# Identifying Best Practices for Medication-Based Suicide Prevention Strategies to Minimize the Risk of Medically-Serious Adverse Events

> **NIH VA I01** · EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL · 2024 · —

## Abstract

Background: Lithium (LI) and clozapine (CLOZ) are the most evidence-based medications for preventing fatal
and nonfatal suicidal behavior (SB). Unfortunately, both medications also can cause numerous medically
serious side effects (SSEs). The VA is conducting a large randomized trial of LI for SB, and VA program
offices are considering encouraging greater LI and CLOZ use. This study features a comprehensive database
analysis and national survey to gather data to maximize the success of any effort to expand LI and CLOZ use.
Specific Aims: 1) Rapidly Assess the Current Safety of LI & CLOZ & Identify Opportunities for Expanded Use;
2) Refine Knowledge about the Timing of SSE Risks and the Implications for Clinical Care; 3) Examine Use
Across Providers & Identify Perceived Barriers / Facilitators to LI and CLOZ use; and 4) Integrate Results &
Develop Policy Recommendations, Provider Guide, & Communication Tool.
Significance: This study will markedly advance knowledge about how to safely use LI and CLOZ. These
advances will include identifying the safest populations to target for expanded use, and how to best manage
patients once LI and CLOZ are started. Understanding will be obtained about barriers besides SSEs that may
impede wider LI and CLOZ use, and input will be obtained from providers on how to surmount these barriers.
Findings will be integrated in several ways, including synthesis into a useful guide and communication tool.
Priority Area(s): Suicide Prevention, Mental & Behavioral Health, and Predictive Analytics.
Uniqueness: No prior study has examined the SSEs of LI or CLOZ as comprehensively, evaluated prevention
and treatment strategies as thoroughly, or condensed its findings into tools for providers and patients.
Methodology: Aim 1: Cox Regressions with Propensity Scores stratification will be used to facilitate the rapid
estimation of risks associated in patient groups possessing plausible SSE risks factors (e.g., particular medical,
psychiatric, or substance use diagnoses). Aim 2: Cox regression with marginal structural models will evaluate
the emergence and development of risks over time, seeking to identify clinically-useful “Decision Points”, and
incidence rates will be derived to promote patient-provider communication regarding SSEs. Survey: A brief
nationwide mental health prescriber survey focused on Barriers and Facilitators to Lithium use. Open
response survey components will help ensure that any unanticipated barriers or facilitators to LI or CLOZ use
will likely be identified. An all-cause mortality analysis and an example Predictive Model will help integrate
results, as will an Advisory Board. A user-friendly Provider Guide and Patient-Provider Communication Tool
will be developed.
Expected Results: For LI and CLOZ, we expect to find some patient groups at lower risk than others for SSEs
(e.g., male patients may be at lower risk for renal effects). We also expect immediate release LI to be
associated with less renal risk. F...

## Key facts

- **NIH application ID:** 11031350
- **Project number:** 5I01HX002794-04
- **Recipient organization:** EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL
- **Principal Investigator:** ERIC G. SMITH
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-04-01 → 2023-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11031350

## Citation

> US National Institutes of Health, RePORTER application 11031350, Identifying Best Practices for Medication-Based Suicide Prevention Strategies to Minimize the Risk of Medically-Serious Adverse Events (5I01HX002794-04). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/11031350. Licensed CC0.

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