Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Jul;35(7):2050-2058.
doi: 10.1007/s11606-020-05769-3. Epub 2020 Mar 17.

Tailored Activation of Middle-Aged Men to Promote Discussion of Recent Active Suicide Thoughts: a Randomized Controlled Trial

Anthony Jerant  1 , Paul Duberstein  2 , Richard L Kravitz  3 , Deborah M Stone  4 , Camille Cipri  5 , Peter Franks  6
Affiliations
Randomized Controlled Trial

Tailored Activation of Middle-Aged Men to Promote Discussion of Recent Active Suicide Thoughts: a Randomized Controlled Trial

Anthony Jerant et al. J Gen Intern Med. 2020 Jul.

Abstract

Purpose: Middle-aged men are at high risk of suicide. While about half of those who kill themselves visit a primary care clinician (PCC) shortly before death, in current practice, few spontaneously disclose their thoughts of suicide during the visits, and PCCs seldom inquire about such thoughts. In a randomized controlled trial, we examined the effect of a tailored interactive computer program designed to encourage middle-aged men's discussion of suicide with PCCs.

Methods: We recruited men 35-74 years old reporting recent (within 4 weeks) active suicide thoughts from the panels of 42 PCCs (the unit of randomization) in eight offices within a single California health system. In the office before a visit, men viewed the intervention corresponding to their PCC's random group assignment: Men and Providers Preventing Suicide (MAPS) (20 PCCs), providing tailored multimedia promoting discussion of suicide thoughts, or control (22 PCCs), composed of a sleep hygiene video plus brief non-tailored text encouraging discussion of suicide thoughts. Logistic regressions, adjusting for patient nesting within physicians, examined MAPS' effect on patient-reported suicide discussion in the subsequent office visit.

Results: Sixteen of the randomized PCCs had no patients enroll in the trial. From the panels of the remaining 26 PCCs (12 MAPS, 14 control), 48 men (MAPS 21, control 27) were enrolled (a mean of 1.8 (range 1-5) per PCC), with a mean age of 55.9 years (SD 11.4). Suicide discussion was more likely among MAPS patients (15/21 [65%]) than controls (8/27 [35%]). Logistic regression showed men viewing MAPS were more likely than controls to discuss suicide with their PCC (OR 5.91, 95% CI 1.59-21.94; P = 0.008; nesting-adjusted predicted effect 71% vs. 30%).

Conclusions: In addressing barriers to discussing suicide, the tailored MAPS program activated middle-aged men with active suicide thoughts to engage with PCCs around this customarily taboo topic.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Fig. 1
Fig. 1
Conceptual model guiding the development and deployment of MAPS and its intended effects during linked primary care visits MAPS, Men and Providers Preventing Suicide; PCC, primary care clinician.
Fig. 2
Fig. 2
Overview of the content and sequence of MAPS-tailored activation program and non-tailored control program MAPS, Men and Providers Preventing Suicide; PCC, primary care clinician. The basic structure of tailoring in each module (1) give all users brief feedback tailored to their response(s) to relevant question(s) and (2) offer the option to view more detailed information.
Fig. 3
Fig. 3
Flow of participants through the trial. PCC, primary care clinician.
See this image and copyright information in PMC

References

    1. Suicide. Facts at a glance. Atlanta, GA: National Center for Injury Prevention and Control, Division of Violence Prevention, Centers for Disease Control and Prevention; 2015.
    1. Curtin SC, Warner M, Hedegaard H. Increase in suicide in the United States, 1999-2014. NCHS Data Brief. 2016:1–8. - PubMed
    1. 10 leading causes of death by age group, United States - 2017. U.S. Centers for Disease Control and Prevention. 2019; https://www.cdc.gov/injury/wisqars/leadingcauses.html
    1. Shepard DS, Gurewich D, Lwin AK, Reed GA, Jr, Silverman MM. Suicide and Suicidal Attempts in the United States: Costs and Policy Implications. Suicide Life Threat Behav. 2016;46:352–362. - PMC - PubMed
    1. Injury Prevention & Control: Data & Statistics (WISQARS). U.S. Centers for Disease Control and Prevention. 2016; http://www.cdc.gov/injury/wisqars/index.html. Accessed 11 March 2020.

Publication types