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Evaluation of the Safety Plan to Prevent Suicidal Reiteration (PROTECT)

Primary Purpose

Suicide, Attempted

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
As usual
Protection plan
Sponsored by
Hôpital le Vinatier
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Suicide, Attempted

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: 18 years of age or older Seen in an emergency department Admitted in emergency department following a suicide attempt <48h whose duration of care does not exceed 24 hours For whom the care project results in a return home, Who agree to be included in the Vigilans system Who have social security coverage Fluent in French Exclusion Criteria: Refusal to participate in the study Refusal to be accompanied by the Vigilans system Hospitalisation for more than 24 hours in the immediate aftermath of the suicide attempt Under protective measures.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Other

    Other

    Arm Label

    Control group

    Protection plan group

    Arm Description

    Step in "control group" This stepped wedge study does not use two parallel treatment arms. The stepped wedge design allows each center to be its own "control group" and then, after implementation of the practice by the research team, to become a "intervention group". The characteristics of these two phases are detailed below. Patients included in the control phase, i.e. without intervention, will be asked not to oppose participation in the research, after having received the presentation of the study and the information notice. The data collection will be similar to the data collection during the intervention period.

    The intervention consists of making the protection plan in a co-constructed process with the care user. This tool is built in 6 steps, is written and takes 20 to 40 minutes to complete. These 6 steps allow to identify the first signs of a suicidal crisis and to identify different strategies to face it. They are constructed in an ascending order, with the aim of being used by the care user in an autonomous situation.

    Outcomes

    Primary Outcome Measures

    Suicidal recurrence at 6 months
    Suicidal reiteration is characterized by non-fatal suicidal behavior, self-inflicted injury with a desire to end one's life that does not result in death (WHO).

    Secondary Outcome Measures

    Suicidal recurrence
    Suicidal reiteration is characterized by non-fatal suicidal behavior, self-inflicted injury with a desire to end one's life that does not result in death (WHO).
    Commitment to healthcare
    Currently in mental health care? Y/N number of appointments in mental health care since the suicide attempt
    Death by suicide attempt
    Collected by cross-referencing information from the Vigilans system, by contacting the doctor or family members and other contacts. In the event of a lost person with no vital status data, civil status registers may be used.

    Full Information

    First Posted
    November 1, 2022
    Last Updated
    April 6, 2023
    Sponsor
    Hôpital le Vinatier
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05609487
    Brief Title
    Evaluation of the Safety Plan to Prevent Suicidal Reiteration
    Acronym
    PROTECT
    Official Title
    Evaluation of the Effectiveness of the Implementation of a Safety Plan by the Emergency Nurse to Prevent Suicidal Reiteration - National Multicenter Randomized Controlled Trial in Stepped-wedge
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    April 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    June 15, 2023 (Anticipated)
    Primary Completion Date
    January 15, 2026 (Anticipated)
    Study Completion Date
    December 31, 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Hôpital le Vinatier

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    Each year, suicide is the cause of 8,580 deaths in France, it is the second leading cause of death among 15-24 year olds. People who have made a first suicide attempt are identified as being at greater risk of repeating a suicidal gesture, particularly in the first month following the gesture . At the same time, Brief Intervention Contact (BIC) is recognized as effective in reducing suicide deaths. A new brief intervention to prevent suicidal attempts has been developed in the United States by Santley & Brown (2012) the results of its effectiveness are very encouraging. Investigators hypothesise that the implementation of a safety plan by the emergency department for suicidal patients included in the Vigilans system leads to a greater reduction in the reiteration of suicidality at 6 months compared to the usual management. Our main objective is to evaluate the effectiveness of the implementation of a safety plan by the emergency department nurse before discharge from the emergency department in reducing suicidal reiteration at six months after the suicide attempt, for suicidal patients included in the Vigilans programe, compared with the Vigilans programe alone. Our secondary objectives are Reduce the reiteration of the suicidal act at 1 month Encourage engagement in care at 1 month and 6 months Reduce the use of emergency departments at 1 month and 6 months due to a suicidal crisis Decrease suicide mortality at 6 months To study the implementation of the intervention: To measure the quality of completion, and the duration of completion of the safety plan at 1 month, and 6 months. Assess the acceptability of the safety plan by emergency department nurses, and then by the vigilantes. Assess the acceptability of the safety plan by patient
    Detailed Description
    Each year, suicide is the cause of 8,580 deaths in France , and although the suicide rate in France has decreased by 10% over the last ten years, it is the second leading cause of death among 15-24 year olds. People who have made a first suicide attempt are identified as being at greater risk of repeating a suicidal gesture, particularly in the first month following the gesture . At the same time, Brief Intervention Contact (BIC) is recognised as effective in reducing suicide deaths. In 2012, two American psychiatrists developed and evaluated the effectiveness of a tool for preventing the recurrence of suicide: the safety plan. It consists of a list of strategies co-constructed by a trained health professional with the person concerned, which make it possible to deal with thoughts of suicide. It is deployed in 6 steps. Once completed, it is kept by the user and can be used in complete autonomy at the first signs of a potential suicidal crisis. This prevention tool, whose initial results across the Atlantic are very encouraging, is not used in daily practice in France. The main objective of the study is therefore to evaluate its effectiveness at 6 months when it is implemented by the emergency room nurse, before discharge, for people already included in the VigilanS programme. The VigilanS programme is the national system for preventing suicidal recurrence and consists of three complementary strategies: Firstly, a resource card indicates a toll-free number, open during the day, for people who have made a gesture. Respondents are health professionals (vigilance workers) who can assess and guide people in the event of a recurrence of suicidal thoughts. Then investigators contact the person's existing care network, investigators inform the attending doctor, but also other care providers (psychologist, physiotherapist, liberal nurse...) of their patient's inclusion in the system. Finally, telephone calls are made by the health professionals in the first month following discharge, and six months after the suicidal act. In parallel, a postcard is sent monthly during the first 4 months to continue the link. This national study will work with 11 hospitals with a Vigilans service and will be implemented in 19 emergency departments. Doctors, nurses and health managers will be identified in each center. The first step of the study is to translate the tool (the safety plan), with the help of a committee of experts and specialized translators. Then investigators will evaluate its effectiveness with 2,387 study participants included in the 19 emergency departments over a two-year period. Each participating center (the emergency department) will initially be in an observation (or control) phase, i.e. the safety plan will not be used by the care workers. Then in a second phase, the research team will implement the practice of the tool through training, and in a third phase the center will be in the intervention phase, i.e. it will use the tool in daily practice. The order of training, where the practice is implemented in the units, is chosen by randomization. The main objective of the study is to evaluate six months after the suicide attempt, by a telephone call that will ask the patient if he or she has made a suicidal attempt again. Investigators will thus be able to compare a population that has not received the tool (the control group) with a population that has received the tool (the intervention group) and thus measure its effectiveness. Finally, the last stage of the study consists of evaluating the use of the tool by emergency service professionals, the Vigilans device, and the participants in the study. To do this, investigators will use questionnaires (evaluation scales) and conduct semi-structured interviews with several participants

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Suicide, Attempted

    7. Study Design

    Primary Purpose
    Prevention
    Study Phase
    Not Applicable
    Interventional Study Model
    Crossover Assignment
    Model Description
    The study is structured in three phases: 1) translation and adaptation of the safety plan into French; 2) effectiveness study; and 3) evaluation of the implementation of the safety plan in practice
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    2387 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Control group
    Arm Type
    Other
    Arm Description
    Step in "control group" This stepped wedge study does not use two parallel treatment arms. The stepped wedge design allows each center to be its own "control group" and then, after implementation of the practice by the research team, to become a "intervention group". The characteristics of these two phases are detailed below. Patients included in the control phase, i.e. without intervention, will be asked not to oppose participation in the research, after having received the presentation of the study and the information notice. The data collection will be similar to the data collection during the intervention period.
    Arm Title
    Protection plan group
    Arm Type
    Other
    Arm Description
    The intervention consists of making the protection plan in a co-constructed process with the care user. This tool is built in 6 steps, is written and takes 20 to 40 minutes to complete. These 6 steps allow to identify the first signs of a suicidal crisis and to identify different strategies to face it. They are constructed in an ascending order, with the aim of being used by the care user in an autonomous situation.
    Intervention Type
    Other
    Intervention Name(s)
    As usual
    Intervention Description
    Patients included in the control phase, i.e. without intervention, will be asked not to oppose participation in the research, after having received the presentation of the study and the information notice. The data collection will be similar to the data collection during the intervention period.
    Intervention Type
    Device
    Intervention Name(s)
    Protection plan
    Intervention Description
    The intervention consists of making the protection plan in a co-constructed process with the care user. This tool is built in 6 steps, is written and takes 20 to 40 minutes to complete. These 6 steps allow to identify the first signs of a suicidal crisis and to identify different strategies to face it. They are constructed in an ascending order, with the aim of being used by the care user in an autonomous situation.
    Primary Outcome Measure Information:
    Title
    Suicidal recurrence at 6 months
    Description
    Suicidal reiteration is characterized by non-fatal suicidal behavior, self-inflicted injury with a desire to end one's life that does not result in death (WHO).
    Time Frame
    6 months
    Secondary Outcome Measure Information:
    Title
    Suicidal recurrence
    Description
    Suicidal reiteration is characterized by non-fatal suicidal behavior, self-inflicted injury with a desire to end one's life that does not result in death (WHO).
    Time Frame
    one month
    Title
    Commitment to healthcare
    Description
    Currently in mental health care? Y/N number of appointments in mental health care since the suicide attempt
    Time Frame
    One month and 6 months
    Title
    Death by suicide attempt
    Description
    Collected by cross-referencing information from the Vigilans system, by contacting the doctor or family members and other contacts. In the event of a lost person with no vital status data, civil status registers may be used.
    Time Frame
    6 months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    65 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: 18 years of age or older Seen in an emergency department Admitted in emergency department following a suicide attempt <48h whose duration of care does not exceed 24 hours For whom the care project results in a return home, Who agree to be included in the Vigilans system Who have social security coverage Fluent in French Exclusion Criteria: Refusal to participate in the study Refusal to be accompanied by the Vigilans system Hospitalisation for more than 24 hours in the immediate aftermath of the suicide attempt Under protective measures.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    BENOIT CHALANCON, IDE
    Phone
    0033437915210
    Email
    benoit.chalancon@ch-le-vinatier.fr
    First Name & Middle Initial & Last Name or Official Title & Degree
    VERONIQUE VIAL
    Phone
    0033437915522
    Email
    veronique.vial@ch-le-vinatier.fr
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    BENOIT CHALANCON, IDE
    Organizational Affiliation
    CH LE VINATIER
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    Evaluation of the Safety Plan to Prevent Suicidal Reiteration

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