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NCT Number: NCT07469917

Safety Planning Intervention in Swedish Healthcare: A Multisite Study for Suicide Prevention

Suicide is one of the leading causes of premature death and a prioritized public health concern.

Safety Planning Intervention (SPI) is a method with strong international research support for reducing suicidal behaviour by enhancing individuals' strategies for crisis management and improving access to support. SPI is a single-session intervention lasting approximately 45 minutes, which any healthcare provider can deliver after a brief training. Despite promising results, the implementation of SPI in Swedish healthcare remains limited. This project examines how SPI can be integrated into various healthcare settings and evaluates its impact on suicide-related emergency visits, psychiatric hospitalizations, and healthcare utilization. Data and Methods Stepped-Wedge implementation study in specialist psychiatry, where SPI is gradually introduced in psychiatric units. This study design allows for a robust evaluation of effects while ensuring all units eventually receive the intervention. As part of this study, a survey among healthcare professionals will be conducted to assess their experiences with feasibility, usability, and implementation barriers.

Data will be collected from QlikView healthcare utilization data. Poisson regression models with mixed effects will be used to analyze the impact of SPI on emergency visits and psychiatric hospitalizations. A health economic analysis will be conducted to evaluate the cost-effectiveness of SPI. Societal Relevance and Impact

The project contributes to Sweden's national suicide prevention strategy by:

1. Scientifically evaluating the feasibility and effects of SPI in Swedish healthcare. 2. Developing training programs for healthcare professionals in suicide prevention. 3. Informing policy decisions and national guidelines. 4. Analyzing the cost-effectiveness of SPI from a societal perspective. Implementation The research team includes experts in suicide prevention, psychiatry, epidemiology, patient safety, and health economics, creating a strong multidisciplinary foundation. The Stepped-Wedge design ensures an ethically and methodologically sound evaluation of SPI.

Gradual implementation allows for time-based comparisons, minimizes selection bias, and ensures all patients receive the intervention. The project is conducted in close collaboration with healthcare providers and policymakers to ensure that research findings can be integrated into clinical practice and strengthen suicide prevention efforts in Sweden.

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Key information

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Region Skåne, psychiatric services, Helsingborg, Skåne County, Sweden

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Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Patients presenting to psychiatric services with suicidal ideation, suicidal planning, or a suicide attempt

Patients receiving care in participating adult psychiatric emergency or inpatient units

Exclusion criteria

Age under 18 years

Treatment and study plan

Safety Planning Intervention (SPI)

Behavioral

Safety Planning Intervention (SPI), developed by Stanley & Brown (12), is a brief, structured suicide preventive intervention designed to help individuals identify warning signs, develop coping strategies, and establish emergency contact pathways. SPI is a single-session intervention that typically lasts approximately 45 minutes and is delivered in clinical or emergency care settings. It is designed to help individuals identify warning signs, develop coping strategies, and establish a concrete plan for seeking support during a suicidal crisis. Unlike traditional risk assessments that focus on predicting suicide risk, SPI actively engages individuals in managing crises before they escalate. The intervention consists of six core steps.

Primary outcomes

  1. Monthly rate of emergency visits for suicide attempts

    Time frame: Monthly measurements throughout the 45-month study period

    Monthly number of emergency department visits for suicide attempts identified using ICD-10 codes X60-X84 and events of undetermined intent (Y10-Y34), obtained from aggregated healthcare utilization data from psychiatric clinics in Region Skåne.

Secondary outcomes

  1. Monthly rate of psychiatric inpatient admissions for suicide attempts

    Time frame: Monthly measurements throughout the 45-month study period

    Monthly number of psychiatric inpatient admissions with ICD-10 diagnoses indicating suicide attempts (X60-X84) or events of undetermined intent (Y10-Y34), obtained from aggregated healthcare utilization data.

  2. Emergency department revisits following suicide attempts

    Time frame: Monthly measurements throughout the 45-month study period

    Monthly number of emergency department revisits due to suicide attempts or events of undetermined intent within 30 days, 6 months, or 12 months after a previous visit.

  3. Psychiatric inpatient readmissions following suicide attempts

    Time frame: Monthly measurements throughout the 45-month study period

    Monthly number of psychiatric inpatient readmissions due to suicide attempts or events of undetermined intent within 30 days, 6 months, or 12 months after a previous admission.

  4. Incremental cost-effectiveness of SPI implementation

    Time frame: Assessed over the 45-month implementation period

    Incremental cost-effectiveness ratio comparing the Safety Planning Intervention (SPI) with usual care based on healthcare utilization costs and suicide-related healthcare events.

Study contacts

Contact information is provided by the study sponsor or research team.

Sara Lindström, Associate professor

CONTACT

[email protected]

+46702823770

Sponsors and collaborators

Lead sponsor

Region Skane

Other

Collaborators

  • Forte

Registry information

Important dates

Study start
2025
Primary completion
2028
Study completion
2029
First posted
Mar 13, 2026
Registry last updated
Mar 13, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

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This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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