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Celedonia KL, Karukivi M, Valenti MW, Geldsetzer P, Wilson ML. Temporal Patterns of Suicidality Among Adolescents Receiving Behavioral and Mental Health Services in the Community: A Survival Analysis. Community Ment Health J 2024:10.1007/s10597-024-01334-y. [PMID: 39110294 DOI: 10.1007/s10597-024-01334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/23/2024] [Indexed: 08/24/2024]
Abstract
Adolescent suicide is a major public health concern, particularly among adolescents who have endured Adverse Childhood Experiences (ACEs). Adolescents who have been exposed to multiple ACEs are as much as three times more likely to present with suicidality compared to the general adolescent population. Adolescents who have been exposed to multiple ACEs are also more likely to receive behavioral and mental health services in the community. It is therefore important to understand patterns of suicidality among this sub-population of adolescents in order to provide the best clinical care. The present study examined the temporal patterns of suicidality among adolescents who have been exposed to multiple ACEs and are receiving behavioral and mental health services in the community. Using Electronic Health Record (EHR) data from a community-based behavioral and mental health care organization, an exploratory survival analysis was conducted on time to suicidal thoughts and behaviors (STBs) after suicidality risk screen at intake. Average time from suicidality risk screen at intake to STB was 185 days (6.2 months). Youth who screened negative for suicidality risk at intake had a longer survival time than youth who screened positive for suicidality risk, and the survival distributions between the two groups was significant. Predictors of STBs were also examined, with gender being a significant predictor of an STB occurring during the follow-up period. These findings may be used to guide suicidality screening and clinical practice at community-based behavioral and mental health care organizations serving adolescents who have been exposed to multiple ACEs.
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Affiliation(s)
- Karen L Celedonia
- Turku Brain Injury Centre, Injury Epidemiology and Prevention (IEP) Research Group, Turku University Hospital, University of Turku, Turku, Finland.
- Social Research and Innovation Center, Pressley Ridge, Pittsburgh, PA, USA.
| | - Max Karukivi
- Department of Adolescent Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Michael W Valenti
- Social Research and Innovation Center, Pressley Ridge, Pittsburgh, PA, USA
| | - Pascal Geldsetzer
- Department of Medicine (Primary Care and Population Health), Stanford University, California, USA
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Schafer KM, Joiner TE. A Comparison of Patients Presenting with Suicide Attempts, Psychopathology Symptoms, or Pain within Emergency Departments. Arch Suicide Res 2024; 28:512-522. [PMID: 36994500 DOI: 10.1080/13811118.2023.2192765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Previous suicide attempts, psychopathology symptoms, and pain significantly increase risk of suicide, a leading cause of death. It is possible that patients across these three groups exhibit key differences that could provide insights into unique interventions for suicide-related outcomes. Data were collected using a standardized form at 432 emergency departments (EDs; 14,018 participants [females, n = 8,042; 57.4%; males, n = 5,976; 42.6%]). We conducted a series of ANOVAs to investigate if patients presenting for (1) suicide attempts (n = 33; 0.2%), (2) psychopathology symptoms (n = 1,104; 7.9%), or (3) pain (n = 12,881; 91.9%) varied across a variety of healthcare-relevant variables. Findings indicated that patients presenting with suicide attempts were seen with more urgency (F[2,12054] = 66.41, p < .001) and were more likely to be admitted to hospitalization (F[2,14015] = 187.296, p < .001), observation unit overall (F[2,14015] = 78.572, p < .001), or transferred to another hospital (F[2,14015] = 406.568, p < .001); they also required longer visits (F [2, 12054] = 66.41, p < .001) as compared to patients with psychopathology symptoms or pain. Notably, potentially important similarities between groups emerged: groups did not differ across leaving without medical screening, leaving against medical advice, or contact with healthcare providers in the long-term (i.e., twelve months) or short-term (i.e., 72 hours) preceding ED admission. These findings in particular indicate that there could be ample time (1) prior to admission to intervene and (2) during care in EDs to connect patients to goal-oriented, time-limited evidence based psychotherapies at a time when they may be particularly willing to engage in care.
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Stanley B, Brodsky B, Monahan M. Brief and Ultra-Brief Suicide-Specific Interventions. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:129-136. [PMID: 37201146 PMCID: PMC10172548 DOI: 10.1176/appi.focus.20220083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The rising rates of suicide warrant effective treatments that can quickly help stabilize suicidal individuals and prevent future suicidal crises from occurring. Across the past few decades, there has been a rise in the development of ultra-brief (1-4 sessions) and brief suicide-specific interventions (6-12 sessions) to meet this need. This article reviews several prominent ultra-brief and brief interventions, including the Teachable Moment Brief Intervention, Attempted Suicide Short Intervention Program, Safety Planning Intervention, Crisis Response Planning, Cognitive Therapy for Suicide Prevention, Brief Cognitive-Behavioral Therapy for Suicide Prevention, Collaborative Assessment and Management of Suicidality, and the Coping Long-Term With Active Suicide Program. A brief review of each interventions' evidence base is also provided. Current challenges and directions for future research in testing the efficacy and effectiveness of suicide prevention initiatives are discussed.
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Affiliation(s)
- Barbara Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, New York (all authors); Molecular Imaging and Neuropathology Division (Stanley) and Division of Behavioral Health Services and Policy Research (all authors), New York State Psychiatric Institute, New York
| | - Beth Brodsky
- Department of Psychiatry, Columbia University Irving Medical Center, New York (all authors); Molecular Imaging and Neuropathology Division (Stanley) and Division of Behavioral Health Services and Policy Research (all authors), New York State Psychiatric Institute, New York
| | - Maureen Monahan
- Department of Psychiatry, Columbia University Irving Medical Center, New York (all authors); Molecular Imaging and Neuropathology Division (Stanley) and Division of Behavioral Health Services and Policy Research (all authors), New York State Psychiatric Institute, New York
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Ariapooran S, Khezeli M, Janjani P, Jafaralilou H, Narimani S, Mazaheri M, Khezeli M. Protective factors against suicide attempt in Iranian Kurdish women: a qualitative content analysis. BMC Psychiatry 2023; 23:58. [PMID: 36681794 PMCID: PMC9867852 DOI: 10.1186/s12888-023-04544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A proper understanding of the protective factors against suicide attempt can provide the basis for planning preventive interventions. This study aimed to identify protective factors against suicide attempt among women. METHODS This qualitative study was conducted in Kermanshah, Iran between January and May 2021. Participants were 20 Kurdish women, survivors of suicide attempt, selected by purposive sampling method. The data collection method was face-to face and audio-recorded semi-structured interview. Qualitative data analysis was done according to Diekelmann 7-step approach. FINDINGS According to the results, the main topic was protective factors against suicide attempt in women, with two categories; "Individual factors" and "Social factors". "Individual factors" had five subcategories including coping strategies, reasons for living, resilience, religious beliefs, and fear of death, and "social factors" had two subcategories including social support and effective communication. CONCLUSION This study showed that women who intend to commit suicide may encounter some individual and social factors that play a protective role against suicide. It is recommended to identify and strengthen these protective factors for the effectiveness of suicide prevention interventions.
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Affiliation(s)
| | - Mehdi Khezeli
- Social Development and Health Promotion Research Center , Health Institute Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Parisa Janjani
- Cardiovascular Research Center, Health Institute Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hamid Jafaralilou
- Department of Public Health, Khoy University of Medical Sciences, Khoy, Iran
| | - Sajad Narimani
- Department of Nursing and midwifery, School of Nursing, Social Determinant of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Maryam Mazaheri
- Department of Social Medicine and Family, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Mohsen Khezeli
- Social Development and Health Promotion Research Center , Health Institute Kermanshah University of Medical Sciences, Kermanshah, Iran
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Comtois KA, Hendricks KE, DeCou CR, Chalker SA, Kerbrat AH, Crumlish J, Huppert TK, Jobes D. Reducing short term suicide risk after hospitalization: A randomized controlled trial of the Collaborative Assessment and Management of Suicidality. J Affect Disord 2023; 320:656-666. [PMID: 36162692 DOI: 10.1016/j.jad.2022.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/12/2022] [Accepted: 09/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study compared the "next day appointment" (NDA) use of the Collaborative Assessment and Management of Suicidality (CAMS) to treatment as usual (TAU) for individuals discharged from the hospital following a suicide-related crisis. We hypothesized that CAMS would significantly reduce suicidal thoughts and behaviors as well as improve psychological distress, quality of life/overall functioning, treatment retention and patient satisfaction. METHODS Participants were 150 individuals who had at least one lifetime actual, aborted, or interrupted attempt and were admitted following a suicide-related crisis. There were 75 participants in the experimental condition who received adherent CAMS and 75 participants who received TAU. Suicidal thoughts and behaviors, psychological distress, and quality of life/overall functioning were assessed at baseline and at 1, 3, 6, and 12 months post-baseline. Treatment retention and patient satisfaction were assessed at post-treatment. RESULTS Participants in both conditions improved from baseline to 12 months but CAMS was not superior to TAU for the primary outcomes. A small but significant improvement was found in probability of suicidal ideation at 3 months favoring TAU and amount of suicidal ideation at 12 months favoring CAMS. CAMS participants experienced less psychological distress at 12 months compared to baseline. LIMITATIONS The study was limited by only one research clinic, lower than expected recruitment, and imbalance of suicidal ideation at baseline. CONCLUSIONS All participants improved but CAMS was not more effective than TAU. The NDA clinic was feasible and acceptable to clients and staff in both conditions and future research should investigate its potential benefit.
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Affiliation(s)
- Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America.
| | - Karin E Hendricks
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
| | - Christopher R DeCou
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
| | - Samantha A Chalker
- Department of Psychology, Catholic University of America, United States of America
| | - Amanda H Kerbrat
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
| | - Jennifer Crumlish
- Department of Psychology, Catholic University of America, United States of America
| | - Tierney K Huppert
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
| | - David Jobes
- Department of Psychology, Catholic University of America, United States of America
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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).
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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
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Gutierrez PM, Johnson L, Podlogar MC, Hagman S, Muehler TA, Hanson J, Pierson JT, Brown AA, O'Connor S. Pilot study of the Collaborative Assessment and Management of Suicidality-Group. Suicide Life Threat Behav 2022; 52:244-255. [PMID: 34780099 DOI: 10.1111/sltb.12817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/06/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Few evidence-based options exist for outpatient treatment of patients at risk of suicide, and to-date almost all research has focused on individually delivered psychotherapy. Group therapy for veterans at risk of suicide is a promising alternative. METHODS Thirty veterans receiving care at an urban Veterans Affairs Medical Center in the southern United States were randomized to either care as usual (CAU) or to CAU plus the Collaborative Assessment and Management of Suicide-Group (CAMS-G). Veterans were assessed prior to randomization to condition and at 1, 3, and 6 months post-randomization on a range of suicide-specific measures, burdensomeness, belonging, treatment satisfaction, and group cohesion. RESULTS Across measures and follow-up assessments, veterans in CAMS-G reported good satisfaction with the intervention, a sense of cohesion with other members of the group, and reduced symptom distress. Veterans in both conditions reported decreases in suicidal ideation and behavior, with CAMS-G participants potentially improving slightly faster. CONCLUSION This description of CAMS-G for veterans adds to the growing literature on suicide-specific interventions and supports the need for additional research to determine if wide-spread rollout is justifiable.
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Affiliation(s)
- Peter M Gutierrez
- Military Suicide Research Consortium, Tallahassee, Florida, USA.,Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lora Johnson
- Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Matthew C Podlogar
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stacy Hagman
- Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Tanner A Muehler
- Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Jetta Hanson
- Military Suicide Research Consortium, Tallahassee, Florida, USA.,Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
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Bossarte RM, Kennedy CJ, Luedtke A, Nock MK, Smoller JW, Stokes C, Kessler RC. Invited Commentary: New Directions in Machine Learning Analyses of Administrative Data to Prevent Suicide-Related Behaviors. Am J Epidemiol 2021; 190:2528-2533. [PMID: 33877322 DOI: 10.1093/aje/kwab111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
This issue contains a thoughtful report by Gradus et al. (Am J Epidemiol. 2021;190(12):2517-2527) on a machine learning analysis of administrative variables to predict suicide attempts over 2 decades throughout Denmark. This is one of numerous recent studies that document strong concentration of risk of suicide-related behaviors among patients with high scores on machine learning models. The clear exposition of Gradus et al. provides an opportunity to review major challenges in developing, interpreting, and using such models: defining appropriate controls and time horizons, selecting comprehensive predictors, dealing with imbalanced outcomes, choosing classifiers, tuning hyperparameters, evaluating predictor variable importance, and evaluating operating characteristics. We close by calling for machine-learning research into suicide-related behaviors to move beyond merely demonstrating significant prediction-this is by now well-established-and to focus instead on using such models to target specific preventive interventions and to develop individualized treatment rules that can be used to help guide clinical decisions to address the growing problems of suicide attempts, suicide deaths, and other injuries and deaths in the same spectrum.
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Bloch-Elkouby S, Barzilay S, Gorman BS, Lawrence OC, Rogers ML, Richards J, Cohen LJ, Johnson BN, Galynker I. The revised suicide crisis inventory (SCI-2): Validation and assessment of prospective suicidal outcomes at one month follow-up. J Affect Disord 2021; 295:1280-1291. [PMID: 34706442 DOI: 10.1016/j.jad.2021.08.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/10/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIM The Suicide Crisis Syndrome (SCS) is an evidence-based pre-suicidal cognitive and affective state predictive of short-term suicide risk. The most recent SCS formulation, proposed as a suicide-specific DSM diagnosis, features a feeling of Entrapment accompanied by four additional symptom clusters: Affective Disturbance; Loss of Cognitive Control; Hyperarousal; and Social Withdrawal. The aim of the present study was to revise the Suicide Crisis Inventory (SCI; Barzilay et al., 2020), a self-report measure assessing the presence of the SCS,in accordance with the current SCS formulation, as well as to assess the psychometric properties and clinical utility of its revised version, the Suicide Crisis Inventory-2 (SCI-2). METHODS The SCI-2, a 61-item self-report questionnaire, was administered to 421 psychiatric inpatients and outpatients at baseline. Prospective suicidal outcomes including suicidal ideation, preparatory acts, and suicidal attempts were assessed after one month. Internal structure and consistency were assessed with confirmatory factor analysis, convergent, discriminant, and current criterion validity. Receiver-operating characteristic (ROC) curves with Area under the Curve (AUC) were used to examine the predictive validity of the SCI-2 to prospective outcomes. Exploratory analyses assessed the predictive validity of the five SCI-2 dimensions. RESULTS The SCI-2 demonstrated excellent internal consistency (Cronbach's α = 0.971), good convergent, discriminant, and current criterion validity. The SCI-2 significantly predicted all three outcomes, and was the only significant predictor of suicidal attempts with AUC = 0.883. DISCUSSION The results of this study indicate that the SCI-2 is a valid and reliable tool to assess the presence and intensity of the Suicide Crisis Syndrome and to predict short-term prospective suicidal behaviors and attempts among psychiatric outpatients and inpatients regardless of patients' readiness to disclose suicidal ideation.
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Affiliation(s)
- Sarah Bloch-Elkouby
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States.
| | - Shira Barzilay
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Bernard S Gorman
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Olivia C Lawrence
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Megan L Rogers
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Jenelle Richards
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Lisa J Cohen
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Benjamin N Johnson
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
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Querdasi FR, Bacio GA. Suicidal behaviors among Latina adolescents: An ecodevelopmental approach and narrative review. J Adolesc 2021; 93:161-176. [PMID: 34785380 DOI: 10.1016/j.adolescence.2021.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 08/10/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION For the past several decades, Latina adolescents have consistently shown high rates of suicidal behaviors (i.e., suicidal ideation, planning, and attempts), higher than Latino adolescents and adolescents of most other ethnic groups. Yet, progress toward establishing evidence-based intervention efforts to address this urgent public health issue has been slow. The purpose of this narrative review is to summarize empirical findings on etiological factors associated with Latina adolescent suicidal behaviors using an ecodevelopmental, gender-specific framework that contextualizes Latina adolescent development. METHODS To be included, peer reviewed empirical manuscripts had to focus on suicidal behaviors (i.e., suicide attempts, suicide plan, and/or suicidal ideation) of adolescents (ages 11-19 or in grades 7-12) who self-identified as either Latina or Hispanic and a girl in the United States. RESULTS A total of 19 studies met review criteria and focused on microsystemic and intrapersonal predictors. Microsystemic predictors included family (i.e., family-adolescent discrepancies in acculturation, family functioning, family-daughter interactions), peer (i.e., victimization, friendships), and school (i.e., functioning, achievement) factors, while intrapersonal predictors were emotional vulnerability, psychosocial functioning, and substance use. CONCLUSIONS Family-related phenomena were the most widely studied. Research on school and peer microsystems was comparatively sparse, and several promising intrapersonal development factors have been underexplored. A notable limitation of existing studies is that samples consisted primarily of U.S.-born adolescents living in urban areas. Additional research is needed to characterize factors on other ecodevelopmental levels, identify resilience processes, and examine within-group diversity among Latina adolescents. Implications for intervention and future directions are discussed.
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Affiliation(s)
- Francesca R Querdasi
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, USA.
| | - Guadalupe A Bacio
- Departments of Psychological Science and Intercollegiate Chicana/o-Latina/o Studies, Pomona College, 647 N College Way, Claremont, CA, 91711, USA.
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Sullivan SR, Monahan MF, Mitchell EL, Spears AP, Walsh S, Szeszko JR, Gromatsky M, Stanley B, Goodman M. Group treatments for individuals at risk for suicide: A PRISMA scoping review (ScR). Psychiatry Res 2021; 304:114108. [PMID: 34352592 DOI: 10.1016/j.psychres.2021.114108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/14/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This PRISMA scoping review explored worldwide research of interventions for suicide prevention delivered within a group setting. Research on group treatments underscores the importance of peer connection in diminishing social isolation and increasing social support. Additional benefits of group treatment include cost efficiency and maximization of staff time. However, the clinical outcomes of group treatments with individuals at risk for suicide are less understood and under researched. AIM This scoping review had two objectives: 1) To identify existing group treatments where suicidal thoughts and behaviors are openly discussed; 2) To examine the outcomes of these identified treatments, with special attention to treatment integrity. METHOD To address these aims the authors searched Medline (Ovid), Embase (Ovid), and PsycINFO (Ovid), on November 25, 2020. At the Full Text stage, articles were included that were peer reviewed, described a suicide specific group intervention and reported suicide specific outcomes. An additional requirement was open dialogue of suicide in the group intervention. RESULTS Only ten research reports of suicide-specific group treatments were identified in our PRISMA-ScR. In spite of many differences in setting, population, length, and frequency of sessions, all ten groups reported improvements in varying aspects of suicide symptoms. The only adverse impacts were reported by two studies wherein two (of 92) participants attempted suicide and a small number (7%) of adolescents reported feeling triggered with suicidal thinking during a session. Despite our focus on empirical data in this review, the methodological rigor of the studies evaluated was limited. CONCLUSION Despite the paucity of group treatment research in which suicidal thoughts and behaviors are openly discussed, the outcomes of these treatments were promising in decreasing suicide risk. These results may be due to unfounded fears of contagion. Further implications of these findings are considered along with limitations that may have excluded clinical work from meeting inclusion criteria for this review. Nonetheless, this evidence suggests that, suicide-focused groups have great potential for prevention of suicidal symptoms and should be further expanded in the future.
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Affiliation(s)
- Sarah R Sullivan
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Maureen F Monahan
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
| | - Emily L Mitchell
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - Angela Page Spears
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY; Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Samantha Walsh
- Icahn School of Medicine Library at Mt. Sinai Hospital, New York, NY, USA
| | | | - Molly Gromatsky
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Barbara Stanley
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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12
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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: 34] [Impact Index Per Article: 11.3] [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.
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13
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Fulginiti A, Hsu HT. Gatekeeping beliefs, intent, and behavior among homeless youth. DEATH STUDIES 2021; 46:2247-2255. [PMID: 33983869 DOI: 10.1080/07481187.2021.1922543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
No research has explored the potential of homeless youth to serve as gatekeepers for suicide prevention purposes. This study described and examined associations between gatekeeping beliefs (i.e. preparedness and efficacy), intent-to-intervene, and gatekeeping behaviors (approach/referral behavior). In a sample of 139 homeless youth (aged 14-24), regression analysis was used to characterize associations between gatekeeper beliefs, intent, and behaviors. On average, participants engaged in gatekeeper behaviors with 1-2 people over the past 3 months. Gatekeeping beliefs and intent were positively associated with behaviors. Gatekeeper training that targets these attributes is a promising prevention strategy for homeless youth, but may require population-specific adaptation.
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Affiliation(s)
- Anthony Fulginiti
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, MO, USA
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14
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Johnson LL, Muehler T, Stacy MA. Veterans' satisfaction and perspectives on helpfulness of the Veterans Crisis Line. Suicide Life Threat Behav 2021; 51:263-273. [PMID: 33876480 DOI: 10.1111/sltb.12702] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Crisis hotlines are an important part of a public health approach to suicide prevention. The Veterans Crisis Line (VCL) provides hotline services to Veterans. There is a paucity of research concerning the effectiveness of the VCL. The current work describes efforts to establish groundwork for VCL effectiveness research. METHODS 155 VCL users who were referred to a Veterans Affairs Medical Center Suicide Prevention Team completed interviews including open-ended and closed-ended questions. Outcomes are reported for suicidal participants, non-suicidal participants, and those who had emergency intervention. Thematic analysis was used for open-ended questions. RESULTS Eighty-seven percent of interviewees expressed satisfaction with the VCL, 81.9% reported that the VCL was helpful, and 72.9% said that the VCL helped keep them safe. Of those with suicidal thoughts, 82.6% said the contact helped stop them from killing themselves. Themes are described concerning user identified reasons for VCL contact, most and least helpful aspects of the contact, and suggestions for improvement. DISCUSSION This project demonstrates that this group of people who used the VCL overwhelmingly finds the service to be helpful and a barrier to suicide. Further, implications of user feedback for application to VCL operations and future research are discussed.
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Affiliation(s)
- Lora L Johnson
- Department of Veterans Affairs, Robley Rex VA Medical Center, Louisville, KY, USA
| | - Tanner Muehler
- Department of Veterans Affairs, Robley Rex VA Medical Center, Louisville, KY, USA.,Eastern Kentucky University, Richmond, KY, USA
| | - Meaghan A Stacy
- Department of Veterans Affairs, Veterans Crisis Line, National Care Coordination and Field Operations Team, Canandaigua, NY, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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15
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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.
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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
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16
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Bloch-Elkouby S, Gorman B, Lloveras L, Wilkerson T, Schuck A, Barzilay S, Calati R, Schnur D, Galynker I. How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide. J Affect Disord 2020; 277:914-926. [PMID: 33065834 DOI: 10.1016/j.jad.2020.08.088] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 07/17/2020] [Accepted: 08/25/2020] [Indexed: 12/25/2022]
Abstract
AIM The Narrative Crisis Model of suicide posits that when individuals with trait vulnerabilities for suicide face stressful life events, they may develop distorted perceptions of themselves and society that culminate in a sense of no future. Referred to as the suicide narrative, these perceptions makes them more likely to experience the Suicidal Crisis Syndrome, an acute affective condition that increases the risk of engaging in suicidal ideation behaviors. The goal of this study was to assess the stage components of this model. METHODS The stage components of the NCM were assessed among adult psychiatric inpatients (N = 223; listwise N = 85) aged 18-65 years old and admitted for suicidal ideation or attempts. Suicidal outcomes were assessed at one month follow-up. Structural equation modeling (SEM) was used to assess the model and its prediction of prospective suicidal outcomes. RESULTS The model was supported by the SEM and proved to be a good fit for the data. Each temporal stage was significantly predicted by the precedent stage in the model and 13% of the variance in suicidal ideation and behaviors (when assessed conjointly) were explained by the model. When suicidal ideation and attempts were assessed separately, the amount of variance explained was 10.8% for suicidal ideation and 40.7% for suicidal attempts. DISCUSSION The progression from trait vulnerabilities to suicidal outcomes proposed by the NCM was supported by our findings. These findings have clinical implications in the assessment and treatment of suicide risk and will need replication with larger samples.
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Affiliation(s)
| | | | - Lauren Lloveras
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Timothy Wilkerson
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Allison Schuck
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Shira Barzilay
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - David Schnur
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Adelphi University, New York City, USA
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17
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Singh S, Turin TC. Short therapy programmes may reduce the risk of suicide reattempts. Evid Based Nurs 2020; 24:67. [PMID: 32518065 DOI: 10.1136/ebnurs-2020-103257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Shaminder Singh
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Tanvir C Turin
- Department of Family Medicine & Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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18
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Kar Ray M, Wyder M, Crompton D, Kousoulis AA, Arensman E, Hafizi S, Van Bortel T, Lombardo C. PROTECT: Relational safety based suicide prevention training frameworks. Int J Ment Health Nurs 2020; 29:533-543. [PMID: 31880076 DOI: 10.1111/inm.12685] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 11/29/2022]
Abstract
Preventing suicide is a global priority, and staff training is a core prevention strategy. However, frontline pressures make translating training into better care and better outcomes difficult. The aim of the paper was to highlight challenges in suicide risk assessment and management and introduce training frameworks to assist with mindful practice so professionals can strike a balance between risk and recovery. We combined the scientific literature with contemporary practice from two successful initiatives from Cambridgeshire, UK: 333 - a recovery-oriented model of inpatient/community crisis care and PROMISE - a programme to reduce coercion in care by enhancing patient experience. The resulting PROTECT (PROactive deTECTion) frameworks operationalize ongoing practice of relational safety in these programmes. PROTECT is a combination of novel concepts and adaptations of well-established therapeutic approaches. It has four training frameworks: AWARE for reflection on clinical decisions; DESPAIR for assessment; ASPIRE for management; and NOTES for documentation. PROTECT aims to improve self-awareness of mental shortcuts and risk-taking thresholds and increase rigour through time-efficient cross-checks. The training frameworks should support a relational approach to self-harm/suicide risk detection, mitigation, and documentation, making care safer and person-centred. The goal is to enthuse practitioners with recovery-oriented practice that draws on the strengths of the person in distress and their natural circle of support. It will provide the confidence to engage in participatory approaches to seek out unique individualized solutions to the overwhelming psychological pain of suicidal distress. Future collaborative research with people with lived and carer experience is needed for fine-tuning.
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Affiliation(s)
- Manaan Kar Ray
- Addictions and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia.,Southside Clinical Unit, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia.,Adult Mental Health Services, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Marianne Wyder
- Addictions and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - David Crompton
- Addictions and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia.,Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, Queensland, Australia.,Neuro-imaging Facility, Translational Research Institute (TRI), Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | - Ella Arensman
- School of Public Health, National Suicide Research Foundation, University College Cork, National University of Ireland, Cork, Ireland
| | - Sepehr Hafizi
- Adult Mental Health Services, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Tine Van Bortel
- Institute for Health and Human Development, University of East London, London, UK.,Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Chiara Lombardo
- Adult Mental Health Services, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK.,Research and Development, Mental Health Foundation, London, UK.,Institute for Health and Human Development, University of East London, London, UK
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19
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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".
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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
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20
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Kessler RC, Chalker SA, Luedtke AR, Sadikova E, Jobes DA. A Preliminary Precision Treatment Rule for Remission of Suicide Ideation. Suicide Life Threat Behav 2020; 50:558-572. [PMID: 31814153 DOI: 10.1111/sltb.12609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/10/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There is growing interest in the development of composite precision treatment rules (PTRs) to guide the selection of the treatments most likely to be helpful for individual patients. We present here the results of an effort to develop a preliminary PTR for Collaborative Assessment and Management of Suicidality (CAMS) relative to enhanced-care as usual based on secondary analysis of the Operation Worth Living (OWL) randomized controlled trial. The outcome of interest is eliminating suicide ideation (SI) within 3 months of initiating treatment. METHOD A state-of-the-art ensemble machine learning method was used to develop the PTR among the n = 148 U.S. Soldiers (predominately male and White, age range 18-48) OWL patients. RESULTS We estimated that CAMS was the better treatment for 77.8% of patients and that treatment assignment according to the PTR would result in a 13.6% (95% CI: 0.9%-26.3%) increase in 3-month SI remission compared to random treatment assignment. CONCLUSIONS Although promising, results are limited by the small sample size, restrictive baseline assessment, and inability to evaluate effects on suicidal behaviors or disaggregate based on history of suicidal behaviors. Replication is needed in larger samples with comprehensive baseline assessments, longer-term follow-ups, and more extensive outcomes.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Samantha A Chalker
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Alex R Luedtke
- Department of Statistics, University of Washington, Seattle, WA, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ekaterina Sadikova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
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21
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Kessler RC, Bossarte RM, Luedtke A, Zaslavsky AM, Zubizarreta JR. Suicide prediction models: a critical review of recent research with recommendations for the way forward. Mol Psychiatry 2020; 25:168-179. [PMID: 31570777 PMCID: PMC7489362 DOI: 10.1038/s41380-019-0531-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 12/26/2022]
Abstract
Suicide is a leading cause of death. A substantial proportion of the people who die by suicide come into contact with the health care system in the year before their death. This observation has resulted in the development of numerous suicide prediction tools to help target patients for preventive interventions. However, low sensitivity and low positive predictive value have led critics to argue that these tools have no clinical value. We review these tools and critiques here. We conclude that existing tools are suboptimal and that improvements, if they can be made, will require developers to work with more comprehensive predictor sets, staged screening designs, and advanced statistical analysis methods. We also conclude that although existing suicide prediction tools currently have little clinical value, and in some cases might do more harm than good, an even-handed assessment of the potential value of refined tools of this sort cannot currently be made because such an assessment would depend on evidence that currently does not exist about the effectiveness of preventive interventions. We argue that the only way to resolve this uncertainty is to link future efforts to develop or evaluate suicide prediction tools with concrete questions about specific clinical decisions aimed at reducing suicides and to evaluate the clinical value of these tools in terms of net benefit rather than sensitivity or positive predictive value. We also argue for a focus on the development of individualized treatment rules to help select the right suicide-focused treatments for the right patients at the right times. Challenges will exist in doing this because of the rarity of suicide even among patients considered high-risk, but we offer practical suggestions for how these challenges can be addressed.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
| | - Robert M Bossarte
- West Virginia University Injury Control Research Center and Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, USA
- West Virginia and VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Jose R Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Statistics, Harvard University, Cambridge, MA, USA
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22
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Jobes DA, Chalker SA. One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193606. [PMID: 31561488 PMCID: PMC6801408 DOI: 10.3390/ijerph16193606] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/14/2019] [Accepted: 09/25/2019] [Indexed: 01/24/2023]
Abstract
While the existence of mental illness has been documented for centuries, the understanding and treatment of such illnesses has evolved considerably over time. Ritual exorcisms and locking mentally ill patients in asylums have been fundamentally replaced by the use of psychotropic medications and evidence-based psychological practices. Yet the historic roots of mental health management and care has left a certain legacy. With regard to suicidal risk, the authors argue that suicidal patients are by definition seen as mentally ill and out of control, which demands hospitalization and the treatment of the mental disorder (often using a medication-only approach). Notably, however, the evidence for inpatient care and a medication-only approach for suicidal risk is either limited or totally lacking. Thus, the "one-size-fits-all" approach to treating suicidal risk needs to be re-considered in lieu of the evolving evidence base. To this end, the authors highlight a series of evidence-based considerations for suicide-focused clinical care, culminating in a stepped care public health model for optimal clinical of suicidal risk that is cost-effective, least-restrictive, and evidence-based.
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Affiliation(s)
- David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC 20064, USA.
| | - Samantha A Chalker
- Department of Psychology, The Catholic University of America, Washington, DC 20064, USA.
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23
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Jobes DA, Vergara GA, Lanzillo EC, Ridge-Anderson A. The potential use of CAMS for suicidal youth: building on epidemiology and clinical interventions. CHILDRENS HEALTH CARE 2019. [DOI: 10.1080/02739615.2019.1630279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- David A. Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Genesis A. Vergara
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | | | - Abby Ridge-Anderson
- Department of Psychology, The Catholic University of America, Washington, DC, USA
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24
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Rojas SM, Carter SP, McGinn MM, Reger MA. A Review of Telemental Health as a Modality to Deliver Suicide-Specific Interventions for Rural Populations. Telemed J E Health 2019; 26:700-709. [PMID: 31502929 DOI: 10.1089/tmj.2019.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Despite recent advancements in the development of new suicide prevention interventions, suicide rates continue to rise in the United States. As such, suicide prevention efforts must continue to focus on expanding dissemination of suicide-specific interventions. Methods: This review explores telemental health through two-way synchronous clinical video telehealth (CVT) technologies as one approach to improving access to suicide-specific interventions. Results: Studies were reviewed if (1) the modality of interest was telemental health by CVT and (2) management, assessment, or intervention of suicidal thoughts or behaviors was discussed. A total of 22 studies were included. Conclusions: Findings from the limited existing studies are synthesized, and recommendations are provided for future research, clinical, and educational advancements.
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Affiliation(s)
- Sasha M Rojas
- VA Puget Sound Health Care System, Seattle, Washington.,University of Arkansas, Fayetteville, Arkansas, USA
| | - Sarah P Carter
- VA Puget Sound Health Care System, Seattle, Washington.,Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Meghan M McGinn
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mark A Reger
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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25
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Cramer RJ, Rasmussen S, Webber WB, Sime VL, Haile C, McFadden C, McManus MC. Preferences in Information Processing and suicide: Results from a young adult health survey in the United Kingdom. Int J Soc Psychiatry 2019; 65:46-55. [PMID: 30488744 DOI: 10.1177/0020764018815206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suicide prevention literature currently suffers from inconsistent measurement and incomplete theoretical development. AIMS Using a recommended suicide measurement approach for epidemiological studies (i.e. the Suicidal Behaviors Questionnaire-Revised (SBQ-R)), the present investigation assessed United Kingdom young adult suicide prevalence rates. This study also investigated the utility of a Preferences in Information Processing (PIP) model of suicide in identifying those at increased odds for elevated suicide risk, as well as lifetime ideation and attempt. METHOD A cross-sectional mental health and well-being survey study ( n = 414) was conducted. RESULTS The prevalence rates of elevated risk (49.8%), lifetime ideation only (55.3%) and lifetime attempt (13.5%) were high. Bivariate associations demonstrated that elevated depression, anxiety and Need for Affect (NFA) Avoidance were associated with worsened suicide outcomes, whereas elevated Need for Cognition (NFC) was associated with decreased suicide risk. Logistic regression results identified depression and NFA Avoidance as the strongest predictors of elevated suicide risk. Multinomial logistic regression results established several PIP-based moderation effects for depression and anxiety in which NFA Approach and NFC differentially influenced odds of suicide attempt group membership. CONCLUSION The SBQ-R is an appropriate tool for UK young adult suicide research. NFA and NFC demonstrated potential for inclusion in young adult suicide prevention programming. Further research is needed to fully evaluate the PIP model of suicide and effectiveness of proposed theory-based approaches to suicide prevention.
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Affiliation(s)
- Robert J Cramer
- 1 School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Susan Rasmussen
- 2 School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Wesley B Webber
- 3 Department of Educational Studies in Psychology, Research Methodology, and Counseling, The University of Alabama, Tuscaloosa, AL, USA
| | - Victoria L Sime
- 2 School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Caitlin Haile
- 2 School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Claire McFadden
- 2 School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Moira C McManus
- 4 College of Health Sciences, Old Dominion University, Norfolk, VA, USA
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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
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Pistorello J, Jobes D, Compton S, Locey NS, Walloch JC, Gallop R, Au JS, Noose SK, Young M, Johnson J, Dickens Y, Chatham P, Jeffcoat T, Dalto G, Goswami S. Developing Adaptive Treatment Strategies to Address Suicidal Risk in College Students: A Pilot Sequential, Multiple Assignment, Randomized Trial (SMART). Arch Suicide Res 2017; 22:644-664. [PMID: 29220633 PMCID: PMC6125229 DOI: 10.1080/13811118.2017.1392915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This pilot study investigated the potential to utilize adaptive treatment strategies for treating moderate to severe suicidal risk among college students. This article will describe the unique study design and report on feasibility and acceptability findings. A 2-stage Sequential Multiple Assignment Randomized Trial (SMART) was conducted: In Stage 1, 62 suicidal college students were randomized to either a suicide-focused or a treatment-as-usual condition (4-8 weeks). Those deemed insufficient responders were re-randomized to one of two Stage 2 interventions-both suicide-focused but one comprehensive and multimodal and the other flexible and theoretically agnostic (4-16 additional weeks). Recruitment rates were high, treatment dropout levels were lower than expected for the setting, study dropouts were rare, and counselors were able to deliver suicide-focused approaches with fidelity. Treatment satisfaction was high among clients and moderately high among counselors. Findings from this pilot show that a SMART is highly feasible and acceptable to suicidal college students, counselors, and campuses.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Maria Young
- University of Nevada, Reno, Counseling Services
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Jobes DA, Comtois KA, Gutierrez PM, Brenner LA, Huh D, Chalker SA, Ruhe G, Kerbrat AH, Atkins DC, Jennings K, Crumlish J, Corona CD, Connor SO, Hendricks KE, Schembari B, Singer B, Crow B. A Randomized Controlled Trial of the Collaborative Assessment and Management of Suicidality versus Enhanced Care as Usual With Suicidal Soldiers. Psychiatry 2017; 80:339-356. [PMID: 29466107 DOI: 10.1080/00332747.2017.1354607] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study describes a randomized controlled trial called "Operation Worth Living" (OWL) which compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced care as usual (E-CAU). We hypothesized that CAMS would be more effective than E-CAU for reducing suicidal ideation (SI) and suicide attempts (SA), along with secondary behavioral health and health care utilization markers for U.S. Army Soldier outpatients with significant SI (i.e., > 13 on Beck's Scale for Suicide Ideation). METHOD Study participants were 148 Soldiers who presented to a military outpatient behavioral health clinic. There were 73 Soldiers in the experimental arm of the trial who received adherent CAMS; 75 Soldiers received E-CAU. Nine a-priori treatment outcomes (SI, past year SA, suicide-related emergency department (ED) admits, behavioral health-related ED admits, suicide-related inpatient psychiatric unit (IPU) days, behavioral health-related IPU days, mental health, psychiatric distress, resiliency) were measured through assessments at Baseline and at 1, 3, 6, and 12 months post-Baseline (with a 78% retention of intent-to-treat participants at 12 months). RESULTS Soldiers in both arms of the trial responded to study treatments in terms of all primary and secondary outcomes (effect sizes ranged from 0.63 to 12.04). CAMS participants were significantly less likely to have any suicidal thoughts by 3 months in comparison to those in E-CAU (Cohen's d = 0.93, p=.028). CONCLUSIONS Soldiers receiving CAMS and E-CAU significantly improved post-treatment. Those who received CAMS were less likely to report SI at 3 months; further group differences were not otherwise seen.
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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.
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