Inpatient Cognitive-Behavioral Therapy to Reduce Suicide Risk Post-Discharge

Individuals hospitalized for suicidal crises face an elevated risk of suicide, particularly during the months immediately following discharge. Despite the urgent need for effective suicide prevention treatments in inpatient settings, the availability of evidence-based interventions tailored to this population has remained limited. To address this public health challenge, innovative approaches are needed to reduce suicide attempts, suicidal ideation, and psychiatric readmissions. Brief, targeted therapies that can be feasibly implemented during short, inpatient stays may hold promise for improving outcomes and bridging the gap in care after discharge.

In his AFSP-funded focus grant, Dr. David Tolin and his team evaluated the effectiveness of a four-session inpatient version of Brief Cognitive Behavioral Therapy (BCBT-inpatient) compared to treatment as usual (TAU) in a sample of 200 psychiatric inpatients admitted for suicidal thoughts and behaviors. Over a six-month follow-up, BCBT-inpatient reduced the odds of suicide attempts by 60% and lowered psychiatric readmission rates by 71% among participants without substance use disorders (SUDs). However, the intervention's impact on suicidal ideation was less clear, with only modest reductions in ideation severity at one- and two-month follow-ups. Interestingly, participants with SUDs showed the same reduction in suicide attempts, but did not have the same effect on readmissions. These results represent a significant step forward in treating individuals hospitalized for suicidal crises.

Citation: Diefenbach, G. J., Lord, K. A., Stubbing, J., Rudd, M. D., Levy, H. C., Worden, B., Sain, K. S., Bimstein, J. G., Rice, T. B., Everhardt, K., Gueorguieva, R., & Tolin, D. F. (2024). Brief Cognitive Behavioral Therapy for Suicidal Inpatients: A Randomized Clinical Trial. JAMA psychiatry, 81(12), 1177–1186. https://doi.org/10.1001/jamapsychiatry.2024.2349

Substance use has long been established as a risk factor for suicide attempts. However, there is limited knowledge of the role this risk factor plays in suicidal behaviors. By understanding whether substance use plays a part in suicide attempts as a baseline vulnerability (i.e., if it increases risk by affecting an individual’s physiological, social, emotional, and cognitive states over time); as a short-term risk factor (i.e., if acute intoxication alters an individual’s decision making and behavioral control); as the lethal means used for suicide attempt; or as a combination of all three, researchers could help identify treatment targets for clinicians and substance use counselors.

To uncover more about the role of substance use in suicide attempts, Dr. David Tolin and his team recruited 213 adult inpatients admitted for treatment following a suicidal crisis, 127 of whom had a substance use disorder (SUD). After administering assessments for suicide attempt history, along with demographic and clinical suicide risk factors, Dr. Tolin found that the presence of alcohol use disorder (AUD) or drug use disorder (DUD) was associated with a higher number of lifetime suicide attempts. Dr. Tolin then assessed the role of substance use in each person’s suicidal crisis. Substance use was found to play a part at baseline, as a short-term risk factor, and as a means of suicide attempt. These results underline the dynamic relationship between substance use and suicidal behavior and the importance of understanding individual differences during treatment.

Citation: Diefenbach, G. J., Stubbing, J., Rice, T. B., Lord, K. A., Rudd, M. D., & Tolin, D. F. (2023). Uncovering the role of substance use in suicide attempts using a mixed-methods approach. Suicide & life-threatening behavior, 10.1111/sltb.13019. Advance online publication. https://doi.org/10.1111/sltb.13019