See past highlights of MHRN activity in our Spring Newsletter





The Latest from MHRN

Do patients diagnosed with skin conditions have a higher risk of suicide?
Research suggests that patients diagnosed with skin conditions may have a higher risk of comorbid psychiatric conditions and suicide-related outcomes. To examine this theory in the US general population, Deepak Prabhakar, MD, MPH, led a study to examine the risk of suicide death in patients with dermatologic conditions using a retrospective case-control study conducted in 8 US health systems. A total of 2,674 individuals who died by suicide (cases) were matched with 267,400 general population control individuals. Overall, 619 cases and 54364 controls with skin conditions were analyzed.

After adjusting for age, sex, and any mental health or substance use condition, the authors did not find an association between death by suicide and any skin condition, and the study provides no evidence of increased risk of death by suicide in individuals with major skin disorders in the US general population.


Henry Ford Health System begins enrollment as part of the All of Us Precision Medicine Initiative Cohort Program
Henry Ford Health System has begun enrollment as part of the All of Us Precision Medicine Initiative Cohort Program

A team of MHRN-affiliated health systems, including Henry Ford, Baylor Scott & White, and Essentia, recently received NIH funding to lead a five-member Healthcare Provider Organization research consortium to expand the geographic reach and diversity of enrollment and engagement in the NIH's All of Us Precision Medicine Initiative (PMI) Cohort Program.

The consortium, led by co-PIs Brian K. Ahmedani, PhD and Christine Johnson, PhD, is a landmark research effort with a goal to advance personalized health care by studying how individual differences in lifestyle, clinical history, environment and genetics influence a person's health, disease risk, and optimal prevention and treatment approaches.

More information on this program can be found on the following websites: the NIH reporter website and the program’s lead site, Henry Ford Health System


MHRN Scientific Interest Group (SIG) on Perinatal Mental Health – new members welcome!  
A new MHRN Scientific Interest Group (SIG) has recently been formed to:

  • Promote a research agenda focused on perinatal mental health,
  • Facilitate collaboration among investigators,
  • Work on developing data infrastructure to support multisite perinatal mental health research projects,
  • Provide a forum for discussing research ideas and updating grant applications, projects, and papers.

SIG members meet regularly by phone and at an annual in-person meeting. New SIG members are always welcome! Contact Arne Beck, PhD, Director of Quality Improvement and Strategic Research, Kaiser Permanente, Colorado Region, or visit our website to learn more about taking part in this SIG.


MHRN study examines proportion of suicide deaths that could be prevented by limiting firearm access for people with a mental health condition or history of suicidal behavior
Since firearms account for half of all suicide deaths in the United States, many assume that reducing access to firearms among at-risk patients will reduce suicide mortality, and attempts to reduce access to firearms have focused on persons with a mental health condition or a history of suicidal behavior. To examine this theory, Jennifer M. Boggs,led an MHRN manuscript, as part of the Treatment Utilization Before Suicide study, to identify the proportion of suicide deaths that could potentially be prevented by limiting firearm access for people with a mental health condition or a history of suicidal behavior.

Using medical records and claims information, the team identified a group who had a history of any mental health or substance use condition, diagnosed at any medical or mental health visit in the year preceding death. They then identified a second group who had a history of previous suicide attempts (these were not mutually exclusive groups).
More people without a mental health or substance-use condition used firearms in their death than did people with those conditions (671 vs. 627). Also, more people without a previous suicide attempt used firearms in their death than did those with a previous attempt (1189 vs. 109). In fact, among people who died by suicide, only 4.1% had previously attempted suicide and used a firearm; 23.5% had a mental health or substance use condition and used a firearm.

Their findings indicate that, even if successful, current efforts to limit firearm access only for people with a mental health condition (including substance use disorders) or those who previously attempted suicide would prevent few suicide deaths by firearm. The authors suggest that prevention of firearm suicide should be expanded beyond the exclusive focus on patients with mental health conditions to include other persons at risk for suicide. Findings also highlight the importance of expanding attention beyond firearms—especially for persons with mental health or substance use conditions—to include other common means of suicide.


Funding received to evaluate the Zero Suicide Model across learning healthcare systems
Brian Ahmedani PhD and Greg Simon, MD, MPH lead a recently funded 5-year MHRN study to evaluate the Zero Suicide Model across learning healthcare systems.The study is based uponHenry Ford Health System’s Perfect Depression Care (PDC) Zero Suicide Initiative, which demonstrated a sustained decrease in the suicide rate of nearly 80% among behavioral health patients.

The 2012 National Strategy for Suicide Prevention promoted this initiative and its adoption of Zero Suicides as an aspirational goal of healthcare systems across the US. The Suicide Prevention Resource Center developed the resources and tools to prepare US health systems for local implementation of the National ZS Model (NZSM).

Funded by NIMH, the study aims to do the following:

  • Collaborate with health system leaders to develop electronic health record (HER) metrics to measure specific quality improvement targets and care processes tailored to local NZSM implementation.
  • Examine the fidelity of the specific NZSM care processes implemented in each system.
  • Investigate suicide attempt and mortality outcomes within and across NZSM system models.

Acknowledging that suicidal individuals often fall through multiple cracks in a fragmented healthcare system, the NZSM calls for a systematic, comprehensive approach across health service settings.  The NZSM approach involves local implementation of a series of evidence-based clinical interventions in four areas:

  • Identifying those at risk (IDENTIFY)
  • Initiating and maintaining engagement in care (ENGAGE)
  • Delivering effective treatments (TREAT)
  • Assuring appropriate care transitions (TRANSITION)

This project aims to fill a major research need by evaluating the separate and cumulative benefits of implementing specific components of the NZSM in large integrated healthcare systems within various service settings and patient populations.


Suicide Prevention Trial: Over 10,000 enrolled!
The Pragmatic Trial of Population-based Programs to Prevent Suicide Attempt, led by Greg Simon, MD, MPH has enrolled over 10,000 participants. Visit the MHRN website for more information on this project, which aims to conduct a large, pragmatic trial to examine two population-based programs to prevent suicide attempt.


Development of a population-based risk calculator for suicidal behavior continues with newly awarded supplemental funding
In 2015 MHRN began a project to use population-based data from large health systems to develop evidence-based suicide attempt risk calculators for mental health and primary care clinicians. The models developed by the project were a substantial advance over existing risk prediction or risk stratification tools, however there were limitations. In 2017 NIMH awarded MHRN a supplement to extend this work, address some of these limitations, and do the following:

  • Expand and enhance the risk prediction dataset to: include larger numbers of observations with data regarding self-reported suicidal ideation (PHQ9 Item 9), include additional encounters and events following the transition from ICD9 to ICD10 diagnoses, and allow more detailed consideration of the timing of predictor events (diagnoses, encounters, prescription fills)
  • Expand sampling to include emergency department and inpatient encounters
  • Evaluate alternative modeling approaches, including classification- or tree-based approaches such as Classification and Regression Trees (CART), Mixed Effects Regression Trees (MERT), and Random Forest.
  • Rapidly disseminate all methods, tools and results to a wide range of stakeholders including health systems, researchers, and EHR vendors.


This research will make several significant and unique contributions to suicide prevention research, including:

  • An unprecedented sample size of patients, visits, and suicidal behavior outcomes
  • A population-based sample including mental health and primary care visits from seven health systems
  • Integration of electronic health records data (diagnoses, prescriptions) with systematically collected data regarding suicidal ideation
  • Inclusion of more diverse and detailed predictors than any previous research in this area