CAMS Intervention Does Not Improve Suicide Outcomes

CAMS did not provide any meaningful improvements in the domains of suicidal ideation, psychological distress, or patient satisfaction.

Collaborative Assessment and Management of Suicidality (CAMS) is a feasible and acceptable treatment framework for individuals at risk for suicide, but it does not improve suicide outcomes or patient satisfaction compared with usual care, according to study results published in Journal of Affective Disorders.

Patients (N=150) who were admitted for suicide risk as an inpatient or at the emergency department, or who had attempted suicide in the previous month were recruited from 2 university medical centers between 2016 and 2018. They were randomly assigned to receive either CAMS (n=75) or usual treatment (n=75), then were evaluated for suicide outcomes.

The CAMS intervention comprised weekly individual therapy sessions aimed at fostering hope and reasons for living, and a weekly therapist consultation with a team. The CAMS team was trained by a single clinician via online sessions and live role-playing exercises. Usual treatment comprised 1 to 11 visits with a clinician and medication management.

Study patients had a mean age of 33.8 (range, 18-79) years, 48.0% were men, 41.3% were women, 10.7% were transgender or nonbinary, 62.7% were White, 20.7% were multiracial, 7.3% were Asian, 4.0% were Black, 3.3% were Hispanic, 1.3% were Hawaiian Native or Pacific Islander, and 0.7% were Native American or Alaskan Native, respectively. The intervention and control cohorts were well-balanced, except individuals who were randomly assigned to the control group had more lifetime suicide attempts (odds ratio [OR], 0.38; P =.000).

This negative study did not replicate earlier findings of improvements in suicidal ideation, psychological distress, or client satisfaction.

Patients in the CAMS and control groups attended an average of 10.71 and 12.76 sessions, 19.4% and 9.2% were not receiving any psychiatric medications, and the patients on medications were receiving 2.94 and 3.17 medication classes, respectively.

A suicide event occurred among 38.9% of the CAMS and 37.5% of the control patients.

The CAMS intervention did not have an effect on suicidal behavior (β, -0.05; P =.893) or suicide attempt (β, 0.52; P =.274).

Regarding suicidal ideation, more control recipients had ideation at baseline. A single treatment-by-time interaction was observed, in which patients who were randomly assigned to receive control intervention improved faster than the CAMS group between baseline and month 3.

The CAMS and usual care conditions were similarly acceptable, with patients reporting client satisfaction scores of 26.81 and 25.36 points, therapist satisfaction scores of 23.48 and 21.22 points, and therapist acceptability scores of 5.90 and 5.14 points, respectively.

No serious adverse events were reported other than expected suicidal behaviors or psychiatric hospitalizations.

Limitations of the study include the baseline difference in lifetime suicidal attempt observed between cohorts.

Study authors concluded, “This negative study did not replicate earlier findings of improvements in suicidal ideation, psychological distress, or client satisfaction. This study does replicate previous findings that CAMS is a feasible and acceptable treatment that is easily trained to community mental health clinicians.”

References:

Comtois KA, Hendricks KE, DeCou CR, et al. Reducing short term suicide risk after hospitalization: a randomized controlled trial of the Collaborative Assessment and Management of Suicidality. J Affect Disord. 2022;320:656-666. doi:10.1016/j.jad.2022.09.042