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Cited by 648Suicide and Self-Harm StudiesPsychiatric care and mental health servicesEmergency and Acute Care Studies

Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department

Open access
Stanley, Barbara, Brown, Gregory K., Brenner, Lisa A., Galfalvy, Hanga C., Currier, Glenn W., Knox, Kerry L., Chaudhury, Sadia R., Bush, Ashley L. +1 more·2018·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2018.1776PMC PMC6142908
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Abstract

Importance Suicidal behavior is a major public health problem in the United States. The suicide rate has steadily increased over the past 2 decades; middle-aged men and military veterans are at particularly high risk. There is a dearth of empirically supported brief intervention strategies to address this problem in health care settings generally and particularly in emergency departments (EDs), where many suicidal patients present for care. Objective To determine whether the Safety Planning Intervention (SPI), administered in EDs with follow-up contact for suicidal patients, was associated with reduced suicidal behavior and improved outpatient treatment engagement in the 6 months following discharge, an established high-risk period. Design, Setting, and Participants Cohort comparison design with 6-month follow-up at 9 EDs (5 intervention sites and 4 control sites) in Veterans Health Administration hospital EDs. Patients were eligible for the study if they were 18 years or older, had an ED visit for a suicide-related concern, had inpatient hospitalization not clinically indicated, and were able to read English. Data were collected between 2010 and 2015; data were analyzed between 2016 and 2018. Interventions The intervention combines SPI and telephone follow-up. The SPI was defined as a brief clinical intervention that combined evidence-based strategies to reduce suicidal behavior through a prioritized list of coping skills and strategies. In telephone follow-up, patients were…

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2018.1776

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

7 of 27 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured

  • Interpretationcitation

    Using the low-burden intervention in this project and others was associated with about the same reduction in suicidal behavior as more intensive and costly psychosocial interventions.

    “Importantly, using the low-burden intervention in this project and others 30 was associated with about the same reduction in suicidal behavior as more intensive and costly psychosocial interventions.43,44”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [30] 30. Miller IW, Camargo CA Jr, Arias SA, et al; ED-SAFE Investigators. Suicide prevention in an emergency department population: the ED-SAFE study. JAMA Psychiatry. 2017;74(6):563-570. doi:10.1001/jamapsychiatry.2017.0678 source
    • cites [43] 43. Brown GK, Ten Have T, Henriques GR, Xie SX, Hollander JE, Beck AT. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA. 2005;294(5):563-570. doi:10.1001/jama.294.5.563 source
    • cites [44] 44. Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991;48(12):1060-1064. doi:10.1001/archpsyc.1991.01810360024003 source
  • Premisecitation

    Patients report that safety planning helps maintain their safety.

    “Patients report it helps maintain their safety.25,26”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [25] 25. Stanley B, Chaudhury SR, Chesin M, et al. An emergency department intervention and follow-up to reduce suicide risk in the VA: acceptability and effectiveness. Psychiatr Serv. 2016;67(6):680-683. doi:10.1176/appi.ps.201500082 source
    • cites [26] 26. Chesin MS, Stanley B, Haigh EA, et al. Staff views of an emergency department intervention using safety planning and structured follow-up with suicidal veterans. Arch Suicide Res. 2017;21(1):127-137. doi:10.1080/13811118.2016.1164642 source
  • Interpretationcitation

    Our results are also consistent with past research that found that a combination of in-person intervention using screening and a safety plan coupled with telephone follow-up reduced suicide attempts.

    “Our results are also consistent with past research 30 that found that a combination of in-person intervention using screening and a safety plan coupled with telephone phone follow-up reduced suicide attempts.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [30] 30. Miller IW, Camargo CA Jr, Arias SA, et al; ED-SAFE Investigators. Suicide prevention in an emergency department population: the ED-SAFE study. JAMA Psychiatry. 2017;74(6):563-570. doi:10.1001/jamapsychiatry.2017.0678 source
  • Premisecitation

    One ED study found a 30% lower suicide attempt rate with an intervention consisting of screening, providing basic written material on safety planning, and several calls to suicidal patients and their significant others.

    “One ED study found a 30% lower suicide attempt rate with an intervention consisting of screening, providing basic written material on safety planning, and several calls to suicidal patients and their significant others.30”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [30] 30. Miller IW, Camargo CA Jr, Arias SA, et al; ED-SAFE Investigators. Suicide prevention in an emergency department population: the ED-SAFE study. JAMA Psychiatry. 2017;74(6):563-570. doi:10.1001/jamapsychiatry.2017.0678 source
  • Interpretationcitation

    Our results are consistent with findings that crisis response planning reduced suicide attempts during a 6-month follow-up period in high-risk active duty soldiers.

    “Our results are consistent with findings that crisis response planning reduced suicide attempts during a 6-month follow-up period in high-risk active duty soldiers.42”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [42] 42. Bryan CJ, Mintz J, Clemans TA, et al. Effect of crisis response planning on patient mood and clinician decision making: a clinical trial with suicidal U.S. soldiers. Psychiatr Serv. 2018;69(1):108-111. doi:10.1176/appi.ps.201700157 source

      The Methods section reports that the parent trial found a significant reduction in suicide attempt rates among acutely suicidal active-duty Army personnel who received crisis response planning. The paper does not specify a six-month follow-up period for that finding; this paper itself examines immediate effects. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 24
  • May combine two claims. 17

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Some but not all studies have reported similar findings with mail interventions.

    “Some [33][34][35] but not all 36 studies have reported similar findings with mail interventions.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [33][34][35]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [36] 36. Beautrais AL, Gibb SJ, Faulkner A, Fergusson DM, Mulder RT. Postcard intervention for repeat self-harm: randomised controlled trial. Br J Psychiatry. 2010;197(1):55-60. doi:10.1192/bjp.bp.109.075754 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Patients in SPI+ were less educated than those in usual care (χ2 1 = 4.627; P = .03).

    “less educated (χ 2 1 = 4.627; P = .03),”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Patients in SPI+ were more likely to have served in Operation Enduring Freedom or Operation Iraqi Freedom vs other service periods than usual care patients.

    “Also, patients in SPI+ were also more likely to have served in the 2 most recent military operations (Operation Enduring Freedom or Operation Iraqi Freedom) vs other service periods (Table ).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Patients in SPI+ were less likely to be homeless than those in usual care (χ2 1 = 8.453; P = .004).

    “and less likely to be homeless (χ 2 1 = 8.453; P = .004)than those in usual care (Table).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Depression, PTSD, and substance use disorder were not significantly associated with suicidal behavior during follow-up overall.

    “nor were they significantly associated with suicidal behavior during follow-up overall (depression: z = -0.71;P = .48;PTSD: z = -1.05;P = .29;substance abuse: z = 0.22; P = .83).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of eligible patients at intervention sites, 99.4% (n = 1179) agreed to receive the SPI.

    “Of the eligible patients at the intervention sites, 99.4% (n = 1179) agreed to receive the SPI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A total of 1640 patients with a mean (SD) age of 48 (14) years, 88% men, were included in the analyses.

    “A total of 1640 patients with a mean (SD) age of 48 (14) years, 88% men, were included in the analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Fewer patients (89.6%; n = 1063) were able to be contacted for at least 1 follow-up call.

    “Fewer patients (89.6%; n = 1063) were able to be contacted for at least 1 follow-up call.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Patients completed a mean (SD) of 3.7 (3.3) calls (median, 4; range, 0-26).

    “Patients completed a mean (SD) of 3.7 (3.3) calls (median, 4; range, 0-26).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Depression, PTSD, and substance use disorder had no moderating effect on the treatment effect on suicidal behavior.

    “Depression, PTSD, and substance use disorder had no moderating effect on the treatment (interaction with treatment: depression OR, 0.62; 95% CI, 0.21-1.85;P = .39;PTSD OR, 0.37; 95% CI, 0.11-1.28;P = .12;and substance abuse OR, 2.72; 95% CI, 0.87-8.51;P = .09)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When entering both treatment group and mental health treatment attendance as predictors of posttreatment suicidal behavior, the treatment group effect stayed significant and the effect size did not decrease (OR, 0.46; 95% CI, 0.23-0.91; P = .03).

    “When entering both treatment group and mental health treatment attendance as predictors of posttreatment suicidal behavior, the treatment group effect stayed significant, and the effect size did not decrease (OR, 0.46; 95% CI, 0.23-0.91;P = .03)”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Because patients were not randomized, propensity scores were calculated based on variables that differed by condition.

    “Because patients were not randomized, we next calculated propensity scores based on variables that differed by condition.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Given that this was a clinical demonstration project, limited information is available about individual patients.

    “Given that this was a clinical demonstration project, limited information is available about individual patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    This was not a randomized trial, so there is a potential for confounding.

    “Although intervention sites were matched with control sites and the analyses used propensity scoring, this was not a randomized trial, so there is a potential for confounding.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Owing to the relatively low event rate, separate analyses by propensity score strata were not performed.

    “Owing to the relatively low event rate, we did not perform separate analyses by propensity score strata.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    We have no reason to believe that underreporting of suicidal behaviors occurred more often in either condition.

    “However, we have no reason to believe that this occurred more often in either condition.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The reach of the intervention may be greater if the range of suicide risk is not restricted and the intervention is provided to all suicidal patients including those admitted to inpatient units.

    “The reach of this intervention may be greater if the range of suicide risk is not restricted and the intervention is provided to all suicidal patients including those admitted to inpatient units.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    Some suicide events may not have been captured by suicide behavior reports either because reports were not written or patients did not reveal all events to clinicians.

    “Another possibility is that some suicide events were not captured by suicide behavior reports either because reports were not written or patients did not reveal all events to clinicians.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Joint Commission recommended development of a collaborative safety plan as an alternative to no-suicide contracts.

    “The Joint Commission 22 recommended development of a collaborative safety plan as an alternative to no-suicide contracts.23,24”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [22] 22. The Joint Commission. Sentinel Event Alert 56: Detecting and treating suicide ideation in all settings 2016; https://www.jointcommission.org /assets/1/18/SEA_56_Suicide.pdf. Accessed March 11, 2017.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [23] 23. Rudd MD, Mandrusiak M, Joiner TE Jr. The case against no-suicide contracts: the commitment to treatment statement as a practice alternative. J Clin Psychol. 2006;62(2):243-251. doi:10.1002/jclp.20227 source
    • cites [24] 24. Stanley B, Brown GK. Safety planning intervention: a brief intervention to mitigate suicide risk. Cognit Behav Pract. 2012;19(2):256-264. doi:10.1016/j.cbpra.2011.01.001 source

  • May combine two claims.

    Interpretationreasoning

    This project was conducted in Veterans Health Administration hospital EDs with predominantly men, so we do not know how well our findings generalize to civilian settings and women.

    “Furthermore, this project was conducted in Veterans Health Administration hospital EDs with predominantly men; therefore, we do not know how well our findings generalize to civilian settings and women.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationown data

    SPI+ has a positive association with suicidal behavior apart from attendance in outpatient behavioral health care.

    “This finding suggests that SPI+ has a positive association with suicidal behavior apart from attendance in outpatient behavioral health care.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Some suicidal behaviors may have occurred that were not entered into the medical record because staff were unaware of them.

    “Some suicidal behaviors may have occurred that were not entered into the medical record because staff were unaware of them.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Sites were matched on geographic location, approximate number of psychiatric ED evaluations per year, and presence of a psychiatric inpatient unit.

    “Sites were matched on geographic location, approximate number of psychiatric ED evaluations per year, and presence of a psychiatric inpatient unit.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Suicide Behavior Reports are mandated in the VA and include descriptions of all suicide attempts, suicide deaths, and other suicidal behaviors including interrupted attempts.

    “Suicide Behavior Reports for suicide behaviors in the postdischarge 6 months were also retrieved from the medical records at each hospital.These reports are mandated in the VA and include descriptions of all suicide attempts, suicide deaths, and other suicidal behaviors including interrupted attempts.2,40”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [2] 2. Office of Mental Health and Suicide Prevention. Suicide among veterans and other Americans 2001-2014. https://www.mentalhealth.va.gov/docs /2016suicidedatareport.pdf. Published 2016. Accessed December 5, 2017. source
    • cites [40] 40. Hoffmire C, Stephens B, Morley S, Thompson C, Kemp J, Bossarte RM. VA suicide prevention applications network: a national health care system-based suicide event tracking system. Public Health Rep. 2016;131(6):816-821. doi:10.1177/0033354916670133 source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Propensity scores were used to perform covariate adjustment, first with a categorical propensity variable by quartiles and then with a continuous covariate.

    “We used propensity scores to perform covariate adjustment: first with a categorical propensity variable by breaking the propensity score into quartiles (ie, 4 strata) and then with a continuous covariate.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    To account for intrasite correlations in the outcome measures, mixed-effect logistic regression models were run with intervention group as a fixed effect and site-specific random intervention effects.

    “To account for intrasite correlations in the outcome measures, mixed-effect logistic regression models were run using the”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] 41. Bates D, Maechler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015;67(1):1-48. doi:10.18637/jss.v067.i01 source

  • May combine two claims.

    Premisecitation

    Patients are at increased risk for suicide attempts and suicide following an ED visit.

    “Patients are at increased risk for suicide attempts and suicide following an ED visit.[8][9][10][11]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8][9][10][11]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Crisis response planning is an abbreviated form of safety planning that uses 4 of 6 elements of the SPI (without social interaction as a means of distracting from suicidal thoughts and lethal means counseling).

    “Crisis response planning is an abbreviated form of safety planning that uses 4 of 6 elements of the SPI (without social interaction as a means of distracting from suicidal thoughts and lethal means counseling).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] 42. Bryan CJ, Mintz J, Clemans TA, et al. Effect of crisis response planning on patient mood and clinician decision making: a clinical trial with suicidal U.S. soldiers. Psychiatr Serv. 2018;69(1):108-111. doi:10.1176/appi.ps.201700157 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We were reliant on medical records for suicidal behavior reports and diagnostic and demographic information.

    “We were reliant on medical records for suicidal behavior reports and diagnostic and demographic information.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Safety planning has been found to be acceptable to and feasible by both suicidal patients and staff.

    “Safety planning has been found to be acceptable to and feasible by both suicidal patients and staff.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a randomized clinical trial, crisis response planning, a form of safety planning, resulted in fewer suicide attempts, lower suicidal ideation, and greater treatment engagement than no-suicide contracts during a 6-month follow-up with active duty military members.

    “In a randomized clinical trial, crisis response planning, a form of safety planning, resulted in fewer suicide attempts, lower suicidal ideation, and greater treatment engagement than no-suicide contracts during a 6-month follow-up with active duty military members.27”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] 27. Bryan CJ, Mintz J, Clemans TA, et al. Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army soldiers: a randomized clinical trial. J Affect Disord. 2017;212:64-72. doi:10.1016/j.jad.2017.01.028 source

  • May combine two claims.

    Premisecitation

    Nearly half of suicidal ED patients do not attend treatment or discontinue quickly.

    “Unfortunately, nearly half of suicidal ED patients do not attend treatment 12,13 or discontinue quickly.14”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [12] 12. Kurz A, Möller HJ. Help-seeking behavior and compliance of suicidal patients. Psychiatr Prax. 1984;11(1):6-13.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [13] 13. Piacentini J, Rotheram-Borus MJ, Gillis JR, et al. Demographic predictors of treatment attendance among adolescent suicide attempters. J Consult Clin Psychol. 1995;63(3):469-473. doi:10.1037/0022-006X.63.3.469 source
    • cites [14] 14. Lizardi D, Stanley B. Treatment engagement: a neglected aspect in the psychiatric care of suicidal patients. Psychiatr Serv. 2010;61(12):1183-1191. doi:10.1176/ps.2010.61.12.1183 source

  • May combine two claims.

    Interpretationown data

    Our mediation analysis demonstrated that the association with suicidal behavior was not attributable to the increased treatment engagement in the intervention group nor was it accounted for by the number of follow-up calls.

    “our mediation analysis demonstrated that the association with suicidal behavior was not attributable to the increased treatment engagement in the intervention group nor was it accounted for by the number of follow-up calls.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All eligible patients were included in the analyses.

    “All eligible patients were included in the analyses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    If implemented broadly, SPI+ has the potential to reduce suicidal behavior and enhance behavioral health treatment engagement, particularly during high-risk periods following ED discharge.

    “If implemented broadly, SPI+ has the potential to reduce suicidal behavior and enhance behavioral health treatment engagement, particularly during high-risk periods following ED discharge.”
    Quote in the paperSubstantial claim
35 of 35

  • The paper relies on this without support.

    The comparison group receiving usual care at matched sites is an adequate counterfactual for what would have happened to intervention patients without SPI+.

    “Patients were not prospectively assigned to intervention or comparison groups.”

  • The paper relies on this without support.

    The results from VA emergency departments generalize to other health care settings.

    “and may be a valuable clinical tool in health care settings.”

  • The paper relies on this without support.

    The propensity score model includes all confounders needed to make the groups comparable.

    “Because patients were not randomized, we next calculated propensity scores based on variables that differed by condition.”

  • The paper relies on this without support.

    The principal difficulty with suicidal patients is that they tend to not attend a first appointment.

    “We chose attendance at more than 1 outpatient appointment as our outcome because the principal difficulty with suicidal patients is that they tend to not attend a first appointment.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Safety planning interventions administered in the emergency department with follow-up telephone contact produced a 45% reduction in suicidal behaviors compared with treatment as usual.

    “A cohort comparison study of safety planning interventions, administered in ED with follow-up telephone contact produced a 45% reduction in suicidal behaviors vs. TAU.(115)”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [115]

    The Suicidal Behavior Report Outcomes section reports 45% fewer suicidal behaviors over six months among patients receiving ED safety planning with telephone follow-up than among those receiving usual care. The paper describes this as an association in a cohort comparison study; saying the intervention “produced” the reduction implies a causal conclusion the study does not establish. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Initial studies have provided clear evidence that the risk of repeat suicide attempts can be effectively reduced through brief safety planning interventions, even in emergency departments.

    “Initial studies have provided clear evidence that the risk of repeat suicide attempts can be effectively reduced through brief safety planning interventions (72) – even in emergency departments (73).”

    From Suicide risk assessment: clinical implications of the unpredictability of suicidal behavior (2026) · cites this paper as [73]

    The Key Points and Suicidal Behavior Report Outcomes sections report fewer suicidal behaviors over six months among emergency-department patients receiving safety planning with structured telephone follow-up than among those receiving usual care. The study measured suicidal behavior, a category that includes but is not limited to attempts, and reports an association for the combined intervention rather than establishing that brief safety planning alone reduced repeat attempts. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Intention-to-treat data were extracted when possible; five studies had ITT data and one had only completers' data.

    “Intention-to-treat data could be extracted from five studies, 12,13,17,18,30 and one study had only study completers' data available.29”

    From Safety planning-type interventions for suicide prevention: meta-analysis (2021) · cites this paper as [18]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • The meta-analysis included four randomised controlled trials, one non-randomised controlled trial, and one interrupted time-series design.

    “The meta-analysis included four randomised controlled trials, 12,13,29,30 a non-randomised controlled trial 18 and one study with an interrupted time-series design.17”

    From Safety planning-type interventions for suicide prevention: meta-analysis (2021) · cites this paper as [18]

  • Individual trials on the effectiveness of SPTIs have yielded conflicting results.

    “Individual trials on the effectiveness of SPTIs have yielded conflicting results, 17,18”

    From Safety planning-type interventions for suicide prevention: meta-analysis (2021) · cites this paper as [18]

    The Discussion (page unavailable) says this study’s results were consistent with two earlier studies reporting fewer suicide attempts. The Suicidal Behavior Report Outcomes section reports a benefit for SPI+, but neither passage establishes whether individual trials of SPTIs have yielded conflicting results. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Mental-health attendance odds ratios differ between abstract and results

    Major

    For attendance at a mental-health visit, the abstract reports an odds ratio of 2.06, while the results report 2.20 without identifying a different model for the abstract estimate.

  • Usual-care White race percentage does not match its count

    Minor

    The table reports 251 of 454 usual-care patients as White, which is 55.29%, not 62.4%.

    Reported 62.4 · recomputed 55.286344

  • Male patient counts differ between the abstract and table

    Minor

    The abstract gives 1050 men in the intervention group and 400 in usual care; the table gives 1044 and 399, respectively.

  • SPI+ White race percentage does not match its count

    Minor

    The table reports 715 of 1186 SPI+ patients as White, which is 60.29%, not 65.7%.

    Reported 65.7 · recomputed 60.286678

  • Treatment-engagement outcome uses conflicting visit thresholds

    Minor

    The discussion says the outcome required more than one outpatient appointment, whereas the results define it as at least one visit. These thresholds classify patients with exactly one visit differently.

5 of 5

Cites

Flagged first, then by citations

3 of the 45 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Reid, 1998, Promises, promises: don’t rely on patients’ no-suicide/no-violence “contracts”., J Pract Psychiatry Behav Health, 4, 316
  2. Stanley, 2008, Safety Planning Intervention: Brief Instructions

Cited by

Sorted by citations

Related

Authors
Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., Chaudhury, S. R., Bush, A. L., & Green, K. L.
Affiliations
  • Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
  • University of Pennsylvania (US)
  • United States Department of Veterans Affairs (US)
  • New York State Psychiatric Institute (US)
  • University of South Florida (US)
  • Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2018-09-01
Volume
75
Issue
9
Pages
894
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2018.1776
PMC
PMC6142908
OpenAlex
W2846110109
Cited by
648
References
45
Citations by year
2026: 76 · 2025: 86 · 2024: 71 · 2023: 93 · 2022: 75 · 2021: 110 · 2020: 70 · 2019: 57 · 2018: 9
FWCI
72.09
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
Safety Planning Intervention, suicide prevention, suicidal behavior, emergency department, telephone follow-up, veterans, suicide risk monitoring, coping strategies, brief intervention
MeSH terms
Suicide Prevention, Adaptation, Psychological, Adult, Aftercare, Ambulatory Care, Emergency Service, Hospital, Female, Humans, Interviews as Topic, Male, Outcome and Process Assessment, Health Care, Psychotherapy, Brief, Suicide, United States, United States Department of Veterans Affairs, Veterans, Cohort Studies, Suicidal Ideation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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