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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自杀住院患者的简要认知行为疗法


重要性从住院护理水平出院后自杀风险升高。需要经验支持的住院自杀预防治疗。目的确定在常规治疗中加入住院版本的简短认知行为疗法以预防自杀是否能减少出院后自杀未遂、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、环境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的住院患者 （n = 94） 的常规治疗 （n = 106） 与常规治疗加简短的认知行为疗法进行了比较。出院后 6 个月每月完成一次随访评估。参与者于 2020 年 1 月至 2023 年 2 月入组。包括因自杀危机 （过去一周自杀未遂或计划入院和过去 2 年内企图入院和未遂的意念） 而入院的患者。筛选了连续入院的病历 （n = 4137），其中 213 例符合研究条件并随机分组，并分析了 200 例。共有 114 名参与者 （57.0%） 完成了 6 个月的随访评估。通过 6 个月的随访也获得了来自病历的数据。干预最多 4 次专为住院患者设计的简短认知行为预防治疗。主要结局和措施通过盲访和病历审查评估自杀未遂和再入院。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 名为男性。 简短认知行为疗法 – 住院患者使整个患者组出院后 6 个月内自杀未遂的发生率降低了 60% （比值比，0.40;95% CI，0.20-0.80;需要治疗的人数，7），在没有物质使用障碍的患者中，精神病再入院率降低了 71% （率比，0.29;95% CI，0.09-0.90）。治疗条件对自杀意念的影响不太清楚，尽管事后分析表明，在出院后 1 个月和 2 个月，短暂的认知行为治疗 - 住院与常规治疗相比，自杀意念的严重程度较低。结论和相关性简要认知行为疗法 – 住院患者在正常治疗中加入治疗时，减少了出院后 6 个月的自杀再尝试率和再入院率。物质使用障碍调节了治疗对再入院率的影响。对自杀意念的治疗效果不太清楚。需要实施研究以促进传播。还需要更多的研究来优化物质使用障碍患者的预后。试验注册临床试验。gov 标识符： NCT04168645