The effect of inpatient brief cognitive-behavioral therapy for suicide prevention on post-discharge emergency department utilization: Secondary analysis of a randomized clinical trial

Abstract

Objective

Diefenbach and colleagues (2024) found that inpatient Brief Cognitive-Behavioral Therapy for Suicide Prevention (BCBT-I) reduced the rate of six-month post-discharge psychiatric readmissions compared to treatment as usual (TAU). This treatment effect; however, was limited to inpatients, whom were not diagnosed with substance use disorder (SUD). The aim of this secondary analysis was to determine BCBT-I treatment effects and SUD moderation on post-discharge emergency department (ED) utilization.

Methods

Inpatients with a history of suicide attempt were assigned to BCBT-I + TAU (n = 94) or TAU alone (n = 106). Presence and number of ED visits were determined via self-report and electronic medical record review for six months after discharge. Generalized linear models for count and binary data were conducted.

Results

Adding BCBT-I to TAU reduced the odds and rate of post-discharge ED visits by three quarters [Odds Ratio estimate = 0.25, 95 % CI:(0.12, 0.46); Rate Ratio estimate = 0.24, 95 % CI:(0.11, 0.53)], but only among participants without SUD. Over one-third (36 %) of ED visits were related to suicide. Findings for suicide-related ED visits mirrored those of all-cause ED visits.

Conclusions

Adding BCBT-I to TAU reduced post-discharge ED utilization in participants without SUD. Additional research is needed to improve the efficacy of BCBT-I for patients with SUD.