Comparing Suicide Prevention Interventions to Guide Follow-up Care: The SPRING Trial

Measured using the Harkavy-Asnis Suicide Scale (HASS) Active Suicidal Behavior Sub-Scale. The HASS has been validated for self-report, with strong psychometric properties in adolescents and adults. This measure asks about the frequency of suicide attempt planning, and actual and aborted/interrupted suicide attempts. Participants respond using the Likert scale response options used by Asarnow et al.'s validation study, modified to fit the survey time period (past six months at baseline/12-month outcome surveys, and past 3 months for 3- and 6-month outcome surveys). Each HASS sub-scale is scored separately by summing the response values. Scores on the Active Suicidal Behavior Sub-Scale range from 0 - 20, with higher scores corresponding to higher suicide risk. The primary outcome will be the cumulative risk of suicidal behavior assessed using area under the curve of the HASS scores over the 12-month study period.

Suicide attempts will be measured using the Columbia Suicide Severity Rating Scale (C-SSRS), which is valid for adolescents and adults.

Suicidal ideation will be measured using the Passive Suicidal Ideation Subscale of the Harkavy-Asnis Suicide Scale (HASS), which includes 12 items. Scores on the Passive Suicidal Ideation Sub-Scale range from 0 - 48, with higher scores corresponding to higher suicide risk.

Suicide-related ED utilization and hospitalization will be assessed by self-report and using electronic medical records. Reason for visit/diagnoses may be reviewed in electronic medical records for any inpatient or outpatient encounters that occur during the study period.

Outpatient mental health treatment will be self-reported and assessed using electronic medical records. Reason for visit/diagnoses may be reviewed in electronic medical records for any inpatient or outpatient encounters that occur during the study period.

Thwarted belongingness will be measured using the 15-item version of the Interpersonal Needs Questionnaire.

The 15-item version of the Interpersonal Needs Questionnaire (INQ15) is a validated tool to measure both perceived burdensomeness (PB) (6 items, scores range from 6 to 42) and thwarted belongingness (TB) (9 items; scores range from 9 to 63), which are related to desire for suicide. Individuals provide a self-report response to each of 15 items using a Likert scale ranging from 1 (Not at all true for me) to 7 (Very true for me). The appropriate items are reverse coded, and items are summed to calculate the TB and PB subscale scores with higher scores indicating greater TB and PB. Clinical Cutoff scores predicting desire for death are 35 or greater for TB and 19 or greater for PB. Clinical cutoff scores predicting desire for suicide are 50 or greater for TB and 30 or greater for PB.

Perceived burdensomeness will be measured using the 15-item version of the Interpersonal Needs Questionnaire.

The 15-item version of the Interpersonal Needs Questionnaire (INQ15) is a validated tool to measure both perceived burdensomeness (PB) (6 items, scores range from 6 to 42) and thwarted belongingness (TB) (9 items; scores range from 9 to 63), which are related to desire for suicide. Individuals provide a self-report response to each of 15 items using a Likert scale ranging from 1 (Not at all true for me) to 7 (Very true for me). The appropriate items are reverse coded, and items are summed to calculate the TB and PB subscale scores with higher scores indicating greater TB and PB. Clinical Cutoff scores predicting desire for death are 35 or greater for TB and 19 or greater for PB. Clinical cutoff scores predicting desire for suicide are 50 or greater for TB and 30 or greater for PB.

A combined indicator of suicidal ideation and behavior will be assessed using the Columbia Suicide Severity Rating Scale self-report 6-item screener for primary care (C-SSRS) plus several additional items from the full Columbia Suicide Severity Rating Scale (interview) (interrupted suicide attempts, self-aborted suicide attempts, actual suicide attempts, and suicide deaths). Scores range from 0 (no suicide risk indicated) to 10 (death by suicide), with higher scores indicating higher suicide risk.

The frequency of suicide attempts (including actual attempts, interrupted attempts, and self-aborted attempts) will be measured using the two-item Suicide Attempts Sub-Scale of the Harkavy-Asnis Suicide Scale (HASS). Scores on the Suicide Attempts Sub-Scale range from 0 - 8, with higher scores corresponding to higher suicide risk.

The General Mattering Scale (GMS) will be used to assess the extent to which participants believe they matter to other people. Participants use a Likert scale from 1-4 to respond to each of five items. Scoring is completed by summing the responses, with results ranging from 5 to 20 and higher scores corresponding to higher levels of perceived mattering to others (better outcomes).

Non-suicidal self-injury will be measured with select items from the Self-Injurious Thoughts and Behavior Interview - Revised (SITBI-R). Each item is assessed individually, and items are not scored together in a scale.

The number of and reason for visit/diagnoses for ED encounters and hospitalizations will be assessed using electronic medical records.

The manner and cause/lethal means of all deaths including death by suicide will be assessed based on electronic medical records and vital records

The manner and cause/lethal means of all deaths including death by suicide will be assessed based on electronic medical records and vital records

Suicide attempts will also be measured with select items from the Self-Injurious Thoughts and Behavior Interview - Revised (SITBI-R). Each item is assessed individually, and items are not scored together in a scale. Some items are dichotomous (e.g.: ever vs never had a suicide attempt). Several items ask for an age or date when suicide attempts occurred. The number of reported suicide attempts ranges from 0+, with no upper limit to the range.