A lived experience co-designed study protocol for a randomised control trial: the Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as additional interventions after a suicide attempt compared to a standard Suicide Prevention Pathway (SPP)

Nicolas J C Stapelberg, Candice Bowman, Sabine Woerwag-Mehta, Sarah Walker, Angela Davies, Ian Hughes, Konrad Michel, Anthony R Pisani, Heidy Van Engelen, Mia Delos, Tamara Hageman, Kim Fullerton-Smith, Ravikumar Krishnaiah, Sarah McDowell, Alison Cameron, Trudy-Lee Scales, Cherie Dillon, Titta Gigante, Cindy Heddle, Natalie Mudge, Anne Zappa, Michelle Edwards, Sigi Gutjahr, Hitesh Joshi, Kathryn Turner, Nicolas J C Stapelberg, Candice Bowman, Sabine Woerwag-Mehta, Sarah Walker, Angela Davies, Ian Hughes, Konrad Michel, Anthony R Pisani, Heidy Van Engelen, Mia Delos, Tamara Hageman, Kim Fullerton-Smith, Ravikumar Krishnaiah, Sarah McDowell, Alison Cameron, Trudy-Lee Scales, Cherie Dillon, Titta Gigante, Cindy Heddle, Natalie Mudge, Anne Zappa, Michelle Edwards, Sigi Gutjahr, Hitesh Joshi, Kathryn Turner

Abstract

Background: Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently, there are limited treatment options with limited underpinning research for those who present to emergency departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide-specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves the outcomes for consumers presenting to a Mental Health Service with a suicide attempt.

Methods: This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP), and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospitals with suicide attempts. Presentations with suicidal ideation will also be examined (in a descriptive analysis) to ascertain whether a rise in suicidal ideation is commensurate with a fall in suicide attempts (which might indicate an increase in help-seeking behaviours). Death by suicide rates will also be examined to ensure that representations with a suicide attempt are not due to participants dying, but due to a potential improvement in mental health. For participants without a subsequent suicide attempt, the total number of days from enrolment to the last assessment (24 months) will be calculated. Self-reported levels of suicidality, depression, anxiety, stress, resilience, problem-solving skills, and self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, and 6,12, and 24 months.

Discussion: This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions.

Trials registration: ClinicalTrials.gov NCT04072666 . Registered on 28 August 2019.

Keywords: Attempted Suicide Short Intervention Program (ASSIP); Brief intervention; Cognitive behavioural therapy (CBT); Emergency department; Lived experience; Mental health; Self-harm; Suicidality; Suicide attempt; Suicide prevention.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
SPIRIT figure—ASSIP-CBT study schedule of recruitment, interventions, and baseline and follow-up assessments. *For all participants, including SPP. **Includes ASSIP follow-up letters sent over 24 months after therapy. ***This includes employment status; cultural and linguistically diverse (CALD) status; Aboriginal and Torres Strait Islander and lesbian, gay, bisexual, transgender, intersex, and queer (LGBTQI) status; education history; living situation; known diagnoses; and history of service provision

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