ImportanceSuicide risk is elevated after discharge from inpatient level of care. Empirically supported inpatient suicide prevention treatments are needed.ObjectiveTo determine whether adding an inpatient version of brief cognitive behavioral therapy for suicide prevention to treatment as usual reduces postdischarge suicide attempts, suicidal ideation, and psychiatric readmissions and to determine whether substance use disorder moderates treatment effects.Design, Setting, and ParticipantsThis randomized clinical trial compared treatment as usual (n = 106) to treatment as usual plus brief cognitive behavioral therapy for inpatients (n = 94) at a private psychiatric hospital in Connecticut. Follow-up assessments were completed monthly for 6 months postdischarge. Participants were enrolled from January 2020 through February 2023. Inpatients admitted following a suicidal crisis (past-week suicide attempt or ideation with plan on admission and attempt within previous 2 years) were included. Medical records of consecutive admissions (n = 4137) were screened, 213 were study eligible and randomized, and 200 were analyzed. A total of 114 participants (57.0%) completed 6-month follow-up assessments. Data from medical records were also obtained through 6-month follow-up.InterventionUp to 4 individual sessions of brief cognitive behavioral therapy for suicide prevention designed for inpatients.Main Outcomes and MeasuresSuicide attempts and readmissions were assessed via blind interviews and medical record review. Suicidal ideation was assessed via self-report.ResultsThe mean (SD) age among 200 analyzed participants was 32.8 (12.6) years; 117 participants were female and 83 were male. Brief cognitive behavioral therapy–inpatient reduced the occurrence of suicide attempt over 6 months postdischarge by 60% (odds ratio, 0.40; 95% CI, 0.20-0.80; number needed to treat, 7) in the entire patient group, and the rate of psychiatric readmissions by 71% (rate ratio, 0.29; 95% CI, 0.09-0.90) in those without a substance use disorder. The effect of treatment condition on suicidal ideation was less clear, although post hoc analyses indicated less severe suicidal ideation following brief cognitive behavioral therapy–inpatient vs treatment as usual at 1 and 2 months postdischarge.Conclusions and RelevanceBrief cognitive behavioral therapy–inpatient reduced 6-month postdischarge suicide reattempts and rate of readmissions when added to treatment as usual. Substance use disorder moderated the treatment’s effect on readmission rates. Treatment effects on suicidal ideation were less clear. Implementation research is needed to facilitate dissemination. Additional research is also needed to optimize outcomes for individuals with substance use disorders.Trial RegistrationClinicalTrials.gov Identifier: NCT04168645

中文翻译：

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针对自杀住院患者的简短认知行为治疗


重要性 从住院护理级别出院后，自杀风险会升高。需要实证支持的住院患者自杀预防治疗。目的确定在常规治疗中添加住院患者简短的认知行为疗法以预防自杀是否会减少出院后的自杀企图、自杀意念和精神病再入院，并确定物质使用障碍是否会缓和治疗效果。设计、设置和参与者 这项随机临床试验对康涅狄格州一家私立精神病医院住院患者 (n = 94) 的常规治疗 (n = 106) 与常规治疗加简短认知行为治疗进行了比较。出院后 6 个月内每月完成一次随访评估。参与者的招募时间为 2020 年 1 月至 2023 年 2 月。自杀危机后入院的住院患者（过去一周的自杀企图或在入院时计划自杀的意念以及过去 2 年内的企图）也包括在内。对连续入院的医疗记录 (n = 4137) 进行了筛选，其中 213 例符合研究资格并进行了随机分组，并对 200 例进行了分析。共有 114 名参与者（57.0%）完成了 6 个月的随访评估。还通过 6 个月的随访获得了病历数据。 干预 为住院患者设计了最多 4 次简短的认知行为疗法，用于预防自杀。 主要结果和措施 通过盲访和病历审查来评估自杀企图和再入院情况。通过自我报告评估自杀意念。结果 200 名分析参与者的平均 (SD) 年龄为 32.8 (12.6) 岁； 117 名参与者为女性，83 名参与者为男性。 短期认知行为治疗——住院患者在出院后 6 个月内将整个患者组的自杀企图发生率降低了 60%（比值比，0.40；95% CI，0.20-0.80；需要治疗的人数，7），并且自杀率没有物质使用障碍的患者的精神科再入院率降低了 71%（比率，0.29；95% CI，0.09-0.90）。治疗条件对自杀意念的影响尚不清楚，尽管事后分析表明，短期认知行为治疗（住院患者与出院后 1 个月和 2 个月照常治疗相比）自杀意念较轻。结论和相关性短暂认知行为治疗（住院患者）减少了 6-出院后一个月的自杀再尝试率以及在照常治疗的情况下再次入院的比率。药物滥用障碍减轻了治疗对再入院率的影响。治疗对自杀意念的效果尚不清楚。需要实施研究以促进传播。还需要进行更多研究来优化患有物质使用障碍的个体的结果。试验注册临床试验。政府标识符：NCT04168645