Peer Support Intervention for Suicide Prevention Among High-Risk Adults in Michigan: A Randomized Clinical Trial.

Abstract

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. 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.