1
|
Kasal A, Táborská R, Juríková L, Grabenhofer-Eggerth A, Pichler M, Gruber B, Tomášková H, Niederkrotenthaler T. Facilitators and barriers to implementation of suicide prevention interventions: Scoping review. Glob Ment Health (Camb) 2023; 10:e15. [PMID: 37854412 PMCID: PMC10579684 DOI: 10.1017/gmh.2023.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/12/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
We know that suicide is preventable, yet hundreds of thousands of people still die due to suicide every year. Many interventions were proven to be effective, and dozens of others showed promising results. However, translating these interventions into new settings brings several challenges. One of the crucial obstacles to success is not anticipating possible barriers to implementation nor enhancing possible benefits of factors facilitating the implementation. While we witnessed great support for suicide prevention activities globally in the past years, implementation barriers and facilitating factors are yet to be comprehensively mapped to help implementation activities worldwide. This scoping review maps current knowledge on facilitators and barriers to the implementation of suicide prevention interventions while using the Consolidated Framework for Implementation Research (CFIR) for classification. We included 64 studies. Barriers and facilitators were most commonly identified in the outer setting CFIR domain, namely in the sub-domain of patient needs and resources, which refers to the way in which these needs and resources are reflected by the reviewed interventions. The second most saturated CFIR domain for facilitators was intervention characteristics, where relative advantage, adaptability and cost of intervention sub-domains were equally represented. These sub-domains refer mostly to how the intervention is perceived by key stakeholders, to what extent it can be tailored to the implementation context and how much it costs. While intervention characteristics domain was the second most common also for barriers, the complexity sub-domain referring to high perceived difficulty of implementation was the most frequently represented. With reference to the results, we recommend adapting interventions to the needs of the target groups. Furthermore, carefully selecting the intervention to suit the target context concerning their adaptability, costs and complexity is vital for a successful implementation. Further implications for practice and research are discussed.
Collapse
Affiliation(s)
- Alexandr Kasal
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Faculty of Social Sciences, Charles University, Prague, Czech Republic
| | - Roksana Táborská
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
| | - Laura Juríková
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | | | - Michaela Pichler
- Department of Psychosocial Health, Gesundheit Österreich GmbH, Wien, Austria
| | - Beate Gruber
- Department of Psychosocial Health, Gesundheit Österreich GmbH, Wien, Austria
| | - Hana Tomášková
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | | |
Collapse
|
2
|
Santel M, Neuner F, Berg M, Steuwe C, Jobes DA, Driessen M, Beblo T. The Collaborative Assessment and Management of Suicidality compared to enhanced treatment as usual for inpatients who are suicidal: A randomized controlled trial. Front Psychiatry 2023; 14:1038302. [PMID: 36937739 PMCID: PMC10017970 DOI: 10.3389/fpsyt.2023.1038302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Although use of inpatient crisis hospital intervention for suicide risk is common, the evidence for inpatient treatments that reduce suicidal thoughts and behaviors is remarkably limited. To address this need, this novel feasibility pilot randomized controlled trial compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced treatment as usual (E-TAU) within a standard acute inpatient mental health care setting. Objectives We hypothesized that CAMS would be more effective than E-TAU in reducing suicidal thoughts and behaviors. As secondary outcomes we also investigated depressive symptoms, general symptom burden, reasons for living, and quality of the therapeutic relationship. Methods All patients were admitted due to acute suicidal thoughts or behaviors. They were randomly assigned to CAMS (n = 43) or E-TAU (n = 45) and assessed at four time points (admission, discharge, 1 month and 5 months after discharge). We used mixed-effects models, effect sizes, and reliable change analyses to compare improvements across and between treatment groups over time. Results Intent-to-treat analyses of 88 participants [mean age 32.1, SD = 13.5; n = 47 (53%) females] showed that both groups improved over time across all outcome measures with no significant between-group differences in terms of change in suicidal ideation, depression, reasons for living, and distress. However, CAMS showed larger effect sizes across all measures; for treatment completers CAMS patients showed significant improvement in suicidal ideation (p = 0.01) in comparison to control patients. CAMS patients rated the therapeutic relationship significantly better (p = 0.02) than E-TAU patients and were less likely to attempt suicide within 4 weeks after discharge (p = 0.05). Conclusions CAMS and E-TAU were both effective in reducing suicidal thoughts and symptom distress. Within this feasibility RCT the pattern of results was generally supportive of CAMS suggesting that inpatient use of CAMS is both feasible and promising. However, our preliminary results need further replication within well-powered multi-site randomized controlled trials. Trial registration DRKS-ID/ICTRP-ID: DRKS00013727. The trial was retrospectively registered in the German Clinical Trials Register, registration code/ DRKS-ID: DRKS00013727 on 12.01.2018 and also in the International Clinical Trials Registry Platform of the World Health Organization (identical registration code).
Collapse
Affiliation(s)
- Miriam Santel
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
- *Correspondence: Miriam Santel
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Michaela Berg
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Carolin Steuwe
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - David A. Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, United States
| | - Martin Driessen
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Thomas Beblo
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| |
Collapse
|
3
|
Chammas F, Januel D, Bouaziz N. Inpatient suicide in psychiatric settings: Evaluation of current prevention measures. Front Psychiatry 2022; 13:997974. [PMID: 36386981 PMCID: PMC9650354 DOI: 10.3389/fpsyt.2022.997974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2022] Open
Abstract
The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.
Collapse
Affiliation(s)
- Francesca Chammas
- Centre de Recherche Clinique, EPS Ville-Evrard, Neuilly-sur-Marne, France
| | | | | |
Collapse
|
4
|
McCutchan PK, Yates BT, Jobes DA, Kerbrat AH, Comtois KA. Costs, benefits, and cost-benefit of Collaborative Assessment and Management of Suicidality versus enhanced treatment as usual. PLoS One 2022; 17:e0262592. [PMID: 35113921 PMCID: PMC8812929 DOI: 10.1371/journal.pone.0262592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 12/30/2021] [Indexed: 11/19/2022] Open
Abstract
Suicide rates have been steadily increasing in both the U.S. general population and military, with significant psychological and economic consequences. The purpose of the current study was to examine the economic costs and cost-benefit of the suicide-focused Collaborative Assessment and Management of Suicidality (CAMS) intervention versus enhanced treatment as usual (ETAU) in an active duty military sample using data from a recent randomized controlled trial of CAMS versus ETAU. The full intent-to-treat sample included 148 participants (mean age 26.8 years ± 5.9 SD years, 80% male, 53% White). Using a micro-costing approach, the cost of each condition was calculated at the individual level from a healthcare system perspective. Benefits were estimated at the individual level as cost savings in past-year healthcare expenditures based on direct care reimbursement rates. Cost-benefit was examined in the form of cost-benefit ratios and net benefit. Total costs, benefits, cost-benefit ratios, and net benefit were calculated and analyzed using general linear mixed modeling on multiply imputed datasets. Results indicated that treatment costs did not differ significantly between conditions; however, CAMS was found to produce significantly greater benefit in the form of decreased healthcare expenditures at 6-month follow-up. CAMS also demonstrated significantly greater cost-benefit ratios (i.e., benefit per dollar spent on treatment) and net-benefit (i.e., total benefit less the cost of treatment) at 12-month follow-up. The current study suggests that beyond its clinical effectiveness, CAMS may also convey potential economic advantages over usual care for the treatment of suicidal active duty service members. Our findings demonstrate cost savings in the form of reduced healthcare expenditures, which theoretically represent resources that can be reallocated toward other healthcare system needs, and thus lend support toward the overall value of CAMS.
Collapse
Affiliation(s)
- Phoebe K. McCutchan
- Department of Psychology, American University, Washington, DC, United States of America
| | - Brian T. Yates
- Department of Psychology, American University, Washington, DC, United States of America
| | - David A. Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, United States of America
| | - Amanda H. Kerbrat
- Center for Suicide Prevention and Recovery, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Katherine Anne Comtois
- Center for Suicide Prevention and Recovery, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| |
Collapse
|
5
|
Bellairs-Walsh I, Byrne SJ, Bendall S, Perry Y, Krysinska K, Lin A, Michail M, Lamblin M, Li TY, Hetrick S, Robinson J. Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12926. [PMID: 34948536 PMCID: PMC8701929 DOI: 10.3390/ijerph182412926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm; however, no studies have explored GPs' perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges; (2) screening and assessment tools can help to manage uncertainty and discomfort; (3) going beyond tools-the dialogue and relationship are most important; (4) there are limits to what we can offer in the time available; (5) the service access and referral pathways lack clarity and coordination; (6) the provision of mental health support should not fall on GPs alone; and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.
Collapse
Affiliation(s)
- India Bellairs-Walsh
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Sadhbh J. Byrne
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Global Health, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Sarah Bendall
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Yael Perry
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Karolina Krysinska
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK;
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Tina Yutong Li
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Townsville University Hospital, Douglas, QLD 4814, Australia
| | - Sarah Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1010, New Zealand
| | - Jo Robinson
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| |
Collapse
|
6
|
Treatment Fidelity of a Randomized Controlled Trial for Suicidal Risk. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021. [DOI: 10.1007/s10879-021-09528-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
7
|
Pistorello J, Jobes DA, Gallop R, Compton SN, Locey NS, Au JS, Noose SK, Walloch JC, Johnson J, Young M, Dickens Y, Chatham P, Jeffcoat T. A Randomized Controlled Trial of the Collaborative Assessment and Management of Suicidality (CAMS) Versus Treatment as Usual (TAU) for Suicidal College Students. Arch Suicide Res 2021; 25:765-789. [PMID: 32275480 PMCID: PMC7585690 DOI: 10.1080/13811118.2020.1749742] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This randomized controlled trial compared the Collaborative Assessment and Management of Suicidality (CAMS) and Treatment as Usual (TAU) for suicidal college students within a feasibility trial. Sixty-two suicidal college students were randomized to CAMS (n = 33) or TAU (n = 29). We hypothesized that those receiving CAMS would show more improvement in suicide-related measures, and effects would be moderated by borderline personality disorder (BPD), prior suicide attempts, and age. Both treatment groups showed improvements in all outcome variables; CAMS had a significantly higher impact on depression and suicidal ideation when measured weekly during care and was more likely than TAU to decrease hopelessness among students with fewer BPD features, no suicide attempt history, and older age. Conversely, TAU did better for students with BPD features and history of multiple suicide attempts.
Collapse
|
8
|
Swift JK, Trusty WT, Penix EA. The effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) compared to alternative treatment conditions: A meta-analysis. Suicide Life Threat Behav 2021; 51:882-896. [PMID: 33998028 DOI: 10.1111/sltb.12765] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This meta-analysis aimed to test the efficacy of the Collaborative Assessment and Management of Suicidality (CAMS) intervention against other commonly used interventions for the treatment of suicide ideation and other suicide-related variables. METHOD Database, expert, and root and branch searches identified nine empirical studies that directly compared CAMS to other active interventions. A random effects model was used to calculate the effect size differences between the interventions; additionally, moderators of the effect sizes were tested for suicidal ideation. RESULTS In comparison to alternative interventions, CAMS resulted in significantly lower suicidal ideation (d = 0.25) and general distress (d = 0.29), significantly higher treatment acceptability (d = 0.42), and significantly higher hope/lower hopelessness (d = 0.88). No significant differences for suicide attempts, self-harm, other suicide-related correlates, or cost effectiveness were observed. The effect size differences for suicidal ideation were consistent across study types and quality, timing of outcome measurement, and the age and ethnicity of participants; however, the effect sizes favoring CAMS were significantly smaller with active duty military/veteran samples and with male participants. CONCLUSIONS The existing research supports CAMS as a Well Supported intervention for suicidal ideation per Center of Disease Control and Prevention criteria. Limitations and future directions are discussed.
Collapse
|
9
|
Adrian M, Blossom JB, Chu PV, Jobes D, McCauley E. Collaborative Assessment and Management of Suicidality for Teens: A Promising Frontline Intervention for Addressing Adolescent Suicidality. PRACTICE INNOVATIONS (WASHINGTON, D.C.) 2021; 7:154-167. [PMID: 35747427 PMCID: PMC9211019 DOI: 10.1037/pri0000156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This pilot open trial examined the feasibility, acceptability, and preliminary outcomes of the Collaborative Assessment and Management of Suicidality for teens (CAMS-4Teens) who presented to outpatient care with suicidal thoughts and behaviors. Participants were 22 adolescents (13-17; 59% identified as female) with clinical elevations (≥7) on the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Primary outcomes were feasibility and acceptability. We also explored outcomes of suicidal thoughts and behaviors, as well as mixed effects modeling for weekly assessments of the Suicide Status Form (SSF) Core Assessment constructs. Our main implementation outcomes suggest that the intervention is acceptable, appropriate, and feasible to deliver. Clinicians were adherent to the model with high ratings of adherence. In addition, preliminary evaluation of suicidal thoughts and behaviors found a large effect size for reduction in suicidal thoughts. Benchmarking to other adolescent suicide specific interventions and the Collaborative Assessment of Management of Suicidality with adult populations provide promise that suicidal adolescent responses may be on par with established interventions. Findings from the study are preliminary in nature and intended to inform if CAMS with adolescents is a promising approach to engage and treat patient-defined "drivers" of suicide. The results suggest that a future investigation with power to detect significant change over another active intervention is warranted.
Collapse
Affiliation(s)
- Molly Adrian
- University of Washington, Department of Psychiatry and Behavioral Sciences
- Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development
| | - Jennifer B. Blossom
- University of Maine at Farmington, Division of Psychology and Human Development
| | - Phuonguyen V Chu
- University of Washington, Department of Psychiatry and Behavioral Sciences
- Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development
| | - David Jobes
- The Catholic University of America, Department of Psychology
| | - Elizabeth McCauley
- University of Washington, Department of Psychiatry and Behavioral Sciences
- Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development
| |
Collapse
|
10
|
Santel M, Beblo T, Leygraf J, Driessen M. [Collaborative Assessment and Management of Suicidality: An Effective Brief Intervention for the Treatment of Suicidal Patients]. Psychother Psychosom Med Psychol 2021; 72:9-17. [PMID: 34282600 DOI: 10.1055/a-1524-3060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Das "Collaborative Assessment and Management of Suicidality" (CAMS) ist einer von mehreren Interventionsansätzen zur Behandlung von suizidalen Patienten und Patientinnen und wurde weltweit seit 3 Jahrzehnten untersucht und weiterentwickelt. Das CAMS ist auf die Etablierung einer tragenden therapeutischen Beziehung auf Augenhöhe zu einer suizidalen Person ausgerichtet. Der Patient wird aktiv an der Einschätzung seines Suizidrisikos beteiligt und zum "Mitverfasser" seines eigenen suizidspezifischen Behandlungsplans. Das konkrete therapeutische Vorgehen wird durch ein vielseitig anwendbares Instrument, die sogenannte Suizidstatusform (SSF), strukturiert und geleitet. Das CAMS kann von verschiedenen therapeutischen Berufsgruppen sowie bei Patienten und Patientinnen mit unterschiedlichen Diagnosen angewandt werden. Die Wirksamkeit im Hinblick auf eine Verringerung von Suizidgedanken, der allgemeinen psychischen Belastung und Depressivität sowie auf eine Zunahme von Hoffnung und Zuversicht ist mittlerweile empirisch gut belegt.The "Collaborative Assessment and Management of Suicidality" (CAMS) is an intervention approach for the treatment of suicidal patients that has been studied and developed for three decades around the world. CAMS is focused on establishing a continuing therapeutic relationship at eye level with a suicidal person. The patient is actively involved in assessing his or her suicide risk and becomes the "co-author" of his or her own suicide-specific treatment plan. The specific therapeutic procedure is structured and guided by a versatile instrument called the Suicide Status Form (SSF). CAMS can be applied by different therapeutic professional groups to patients with different diagnoses. Its effectiveness in reducing suicidal ideation, general psychological distress and depressiveness, and increasing hope and confidence is now empirically well established.
Collapse
Affiliation(s)
- Miriam Santel
- Klinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Bielefeld, Deutschland
| | - Thomas Beblo
- Klinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Bielefeld, Deutschland
| | - Jan Leygraf
- Klinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Bielefeld, Deutschland
| | - Martin Driessen
- Klinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Bielefeld, Deutschland
| |
Collapse
|
11
|
Fogarty B, Houghton S, Galavan E, O'Súilleabháin PS. Clinicians' Experience of Collaboration in the Treatment of Suicidal Clients Within the Collaborative Assessment and Management of Suicidality Framework. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:424-447. [PMID: 34056984 DOI: 10.1177/00302228211020579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is little known about the clinicians' experience of collaboration using the Collaborative Assessment and Management of Suicide (CAMS) framework. This study aimed to give voice to the clinician experience. METHOD A qualitative design utilised semi-structured interviews with ten psychologists who worked in a Suicide Assessment and Treatment Service (SATS) in Ireland which utilises the CAMS framework. RESULTS An Interpretative Phenomenological Analysis (IPA) approach revealed several important findings. The superordinate themes included 'Finding Safety', 'Regulation of the Self', 'Connecting', and 'Systemic Challenges'. DISCUSSION The CAMS framework plays an important role in providing a safe base for the clinician (in terms of understanding suicidality, in addition to the structures of the framework). It provides a mechanism in which to process difficult emotions, and a way of communicating a formulation of suicide to the treating team. Importantly, the CAMS emerged as facilitating a collaborative, therapeutic way of working.
Collapse
Affiliation(s)
- Bríd Fogarty
- Department of Psychology, University of Limerick, Ireland
| | | | | | - Páraic S O'Súilleabháin
- Department of Psychology, University of Limerick, Ireland.,Health Research Institute, University of Limerick, Ireland
| |
Collapse
|
12
|
Macintyre VG, Mansell W, Pratt D, Tai SJ. The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness. Front Psychol 2021; 12:588683. [PMID: 33815194 PMCID: PMC8012495 DOI: 10.3389/fpsyg.2021.588683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives This paper aims to identify potential areas for refinement in existing theoretical models of suicide, and introduce a new integrative theoretical framework for understanding suicide, that could inform such refinements. Methods Literature on existing theoretical models of suicide and how they contribute to understanding psychological processes involved in suicide was evaluated in a narrative review. This involved identifying psychological processes associated with suicide. Current understanding of these processes is discussed, and suggestions for integration of the existing literature are offered. Results Existing approaches to understanding suicide have advanced the current knowledge of suicide in various ways. They have guided valuable research in the following areas: motivations for suicide and the psychological distress which influences suicide attempts; ambivalence about suicide; suicidal individuals’ focus of attention; and ways in which individuals who contemplate suicide differ from individuals who attempt suicide. We outline a new theoretical framework as a means to integrating all of these concepts into the three principles of control, conflict, and awareness. Within this framework, suicide is regarded as occurring due to a long standing conflict between an individual’s personal goals, culminating in an episode of acute loss of control. The new framework posits that the individual then strives to regain control through the means of suicide because of a narrowed awareness of consequences of their actions on other valued goals. This psychological mechanism of limited awareness is posited to be the common pathway by which individuals make a suicide attempt, regardless of which risk factors are present. Conclusion This article introduces a theoretical framework that generates several hypotheses for future research, and focuses on psychological processes occurring during immediate crisis. One of the key hypotheses resulting from our predictions on how individuals progress from contemplating to attempting suicide will be tested in an ongoing program of research: Individuals who attempt suicide have a significantly reduced awareness of consequences of suicide, which would negatively impact on their important life goals, values, principles, or ideals, compared to individuals who contemplate suicide. Therapy guided by the new framework may be more flexible, immediate, and client-focused than other therapies for suicidal individuals.
Collapse
Affiliation(s)
- Vanessa G Macintyre
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Warren Mansell
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Sara J Tai
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
13
|
Graure EW, Colborn VA, Miller AM, Jobes DA. An Archival Study of Suicide Status Form Responses Among Crisis Stabilization Center Consumers. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021. [DOI: 10.1007/s10879-021-09491-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
14
|
Elrefaay SMM, Soltis-Jarrett V. Suicide Prevention Education for Psychiatric Inpatient Nurses in Egypt. J Psychosoc Nurs Ment Health Serv 2020; 58:32-38. [DOI: 10.3928/02793695-20200305-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022]
|
15
|
Santel M, Beblo T, Neuner F, Berg M, Hennig-Fast K, Jobes DA, Driessen M. Collaborative Assessment and Management of Suicidality (CAMS) compared to enhanced treatment as usual (E-TAU) for suicidal patients in an inpatient setting: study protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:183. [PMID: 32321477 PMCID: PMC7178967 DOI: 10.1186/s12888-020-02589-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/07/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic framework that has been shown to reduce suicidal ideation and overall symptom distress. CAMS has not been previously evaluated in a standard acute inpatient mental health care setting with only short treatment times for suicidal patients. In this randomized controlled trial (RCT) we are investigating whether CAMS is more effective than Enhanced-Treatment as Usual (E-TAU) in reducing suicidal thoughts as primary outcome variable. We are also investigating depressive symptoms, general symptom relief, and the quality of the therapeutic alliance as secondary outcomes. METHODS/DESIGN This RCT is designed as a single-center, two-armed, parallel group observer-blinded clinical effectiveness investigation. We are recruiting and randomizing 60 participants with different diagnoses, who are admitted as inpatients because of acute suicidal thoughts or behaviors into the Clinic for Psychiatry and Psychotherapy, Ev. Hospital Bethel in Bielefeld, Germany. The duration of treatment will vary depending on patients' needs and clinical assessments ranging between 10 and 40 days. Patients are assessed four times, at admission, discharge, 1 month, and 5 months post-discharge. The primary outcome measure is the Beck Scale for Suicide Ideation. Other outcome measures are administered as assessment timepoints including severity of psychiatric symptoms, depression, reasons for living, and therapeutic relationship. DISCUSSION This effectiveness study is being conducted on an acute ward in a psychiatric clinic where patients have multiple problems and diagnoses. Treatment is somewhat limited, and therapists have a large caseloads. The results of this study can thus be generalizable to a typical inpatient psychiatric hospital settings. TRIAL REGISTRATION This clinical trial has been retrospectively registered with the German Clinical Trials Register; registration code/ DRKS-ID: DRKS00013727 (on January 12, 2018). In addition, the study was also registered with the International Clinical Trials Registry Platform of the World Health Organization (identical registration code). Registry Name: "Evaluation von CAMS versus TAU bei suizidalen Patienten - Ein stationärer RCT".
Collapse
Affiliation(s)
- Miriam Santel
- Clinic of Psychiatry and Psychotherapy, Ev. Hospital Bethel, Bielefeld, Germany.
| | - Thomas Beblo
- Clinic of Psychiatry and Psychotherapy, Ev. Hospital Bethel, Bielefeld, Germany
| | - Frank Neuner
- grid.7491.b0000 0001 0944 9128Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Michaela Berg
- Clinic of Psychiatry and Psychotherapy, Ev. Hospital Bethel, Bielefeld, Germany
| | | | - David A. Jobes
- grid.39936.360000 0001 2174 6686Department of Psychology, The Catholic University of America, Washington, DC USA
| | - Martin Driessen
- Clinic of Psychiatry and Psychotherapy, Ev. Hospital Bethel, Bielefeld, Germany
| |
Collapse
|
16
|
Dimeff LA, Jobes DA, Chalker SA, Piehl BM, Duvivier LL, Lok BC, Zalake MS, Chung J, Koerner K. A novel engagement of suicidality in the emergency department: Virtual Collaborative Assessment and Management of Suicidality. Gen Hosp Psychiatry 2020; 63:119-126. [PMID: 29934033 DOI: 10.1016/j.genhosppsych.2018.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/17/2018] [Accepted: 05/17/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE A novel avatar system (Virtual Collaborative Assessment and Management of Suicidality System; V-CAMS) for suicidal patients and medical personnel in emergency departments (EDs) was developed and evaluated. V-CAMS facilitates the delivery of CAMS and other evidence-based interventions to reduce unnecessary hospitalization, readmissions, and suicide following an ED visit. METHOD Using iterative user-centered design with 24 suicidal patients, an avatar prototype, "Dr. Dave" (based on Dr. Jobes) was created, along with other patient-facing tools; provider-facing tools, including a clinical decision support tool were also designed and tested to aid discharge disposition. RESULTS Feasibility tests supported proof of concept. Suicidal patients affirmed the system's overall merit, positive Perception of Care, and acceptability; medical providers (n = 21) viewed the system as an efficient, effective, and safe method of improving care for suicidal ED patients and reducing unnecessary hospitalization. CONCLUSIONS Technology tools including a patient-facing avatar and e-caring contacts, along with provider-facing tools may offer a powerful method of facilitating best-practice suicide prevention interventions and point-of-care tools for suicidal patients seeking ED services and their medical providers. Future directions include full development of V-CAMS and integration into a health electronic medical record and a rigorous randomized controlled trial to study its effectiveness.
Collapse
Affiliation(s)
- Linda A Dimeff
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA.
| | - David A Jobes
- The Catholic University of America, O'Boyle Hall, Room 314, 620 Michigan Ave NE, Washington, DC 20064, USA.
| | - Samantha A Chalker
- The Catholic University of America, O'Boyle Hall, Room 314, 620 Michigan Ave NE, Washington, DC 20064, USA.
| | - Brian M Piehl
- The Catholic University of America, O'Boyle Hall, Room 314, 620 Michigan Ave NE, Washington, DC 20064, USA.
| | - Leticia Lobo Duvivier
- Central Arkansas Veterans Healthcare System, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146, USA
| | - Benjamin C Lok
- University of Florida, Department of Computer and Information Sciences and Engineering, CSE Room E544, P.O. Box 116120, Gainesville, FL 32611-6120, USA.
| | - Mohan S Zalake
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA
| | - Julie Chung
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA.
| | - Kelly Koerner
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA.
| |
Collapse
|
17
|
O'Brien B, Lee D, Swann AC, Mathew SJ, Lijffijt M. Psychotherapy for Mixed Depression and Mixed Mania. Psychiatr Clin North Am 2020; 43:199-211. [PMID: 32008685 DOI: 10.1016/j.psc.2019.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Treatment guidelines for mixed states of depression or (hypo)mania focus almost exclusively on psychopharmacologic intervention without tapping into the benefits of psychotherapy. The authors highlight the complex clinical picture and illness course of mixed states, and discuss the benefit of taking a patient-centered approach to treatment incorporating techniques from a variety of evidence-based psychotherapies. A careful assessment of suicide risk as well as interventions designed specifically for anxiety are also recommended.
Collapse
Affiliation(s)
- Brittany O'Brien
- Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Delphine Lee
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Alan C Swann
- Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Sanjay J Mathew
- Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Marijn Lijffijt
- Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030, USA.
| |
Collapse
|
18
|
Jordan JT, McNiel DE. Perceived Coercion During Admission Into Psychiatric Hospitalization Increases Risk of Suicide Attempts After Discharge. Suicide Life Threat Behav 2020; 50:180-188. [PMID: 31162700 DOI: 10.1111/sltb.12560] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/09/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE There is an elevated risk for suicide in the year following psychiatric hospitalization. The present study examined whether perceived coercion during admission into psychiatric hospitalization increases risk for postdischarge suicide attempts. METHODS Participants were 905 psychiatric inpatients from the MacArthur Violence Risk Assessment Study that were assessed every 10 weeks during the year following discharge. Perceived coercion during admission was assessed while hospitalized, and suicide attempts were assessed following discharge. Analyses adjusted for nonrandom assignment of groups via propensity score weighting and for established correlates of postdischarge suicidal behavior. RESULTS Of 905 participants, 67% endorsed perception of coercion into psychiatric hospitalization, and 168 (19%) made a postdischarge suicide attempt. Patients who perceived coercion during hospitalization admission were more likely to make a suicide attempt after discharge than those who did not, even after adjusting for established covariates (OR = 1.29, |z| = 2.87, p = .004, 95% CI = 1.08, 1.54). There was no interaction between recent self-harm or suicidal ideation at time of admission and perceived coercion on postdischarge suicide attempts. CONCLUSIONS Patients' perception of the context in which they were hospitalized is associated with a small but significant increase in their likelihood of postdischarge suicide attempts.
Collapse
Affiliation(s)
- Joshua T Jordan
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Dale E McNiel
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
19
|
Abstract
BACKGROUND Death by suicide continues to be a global public health concern with little research demonstrating the effectiveness of treatment options. This exploratory study exams the efficacy of Eye Movement Desensitisation and Reprocessing (EMDR) Therapy delivered to patients experiencing an acute mental health crisis to explore if by treating their background trauma, improvements could be seen in their general psychopathology and if there was a resulting decrease in their desire for suicide. METHODS A practice-based service development project was conducted within a mental health hospital. A non-randomised, exploratory pre-test post-test design was utilised. Participants were identified from adult patients currently receiving care from either an inpatient mental health ward or the Crisis Resolution and Home Treatment Team (CRHTT). Those who had reported experiencing at least one event that they considered to be traumatic were offered EMDR Therapy. Notes from the electronic database were analysed to assess contact with services 12 months prior to treatment and following treatment. RESULTS 72 patients were offered treatment in the study with 57 completing treatment. Patients made significant improvements across all the psychometrics, including a reduction in suicidal ideation. The majority needed less than 10 sessions and needed no onward referral for further psychological therapy. Cost savings were realised by retracting referrals for further therapy and in early discharge from CRHTT and acute wards, and by preventing admissions. Contact with services post treatment also reduced. CONCLUSIONS EMDR Therapy can be an effective treatment for patients experiencing a mental health crisis who have a trauma picture, resulting in significant improvements in their mental well-being and substantial cost savings for the National Health Service (NHS).
Collapse
Affiliation(s)
- Simon Proudlock
- Prospect Park Hospital, Honey End Lane, Tilehurst, Reading, RG30 4EL UK
| | - Jasmine Peris
- School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH UK
| |
Collapse
|
20
|
Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
Collapse
Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| |
Collapse
|
21
|
Hanratty D, Kilicaslan J, Wilding H, Castle D. A systematic review of efficacy of Collaborative Assessment and Management of Suicidality (CAMS) in managing suicide risk and deliberate self-harm in adult populations. Australas Psychiatry 2019; 27:559-564. [PMID: 31184492 DOI: 10.1177/1039856219848832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Evaluate the efficacy of Collaborative Assessment and Management of Suicidality (CAMS) in managing suicide risk and deliberate self-harm in adults. METHODS Ten databases were searched for publications referring to CAMS or the Suicide Status Form. Results were evaluated by two reviewers. RESULTS Limited evidence that CAMS is effective in reducing suicide risk and deliberate self-harm in adult populations. CONCLUSIONS Although CAMS appears to show promise in managing suicidal patients across a range of measures, further evidence is needed to clarify its efficacy in managing suicide risk and deliberate self-harm.
Collapse
Affiliation(s)
- Donal Hanratty
- Senior Research Registrar, Mental Health, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Jan Kilicaslan
- Senior Social Worker, Project Officer, Mental Health, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Helen Wilding
- Senior Medical Research Librarian, Carl de Gruchy Library, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - David Castle
- Professor of Psychiatry, St Vincent's Health and The University of Melbourne, Fitzroy, VIC, Australia
| |
Collapse
|
22
|
Bliokas VV, Hains AR, Allan JA, Lago L, Sng R. Community-based aftercare following an emergency department presentation for attempted suicide or high risk for suicide: study protocol for a non-randomised controlled trial. BMC Public Health 2019; 19:1380. [PMID: 31655571 PMCID: PMC6815378 DOI: 10.1186/s12889-019-7751-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/04/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Suicide is a major public health issue worldwide. Those who have made a recent suicide attempt are at high risk for dying by suicide in the future, particularly during the period immediately following departure from a hospital emergency department. As such the transition from hospital-based care to the community is an important area of focus in the attempt to reduce suicide rates. There is a need for evaluation studies to test the effectiveness of interventions directed to this stage (termed 'aftercare' interventions). METHODS A controlled non-randomised two group (intervention vs treatment-as-usual control) design, using an intention-to-treat model, will evaluate the effectiveness of a suicide prevention aftercare intervention providing follow-up after presentations to a hospital emergency department as a result of a suicide attempt or high risk for suicide. The intervention is a community-based service, utilising two meetings with a mental health clinician and follow-up contacts by peer workers via a combination of face-to-face and telephone for four weeks, with the option of extension to 12 weeks. Seventy-five participants of the intervention service will be recruited to the study and compared to 1265 treatment-as-usual controls. The primary hypotheses are that over 12 months, those who participate in the aftercare follow-up intervention are less likely than controls to present to a hospital emergency department for a repeat suicide attempt or because of high risk for suicide, will have fewer re-presentations during this period and will have lower all-cause mortality. As a secondary aim, the impact of the intervention on suicide risk factors for those who participate in the service will be evaluated using pre- and post-intervention repeated measures of depression, anxiety, stress, hopelessness, belongingness, burdensomeness, and psychological distress. Enrolments into the study commenced on 1 November 2017 and are anticipated to cease in November 2019. DISCUSSION The study aims to contribute to the understanding of effective interventions for individuals who have presented to a hospital emergency department as a result of a suicide attempt or at high risk for suicide and provide evidence in relation to interventions that incorporate peer-workers. TRIAL REGISTRATION ACTRN12618001701213 . Registered on 16 October 2018. Retrospectively registered.
Collapse
Affiliation(s)
- Vida V Bliokas
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, Northfields Avenue, Wollongong, NSW, 2522, Australia.
| | - Alex R Hains
- Illawarra Health and Medical Research Institute, Northfields Avenue, Wollongong, NSW, 2522, Australia.,Illawarra Shoalhaven Suicide Prevention Collaborative, The Central, Innovation Campus, Wollongong, NSW, 2500, Australia.,Coordinare, Primary Health Network South Eastern NSW, The Central, Innovation Campus, Squires Way, Wollongong, NSW, 2500, Australia
| | - Jonathan A Allan
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Luise Lago
- Centre for Health Research Illawarra Shoalhaven Population, University of Wollongong, Building 234, Innovation Campus, Wollongong, NSW, 2500, Australia
| | - Rebecca Sng
- Grand Pacific Health, 336 Keira Street, Wollongong, NSW, 2500, Australia
| |
Collapse
|
23
|
Machine learning discovery of longitudinal patterns of depression and suicidal ideation. PLoS One 2019; 14:e0222665. [PMID: 31539408 PMCID: PMC6754154 DOI: 10.1371/journal.pone.0222665] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background and aim Depression is often accompanied by thoughts of self-harm, which are a strong predictor of subsequent suicide attempt and suicide death. Few empirical data are available regarding the temporal correlation between depression symptoms and suicidal ideation. We investigated the anecdotal concern that suicidal ideation may increase during a period of depression improvement. Data Longitudinal Patient Health Questionnaire (PHQ)-9 is a questionnaire of 9 multiple-choice questions to assess the frequency of depressive symptoms within the previous two weeks. We analyzed a chronic depression treatment population’s electronic health record (EHR) data, containing 610 patients’ longitudinal PHQ-9 scores (62% age 45 and older; 68% female) within 40 weeks. Methods The irregular and sparse EHR data were transformed into continuous trajectories using Gaussian process regression. We first estimated the correlations between the symptoms (total score of the first 8 questions; PHQ-8) and suicide ideation (9th question score; Item 9) using the cross-correlation function. We then used an artificial neural network (ANN) to discover subtypes of depression patterns from the fitted depression trajectories. In addition, we conducted a separate analysis using the unfitted raw PHQ scores to examine PHQ-8’s and Item 9’s pattern changes. Results Results showed that the majority of patients’ PHQ-8 and Item 9 scores displayed strong temporal correlations. We found five patterns in the PHQ-8 and the Item 9 trajectories. We also found 8% - 13% of the patients have experienced an increase in suicidal ideation during the improvement of their PHQ-8. Using a trajectory-based method for subtype pattern detection in depression progression, we provided a better understanding of temporal correlations between depression symptoms over time.
Collapse
|
24
|
Ryberg W, Zahl PH, Diep LM, Landrø NI, Fosse R. Managing suicidality within specialized care: A randomized controlled trial. J Affect Disord 2019; 249:112-120. [PMID: 30771641 DOI: 10.1016/j.jad.2019.02.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/22/2019] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide prevention is a core task in mental health services. Our objective was to determine whether Collaborative Assessment and Management of Suicidality (CAMS) reduced suicidal thoughts and behaviors and mental health distress more effectively than treatment as usual (TAU) in a heterogeneous patient population within specialized mental health care services. METHODS In this observer-blinded pragmatic randomized controlled trial participants who scored 13 or above on Beck's Scale for Suicide Ideation-Current (BSSI-C) were included from seven in- and outpatient units. Primary outcome was suicidal ideation (BSSI-C). Secondary outcomes were mental health distress measured by the Outcome Questionnaire-45, and suicidal behaviors measured by the Suicide Attempt Self-Injury Count. Patients were assessed at baseline and after 6 and 12 months. RESULTS The final intent-to-treat analyses included 78 participants (mean age 35.9 years, SD = 14.5, 41 females). The majority were depressed (65%), had a secondary diagnosis (73%) and 32% suffered from borderline personality disorder or borderline traits. After 6 months, CAMS participants reported lower levels of suicidal ideation compared to TAU (β = -4.29, 95% CI = -8.32 to -0.27, p = .036). Larger changes in mental health distress were observed for CAMS participants after 6 months (β = -11.87, 95% CI = -22.99 to -0.76, p = .036) and 12 months (β = -13.70, 95% CI = -24.88 to -2.51, p = .017). LIMITATIONS The modest sample size rendered the trial unable to detect small between-group differences. CONCLUSIONS CAMS reduced suicidal ideation and mental health distress more efficiently than TAU in a heterogeneous patient population within specialized care.
Collapse
Affiliation(s)
- Wenche Ryberg
- Department of Research and Development, Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; University of Oslo, Oslo, Norway.
| | | | | | | | - Roar Fosse
- Department of Research and Development, Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| |
Collapse
|
25
|
Méndez-Bustos P, Calati R, Rubio-Ramírez F, Olié E, Courtet P, Lopez-Castroman J. Effectiveness of Psychotherapy on Suicidal Risk: A Systematic Review of Observational Studies. Front Psychol 2019; 10:277. [PMID: 30837920 PMCID: PMC6389707 DOI: 10.3389/fpsyg.2019.00277] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 01/28/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Suicidal behavior is a major public health concern worldwide, and the interest in the development of novel and more efficient treatment strategies and therapies to reduce suicidal risk is increasing. Some recent studies have summarized the results of randomized clinical trials (RCTs) assessing the efficacy of psychotherapeutic tools designed to treat patients at suicidal risk. However, observational studies, which reflect real-world effectiveness and may use original approaches, have not been reviewed. Method: The aim of this study is to systematically review the available scientific evidence issued from observational studies on the clinical effectiveness of psychotherapeutic tools designed to treat patients at suicide risk. We have thus performed a systematic search of PubMed and Web of Science databases. Results: Out of 1578 papers, 40 original observational studies fulfilled our selection criteria. The most used psychotherapeutic treatments were dialectical behavioral therapy (DBT, 27.5%) and cognitive behavioral therapy (CBT, 15.0%) in patients with a diagnosis of borderline personality disorder (32.5%) and depression (15.0%). Despite the between-study heterogeneity, interventions lead to a reduction in suicidal outcomes, i.e., suicidal ideation (55.0%) and suicide attempts (37.5%). The content and reporting quality varied considerably between the studies. Conclusion: DBT and CBT are the most widely used psychotherapeutic interventions and show promising results in existing observational studies. Some of the included studies provide innovative approaches. Group therapies and internet-based therapies, which are cost-effective methods, are promising treatments and would need further study.
Collapse
Affiliation(s)
| | - Raffaella Calati
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | | | - Emilie Olié
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,FondaMental Foundation, Créteil, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Philippe Courtet
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,FondaMental Foundation, Créteil, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Jorge Lopez-Castroman
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France
| |
Collapse
|
26
|
Corona CD, Gutierrez PM, Wagner BM, Jobes DA. The psychometric properties of the Collaborative Assessment and Management of Suicidality rating scale. J Clin Psychol 2018; 75:190-201. [PMID: 30291761 DOI: 10.1002/jclp.22699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The CAMS Rating Scale (CRS) is an adherence measure for the Collaborative Assessment and Management of Suicidality (CAMS), a suicide-specific clinical intervention. This study examined the ability of the CRS to assess adherence to CAMS. METHODS Video-recorded therapy sessions of clinicians delivering either CAMS or Enhanced Care-As-Usual (E-CAU) were rated with the CRS. These ratings (N = 98) were used to evaluate criterion validity, internal consistency, and factor structure. RESULTS Criterion validity and factor analyses did not support the organization of the CRS into its current subscales. Furthermore, the identified factor model and item-level statistics revealed weak CRS items. Finally, internal consistency was higher among CAMS clinicians than among clinicians delivering E-CAU. CONCLUSION These results establish the CRS as a measure that can effectively assess the adherence to CAMS in its current form. Potential revisions to future iterations of the CRS are discussed.
Collapse
Affiliation(s)
- Christopher D Corona
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver VA Medical Center, Denver, Colorado.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Barry M Wagner
- Department of Psychology, Catholic University of America, Washington, District of Colombia
| | - David A Jobes
- Department of Psychology, Catholic University of America, Washington, District of Colombia
| |
Collapse
|
27
|
Huh D, Jobes DA, Comtois KA, Kerbrat AH, Chalker SA, Gutierrez PM, Jennings KW. The collaborative assessment and management of suicidality (CAMS) versus enhanced care as usual (E-CAU) with suicidal soldiers: Moderator analyses from a randomized controlled trial. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1503001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- David Huh
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - David A. Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Amanda H. Kerbrat
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Samantha A. Chalker
- Department of Psychology, The Catholic University of America, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Peter M. Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, Colorado, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Keith W. Jennings
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| |
Collapse
|
28
|
Kamphuis JH, Finn SE. Therapeutic Assessment in Personality Disorders: Toward the Restoration of Epistemic Trust. J Pers Assess 2018; 101:662-674. [DOI: 10.1080/00223891.2018.1476360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Jan H. Kamphuis
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
29
|
Corona CD, Ellis TE, Jobes DA. Word count as an indicator of suicide risk in an inpatient setting. Bull Menninger Clin 2018; 82:115-135. [PMID: 29791194 DOI: 10.1521/bumc.2018.82.2.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study replicates a previously used methodology with a suicidal inpatient sample regarding word counts generated by participants writing about suicidal constructs. Word counts (i.e., the number of written words) on the Suicide Status Form from initial sessions with suicidal inpatients were compared to self-rated suicide risk scores as well as to continuous and repeated measures of hopelessness and suicide ideation assessed over the course of inpatient care. Results showed that higher word counts were associated with initially higher suicide ideation scores that steadily declined over the course of treatment. Lower word counts were associated with lower initial hopelessness scores that increased during treatment before ultimately decreasing. In addition, word count was not found to be a significant predictor of self-rated suicide risk. Clinical implications of these data and future directions are discussed.
Collapse
Affiliation(s)
- Christopher D Corona
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Thomas E Ellis
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, D.C
| |
Collapse
|
30
|
Monahan MF, Crowley KJ, Arnkoff DB, Glass CR, Jobes DA. Understanding Therapists' Work With Suicidal Patients: An Examination of Qualitative Data. OMEGA-JOURNAL OF DEATH AND DYING 2018; 81:330-346. [PMID: 29745779 DOI: 10.1177/0030222818775888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The collaborative assessment and management of suicidality (CAMS) serves as a framework for maintaining a collaborative relationship between the therapist and patient. This study used an original coding manual to examine responses to open-ended questions to better understand the ways in which therapists use CAMS collaboratively as well as their reasons for adhering (or not adhering) to certain aspects of the framework. Results suggest differences in treatment application based on therapist characteristics including amount of experience, intensity of training received, and experience of a patient suicide attempt. Implications of this research include informing therapists interested in using the CAMS framework about the specific ways in which implementation can be made collaborative. Further, this research helps to shed light on how experiencing a client's death by suicide can impact therapists' future work with suicidal clients.
Collapse
Affiliation(s)
- Maureen F Monahan
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Kevin J Crowley
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Diane B Arnkoff
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Carol R Glass
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| |
Collapse
|
31
|
Roush JF, Cukrowicz KC, Mitchell SM, Brown SL, Seymour NE. Valued living, life fulfillment, and suicide ideation among psychiatric inpatients: The mediating role of thwarted interpersonal needs. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2017.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
32
|
The relationship between therapeutic alliance and patient's suicidal thoughts, self-harming behaviours and suicide attempts: A systematic review. J Affect Disord 2017; 223:165-174. [PMID: 28755624 DOI: 10.1016/j.jad.2017.07.040] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Suicidality is a common concern for people with mental health problems. The interpersonal nature of suicidality suggests that therapeutic alliance may be important when working clinically with suicidal patients. This paper is a systematic review of studies investigating the association between alliance and treatment outcome relating to suicidal ideation and behaviours. METHODS Systematic searches of PsychINFO, MEDLINE, AMED, EMBASE, Web of Science and CINAHL were completed using words that captured the concepts of alliance and suicidality. Eligible studies: involved participants aged 18-years-old or over; used a validated measure of therapeutic alliance; and reported associations between alliance and suicidality. Abstracts, qualitative studies and articles not written in English were excluded. RESULTS Twelve studies were included. Findings indicated that alliance is associated with suicidality. Alliance was related to suicidality in eleven of the papers. Self-harming behaviours had the strongest association with patient-rated alliance. Suicide attempts had the weakest association, possibly due to the infrequency of suicide attempts in the studies reviewed. LIMITATIONS The twelve studies were heterogeneous in terms of the measure of alliance used, method of assessing suicidality, clinical setting and professional-type. This variability limited the degree to which findings could be synthesised. CONCLUSION Therapists, care-coordinators and mental health teams should recognise the importance of building a strong therapeutic alliance with suicidal patients. Researchers should use consistent methods of measuring alliance and assessing suicidality in future studies. Clinicians and researchers should note that suicidal thoughts, self-harm and suicide attempts may be related to alliance in different ways and therefore should be assessed as separate constructs.
Collapse
|
33
|
Ellis TE. Recognizing and addressing unique vulnerabilities of suicidal patients: Suicide research at The Menninger Clinic. Bull Menninger Clin 2017; 81:39-52. [PMID: 28271906 DOI: 10.1521/bumc.2017.81.1.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Suicide risk is an inescapable presence in the treatment of people with psychiatric disorders, a fact that applies especially in inpatient psychiatric settings. This article summarizes a several-year research initiative at The Menninger Clinic aimed at better understanding psychological contributors to suicidality and developing more effective clinical interventions. Two areas of research are described, an outcomes arm focused on assessing the feasibility and effectiveness of a suicide-specific intervention (The Collaborative Assessment and Management of Suicidality) and an exploratory arm whose objective is to learn about psychological vulnerabilities that distinguish suicidal from nonsuicidal patients, with an eye toward developing interventions that address such vulnerabilities. The author concludes that, combined with other developments in the field, this body of work strongly supports the view that suicidal patients should be treated with interventions that specifically target vulnerabilities that seem to set the stage for suicidal episodes.
Collapse
Affiliation(s)
- Thomas E Ellis
- The Menninger Clinic and Baylor College of Medicine, Houston, Texas
| |
Collapse
|
34
|
Ellis TE, Rufino KA, Allen JG. A controlled comparison trial of the Collaborative Assessment and Management of Suicidality (CAMS) in an inpatient setting: Outcomes at discharge and six-month follow-up. Psychiatry Res 2017; 249:252-260. [PMID: 28126581 DOI: 10.1016/j.psychres.2017.01.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 01/04/2017] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
This controlled comparison trial evaluated a suicide-specific intervention, the Collaborative Assessment and Management of Suicidality (CAMS), in an extended-stay psychiatric inpatient setting. Multiple outcomes were examined for 104 patients, half of whom received individual therapy from therapists trained in CAMS. The comparison group was selected from a larger pool through Propensity Score Matching to ensure comparability on age, sex, treatment program, number of prior suicide attempts, and severity of suicidal ideation. Results showed that a) all patients improved significantly across a wide range of measures, including depression, suicidal ideation, functional disability, and well-being; b) these gains were durable over a 6-month post-discharge period; and c) patients treated by a CAMS-trained individual therapist improved significantly more from admission to discharge across all measures. Differences between CAMS and non-CAMS patients were no longer statistically significant at 6-month follow-up, although statistical power was compromised due to attrition. Although replication studies are needed, these findings suggest that interventions specifically tailored for suicidal patients may have advantages compared to usual, intensive inpatient treatment, perhaps by addressing psychological vulnerabilities specific to the population. The lack of significant differences at follow-up suggest that post-treatment contact may be needed to maintain advantages associated with this and similar interventions.
Collapse
Affiliation(s)
- Thomas E Ellis
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, USA; Baylor College of Medicine, Menninger Department of Psychiatry, One Baylor Plaza, Houston, TX 77030, USA.
| | - Katrina A Rufino
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, USA; University of Houston, Downtown, Department of Social Science, One Main Street, Houston, TX 77002, USA
| | - Jon G Allen
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, USA; Baylor College of Medicine, Menninger Department of Psychiatry, One Baylor Plaza, Houston, TX 77030, USA
| |
Collapse
|
35
|
Allen JG, Fowler JC, Madan A, Ellis TE, Oldham JM, Frueh BC. Discovering the impact of psychotherapeutic hospital treatment for adults with serious mental illness. Bull Menninger Clin 2017; 81:1-38. [DOI: 10.1521/bumc.2017.81.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jon G. Allen
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | | | - Alok Madan
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Thomas E. Ellis
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - John M. Oldham
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | | |
Collapse
|
36
|
Utility of an integrated electronic suicide alert system in a psychiatric hospital. Qual Manag Health Care 2016; 24:79-83. [PMID: 25830616 DOI: 10.1097/qmh.0000000000000053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Management of suicide-related behaviors in a hospital is challenging. This article (1) describes integration of an electronic suicide risk notification system to improve assessment of psychiatric inpatients, (2) details the manner in which these alerts complement standard of care, and (3) provides support of using aggregate data to inform administrative decision-making. Complementing routine clinical care and under the supervision of an assessment coordinator, adult inpatients at a specialty psychiatric hospital complete a computerized battery of outcome assessments throughout the course of their hospitalization. A critical-item response notification system for suicide-related behaviors was implemented within the larger, assessment architecture, sending an alert e-mail to unit staff if patients endorsed suicidal ideation on any 1 of 6 critical items. Analysis of aggregate data over a 19-month period reveal a linear trend of increasing rate of suicide alerts from October 2012 to April 2013 (Phase A) with a stabilization at the heightened level from July 2013 to April 2014 (Phase B), R = 0.697, P = .007. Findings suggest that more nuanced training in the management of suicide-related behavior may be necessary and that traditional approaches to staffing may need to accommodate patient acuity. The communication innovation of this system is in line with the Joint Commission's emphasis on designing and implementing patient-centered systems that enhance quality of care, including improved safety.
Collapse
|
37
|
Collaborative Assessment and Management of Suicidality (CAMS) compared to treatment as usual (TAU) for suicidal patients: study protocol for a randomized controlled trial. Trials 2016; 17:481. [PMID: 27716298 PMCID: PMC5048411 DOI: 10.1186/s13063-016-1602-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/13/2016] [Indexed: 11/18/2022] Open
Abstract
Background Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic framework that appears promising to reduce suicidal ideation and suicidal cognition. CAMS has not previously been evaluated in a standard specialized mental health care setting for patients with suicidal problems in general. In this pragmatic randomized controlled trial (RCT) we will investigate if CAMS is more effective than treatment as usual (TAU) in reducing suicidal thoughts and behaviors. Effects will also be investigated on mental health and symptom relief in general and upon readmissions to inpatient units. Methods/design The study is a multicenter, observer-blinded, superiority, two-armed RCT which will include patients from four clinical departments at Vestre Viken Hospital Trust, Norway. We aim to include 100 patients with moderate to strong suicidal problems, as defined by a score of 13 or more on Beck’s Scale for Suicide Ideation - Current. Patients are included regardless of diagnosis. Randomization will be performed using a stratified four-block procedure with treatment unit as the stratification variable. The duration of treatment will vary depending on patients’ needs and clinical assessments. Patients are interviewed by research staff at four checkpoints: baseline, 2 weeks, 6 months, and 12 months. Central outcome measures are the Beck Scale for Suicide Ideation - Current, Outcome Questionnaire – 45, and Suicide Attempt Self-Injury Count. Discussion This pragmatic trial is effectuated within the Public Health Care System in Norway, where patients have multiple problems and diagnoses and therapists have a high work load. Results from this trial are highly generalizable to a typical everyday clinical setting, and one should expect similar results if CAMS is implemented in the future as a standard component in specialized mental health care systems. Trial registration Open Science Framework: DOI 10.17605/OSF.IO/JHRM2. Registered 5 July 2015. ClinicalTrials.gov: NCT02685943. Registered on 8 February 2016.
Collapse
|
38
|
Stanley IH, Rufino KA, Rogers ML, Ellis TE, Joiner TE. Acute Suicidal Affective Disturbance (ASAD): A confirmatory factor analysis with 1442 psychiatric inpatients. J Psychiatr Res 2016; 80:97-104. [PMID: 27344228 DOI: 10.1016/j.jpsychires.2016.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/02/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022]
Abstract
Acute Suicidal Affective Disturbance (ASAD) is a newly proposed diagnostic entity that characterizes rapid onset suicidal intent. This study aims to confirm the factor structure of ASAD among psychiatric inpatients, and to determine the clinical utility of ASAD in predicting suicide attempt status. Overall, 1442 psychiatric inpatients completed a battery of self-report questionnaires assessing symptoms theorized to comprise the ASAD construct. Utilizing these data, a confirmatory factor analysis with a one-factor solution was performed. Regression analyses were employed to determine if the ASAD construct predicted past suicide attempts, and analyses of variance (ANOVAs) were employed to determine if ASAD symptoms differed by the presence and number of past suicide attempts. The one-factor solution indicated good fit: χ(2)(77) = 309.1, p < 0.001, Tucker-Lewis Index (TLI) = 0.96, comparative fit index (CFI) = 0.97, root-mean-square error of approximation (RMSEA) = 0.05. Controlling for depressive disorders and current symptoms, the ASAD construct significantly predicted the presence of a past suicide attempt. Moreover, ASAD differentiated in the expected directions between individuals with a history of multiple suicide attempts, individuals with a single suicide attempt, and individuals with no history of a suicide attempt. Acute Suicidal Affective Disturbance (ASAD) appears to be a unified construct that predicts suicidal behavior and is distinct from an already-defined mood disorder.
Collapse
Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA.
| | - Katrina A Rufino
- The Menninger Clinic, 12301 S. Main St., Houston, TX 77035, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, USA; Department of Social Sciences, University of Houston-Downtown, One Main Street, Houston, TX 77002, USA
| | - Megan L Rogers
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| | - Thomas E Ellis
- The Menninger Clinic, 12301 S. Main St., Houston, TX 77035, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, USA
| |
Collapse
|
39
|
Andreasson K, Krogh J, Wenneberg C, Jessen HKL, Krakauer K, Gluud C, Thomsen RR, Randers L, Nordentoft M. EFFECTIVENESS OF DIALECTICAL BEHAVIOR THERAPY VERSUS COLLABORATIVE ASSESSMENT AND MANAGEMENT OF SUICIDALITY TREATMENT FOR REDUCTION OF SELF-HARM IN ADULTS WITH BORDERLINE PERSONALITY TRAITS AND DISORDER-A RANDOMIZED OBSERVER-BLINDED CLINICAL TRIAL. Depress Anxiety 2016; 33:520-30. [PMID: 26854478 DOI: 10.1002/da.22472] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/09/2015] [Accepted: 12/29/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Many psychological treatments have shown effect on reducing self-harm in adults with borderline personality disorder. There is a need of brief psychotherapeutical treatment alternative for suicide prevention in specialized outpatient clinics. METHODS/DESIGN The DiaS trial was designed as a pragmatic single-center, two-armed, parallel-group observer-blinded, randomized clinical superiority trial. The participants had at least two criteria from the borderline personality disorder diagnosis and a recent suicide attempt (within a month). The participants were offered 16 weeks of dialectical behavior therapy (DBT) versus up to 16 weeks of collaborative assessment and management of suicidality (CAMS) treatment. The primary composite outcome was the number of participants with a new self-harm (nonsuicidal self-injury [NSSI] or suicide attempt) at week 28 from baseline. Other exploratory outcomes were: severity of borderline symptoms, depressive symptoms, hopelessness, suicide ideation, and self-esteem. RESULTS At 28 weeks, the number of participants with new self-harm in the DBT group was 21 of 57 (36.8%) versus 12 of 51 (23.5%) in the CAMS treatment (OR: 1.90; 95% CI: 0.80-4.40; P = .14). When assessing the effect of DBT versus CAMS treatment on the individual components of the primary outcome, we observed no significant differences in the number of NSSI (OR: 1.60; 95% CI: 0.70-3.90; P = .31) or number of attempted suicides (OR: 2.24; 95% CI: 0.80-7.50; P = .12). CONCLUSION In adults with borderline personality traits and disorder and a recent suicide attempt, DBT does not seem superior compared with CAMS for reduction of number of self-harm or suicide attempts. However, further randomized clinical trials may be needed.
Collapse
Affiliation(s)
- Kate Andreasson
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.,Research Unit, Mental Health Center North Zealand, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Krogh
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Christina Wenneberg
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Helle K L Jessen
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Krakauer
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lasse Randers
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Research Unit, Mental Health Center Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
40
|
Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Hazell P, Townsend E, van Heeringen K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2016; 2016:CD012189. [PMID: 27168519 PMCID: PMC8786273 DOI: 10.1002/14651858.cd012189] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury) is common, often repeated, and associated with suicide. This is an update of a broader Cochrane review first published in 1998, previously updated in 1999, and now split into three separate reviews. This review focuses on psychosocial interventions in adults who engage in self-harm. OBJECTIVES To assess the effects of specific psychosocial treatments versus treatment as usual, enhanced usual care or other forms of psychological therapy, in adults following SH. SEARCH METHODS The Cochrane Depression, Anxiety and Neurosis Group (CCDAN) trials coordinator searched the CCDAN Clinical Trials Register (to 29 April 2015). This register includes relevant randomised controlled trials (RCTs) from: the Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). SELECTION CRITERIA We included RCTs comparing psychosocial treatments with treatment as usual (TAU), enhanced usual care (EUC) or alternative treatments in adults with a recent (within six months) episode of SH resulting in presentation to clinical services. DATA COLLECTION AND ANALYSIS We used Cochrane's standard methodological procedures. MAIN RESULTS We included 55 trials, with a total of 17,699 participants. Eighteen trials investigated cognitive-behavioural-based psychotherapy (CBT-based psychotherapy; comprising cognitive-behavioural, problem-solving therapy or both). Nine investigated interventions for multiple repetition of SH/probable personality disorder, comprising emotion-regulation group-based psychotherapy, mentalisation, and dialectical behaviour therapy (DBT). Four investigated case management, and 11 examined remote contact interventions (postcards, emergency cards, telephone contact). Most other interventions were evaluated in only single small trials of moderate to very low quality.There was a significant treatment effect for CBT-based psychotherapy compared to TAU at final follow-up in terms of fewer participants repeating SH (odds ratio (OR) 0.70, 95% confidence interval (CI) 0.55 to 0.88; number of studies k = 17; N = 2665; GRADE: low quality evidence), but with no reduction in frequency of SH (mean difference (MD) -0.21, 95% CI -0.68 to 0.26; k = 6; N = 594; GRADE: low quality).For interventions typically delivered to individuals with a history of multiple episodes of SH/probable personality disorder, group-based emotion-regulation psychotherapy and mentalisation were associated with significantly reduced repetition when compared to TAU: group-based emotion-regulation psychotherapy (OR 0.34, 95% CI 0.13 to 0.88; k = 2; N = 83; GRADE: low quality), mentalisation (OR 0.35, 95% CI 0.17 to 0.73; k = 1; N = 134; GRADE: moderate quality). Compared with TAU, dialectical behaviour therapy (DBT) showed a significant reduction in frequency of SH at final follow-up (MD -18.82, 95% CI -36.68 to -0.95; k = 3; N = 292; GRADE: low quality) but not in the proportion of individuals repeating SH (OR 0.57, 95% CI 0.21 to 1.59, k = 3; N = 247; GRADE: low quality). Compared with an alternative form of psychological therapy, DBT-oriented therapy was also associated with a significant treatment effect for repetition of SH at final follow-up (OR 0.05, 95% CI 0.00 to 0.49; k = 1; N = 24; GRADE: low quality). However, neither DBT vs 'treatment by expert' (OR 1.18, 95% CI 0.35 to 3.95; k = 1; N = 97; GRADE: very low quality) nor prolonged exposure DBT vs standard exposure DBT (OR 0.67, 95% CI 0.08 to 5.68; k = 1; N =18; GRADE: low quality) were associated with a significant reduction in repetition of SH.Case management was not associated with a significant reduction in repetition of SH at post intervention compared to either TAU or enhanced usual care (OR 0.78, 95% CI 0.47 to 1.30; k = 4; N = 1608; GRADE: moderate quality). Continuity of care by the same therapist vs a different therapist was also not associated with a significant treatment effect for repetition (OR 0.28, 95% CI 0.07 to 1.10; k = 1; N = 136; GRADE: very low quality). None of the following remote contact interventions were associated with fewer participants repeating SH compared with TAU: adherence enhancement (OR 0.57, 95% CI 0.32 to 1.02; k = 1; N = 391; GRADE: low quality), mixed multimodal interventions (comprising psychological therapy and remote contact-based interventions) (OR 0.98, 95% CI 0.68 to 1.43; k = 1 study; N = 684; GRADE: low quality), including a culturally adapted form of this intervention (OR 0.83, 95% CI 0.44 to 1.55; k = 1; N = 167; GRADE: low quality), postcards (OR 0.87, 95% CI 0.62 to 1.23; k = 4; N = 3277; GRADE: very low quality), emergency cards (OR 0.82, 95% CI 0.31 to 2.14; k = 2; N = 1039; GRADE: low quality), general practitioner's letter (OR 1.15, 95% CI 0.93 to 1.44; k = 1; N = 1932; GRADE: moderate quality), telephone contact (OR 0.74, 95% CI 0.42 to 1.32; k = 3; N = 840; GRADE: very low quality), and mobile telephone-based psychological therapy (OR not estimable due to zero cell counts; GRADE: low quality).None of the following mixed interventions were associated with reduced repetition of SH compared to either alternative forms of psychological therapy: interpersonal problem-solving skills training, behaviour therapy, home-based problem-solving therapy, long-term psychotherapy; or to TAU: provision of information and support, treatment for alcohol misuse, intensive inpatient and community treatment, general hospital admission, or intensive outpatient treatment.We had only limited evidence on whether the intervention had different effects in men and women. Data on adverse effects, other than planned outcomes relating to suicidal behaviour, were not reported. AUTHORS' CONCLUSIONS CBT-based psychological therapy can result in fewer individuals repeating SH; however, the quality of this evidence, assessed using GRADE criteria, ranged between moderate and low. Dialectical behaviour therapy for people with multiple episodes of SH/probable personality disorder may lead to a reduction in frequency of SH, but this finding is based on low quality evidence. Case management and remote contact interventions did not appear to have any benefits in terms of reducing repetition of SH. Other therapeutic approaches were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to these interventions is inconclusive.
Collapse
Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK, OX3 7JX
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
BACKGROUND In this article we focused on analyzing surveyed patient-generated responses based on two outcome questions derived from a suicide-specific framework called the Collaborative Assessment and Management of Suicidality (CAMS): Q1 - "Were there any aspects of your treatment that were particularly helpful to you? If so, please describe these. Be as specific as possible." Q2 - "What have you learned from your clinical care that could help you if you became suicidal in the future?" AIMS To develop a reliable coding system based on formerly suicidal patients' responses to two open-ended prompts and examine most frequently identified themes. METHOD The present study utilized a consensual qualitative research process to examine responses of clinically resolved suicidal patients, based on the CAMS resolution criteria (i.e., three consecutive CAMS sessions reporting the effective management of suicidal risk), to two Suicide Status Form (SSF) outcome questions (n = 49 for Q1, and n = 52 for Q2). RESULTS Reliable coding systems were developed and used to determine major themes of successful patient responses. CONCLUSION The results of this study provide insight into patients' experiences of a successful treatment for suicidal risk with larger implications for suicide-specific treatments in general.
Collapse
Affiliation(s)
- Blaire C Schembari
- 1 Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - David A Jobes
- 1 Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Ryan J Horgan
- 1 Department of Psychology, The Catholic University of America, Washington, DC, USA
| |
Collapse
|
42
|
Abstract
Suicidal behavior is a leading cause of death and disability worldwide. Fortunately, recent developments in suicide theory and research promise to meaningfully advance knowledge and prevention. One key development is the ideation-to-action framework, which stipulates that (a) the development of suicidal ideation and (b) the progression from ideation to suicide attempts are distinct phenomena with distinct explanations and predictors. A second key development is a growing body of research distinguishing factors that predict ideation from those that predict suicide attempts. For example, it is becoming clear that depression, hopelessness, most mental disorders, and even impulsivity predict ideation, but these factors struggle to distinguish those who have attempted suicide from those who have only considered suicide. Means restriction is also emerging as a highly effective way to block progression from ideation to attempt. A third key development is the proliferation of theories of suicide that are positioned within the ideation-to-action framework. These include the interpersonal theory, the integrated motivational-volitional model, and the three-step theory. These perspectives can and should inform the next generation of suicide research and prevention.
Collapse
Affiliation(s)
- E David Klonsky
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4 Canada;
| | - Alexis M May
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4 Canada;
| | - Boaz Y Saffer
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4 Canada;
| |
Collapse
|
43
|
Ellis TE, Rufino KA, Allen JG, Fowler JC, Jobes DA. Impact of a Suicide-Specific Intervention within Inpatient Psychiatric Care: The Collaborative Assessment and Management of Suicidality. Suicide Life Threat Behav 2015; 45:556-566. [PMID: 25581595 DOI: 10.1111/sltb.12151] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
A growing body of literature indicates that suicidal patients differ from other psychiatric patients with respect to specific psychological vulnerabilities and that suicide-specific interventions may offer benefits beyond conventional care. This naturalistic controlled-comparison trial (n = 52) examined outcomes of intensive psychiatric hospital treatment (mean length of stay 58.8 days), comparing suicidal patients who received individual therapy from clinicians utilizing the Collaborative Assessment and Management of Suicidality (CAMS) to patients whose individual therapists did not utilize CAMS. Propensity score matching was used to control for potential confounds, including age, sex, treatment unit, and severity of depression and suicidality. Results showed that both groups improved significantly over the course of hospitalization; however, the group receiving CAMS showed significantly greater improvement on measures specific to suicidal ideation and suicidal cognition. Results are discussed in terms of the potential advantages of treating suicide risk with a suicide-specific intervention to make inpatient psychiatric treatment more effective in reducing risk for future suicidal crises.
Collapse
Affiliation(s)
- Thomas E Ellis
- The Menninger Clinic and Baylor College of Medicine, Houston, TX, USA
| | - Katrina A Rufino
- The Menninger Clinic and Baylor College of Medicine, Houston, TX, USA
| | - Jon G Allen
- The Menninger Clinic and Baylor College of Medicine, Houston, TX, USA
| | - James C Fowler
- The Menninger Clinic and Baylor College of Medicine, Houston, TX, USA
| | - David A Jobes
- The Catholic University of America, Washington, DC, USA
| |
Collapse
|
44
|
Draper J, Murphy G, Vega E, Covington DW, McKeon R. Helping callers to the National Suicide Prevention Lifeline who are at imminent risk of suicide: the importance of active engagement, active rescue, and collaboration between crisis and emergency services. Suicide Life Threat Behav 2015; 45:261-70. [PMID: 25270689 PMCID: PMC4491352 DOI: 10.1111/sltb.12128] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Abstract
In 2012, the SAMHSA-funded National Suicide Prevention Lifeline (Lifeline) completed implementation of the first national Policy for Helping Callers at Imminent Risk of Suicide across its network of crisis centers. The policy sought to: (1) provide a clear definition of imminent risk; (2) reflect the state of evidence, field experience, and promising practices related to reducing imminent risk through hotline interventions; and (3) provide a uniform policy and approach that could be applied across crisis center settings. The resulting policy established three essential principles: active engagement, active rescue, and collaboration between crisis and emergency services. A sample of the research and rationale that underpinned the development of this policy is provided here. In addition, policy implementation, challenges and successes, and implications for interventions to help Lifeline callers at imminent risk of suicide are detailed.
Collapse
Affiliation(s)
- John Draper
- National Suicide Prevention Lifeline, Link 2 Health Solutions, Inc.New York, NY, USA
| | - Gillian Murphy
- National Suicide Prevention Lifeline, Link 2 Health Solutions, Inc.New York, NY, USA
| | - Eduardo Vega
- Mental Health Association of San FranciscoSan Francisco, CA, USA,The Center for Dignity, Recovery and EmpowermentSan Francisco, CA, USA
| | | | - Richard McKeon
- Substance Abuse and Mental Health Services AdministrationRockville, MD, USA
| |
Collapse
|
45
|
De Santis ML, Myrick H, Lamis DA, Pelic CP, Rhue C, York J. Suicide-specific Safety in the Inpatient Psychiatric Unit. Issues Ment Health Nurs 2015; 36:190-9. [PMID: 25898018 DOI: 10.3109/01612840.2014.961625] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In total, 75% of suicides reported to the Joint Commission as sentinel events since 1995, have occurred in psychiatric settings. Ensuring patient safety is one of the primary tasks of inpatient psychiatric units. A review of inpatient suicide-specific safety components, inclusive of incidence and risk; guidelines for evidence-based care; environmental safety; suicide risk assessment; milieu observation and monitoring; psychotherapeutic interventions; and documentation is provided. The Veterans Health Administration (VA) has been recognized as an exemplar system in suicide prevention. A VA inpatient psychiatric unit is used to illustrate the operationalization of a culture of suicide-specific safety. We conclude by describing preliminary unit outcomes and acknowledging limitations of suicide-specific inpatient care and gaps in the current inpatient practices and research on psychotherapeutic interventions, observation, and monitoring.
Collapse
Affiliation(s)
- Mark L De Santis
- Ralph H. Johnson VAMC, Mental Health Service Line , Charleston, South Carolina , USA
| | | | | | | | | | | |
Collapse
|
46
|
Marshall E, York J, Magruder K, Yeager D, Knapp R, De Santis ML, Burriss L, Mauldin M, Sulkowski S, Pope C, Jobes DA. Implementation of online suicide-specific training for VA providers. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2014; 38:566-574. [PMID: 24563240 DOI: 10.1007/s40596-014-0039-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/09/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Due to the gap in suicide-specific intervention training for mental health students and professionals, e-learning is one solution to improving provider skills in the Veterans Affairs (VA) health system. This study focused on the development and evaluation of an equivalent e-learning alternative to the Collaborative Assessment and Management of Suicidality (CAMS) in-person training approach at a Veteran Health Affairs medical center. METHODS The study used a multicenter, randomized, cluster, and three group design. the development of e-CAMS was an iterative process and included pilot testing. Eligible and consenting mental health providers, who completed a CAMS pre-survey, were randomized. Provider satisfaction was assessed using the standard VA evaluation of training consisting of 20 items. Two post training focus groups, divided by learning conditions, were conducted to assess practice adoption using a protocol focused on experiences with training and delivery of CAMS. RESULTS A total of 215 providers in five sites were randomized to three conditions: 69 to e-learning, 70 to in-person, 76 to the control. The providers were primarily female, Caucasian, midlife providers. Based on frequency scores of satisfaction items, both learning groups rated the trainings positively. In focus groups representing divided by learning conditions, participants described positive reactions to CAMS training and similar individual and institutional barriers to full implementation of CAMS. CONCLUSIONS This is the first evaluation study of a suicide-specific e-learning training within the VA. The e-CAMS appears equivalent to the in-person CAMS in terms of provider satisfaction with training and practice adoption, consistent with other comparisons of training deliveries across specialty areas. Additional evaluation of provider confidence and adoption and patient outcomes is in progress. The e-CAMS has the potential to provide ongoing training for VA and military mental health providers and serve as a tutorial for psychiatrists in preparation for specialty boards.
Collapse
|
47
|
Andreasson K, Krogh J, Rosenbaum B, Gluud C, Jobes DA, Nordentoft M. The DiaS trial: dialectical behavior therapy versus collaborative assessment and management of suicidality on self-harm in patients with a recent suicide attempt and borderline personality disorder traits - study protocol for a randomized controlled trial. Trials 2014; 15:194. [PMID: 24885904 PMCID: PMC4055911 DOI: 10.1186/1745-6215-15-194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 05/16/2014] [Indexed: 11/15/2022] Open
Abstract
Background In Denmark 8,000 to 10,000 people will attempt suicide each year. The Centre of Excellence in Suicide Prevention in the Capital Region of Denmark is treating patients with suicidal behavior, and a recent survey has shown that 30% of the patients are suffering from borderline personality disorder. The majority of patients (70% to 75%) with borderline personality disorder have a history of deliberate self-harm and 10% have a lifetime risk to die by suicide. The DiaS trial is comparing dialectical behavior therapy with collaborative assessment and management of suicidality-informed supportive psychotherapy, for the risk of repetition of deliberate self-harm in patients with a recent suicide attempt and personality traits within the spectrum of borderline personality disorder. Both treatments have previously shown effects in this group of patients on suicide ideation and self-harm compared with treatment as usual. Methods/Design The trial is designed as a single-center, two-armed, parallel-group observer-blinded randomized clinical superiority trial. We will recruit 160 participants with a recent suicide attempt and at least two traits of the borderline personality disorder from the Centre of Excellence in Suicide Prevention, Capital Region of Denmark. Randomization will be performed though a centralized and computer-generated approach that conceals the randomization sequence. The interventions that are offered are a modified version of a dialectical behavior therapy program lasting 16 weeks versus collaborative assessment and management of suicidality-informed supportive psychotherapy, where the duration treatment will vary in accordance with established methods up to 16 weeks. The primary outcome measure is the ratio of deliberate self-harming acts including suicide attempts measured at week 28. Other exploratory outcomes are included such as severity of symptoms, suicide intention and ideation, depression, hopelessness, self-esteem, impulsivity, anger, and duration of respective treatments. Trial registration Clinical Trial.gov: NCT01512602.
Collapse
Affiliation(s)
- Kate Andreasson
- Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.
| | | | | | | | | | | |
Collapse
|
48
|
Lento RM, Ellis TE, Hinnant BJ, Jobes DA. Using the suicide index score to predict treatment outcomes among psychiatric inpatients. Suicide Life Threat Behav 2013; 43:547-61. [PMID: 23725632 DOI: 10.1111/sltb.12038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/27/2013] [Indexed: 11/30/2022]
Abstract
For many suicidal people, the desire to die is moderated by a competing desire to live. This study aimed to demonstrate the ability of a wish-to-live versus wish-to-die index score to measure ambivalence and trichotomize suicidal inpatients into distinct stratified risk groups. Analyses revealed that index scores calculated for patients at treatment start significantly discriminated among the groups at index and uniquely predicted suicidal ideation, hopelessness, and depression scores across treatment. On average, patients with wish-to-live and wish-to-die orientations resolved suicidal ideation by discharge. Changes in suicidal ideation among ambivalently oriented patients were more variable. Clinical and research implications are discussed.
Collapse
Affiliation(s)
- René M Lento
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | | | | | | |
Collapse
|
49
|
Menon V. Suicide risk assessment and formulation: an update. Asian J Psychiatr 2013; 6:430-5. [PMID: 24011694 DOI: 10.1016/j.ajp.2013.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 07/07/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
There continues to be a lack of clarity on how to assess individual cases for suicidal risk. Though a surfeit of information regarding patient risk factors for suicide is available, clinicians and mental health professionals face difficulties in integrating and applying this information to individuals, in order to come up with an assessment report that is at once comprehensive, operational and easily communicable. This article outlines the basic steps involved in risk assessment with a focus on applying and integrating them. Illustrative questions and examples are used to aid understanding where appropriate. The three major domains emphasized across all contemporary models of risk assessment are specific suicidal thoughts, risk factors and protective factors. Evidence based warning signs associated with near term risk of suicide are reviewed and various approaches proposed for risk formulation are discussed with the aim of providing usable and practical information regarding assessment and formulation of suicide risk. The importance of following a structured, systematic approach is highlighted.
Collapse
Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India.
| |
Collapse
|
50
|
Neely LL, Irwin K, Ponce JTC, Perera K, Grammer G, Ghahramanlou-Holloway M. Post-Admission Cognitive Therapy (PACT) for the Prevention of Suicide in Military Personnel With Histories of Trauma. Clin Case Stud 2013. [DOI: 10.1177/1534650113501863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To date, no inpatient evidence-based psychotherapeutic interventions have been developed for suicidal individuals with psychological trauma. Therefore, we have adapted, refined, implemented, and pilot-tested an inpatient-based cognitive behavioral therapy protocol, named Post-Admission Cognitive Therapy (PACT), for the prevention of suicide. This article briefly describes the theoretical and research underpinnings for PACT, components of the treatment protocol, and clinical challenges. A case study of a traumatized military service member hospitalized following a suicide attempt is presented. Baseline and follow-up assessment data show general improvements in suicide ideation, depression, hopelessness, and Post Traumatic Stress Disorder symptomatology over time. While the data for the presented case appears promising, the efficacy of PACT remains unknown and is currently under investigation in a randomized controlled trial. Recommendations for clinicians and students who deliver care to suicidal psychiatric inpatients are provided.
Collapse
Affiliation(s)
- Laura L. Neely
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kari Irwin
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Kanchana Perera
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | | |
Collapse
|