2 - (IOP 3) Towards Inclusive Treatments for Serious Mental Illness: Adapting a Suicide Prevention Program to Address Barriers for Patients with Psychosis

Individuals with psychosis are at particularly high risk for suicide; and yet, current prevention efforts are limited in effectiveness for this population. Clinical trials for suicide interventions tend to exclude individuals with psychotic symptoms, resulting in limitations in care options for this highly vulnerable population. Therefore, it is essential to adapt suicide prevention strategies to address the unique needs of patients with psychosis. The Coping Long Term with Active Suicide Program (CLASP) is a multifaceted, adjunctive suicide intervention that focuses specifically on acute transitions of care, which is a period of highest risk for patients with psychosis. This pilot feasibility randomized controlled trial adapted CLASP for people with schizophrenia-spectrum disorders (CLASP-S) followed post-hospital discharge for up to 6 months.

Psychosis experts were consulted to finalize intervention components and protocol adaptations for this population, which will be described in detail during the presentation. Thirty patients were enrolled and randomized to conditions: Enhanced Treatment as Usual (ETAU) alone (n = 13) and CLASP-S (n = 17). Forty percent of participants indicated female birth sex, 33% identified as a racial minority, and 27% were Hispanic/Latino, suggesting a largely representative sample. The full sample endorsed high levels of baseline psychiatric symptoms and 70% reported a history of a suicide attempt. There were no statistically significant differences in demographic or clinical characteristics at baseline between CLASP-S and ETAU alone.

Results from the pilot RCT demonstrated that the CLASP-S intervention was safe, acceptable, and potentially effective for decreasing suicide risk and psychiatric symptoms following an acute psychiatric hospitalization. In terms of suicidality, the CLASP-S group demonstrated a significant decrease in Columbia-Suicide Severity Rating Scale (C-SSRS) rated past 3-month suicidal ideation intensity (t = 2.78, p < .014, Cohen’s d = 1.00), as well as past 3-month suicide behaviors composite scores (t = 7.48, p < .001, Cohen’s d = 2.65). Additionally, there was a significant decrease in the Brief Psychiatric Rating Scale (BPRS) total score over time (t = 3.15, p = .008, Cohen’s d = 1.11). The sample size was too small to meaningfully compare group differences. Lastly, informal feedback from patients to their clinicians suggested that they found the program helpful in supporting their hospital aftercare.

We showed that recruiting patients into the program was feasible during their hospital stay. We also successfully engaged most patients in the program in the initial weeks immediately following their discharge to foster a safer and more successful transition to the community. Conducting the pilot RCT provided important lessons that will further enhance the intervention for testing in future. For example, we learned that briefer, more frequent, in-person sessions in the first month post-hospitalization may mitigate the impact of cognitive barriers and symptoms of psychosis (e.g., paranoia). Similarly, we learned that future iterations of this intervention may benefit from prioritizing case management assistance and addressing social determinants of health.