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A multisite study to compare the outcomes of psychiatric treatment of suicidal adolescents in different treatment settings
Investigator (PI): Barzman, Drew
Performing Organization (PO): (Current): Cincinnati Children's Hospital Medical Center, Division of Child and Adolescent Psychiatry / (513) 636-8336
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2019
Final Year: 2025
Record Source/Award ID: PCORI/PCS-2018C1-11111
Funding: Total Award Amount: $7,527,161
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: PCORI has identified the need for large studies that look at real-life questions facing diverse patients, caregivers, and clinicians. In 2014, PCORI launched the Pragmatic Clinical Studies initiative to support large-scale comparative effectiveness studies focusing on everyday care for a wide range of patients. The Pragmatic Clinical Studies initiative funded this research project and others. This research project is in progress. PCORI will post the research findings on the PCORI website within 90 days after the results are final. What is the research about? Suicide is one of the leading causes of death among teens in the United States. After a suicidal event, such as serious thoughts about taking their own life or suicide plans or attempts, most teens get inpatient psychiatric care. Inpatient care involves staying overnight or longer in the hospital. However, some patients and their families prefer treatment outside of the hospital. Outpatient crisis intervention clinics, or OCICs, offer intensive mental health care without the need for a hospital stay. In this study, the research team is comparing inpatient psychiatric care to OCICs for treating teens after a suicidal event. The team is looking to see how well each treatment setting reduces the risk of suicidal events. Who can this research help? Results may help doctors, teens, and families considering psychiatric care settings for treatment after a suicidal event. What is the research team doing? The study includes 1,000 teens who had a suicidal event. The research team is enrolling teens from four emergency departments, or EDs. The team is dividing the teens into two groups that are similar in terms of age, gender, and other factors. Then, the team is assigning the groups by chance to either receive inpatient or OCIC treatment. With inpatient treatment, teens receive mental health care in the hospital. Clinicians manage their daily therapy and medicines. With OCIC, teens have crisis intervention therapy appointments outside the hospital. Therapy begins within three days of the teen's visit to the ED and lasts for one to six weeks. The research team is looking at health records and forms the patients complete to see if teens have another suicidal event in the six months after their ED visit and, if so, how many. Every other week during these six months, teens and their guardians also complete surveys to identify suicidal thoughts and behaviors and rate life satisfaction. Two weeks after teens begin treatment, the team is asking teens how satisfied they are with their treatment. The team also wants to know whether details like age or having insurance can help identify which teens may be at risk of not going to treatment. Teens and parents, psychiatrists, nurses, social workers, and people who specialize in providing community mental health care are helping to plan and conduct the study. Research methods. Design: The study design is a randomized controlled trial. Population: The study population is 1,000 teens ages 12-18 who visit an ED with suicidality and who require a high level of care (OCICs or inpatient psychiatric care). Interventions/comparators are inpatient psychiatric care and OCIC care. Outcomes: The outcomes are (1) primary: first recurrence of a suicidal event and number of suicidal events; and (2) secondary: treatment satisfaction, satisfaction with life, relationship between demographics, and no-show risk. The timeframe is 6-month follow-up for primary outcomes.
Abstract Archived: Suicide is one of the leading causes of death for adolescents in the United States. When a suicidal adolescent arrives in the emergency department, the most common recommended treatment is inpatient psychiatry. Although there are other treatment settings and methods, inpatient treatment has become the standard care for the treatment of suicidal adolescents despite often causing problems and being ineffective for some patients and their families. This study seeks to address the problem concerning the treatment of suicidal adolescents and evaluate the strategies of optimizing the assessment and treatment for this population. Currently, there is an evidence gap in treatment guidelines for suicidal adolescents and which treatment setting is the most effective for the treatment of suicidal adolescents. By comparing outpatient crisis intervention clinics (OCIC) and inpatient psychiatry treatment, we expect to provide the needed evidence for a lower risk of a suicidal event in the OCIC treatment group, as well as higher treatment satisfaction and higher satisfaction with life for patients and their parents in the OCIC treatment group. This study is important because of the clinical burden that the assessment and treatment of adolescent suicidality places on patients, families, and clinicians. The disadvantages of inpatient psychiatry treatment and the continuously increasing number of suicidal adolescents are why there is a demand for this study by patients and families. Throughout this study, patients, parents, and other stakeholders will be thoroughly involved as research partners, co-investigators, and advisors, along with being members of study committees. Their involvement will help to make sure the study remains patient centered. Patients, parents, and stakeholders will play a part in every aspect of this study, working with researchers to make sure this study is successful.

MeSH Terms:
  • Adolescent
  • Adolescent Medicine /*organization & administration
  • Comparative Effectiveness Research
  • Family Health
  • Humans
  • Inpatients
  • Mental Health Services /*organization & administration
  • Multicenter Studies as Topic
  • Outcome Assessment, Health Care
  • Outpatients
  • Patient Satisfaction
  • Program Development
  • Psychiatry /organization & administration
  • Risk
  • Suicide /*prevention & control
Country: United States
State: Ohio
Zip Code: 45224
UI: 20194249
CTgovId: NCT04089254
Project Status: Ongoing
Record History: ('2020: Archived abstract to Abstract Archived 1 field and added new abstract.Alternate Title: Comparing inpatient versus outpatient settings for treating teens after a suicidal event',)