;35:483–497. doi: 10.1521/suli.2005.35.5.483.

Comtois KA, Jobes DA, O’Connor S, Atkins DC, Janis K, Chessen C, Yuodelis FC. Collaborative assessment and management of suicidality (CAMS): Feasibility trial for next-day appointment services. Depression and Anxiety. 2011;28:963–972.

Attachment-based Family Therapy:
Diamond, G., Russon, J., & Levy, S. (2016). Attachment-based family therapy: A review of the empirical support. Family Process, 55(3), p. 595-610.

Diamond GS, Wintersteen MB, Brown GK, Diamond GM, Gallop R, Shelef K, Levy S. Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial. J Amer Acad Child Adol Psychiatry. 2010; 49(2):122-131.

ASSIP:
Gysin-Maillart, A, Schwab, S, Soravia, L, Megert, M, Michel, K. (2016) A Novel Brief Therapy for Patients Who Attempt Suicide: A 24-months Follow-Up Randomized Controlled Study of the Attempted Suicide Short Intervention Program (ASSIP). PLoS Med. 2016 Mar; 13(3): e1001968. Published online 2016 Mar 1. doi: 10.1371/journal.pmed.

Kennard BD, Biernesser C, Wolfe KL, et al. Developing a brief suicide prevention intervention and mobile phone application: a qualitative report. J Technol Hum Serv.  2015; 33:345-357.

Medications/Antidepressants:
Fournier, JC,  DeRubeis, R, Hollon, SD, Dimidjian, S,  Amsterdam, JD,  Shelton, RC, and Fawcett, J, Lineberry, M, Bostwick, M. Antidepressant Drug effects and Depression Severity: A Patient-Level Meta-Analysis. JAMA. 2010 January 6; 303(1): 47–53. doi:10.1001/jama.2009.1943.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712503/pdf/nihms483345.pdf

Gibbons RD, Hur K, Bhaumik DK, Mann JJ. The relationship between antidepressant prescription rates and rate of early adolescent suicide. Am J Psychiatry. 2006 Nov;163(11):1898-904.

Moutier, C. 2004 US Food and Drug Administration (FDA) BBW for “suicidality” in patients taking antidepressants confused the public, prescribers, and patients. Op-Ed, July 2014, “Black Box” Warning. https://afsp.org/op-ed-black-box-warning/

Lithium:
Baldessarini RJ, Tondo L, Davis P, et al. Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review. Bipolar Disord. 2006; 8:625-239.

Tondo L, Isacsson G, Baldessarini R. Suicidal behaviour in bipolar disorder: risk and prevention. CNS Drugs. 2003;17(7):491-511.

Cipriani A, Hawton K, Stockton S, Geddes JR. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ. 2013 Jun 27;346:f3646. doi: 10.1136/bmj.f3646.
http://www.psychiatrictimes.com/special-reports/what-role-does-should-lithium-play-in-suicide-treatment-prevention#sthash.tav0rym5.dpuf
 

Media Guidelines for Reporting on Suicide
http://reportingonsuicide.org/

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