Nearly all efforts to reduce suicide behaviors in men aged 35-64 (heretofore middle-aged men) have been targeted to the general population (e.g., means restriction) or to specialty mental health or acute care (e.g., hospital) settings. Yet about half of all middle-aged men who die by suicide are seen by a primary care provider (PCP) within a month of dying, suggesting the value of primary care-based prevention, to complement strategies in other settings. Current impediments to primary care-based prevention are that many suicidal middle-aged men do not visit a PCP, and among those who do the topic of suicide is rarely broached, due to societal gender-linked norms (e.g., toughness); stigma; spurious concerns that talking about suicide increases risk; competing time demands; and lack of resources to cope with positive responses. PCP-targeted educational interventions increase detection of suicidal men, but inconsistently affect suicide behaviors. Suicide behaviors are more likely to be reduced by evidence-based follow-up care (EBFC: supportive follow-up contact and, for depressed patients, collaborative care). However, such care can only be effective if at-risk men visit a PCP who identifies suicide risk and offers the care, and the men accept it. Thus, there is a pressing need to study the effects of activating at risk middle-aged men to signal receptiveness to suicide discussion and care, prompting PCP inquiry and referrals to a form of EBFC that is feasible for most practices to implement. Also pressing is the need for feasible EBFC; uptake is limited, as most practices lack on-site CMs and psychiatrists to offer it. In this proposal, we will enroll middle-aged men with active suicide thoughts in a RCT to examine whether their pre-PCP visit use of the Multimedia Activation to Prevent Suicide (MAPS) for Men tailored interactive computer program, linked with integrated telephone EBFC (TEBFC) (vs. attention control exposure linked with TEBFC), reduces suicide preparatory behaviors (primary outcome, predictive of suicide attempts and deaths) and ideation over 3 months. We will refine MAPS for Men from our research- proven depression activation program, incorporating input we will solicit from a wide array of stakeholders in suicide prevention, guided by empirically-supported behavioral theories.
This study will determine if suicidal middle-aged men who use a personalized computer program addressing suicide risk before a primary care visit are more likely to discuss suicide and accept treatment, reducing their suicide preparatory behaviors and thoughts. This is important because half of all men who die by suicide visit primary care within a month of death, yet few broach the topic, missing chances for prevention.
