Implementing an evidence-based psychological intervention for suicidal thoughts and behaviors on an inpatient unit: Process, challenges, and initial findings

Gen Hosp Psychiatry. 2020 Mar-Apr:63:76-82. doi: 10.1016/j.genhosppsych.2018.09.012. Epub 2018 Sep 27.

Abstract

Objective: Barriers to implementing evidence-based psychological treatments for suicidal thoughts and behaviors in busy hospital settings exist. Transdiagnostic interventions may serve to facilitate training in evidence-based treatment and more efficiently treat individuals with multiple psychiatric comorbidities. We describe the rationale for, process of, and initial data from implementing the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) on an inpatient unit for adults with suicidal thoughts and behaviors and affective disorders.

Method: We analyzed clinical intake and outcome data from a subsample of patients admitted during the six months before and six months after UP implementation (n = 133 and n = 61, respectively), and available acceptability and fidelity data from the month following UP implementation.

Results: Patients improved significantly over the course of inpatient treatment before and after UP implementation. Effects for depression, suicidal ideation, anxiety, and emotion regulation were similar before and after UP implementation. Patients generally reported high acceptability of the UP and clinician fidelity to the protocol was variable during the month following UP implementation.

Conclusions: The UP may be a promising evidence-based intervention for inpatient settings that treat individuals with suicidal thoughts and behaviors. Well-controlled, randomized trials are needed to determine efficacy, particularly regarding suicidal behavior after discharge.

Keywords: Anxiety; Cognitive-behavioral; Depression; Inpatient; Suicide; Transdiagnostic.

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy / methods*
  • Cognitive Behavioral Therapy / organization & administration
  • Cognitive Behavioral Therapy / statistics & numerical data
  • Evidence-Based Practice / methods
  • Evidence-Based Practice / organization & administration
  • Evidence-Based Practice / statistics & numerical data
  • Female
  • Humans
  • Inpatients*
  • Male
  • Middle Aged
  • Mood Disorders / therapy*
  • Outcome and Process Assessment, Health Care* / statistics & numerical data
  • Patient Acceptance of Health Care* / statistics & numerical data
  • Psychiatric Department, Hospital / statistics & numerical data
  • Suicidal Ideation*
  • Suicide, Attempted / prevention & control*
  • Suicide, Attempted / statistics & numerical data
  • Young Adult