Implementation of the Zero Suicide framework with suicide prevention and intimate partner violence at outpatient clinics: Implementation & clinical impact

Abstract

Objective

As the COVID-19 pandemic persisted for an extended time, rates of depression, anxiety, alcohol consumption, intimate partner violence (IPV), and suicidal ideation surged in the United States during 2020–2022. The aim is to describe the process and relevant outcomes of implementing the Zero Suicide framework with IPV intervention.

Methods

We evaluated depression and suicide screening and treatment outcomes among patients, ages 25 years and older, and IPV screening and follow-up outcomes for female adult patients who were seen at UT Physicians ambulatory primary care clinics from November 2020 to November 2021.

Results

68 % of patients (N = 13,957) were screened for depressive symptoms and suicidality using the Patient Health Questionnaire (PHQ-9). Among patients (N = 633) identified as at risk of suicide using the PHQ-9, 299 patients were further assessed using the Columbia Suicide Severity Rating Scale (C-SSRS) and/or referred to the Crisis Care Transition team for immediate follow-up. Among patients identified at risk for suicide, 92 % of patients received a safety plan. Among patients with suicidal ideation with any methods, 88 % of patients received counseling on access to lethal means to reduce the risk of suicide. 30 % of female patients (N = 4,008) were screened for IPV using the HARK (Humiliation, Afraid, Rape, Kick) assessment. All female patients (N = 82) who reported IPV were connected to services, including therapy and access to a safe place.

Conclusions

The Zero Suicide framework with IPV intervention had a positive impact on screening and treatment outcomes among our patients, indicating the feasibility in implementation and program adoption.