Cognitive-behavioral suicide prevention for psychosis in community mental health: A pilot randomized clinical trial

Abstract

Adults with schizophrenia spectrum disorders (SSDs) have substantially elevated suicide risk, yet few suicide prevention interventions have been developed or tested for this population. The effectiveness of Cognitive-Behavioral Suicide Prevention for psychosis (CBSPp) in US community mental health (CMH) settings remains unknown. This study aimed to examine the preliminary effectiveness of the CBSPp intervention in reducing suicidal ideation, depressive symptoms, psychosis symptoms, and emergency/hospital service use compared with services as usual (SAU) among adults with SSDs in a CMH setting. A pilot randomized clinical trial was conducted between 2022 and 2025 with four assessment timepoints. Adults aged 18 years or older receiving CMH services who met DSM-5 criteria for an SSD and reported suicidal ideation or attempt within 12 months of screening. Fifty-one participants were randomized (CBSPp + SAU, n = 25; SAU, n = 26) and forty-one (80.4%) completed the final follow-up assessment. Primary outcomes were assessed with the Columbia–Suicide Severity Rating Scale, Calgary Depression Rating Scale for Schizophrenia, Positive and Negative Syndrome Scale, and electronic health records. Analyses followed the intention-to-treat principle. Among participants (mean [SD] age, 44.5 [12.9] years; 31 male [60.8%]), significant group × time interactions were observed for suicidal ideation severity (F(3,125.25) = 3.48; P = .018; η 2 ≈ 0.10), depressive symptoms (η 2 ≈ 0.07), negative psychosis symptoms (η 2 ≈ 0.12), and general psychosis symptoms (η 2 ≈ 0.17), indicating greater reductions among participants receiving CBSPp compared with SAU. Preliminary findings provide support for further evaluation of CBSPp in larger, adequately powered trials across diverse clinical settings to establish its effectiveness and impact on suicide-related outcomes among adults with SSDs.