Men and Providers Preventing Suicide (MAPS)

In this study, the investigators will enroll middle-aged men with active suicide thoughts in
a randomized controlled trial (RCT) to examine whether their use of the Men and Providers
Preventing Suicide (MAPS) tailored interactive multimedia patient activation program
immediately before a primary care provider (PCP) visit, linked with integrated telephone
evidence-based follow-up care (TEBFC) (vs. attention control exposure linked with TEBFC),
reduces suicide preparatory behaviors and ideation over 3 months. About half of all
middle-aged men who die by suicide are seen by a PCP within a month of dying, suggesting the
value of primary care-based suicide prevention efforts, 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 have increased detection
of suicidal men, but have inconsistently affected suicide behaviors, and still many suicidal
men went undetected. Suicide behaviors are more likely to be reduced by evidence-based
follow-up care - supportive follow-up contact and collaborative mental health 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 use of
innovative tools like MAPS to activate at risk middle-aged men to signal their receptiveness
to suicide discussion and care, prompting PCP inquiry and referrals to a form of follow-up
care that is feasible for most practices to implement (e.g., TEBFC).

Inclusion Criteria:

- Self-identified male gender

- Aged 35-74

- Has a PCP at a primary care office in one of the two participating health systems who
is actively enrolled in the RCT

- Active suicide thoughts within past 4 weeks

- Able to read and speak English; and self-reported adequate vision, hearing, and hand
function to engage with an interactive computer program on a touchscreen electronic
tablet device.

Exclusion Criteria:

- Reported or apparent highly unstable medical status (e.g. acute decompensated heart
failure requiring immediate care)

- Reported or apparent highly unstable mental health status (e.g. acute uncontrolled
psychosis)

- Presence of terminal illness with death anticipated within 3 months

- Plan to leave the current primary care office (e.g., transfer care) within 3 months

- Incarcerated

- Inability to understand and/or provide informed consent, following appropriate
explanation