Abstract: Effectiveness of a Cognitive-Behavioral Treatment for Suicide Prevention Among Adults with Psychosis: Findings of a Randomized Clinical Trial (Society for Social Work and Research 31st Annual Conference)

Schedule:

Sunday, January 24, 2027

Union Station 23 (Hilton San Francisco Union Square)

* noted as presenting author

Lindsay A. Bornheimer, PhD, LCSW, Associate Professor, University of Michigan-Ann Arbor, Ann Arbor, MI

Jordan DeVylder, PhD, Associate Professor, New York University, New York, NY

Matthew Smith, PhD, Professor, University of Michigan-Ann Arbor, Ann Arbor, MI

Nicholas Brdar, BS, phd student, University of Michigan-Ann Arbor, Ann Arbor, MI

Alexandra Kelter, MD, Medical Resident, University of Michigan-Ann Arbor, MI

Maura Campbell, MSW, Mental Health Therapist & Clinical Research Coordinator, University of Michigan-Ann Arbor, Ann Arbor, MI

Emma Anderson, BS, Project coordinator, University of Michigan-Ann Arbor, MI

Shicheng Xu, MPhil, PhD Student, New York University, New York, NY

Katie Hoener, MSW, Program Administrator, Washtenaw County Community Mental Health, MI

Timothy Florence, MD, Medical Director, Washtenaw County Community Mental Health, MI

Cheryl King, PhD, Professor, University of Michigan

Stephan Taylor, MD, Professor, University of Michigan-Ann Arbor, MI

Joseph Himle, PhD, Professor, University of Michigan-Ann Arbor

Background and Purpose: Suicide risk among adults with schizophrenia spectrum disorders (SSDs) is substantially higher than in the general population, yet there remains a notable lack of empirically supported interventions designed specifically to address suicide thoughts and behavior within this group. Most suicide prevention approaches have not been tailored to the unique clinical features associated with psychosis, such as cognitive disruptions, negative symptoms, and illness-related beliefs. Cognitive-Behavioral Suicide Prevention for psychosis (CBSPp) has emerged as a promising and targeted intervention that integrates cognitive-behavioral strategies with suicide-specific content for individuals experiencing psychosis. Although initial investigations in the United Kingdom has demonstrated feasibility and acceptability, there has been a critical need to evaluate a U.S.-adapted version in community mental health (CMH) where most individuals with SSDs receive care. Our study aimed to examine the preliminary effectiveness of a U.S.-adapted CBSPp protocol delivered in a CMH setting.

Methods: This pilot randomized clinical trial compared outcomes for participants receiving CBSPp in addition to services as usual (SAU; n = 25) with those receiving SAU alone (n = 26). Eligible participants were adults diagnosed with an SSD who reported suicidal ideation and/or a suicide attempt within the previous 12 months. CBSPp was delivered to participants in the treatment group by CMH social workers weekly for 10 sessions total. Participants completed assessments at four timepoints: baseline, mid-treatment (1 month), post-treatment (3 months), and follow-up (5 months). Primary outcomes included suicidal ideation and attempts, measured using the Columbia-Suicide Severity Rating Scale; depressive symptoms, assessed via the Calgary Depression Rating Scale for Schizophrenia; and psychosis symptoms, measured by the Positive and Negative Syndrome Scale. Utilization of emergency and inpatient psychiatric services was also tracked. Linear mixed-effects models and generalized linear mixed models were performed to evaluate Group x Time interactions.

Results: A total of 51 participants were randomized, with 41 completing the final follow-up assessment. Participants receiving CBSPp demonstrated greater reductions in suicidal ideation severity over time compared to those receiving SAU (p = .018, η² ≈ .10). Improvements were also observed in depressive symptoms (η² ≈ .07), negative psychosis symptoms (η² ≈ .12), and general psychosis symptoms (η² ≈ .17), indicating small to moderate effect sizes across domains. In addition, the proportion of individuals endorsing suicidal ideation decreased markedly in the CBSPp group, from 94.6% at baseline to 19.6% at follow-up, compared to a reduction from 65.2% to 31.4% in the SAU group. No statistically significant differences were detected for positive psychosis symptoms. Prevalence of suicide attempts and acute service utilization were low overall, yet, descriptively fewer events occurred among participants receiving CBSPp.

Conclusions and Implications: These findings offer preliminary support for the effectiveness of a U.S.-adapted CBSPp intervention in reducing suicidal ideation, depressive symptoms, and psychosis symptoms among adults with SSDs receiving care in CMH settings. Further research using larger samples and multisite designs is warranted to confirm these findings and to evaluate implementation and scalability across diverse clinical contexts.