Abstract
BackgroundCollaborative Assessment and Management of Suicidality (CAMS) is a therapeutic framework that appears promising to reduce suicidal ideation and suicidal cognition. CAMS has not previously been evaluated in a standard specialized mental health care setting for patients with suicidal problems in general. In this pragmatic randomized controlled trial (RCT) we will investigate if CAMS is more effective than treatment as usual (TAU) in reducing suicidal thoughts and behaviors. Effects will also be investigated on mental health and symptom relief in general and upon readmissions to inpatient units.Methods/designThe study is a multicenter, observer-blinded, superiority, two-armed RCT which will include patients from four clinical departments at Vestre Viken Hospital Trust, Norway. We aim to include 100 patients with moderate to strong suicidal problems, as defined by a score of 13 or more on Beck’s Scale for Suicide Ideation - Current. Patients are included regardless of diagnosis. Randomization will be performed using a stratified four-block procedure with treatment unit as the stratification variable. The duration of treatment will vary depending on patients’ needs and clinical assessments. Patients are interviewed by research staff at four checkpoints: baseline, 2 weeks, 6 months, and 12 months. Central outcome measures are the Beck Scale for Suicide Ideation - Current, Outcome Questionnaire – 45, and Suicide Attempt Self-Injury Count.DiscussionThis pragmatic trial is effectuated within the Public Health Care System in Norway, where patients have multiple problems and diagnoses and therapists have a high work load. Results from this trial are highly generalizable to a typical everyday clinical setting, and one should expect similar results if CAMS is implemented in the future as a standard component in specialized mental health care systems.Trial registrationOpen Science Framework: DOI 10.17605/OSF.IO/JHRM2. Registered 5 July 2015. ClinicalTrials.gov: NCT02685943. Registered on 8 February 2016.
Highlights
Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic framework that appears promising to reduce suicidal ideation and suicidal cognition
This pragmatic trial is effectuated within the Public Health Care System in Norway, where patients have multiple problems and diagnoses and therapists have a high work load
Results from this trial are highly generalizable to a typical everyday clinical setting, and one should expect similar results if CAMS is implemented in the future as a standard component in specialized mental health care systems
Summary
Randomized controlled trials are generally considered to be scientifically superior for evaluating treatment effects. Setting The unique setting of the pragmatic trial generally offers important challenges that may affect motivation of attendance for the involved therapists and cause recruitment difficulties. Low representation of CAMS therapists at each site combined with the need to perform the somewhat unpredictable randomization procedure complicates the inclusion process These factors as a whole may hamper clinicians’ motivation and ability to participate actively in the range that we expect, as we rely on each therapist’s inner motivation to take part in the project. This focus may be difficult both for the system as a whole and for the clinicians (e.g., there may be concerns about extended stay at the inpatient clinic if one focuses on the patient’s problems) These factors combined may be at play as we experience recruitment difficulties.
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