Pfeiffer Paul N, Abraham Kristen M, Lapidos Adrienne, Vega Eduardo, Jagusch Jennifer, Garlick James, Pasiak Sara, Ganoczy Dara, Kim H Myra, Ahmedani Brian, Ilgen Mark, King Cheryl
Department of Psychiatry, University of Michigan Medical School, Ann Arbor.
VA Center for Clinical Management Research, Ann Arbor, Michigan.
JAMA Netw Open. 2025 May 1;8(5):e2510808. doi: 10.1001/jamanetworkopen.2025.10808.
Innovative approaches to address interpersonal risk factors for suicide attempts and suicidal ideation may help reduce persistently elevated suicide rates in the US.
To determine whether Peers for Valued Living (PREVAIL), a posthospital peer support intervention, reduces suicide attempts and suicidal ideation among adults psychiatrically hospitalized for suicide risk.
DESIGN, SETTING, AND PARTICIPANTS: This single-masked, randomized clinical trial recruited adult psychiatric inpatients aged 18 years or older from 3 Michigan-based facilities between June 22, 2018, and December 30, 2022. The study compared 3 months of the PREVAIL intervention plus enhanced usual care with enhanced usual care only, with 3 months of postintervention follow-up.
One-on-one support from a peer specialist initiated during hospital admission and continued 3 months after discharge.
Suicide attempts were measured using the Columbia Suicide Severity Rating Scale, and suicidal ideation was measured using the Beck Scale for Suicidal Ideation at 3 and 6 months after randomization.
Of 5310 patients screened, 455 were randomized using a minimization algorithm. A total of 229 participants were randomized to the PREVAIL peer mentorship arm (mean [SD] age, 32.4 [14.0] years, 134 women [58.5%]), and 226 were randomized to the enhanced usual care arm (mean [SD] age, 31.6 [13.5] years; 139 women [61.5%]). In the intention-to-treat sample with nonmissing data, the percentage of participants with any suicide attempt over 6 months (including participants who only completed 3-month follow-up assessments) was 17.2% (28 of 163) for enhanced usual care and 14.9% (24 of 161 with 2 deaths by suicide) for PREVAIL. Mean (SD) suicidal ideation scores were 4.3 (95% CI, 3.2-5.3) for enhanced usual care and 4.9 (95% CI, 3.7-6.1) for PREVAIL at 6 months. There were no statistically significant effects of the intervention for either outcome in the primary analyses. In post hoc analyses, the interaction between study arm and the COVID-19 pandemic was statistically significant. The enhanced usual care arm had a mean (SD) 6-month suicidal ideation score of 3.5 (6.1) before and 6.1 (7.4) after the pandemic vs the PREVAIL arm (mean [SD] scores, 5.0 [7.7] and 4.5 [6.6], respectively). There were 2 study-related adverse events, with 1 resulting in participant withdrawal from the intervention arm.
In this randomized clinical trial, the peer-delivered PREVAIL intervention up to 3 months after discharge did not significantly differ from enhanced usual care in terms of reducing subsequent suicide attempts or suicidal ideation.
ClinicalTrials.gov Identifier: NCT03373916.
采用创新方法应对自杀未遂和自杀意念的人际风险因素，可能有助于降低美国持续居高不下的自杀率。
确定出院后同伴支持干预项目“珍视生命同伴支持”（PREVAIL）是否能降低因自杀风险而接受精神科住院治疗的成年人的自杀未遂和自杀意念发生率。
设计、背景和参与者：这项单盲随机临床试验于2018年6月22日至2022年12月30日期间，从密歇根州的3家医疗机构招募了18岁及以上的成年精神科住院患者。该研究将3个月的PREVAIL干预加强化常规护理与仅强化常规护理进行比较，并进行3个月的干预后随访。
在住院期间由同伴专家提供一对一支持，并在出院后持续3个月。
采用哥伦比亚自杀严重程度评定量表测量自杀未遂情况，在随机分组后3个月和6个月时，采用贝克自杀意念量表测量自杀意念。
在筛查的5310名患者中，455名通过最小化算法进行随机分组。共有229名参与者被随机分配到PREVAIL同伴指导组（平均[标准差]年龄为32.4[14.0]岁，134名女性[58.5%]），226名被随机分配到强化常规护理组（平均[标准差]年龄为31.6[13.5]岁；139名女性[61.5%]）。在意向性分析样本中，强化常规护理组在6个月内有任何自杀未遂的参与者比例（包括仅完成3个月随访评估的参与者）为17.2%（163名中的28名），PREVAIL组为14.9%（161名中的24名，其中2人自杀死亡）。强化常规护理组在6个月时的平均（标准差）自杀意念得分为4.3（95%置信区间，3.2 - 5.3），PREVAIL组为4.9（95%置信区间，3.7 - 6.1）。在主要分析中，该干预措施对这两个结局均无统计学显著影响。在事后分析中，研究组与新冠疫情之间的交互作用具有统计学显著性。强化常规护理组在疫情前6个月的平均（标准差）自杀意念得分为3.5（6.1），疫情后为6.1（7.4），而PREVAIL组（平均[标准差]得分分别为5.0[7.7]和4.5[6.6]）。有2起与研究相关的不良事件，其中1起导致参与者退出干预组。
在这项随机临床试验中，出院后长达3个月的同伴提供的PREVAIL干预在减少后续自杀未遂或自杀意念方面与强化常规护理没有显著差异。
ClinicalTrials.gov标识符：NCT03373916。
