Examining Alternative Treatment Settings for Adolescents With Suicidal Thoughts During the COVID-19 Pandemic.

Objective: Suicide is a leading cause of death for adolescents in the United States. Alternative settings to treat suicidal ideation (SI) are needed. Study primary objectives include evaluating the safety and effectiveness of telehealth crisis intervention services (CIS) and in-person outpatient crisis intervention clinics (OCIC) relative to the current standard of care of inpatient psychiatric hospitalization. A secondary aim seeks to assess changes in suicidal ideation, and patient and parent treatment satisfaction. Method: The study team, consisting of study staff at 4 sites, conducted an observational longitudinal study of patients (12-18 years of age) who were seen in the Emergency Department (ED) for suicidality and were referred to inpatient treatment, in-person OCIC, or telehealth CIS. Primary outcome data, including recurrent ED visits and hospitalizations because of SI, suicide attempts, and life satisfaction, were collected for 24 weeks. All analyses were adjusted for age, sex, and baseline suicidality severity scores. A total of 249 patients were enrolled. Results: There were no statistically significant differences in suicide attempts, time to first suicide attempt, ED visits, hospitalizations, and life satisfaction among the 3 treatment arms. There was no statistically significant difference in outcomes for treatment satisfaction among the treatment groups. Conclusion: In this observational study, in-person OCIC and telehealth CIS did not have significantly different outcomes from the current standard of care of inpatient psychiatric hospitalization. This broadens the scope of services that appear to be safe and effective for adolescents experiencing moderate suicidal thoughts. Future research using randomized controlled trials to clarify the causal effect of different interventions is warranted. Clinical trial registration information: Observational Study to Compare Outcomes of Different Psychiatric Treatment of Suicidal Adolescents (Pre-START); https://clinicaltrials.gov/study/NCT04625686. Diversity Inclusion Statement: We worked to ensure that the study questionnaires were prepared in an inclusive way. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.