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Doering S, Probert-Lindström S, Ehnvall A, Wiktorsson S, Palmqvist Öberg N, Bergqvist E, Stefenson A, Fransson J, Westrin Å, Waern M. Anxiety symptoms preceding suicide: A Swedish nationwide record review. J Affect Disord 2024; 355:317-324. [PMID: 38552915 DOI: 10.1016/j.jad.2024.03.118] [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] [Received: 12/04/2023] [Revised: 03/01/2024] [Accepted: 03/23/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The literature on the relationship between anxiety and suicidal behaviors is limited and findings are mixed. This study sought to determine whether physicians noted anxiety symptoms and suicidality in their patients in the weeks and months before suicide. METHODS Data were derived from a nationwide medical record review of confirmed suicides in Sweden in 2015. Individuals with at least one documented physician consultation in any health care setting during 12 months before suicide (N = 956) were included. Clinical characteristics were compared between decedents with and without a notation of anxiety symptoms. Odds ratios were calculated to estimate associations between anxiety symptoms and suicidality in relation to suicide proximity. RESULTS Anxiety symptoms were noted in half of individuals 1 week before suicide. Patients with anxiety were characterized by high rates of depressive symptoms, ongoing substance use issues, sleeping difficulties, and fatigue. After adjustment for mood disorders, the odds of having a notation of elevated suicide risk 1 week before death were doubled in persons with anxiety symptoms. Associations were similar across time periods (12 months - 1 week). Two-thirds had been prescribed antidepressants at time of death. LIMITATIONS Data were based on physicians' notations which likely resulted in underreporting of anxiety depending on medical specialty. Records were not available for all decedents. CONCLUSIONS Anxiety symptoms were common in the final week before suicide and were accompanied by increases in documented elevated suicide risk. Our findings can inform psychiatrists, non-psychiatric specialists, and GPs who meet and assess persons with anxiety symptoms.
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Affiliation(s)
- Sabrina Doering
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
| | - Sara Probert-Lindström
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden
| | - Anna Ehnvall
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Psychiatric Outpatient Clinic, Region Halland, Varberg, Sweden
| | - Stefan Wiktorsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Psychotic Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Nina Palmqvist Öberg
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden
| | - Erik Bergqvist
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Psychiatric Inpatient Clinic, Region Halland, Varberg, Sweden
| | - Anne Stefenson
- National Centre for Suicide Research and Prevention, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Fransson
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Psychotic Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Sattler A, Dunn J, Albarran M, Berger C, Calugar A, Carper J, Chirravuri L, Jawad N, Zein M, McGovern M. Asynchronous Versus Synchronous Screening for Depression and Suicidality in a Primary Health Care System: Quality Improvement Study. JMIR Ment Health 2024; 11:e50192. [PMID: 38712997 PMCID: PMC11082433 DOI: 10.2196/50192] [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] [Received: 06/22/2023] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 05/08/2024] Open
Abstract
Background Despite being a debilitating, costly, and potentially life-threatening condition, depression is often underdiagnosed and undertreated. Previsit Patient Health Questionnaire-9 (PHQ-9) may help primary care health systems identify symptoms of severe depression and prevent suicide through early intervention. Little is known about the impact of previsit web-based PHQ-9 on patient care and safety. Objective We aimed to investigate differences among patient characteristics and provider clinical responses for patients who complete a web-based (asynchronous) versus in-clinic (synchronous) PHQ-9. Methods This quality improvement study was conducted at 33 clinic sites across 2 health systems in Northern California from November 1, 2020, to May 31, 2021, and evaluated 1683 (0.9% of total PHQs completed) records of patients endorsing thoughts that they would be better off dead or of self-harm (question 9 in the PHQ-9) following the implementation of a depression screening program that included automated electronic previsit PHQ-9 distribution. Patient demographics and providers' clinical response (suicide risk assessment, triage nurse connection, medication management, electronic consultation with psychiatrist, and referral to social worker or psychiatrist) were compared for patients with asynchronous versus synchronous PHQ-9 completion. Results Of the 1683 patients (female: n=1071, 63.7%; non-Hispanic: n=1293, 76.8%; White: n=831, 49.4%), Hispanic and Latino patients were 40% less likely to complete a PHQ-9 asynchronously (odds ratio [OR] 0.6, 95% CI 0.45-0.8; P<.001). Patients with Medicare insurance were 36% (OR 0.64, 95% CI 0.51-0.79) less likely to complete a PHQ-9 asynchronously than patients with private insurance. Those with moderate to severe depression were 1.61 times more likely (95% CI 1.21-2.15; P=.001) to complete a PHQ-9 asynchronously than those with no or mild symptoms. Patients who completed a PHQ-9 asynchronously were twice as likely to complete a Columbia-Suicide Severity Rating Scale (OR 2.41, 95% CI 1.89-3.06; P<.001) and 77% less likely to receive a referral to psychiatry (OR 0.23, 95% CI 0.16-0.34; P<.001). Those who endorsed question 9 "more than half the days" (OR 1.62, 95% CI 1.06-2.48) and "nearly every day" (OR 2.38, 95% CI 1.38-4.12) were more likely to receive a referral to psychiatry than those who endorsed question 9 "several days" (P=.002). Conclusions Shifting depression screening from in-clinic to previsit led to a dramatic increase in PHQ-9 completion without sacrificing patient safety. Asynchronous PHQ-9 can decrease workload on frontline clinical team members, increase patient self-reporting, and elicit more intentional clinical responses from providers. Observed disparities will inform future improvement efforts.
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Affiliation(s)
- Amelia Sattler
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Julia Dunn
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Marleni Albarran
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Charlotte Berger
- Technology and Digital Solutions, Stanford Health Care, Palo Alto, CA, United States
| | - Ana Calugar
- Department of Quality, Stanford Health Care, Stanford, CA, United States
| | - John Carper
- University Healthcare Alliance, Stanford, CA, United States
| | | | - Nadine Jawad
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Mira Zein
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Mark McGovern
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
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Sharwood LN, Waller M, Draper B, Shand F. Exploring community mental health service use following hospital-treated intentional self-harm among older Australians: a survival analysis. Int Psychogeriatr 2024; 36:405-414. [PMID: 37960921 DOI: 10.1017/s1041610223000959] [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: 11/15/2023]
Abstract
OBJECTIVES This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH. DESIGN A longitudinal whole-of-population record linkage study was conducted (2014-2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data. SETTING Australia's most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review. PARTICIPANTS Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older. INTERVENTION CMH care within 14 days from index, versus not. MEASUREMENTS Cox-proportionate hazards regression analysis evaluated all-cause mortality risk, adjusted for relevant covariates. RESULTS Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall. CONCLUSIONS CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care.
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Affiliation(s)
- Lisa N Sharwood
- Black Dog Institute, University of New South Wales, Sydney, Kensington, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- School of Engineering, University of Technology Sydney, Sydney, NSW, Australia
- School of Population Health, University of NSW, Sydney
| | | | - Brian Draper
- Eastern Suburbs Older Persons' Mental Health Service, Randwick, NSW, 2031, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales,Sydney, NSW, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, Kensington, NSW, Australia
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Podlogar T, Žvelc G, De Leo D. Slovene Translation of the Difficulties in Suicidal Behaviors Intervention Questionnaire (DSBQ). CRISIS 2024. [PMID: 38597228 DOI: 10.1027/0227-5910/a000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Background: Mental health professionals encounter numerous difficulties when working with suicidal clients. To understand these difficulties in clinical practice better, a valid instrument measuring them is needed. Aims: This study aimed to translate the Difficulties in Suicidal Behaviors Intervention Questionnaire (DSBQ) to Slovene, validate it, and explore Slovenian professionals' experiences with it. Method: The participants were 106 professionals (19 men, 87 women), aged 26-66 years. Apart from the DSBQ, scales on attitudes toward suicide prevention and coping strategies in difficult clinical situations were used. The data were collected between October 2017 and January 2019. Results: Although slightly diverging from the originally reported component structure, the Slovene translation of the DSBQ measures difficulties in working with suicidal clients with acceptable/good reliability and sensitivity, and adequate construct validity. Slovenian professionals most commonly experience difficulties related to working with children, followed by technical, system and setting, and other types of difficulties. Limitations: The sample of participants was relatively heterogeneous. Conclusion: Further studies of the DSBQ structure and validity, as well as difficulties, especially those related to working with children/adolescents and facing the theme of death, are warranted. Considering the difficulties most frequently reported in this investigation, more efforts are also needed in Slovenia to address technical and logistic aspects.
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Affiliation(s)
- Tina Podlogar
- Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
- Department of Psychology, FAMNIT, University of Primorska, Koper, Slovenia
- Department of Psychology, Faculty of Arts, University of Ljubljana, Slovenia
| | - Gregor Žvelc
- Department of Psychology, Faculty of Arts, University of Ljubljana, Slovenia
| | - Diego De Leo
- Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
- Department of Psychology, FAMNIT, University of Primorska, Koper, Slovenia
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Arnon S, Shahar G, Brunstein Klomek A. Continuity of care in suicide prevention: current status and future directions. Front Public Health 2024; 11:1266717. [PMID: 38259744 PMCID: PMC10800998 DOI: 10.3389/fpubh.2023.1266717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Continuity of Care (CoC) is central to suicide prevention. The present study aims to review contemporary definitions, operationalization in research, and key components of CoC in the prevention of suicide. Methods The present study is a narrative review. A thorough search of available literature on CoC and suicidality was conducted. Studies published between 1995 and 2021 were reviewed and selected based on relevance to CoC and suicidality. Selected research was subsequently summarized to outline definitions of CoC, its operationalization in research, and key components for suicide prevention. Results The definition, measurement, and operationalization of CoC in suicide prevention varies tremendously, derailing clinical practice. Key elements of CoC identified across the literature include (1) CoC across multiple levels of care, (2) the role of primary care providers and case managers in CoC of suicidal patients, (3) the importance of follow up contact with suicidal patients post-treatment, and (4) the role of national and institutional guidelines for CoC of suicidal patients. Limitations: There is a dearth of randomized controlled trials and insufficient evidence on specific populations. Conclusion CoC refers to a wide, complex concept that must be broken down into specific categories that can provide more nuanced guidance of research and clinical implications.
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Affiliation(s)
- Shay Arnon
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Golan Shahar
- Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Riera-Serra P, Navarra-Ventura G, Castro A, Gili M, Salazar-Cedillo A, Ricci-Cabello I, Roldán-Espínola L, Coronado-Simsic V, García-Toro M, Gómez-Juanes R, Roca M. Clinical predictors of suicidal ideation, suicide attempts and suicide death in depressive disorder: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01716-5. [PMID: 38015265 DOI: 10.1007/s00406-023-01716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/29/2023] [Indexed: 11/29/2023]
Abstract
Patients with depressive disorders are especially prone to suicide risk. Among the clinical predictors of suicidality, those specifically related to depressive disorders have not been accurately detailed. Our aim was to conduct a systematic review and meta-analysis of studies reporting longitudinal predictors of suicidal ideation, suicide attempts and suicide death within depression, including diagnostic subtypes, symptoms, clinical course, and assessment scales. A systematic search of the literature between 2001 and 2022 identified 4422 references, among which 19 studies providing 45 different predictors of suicidality met the inclusion criteria. Random effects meta-analyses were performed for 22 predictors, three for suicidal ideation, eleven for suicide attempts and eight for suicide death. Heterogeneity and publication bias were inspected through I2 tests and Egger's tests respectively. Meta-analysis results showed that severity of hopelessness predicted suicidal ideation and suicide attempts. History of suicide attempts, suicidal ideation, severe depression, and psychotic symptoms predicted subsequent suicide attempts and suicide death. Time to full remission and sleep disturbances were also found as relevant predictors of future suicide behaviours. This review specifies which predictors of suicidality within the clinical features of depression will help clinicians and policy makers to better prevent suicide risk in patients with depressive disorders. Further longitudinal studies are needed to reliably assess the predictive ability of our results and to analyse other possible clinical predictors to prevent suicidality, especially with regard to suicidal ideation.
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Affiliation(s)
- Pau Riera-Serra
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Guillem Navarra-Ventura
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Adoración Castro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain.
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain.
| | - Margalida Gili
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Angie Salazar-Cedillo
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Balearic Islands Health Services (IB-SALUT), Primary Care Research Unit of Mallorca, Palma, Balearic Islands, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Lorenzo Roldán-Espínola
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Victoria Coronado-Simsic
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Mauro García-Toro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Rocío Gómez-Juanes
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Miquel Roca
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
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Zhang J, Liang S, Liu X, Li D, Zhou F, Xiao L, Liu J, Sha S. Factors associated with suicidal attempts in female patients with mood disorder. Front Public Health 2023; 11:1157606. [PMID: 37818303 PMCID: PMC10560740 DOI: 10.3389/fpubh.2023.1157606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
Aim This study aims to establish a nomogram model to predict the relevance of SA in Chinese female patients with mood disorder (MD). Method The study included 396 female participants who were diagnosed with MD Diagnostic Group (F30-F39) according to the 10th Edition of Disease and Related Health Problems (ICD-10). Assessing the differences of demographic information and clinical characteristics between the two groups. LASSO Logistic Regression Analyses was used to identify the risk factors of SA. A nomogram was further used to construct a prediction model. Bootstrap re-sampling was used to internally validate the final model. The Receiver Operating Characteristic (ROC) curve and C-index was also used to evaluate the accuracy of the prediction model. Result LASSO regression analysis showed that five factors led to the occurrence of suicidality, including BMI (β = -0.02, SE = 0.02), social dysfunction (β = 1.72, SE = 0.24), time interval between first onset and first dose (β = 0.03, SE = 0.01), polarity at onset (β = -1.13, SE = 0.25), and times of hospitalization (β = -0.11, SE = 0.06). We assessed the ability of the nomogram model to recognize suicidality, with good results (AUC = 0.76, 95% CI: 0.71-0.80). Indicating that the nomogram had a good consistency (C-index: 0.756, 95% CI: 0.750-0.758). The C-index of bootstrap resampling with 100 replicates for internal validation was 0.740, which further demonstrated the excellent calibration of predicted and observed risks. Conclusion Five factors, namely BMI, social dysfunction, time interval between first onset and first dose, polarity at onset, and times of hospitalization, were found to be significantly associated with the development of suicidality in patients with MD. By incorporating these factors into a nomogram model, we can accurately predict the risk of suicide in MD patients. It is crucial to closely monitor clinical factors from the beginning and throughout the course of MD in order to prevent suicide attempts.
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Affiliation(s)
- Jinhe Zhang
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sixiang Liang
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xinyu Liu
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Dan Li
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Fuchun Zhou
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Le Xiao
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jun Liu
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Muehlenkamp JJ, Grande N, Talbott M. Evidence-Based vs Informal Suicide Training: Nurse Confidence and Comfort With Suicidal Patient Care. J Emerg Nurs 2023; 49:266-274. [PMID: 36599734 DOI: 10.1016/j.jen.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/08/2022] [Accepted: 12/04/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Emergency nurses are on the front line of patient care for suicidal persons, yet many nurses report feeling unprepared to effectively manage suicidal patients owing to a lack of suicide-specific training. The purpose of this study was to examine the suicide-specific training experiences of emergency nurses and evaluate how training relates to burnout, confidence, and comfort working with suicidal patients. METHODS Emergency nurses at critical access and community hospitals completed an anonymous online survey during work hours. The survey included questions about training experiences, burnout, confidence, and comfort working with suicidal patients, perceptions of the quality and interactive nature of training, and desires for future suicide-specific intervention training. RESULTS Group comparisons among the 117 emergency nurses revealed that those who received evidence-based/expert-delivered training reported greater confidence, comfort, and perceived ability to treat suicidal patients and lower burnout than those who received informal or no training. Those with informal training reported greater confidence and ability to treat suicidal patients, but similar levels of comfort and burnout as those with no training. Mediation analyses showed that training was associated with greater comfort working with suicidal patients through its effect on increased confidence. A majority desired additional suicide-specific training. DISCUSSION Evidence-based/expert-delivered professional training in suicide intervention is associated with improved confidence, comfort, and perceived ability to care for suicidal patients and lower burnout. Providing evidence-based suicide intervention training may improve quality of care for suicidal patients by improving emergency nurse confidence and comfort for treating these high-risk patients.
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Porter JE, Dabkowski E, Connolly O, Prokopiv V. Compliance with the Zero Suicide Initiative by Mental Health Clinicians at a Regional Mental Health Service: Development and Testing of a Clinical Audit Tool. NURSING REPORTS 2022; 13:29-42. [PMID: 36648977 PMCID: PMC9844327 DOI: 10.3390/nursrep13010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022] Open
Abstract
AIM The aim of this study is to investigate the compliance of mental health clinicians in applying the Zero Suicide (ZS) approach to their clinical practice in a rural and regional health community setting. METHODS A retrospective clinical audit of six mental health teams was undertaken at a single site. A clinical audit tool was developed and validated using a six-step approach. The data was extracted and analysed via descriptive and inferential statistics and compared to a specialised mental health team, experienced with the ZS approach. RESULTS A total of 334 clinical records were extracted for January, April, August, November 2019 and June 2020. The clinical audit and analysis confirmed that the mental health teams are not consistently using the assessments from their training and are therefore not implementing all of these elements into their practice. This could have implications for the risk formulation and treatment for people at risk of suicide. CONCLUSIONS The use of a validated clinical audit tool can be beneficial to establish compliance with the mental health clinicians and to determine any areas requiring further improvement. Further education and reinforcement may be required to ensure consistency with incorporating the elements of ZS into everyday clinical practice.
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Affiliation(s)
- Joanne E. Porter
- Collaborative Evaluation & Research Group, Federation University Australia, Churchill 3842, Australia
- Correspondence: (J.E.P.); (E.D.)
| | - Elissa Dabkowski
- Collaborative Evaluation & Research Group, Federation University Australia, Churchill 3842, Australia
- Correspondence: (J.E.P.); (E.D.)
| | - Owen Connolly
- Mental Health Services, Latrobe Regional Hospital, Traralgon 3844, Australia
| | - Valerie Prokopiv
- Collaborative Evaluation & Research Group, Federation University Australia, Churchill 3842, Australia
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Rukundo GZ, Wakida EK, Maling S, Kaggwa MM, Sserumaga BM, Atim LM, Atuhaire CD, Obua C. Knowledge, attitudes, and experiences in suicide assessment and management: a qualitative study among primary health care workers in southwestern Uganda. BMC Psychiatry 2022; 22:605. [PMID: 36096787 PMCID: PMC9465925 DOI: 10.1186/s12888-022-04244-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is one of the leading causes of death globally, with over 75% of all suicides occurring in low-and middle-income Countries. Although 25% of people have contact with their health care workers before suicide attempts, most never receive proper suicide assessment and management. We explored primary care health workers' knowledge, attitudes, and experiences in evaluating and managing suicidality in structured primary healthcare services in Uganda. METHODS This was a cross-sectional qualitative study among health workers in southwestern Uganda from purposively selected health facilities. A semi-structured interview guide was used, and data were analyzed using thematic analysis. RESULTS The in-depth interviews were conducted with 18 individuals (i.e., five medical doctors, two clinical officers, two midwives, and nine nurses) from 12 health facilities in the five selected districts. Four themes emerged from the discussions: a) Knowledge and attitudes of primary healthcare workers in the assessment and management of suicidality, b) Experiences in the assessment and management of suicidality, c) challenges faced by primary healthcare workers while assessing and managing suicidality, and d) Recommendations for improving assessment and management of suicidality in PHC. Most participants were knowledgeable about suicide and the associated risk factors but reported challenges in assessing and managing individuals with suicide risk. The participants freely shared individual experiences and attitudes in the assessment and management of suicide. They also proposed possible ways to improve the evaluation and management of suicidality in PHC, such as setting up a system of managing suicidality, regularizing community sensitization, and training health workers. CONCLUSION Suicidality is commonly encountered by primary health care workers in Uganda who struggle with its assessment and management. Improving the knowledge and attitudes of primary health care workers would be a big step towards ensuring equitable services.
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Affiliation(s)
- Godfrey Z. Rukundo
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda ,African Center for Suicide Prevention and Research, Mbarara, Uganda
| | - Edith K. Wakida
- African Center for Suicide Prevention and Research, Mbarara, Uganda ,grid.33440.300000 0001 0232 6272Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samuel Maling
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark M. Kaggwa
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda ,African Center for Suicide Prevention and Research, Mbarara, Uganda ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada
| | - Baker M. Sserumaga
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Letizia M. Atim
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Clara D. Atuhaire
- grid.33440.300000 0001 0232 6272Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- grid.33440.300000 0001 0232 6272Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda
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Cultural attributes of suicidal ideation among older immigrants: a qualitative study. BMC Geriatr 2022; 22:678. [PMID: 35172754 PMCID: PMC8851697 DOI: 10.1186/s12877-021-02628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/24/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Suicide is a large and growing public health problem. Little is known about the attributes of suicidal ideation (SI) in the contexts of immigration. This qualitative study aims to explore immigration- and acculturation-related attributes of SI among older immigrants. METHODS A qualitative semi-structured interview design. Interview were conducted with 57 older Chinese immigrants in Chicago with self-reported SI in the past month. RESULTS In addition to attributes of SI which have been well documented in the literature, we identified immigration- and acculturation-related attributes, including linguistic and cultural barriers of being integrated to the receiving communities, acculturation gaps in intergenerational support, and uselessness. CONCLUSIONS Findings of the study highlight the intersectionality of race, culture, and aging regarding SI, which are essential to improve recognition and understanding of SI among immigrant populations.
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12
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Heisel MJ, Flett GL. Screening for suicide risk among older adults: assessing preliminary psychometric properties of the Brief Geriatric Suicide Ideation Scale (BGSIS) and the GSIS-Screen. Aging Ment Health 2022; 26:392-406. [PMID: 33327729 DOI: 10.1080/13607863.2020.1857690] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To initially assess psychometric properties of two abbreviated versions of the Geriatric Suicide Ideation Scale (GSIS): a 10-item Brief Geriatric Suicide Ideation Scale (BGSIS), and a 5-item Geriatric Suicide Ideation Scale-Screen (GSIS-Screen). METHODS A series of psychometric analyses was conducted, assessing the internal consistency, test-retest reliability, construct and predictive validity of the abbreviated GSIS scales. This was done by selecting-out GSIS items from a combined dataset of studies on suicide ideation in older adults: 1) The GSIS scale development study (n = 107); 2) A clinical trial of Interpersonal Psychotherapy (IPT) modified for suicidal older adults(n = 25); 3) A longitudinal study of risk and resiliency to suicide ideation in community-residing older adults (n = 173). RESULTS Overall findings demonstrated strong internal consistency, test-retest reliability, concurrent and predictive validity for the BGSIS and GSIS-Screen with older adults across community, clinical, and residential settings. CONCLUSION Study findings support the use of the abbreviated GSIS scales when conducting research on suicide risk identification among older adults. Future research is recommended testing these scales prospectively in public health, residential, and clinical settings, in research and healthcare delivery contexts.
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Affiliation(s)
- Marnin J Heisel
- Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, USA
| | - Gordon L Flett
- Department of Psychology, York University, Toronto, Ontario, Canada
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13
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"It Is Difficult to Always Be an Antagonist": Ethical, Professional, and Moral Dilemmas as Potentially Psychologically Traumatic Events among Nurses in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031454. [PMID: 35162485 PMCID: PMC8834915 DOI: 10.3390/ijerph19031454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 02/05/2023]
Abstract
AIMS We explore social and relational dynamics tied to an unexplored potentially psychologically traumatic event (PPTE) that can impact nurses' well-being and sense of their occupational responsibilities: namely, the moral, ethical, or professional dilemmas encountered in their occupational work. DESIGN We used a semi-constructed grounded theory approach to reveal prevalent emergent themes from the qualitative, open-ended component of our survey response data as part of a larger mixed-methods study. METHODS We administered a national Canadian survey on nurses' experiences of occupational stressors and their health and well-being between May and September 2019. In the current study, we analyzed data from four open text fields in the PPTE section of the survey. RESULTS In total, at least 109 participants noted that their most impactful PPTE exposure was a moral, professional, and/or ethical dilemma. These participants volunteered the theme as a spontaneous addition to the list of possible PPTE exposures. CONCLUSIONS Emergent theme analytic results suggest that physicians, other nurses, staff, and/or the decision-making power of patients' families can reduce or eliminate a nurse's perception of their agency, which directly and negatively impacts their well-being and may cause them to experience moral injury. Nurses also report struggling when left to operationalize patient care instructions with which they disagree. IMPACT Nurses are exposed to PPTEs at work, but little is known about factors that can aggravate PPTE exposure in the field, impact the mental wellness of nurses, and even shape patient care. We discuss the implications of PPTE involving moral, professional, and ethical dilemmas (i.e., potentially morally injurious events), and provide recommendations for nursing policy and practice.
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14
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Tang S, Reily NM, Arena AF, Batterham PJ, Calear AL, Carter GL, Mackinnon AJ, Christensen H. People Who Die by Suicide Without Receiving Mental Health Services: A Systematic Review. Front Public Health 2022; 9:736948. [PMID: 35118036 PMCID: PMC8804173 DOI: 10.3389/fpubh.2021.736948] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction The majority of people who die by suicide have never seen a mental health professional or been diagnosed with a mental illness. To date, this majority group has largely been ignored, with most existing research focusing on predictors of suicide such as past suicide attempts. Identifying the characteristics of people who die by suicide without receiving services, often with a fatal first attempt, is crucial to reduce suicide rates through guiding improvements to service pathways and “just in time” interventions. Methods In this systematic review, PsycInfo, PubMed, CINAHL, and Web of Science were searched for peer-reviewed articles published from 1980 to 1st March 2021. Included studies examined predictors of non-receipt of formal mental health services among people who died by suicide. Data were extracted from published reports and the quality of included studies was assessed using a modified version of the Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies. This review was registered with PROSPERO, CRD 42021226543. Results Sixty-seven studies met inclusion criteria, with sample sizes ranging from 39 to 193,152 individuals. Male sex, younger or older age, and rural location were consistently associated with non-receipt of mental health services. People not receiving mental health services were also less likely to have a psychiatric diagnosis, past suicidal behavior or contact with general health services, and more likely to use violent means of suicide. There was some evidence that minority ethnicity and psychosocial stressors were associated with service non-receipt. Conclusion People who die by suicide without receiving mental health services are likely to have diverse profiles, indicating the need for multifaceted approaches to effectively support people at risk of suicide. Identifying the needs and preferences of individuals who are at risk of suicide is crucial in developing new support pathways and services, and improving the quality of existing services. Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021226543.
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Affiliation(s)
- Samantha Tang
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
- *Correspondence: Samantha Tang
| | - Natalie M. Reily
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew F. Arena
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Philip J. Batterham
- Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Alison L. Calear
- Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Gregory L. Carter
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | | | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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15
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Exploring the impact of suicide care experiences and post-intervention supports sought among community pharmacists: a cross-sectional survey. Int J Clin Pharm 2022; 44:1247-1258. [PMID: 35445311 PMCID: PMC9718696 DOI: 10.1007/s11096-022-01398-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is a need to appropriately train, support and remunerate pharmacists for their expanding roles in mental healthcare. Pharmacists often care for people experiencing mental health crises, including suicidal thoughts and behaviours, but little is known about pharmacists' suicide care experiences. AIM This cross-sectional study aimed to explore the impact of professional experiences with people at risk of suicide and support accessed, among community pharmacists. METHOD A survey exploring pharmacists' experiences with people at risk of suicide and post-intervention support-seeking was disseminated through Australian and Canadian professional associations, conferences and social media (June 2016-May 2017). Quantitative data were analysed using Chi-squared, Fisher's exact and independent t-tests, where appropriate. Qualitative data exploring the impact of these experiences were thematically analysed, and reasons for not seeking help post-intervention were identified. RESULTS Among 378 respondents, 84% had encountered patients at risk of suicide and 28% had lost patients to suicide. Some were negatively affected personally and/or professionally (11%), of which 88% did not seek professional support, mainly due to uncertainty about available services. Pharmacists were significantly more negatively affected if they had a personal mental health diagnosis (p = 0.017) and previous suicide care experiences (p = 0.001). Qualitative themes included: expanding knowledge and skills, role limitation and emotional impact and response. CONCLUSION A large proportion of pharmacists have interacted with suicidal patients and are impacted by these experiences, yet few seek help due to lack of awareness and access. There is a need to recognize pharmacists' roles in suicide care, and develop pharmacist-specific post-intervention support.
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16
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Attitudes and opinions towards suicidality in professionals working with oncology patients: results from an online survey. Support Care Cancer 2021; 30:1775-1786. [PMID: 34599381 PMCID: PMC8727409 DOI: 10.1007/s00520-021-06590-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022]
Abstract
Objective To explore and describe attitudes and opinions towards suicidality in healthcare professionals (HCPs) working with oncological patients. Methods A 48-item online questionnaire was developed and distributed to HCPs working with cancer patients. Three hundred fifty-four answered questionnaires were analyzed. Results The majority of HCPs reported that they were able to understand why a cancer patient would commit suicide (87.8%) or would seek help from an assisted suicide organization (ASO; 83.9%). The understandable reasons were pain and physical impairments (51.4%), social isolation (19.8%), loss of control and autonomy (18.1%), terminal disease (17.2%), loss of meaning (15.3%), desperation (14.7%), and psychic distress (9.3%). Personal experiences with suicidality lead only 44.8% of HCPs to believe that thereby they would be better able to understand a patients’ wish for suicide. Religion was negatively associated with understanding of suicide and why a cancer patient would seek help from an ASO. Knowledge of suicidality was positively associated with why a cancer patient would seek help from an ASO. Conclusions There is still little knowledge in oncology about the relation of HCPs’ attitudes toward suicidality in their patients and how those attitudes influence their behavior, especially care and treatment of patients. More research on this topic is needed. It stands to reason that more education about suicidality in cancer patients seems likely to improve understanding and attitudes and thereby influence care for cancer patients.
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17
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de Mendonça Lima CA, De Leo D, Ivbijaro G, Svab I. Suicide prevention in older adults. Asia Pac Psychiatry 2021; 13:e12473. [PMID: 34114355 DOI: 10.1111/appy.12473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Suicide among older adults is a multifactorial problem with several interrelated factors involved that vary with age, gender and culture. The number of suicides is highest in those aged 70 years or older in almost all regions of the world. With the increase in life expectancy, and the decrease in mortality due to other causes of death, we could expect the absolute number of older adults' suicide continue increasing. METHODS Review of the literature on suicide protective factors of suicide among older adults. RESULTS Improvements on social determinants of health and the timely detection and early treatment of affective disorders are key interventions. Prevention based on community actions and training of gatekeepers may have positive impact. Community programs that promote a sense of usefulness, belonging and that contribute to preserve social integration should be encouraged. Governments should develop the improvement of retirement programs and the development of support systems. The access to general health and mental health services should be facilitated and Primary Care professionals should receive proper training to detect and manage older persons at risk. Actively promoting a culture of coping to different stages of life and to the changes imposed by the advancing of age should form the essential part of a process bringing to better successful aging avenues. CONCLUSIONS Suicide prevention in older adults should broaden its focus and pay attention to the many socio-environmental conditions that may be relevant in older age, especially social isolation, financial security and physical health.
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Affiliation(s)
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia.,Slovene Centre for Suicide Research, University of Primorska, Koper, Slovenia
| | - Gabriel Ivbijaro
- NOVA University, Lisbon, Portugal.,Faculty of Management, Law and Social Sciences, University of Bradford, Bradford, UK
| | - Igor Svab
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
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18
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Conner KR, Chapman BP, Beautrais AL, Brent DA, Bridge JA, Conwell Y, Falter T, Holbrook A, Schneider B. Introducing the Psychological Autopsy Methodology Checklist. Suicide Life Threat Behav 2021; 51:673-683. [PMID: 33559215 PMCID: PMC8378509 DOI: 10.1111/sltb.12738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Case-control psychological autopsy studies are the research standard for the postmortem, quantitative study of ongoing or recent risk factors for suicide. We aimed to develop a reliable checklist of methodological quality of these studies. METHOD We adapted items from a validated checklist to address general methodological elements and created novel items to address the unique aspects of psychological autopsy research to generate a 16-item checklist assessing reporting, external validity, internal validity, and power. We used percent agreement and kappa to evaluate inter-rater reliability of the items and overall checklist based on independent ratings of 26 case-control psychological autopsy studies conducted internationally. We also summed the items to generate overall quality ratings, assessing internal consistency with coefficient alpha (α). RESULTS Inter-rater reliability for the overall checklist was high (percent agreement, 86.5%) and that based conservatively on kappa was substantial (κ .71) whereas internal consistency was low (α = 0.56). The inter-rater reliability of the individual items showed acceptable to high agreement. CONCLUSION A novel checklist provides a reliable means to assess the methodological quality of specific elements of quantitative case-control psychological autopsy studies, providing detailed guidance in planning such studies. Lower internal consistency may limit its utility as a summary measure of study quality.
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Affiliation(s)
- Kenneth R. Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Benjamin P. Chapman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - David A. Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey A. Bridge
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Tyler Falter
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Amanda Holbrook
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Barbara Schneider
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Centre of Psychiatry, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany
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19
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Siau CS, Chan CMH, Wee LH, Wahab S, Visvalingam U, Chen WS, Yeoh SH, Tee JN, Yeap LLL, Ibrahim N. Depression and Anxiety Predict Healthcare Workers' Understanding of and Willingness to Help Suicide Attempt Patients. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:469-484. [PMID: 34096373 DOI: 10.1177/00302228211021746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined whether burnout, depression, anxiety, stress, lifetime suicidal ideation, self-efficacy in preventing suicide and demographic factors predicted the understanding of and willingness to help suicidal patients among hospital healthcare workers. A total of 368 healthcare workers from the major surgical and medical departments in a general hospital setting were recruited. Participants responded to the Depression Anxiety and Stress Scale-21, Self-efficacy in Suicide Prevention, and Understanding Suicide Attempt Patient Scale. Those from the psychiatric department, with higher suicide prevention self-efficacy, and lower personal accomplishment indicated more understanding and helpful attitudes; doctors, depressed and anxious healthcare workers reported less understanding and helpful attitudes. Suicide prevention efforts must be conducted in tandem with equipping and supporting the healthcare workers who manage suicidal patients.
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Affiliation(s)
- Ching Sin Siau
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Caryn Mei Hsien Chan
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Lei Hum Wee
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzaily Wahab
- Department of Psychiatry, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Uma Visvalingam
- Hospital Putrajaya, Kementerian Kesihatan Malaysia, Putrajaya, Malaysia
| | - Won Sun Chen
- Faculty of Health, Arts, and Design, Swinburne University, Hawthorn, Australia
| | - Seen Heng Yeoh
- Faculty of Medicine, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Jing Ni Tee
- Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur, Malaysia
| | | | - Norhayati Ibrahim
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Dabkowski E, Porter JE. An exploration into suicide prevention initiatives for mental health nurses: A systematic literature review. Int J Ment Health Nurs 2021; 30:610-623. [PMID: 33856744 DOI: 10.1111/inm.12872] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
Mental health and suicide prevention are national health priorities in Australia, with research currently focussed towards the ZERO Suicide (ZS) initiative. The aim of this review was to evaluate the impact of suicide prevention programmes, in particular the ZS prevention initiative. A systematic review using the PRISMA guidelines was conducted using six EBSCO Host databases; Academic Search Complete, Australian/New Zealand Reference Centre, CINAHL Complete, MEDLINE, APA PsycINFO, and APA Psyc Articles. The data extracted from the eligible papers were analysed using a thematic approach. The final data set consisted of fourteen (n = 14) peer-reviewed articles meeting the eligibility criteria, which included quantitative (n = 10), mixed methods (n = 2), and qualitative studies (n = 2). Results indicated variances between suicide prevention programmes with some papers examining single workshops and others assessing multimodal, organizational interventions. Five major themes were produced from this review including measuring the success of suicide prevention programmes, improvements to the delivery of suicide prevention programmes, barriers to implementing changes, cultural considerations, and further research required for suicide prevention programmes. This review concludes that further long-term research is required to evaluate the implementation and efficacy of suicide prevention programmes in health care. Cultural awareness in suicide prevention training is another area that may benefit from further research. A growing body of evidence establishes the need for multimodal and organizational approaches for suicide prevention initiatives.
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Affiliation(s)
- Elissa Dabkowski
- Collaborative Evaluation Unit, School of Health, Federation University Australia, Churchill, Victoria, Australia
| | - Joanne E Porter
- Collaborative Evaluation Unit, School of Health, Federation University Australia, Churchill, Victoria, Australia
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21
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Wand APF, Draper B, Brodaty H, Hunt GE, Peisah C. Evaluation of an Educational Intervention for Clinicians on Self-Harm in Older Adults. Arch Suicide Res 2021; 25:156-176. [PMID: 31941427 DOI: 10.1080/13811118.2019.1706678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Clinicians may lack knowledge and confidence regarding self-harm in older adults and hold attitudes that interfere with delivering effective care. A 1-hour educational intervention for hospital-based clinicians and general practitioners (GPs) was developed, delivered, and evaluated. Of 119 multidisciplinary clinicians working in aged care and mental health at two hospitals, 100 completed pre/post-evaluation questions. There were significant improvements in knowledge, confidence in managing, and attitudes regarding self-harm in late life, and the education was rated as likely to change clinical practice. No GP education sessions could be conducted. A brief educational intervention had immediate positive impacts for hospital-based clinicians albeit with high baseline knowledge. The sustainability of these effects and effectiveness of the intervention for GPs warrant examination.
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22
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Curtin M, Downs J, Hunt A, Coleman ER, Enneking BA, McNally Keehn R. INteractive Virtual Expert-Led Skills Training: A Multi-Modal Curriculum for Medical Trainees. Front Psychiatry 2021; 12:671442. [PMID: 34248708 PMCID: PMC8260937 DOI: 10.3389/fpsyt.2021.671442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Internationally, pediatric depression and suicide are significant issues. Additionally, in the context of the COVID-19 pandemic, pediatric mental health needs are rising astronomically. In light of Child & Adolescent Psychiatrist (CAP) subspecialist shortages in the United States (US), there is an increasing call for primary care physicians in Family Medicine and Pediatrics to address an increasingly broad variety of patient needs. Here we report on the development and preliminary evaluation of medical student and resident perceptions on the "INteractive Virtual Expert-led Skills Training" (INVEST) medical education curriculum, a virtual synchronous CAP curriculum employing active learning strategies, including expert-led discussion and video modeling, and discussion designed to meet those priorities. Methods: In a standardized 60-min training format, our curriculum leverages audience response system polling, video modeling of key clinical skills, and interactive discussion with an expert subspecialist, over a virtual video conferencing platform. The primary educational strategy relies on use of video modeling to demonstrate best practice with CAP led group discussion to solidify and explain important concepts. Five waves of medical students and residents (N = 149) participated in the INVEST curriculum and completed pre- and post-training surveys regarding knowledge and comfort in the management of pediatric patients with depression and suicidality. Results: Trainee participants reported significant positive gains in perceived likelihood of encountering pediatric suicidality as well as knowledge/comfort with depression screening and suicidality assessment in a primary care setting. Across some competency areas, there was an effect of medical learner level. Learners at lower levels generally reported the highest benefit. Medical students reported significant increases in their comfort interpreting and discussing positive depression screens and evidenced the greatest relative benefit in comfort with discussing suicidality. Conclusion: To our knowledge, INVEST is the first fully virtual, multimodal curriculum led by expert CAP subspecialists. Our findings suggest that INVEST shows promise for equipping medical learners with baseline knowledge for caring for patients with pediatric depression and suicidality. This synchronous, virtually delivered curriculum allows for critical training delivered to diverse medical learners regardless of geographic location, a particular benefit during the current COVID-19 pandemic.
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Affiliation(s)
- Michelle Curtin
- Division of Child Development, Department of Pediatrics, Riley Child Development Center, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jennifer Downs
- Division of Child Development, Department of Pediatrics, Riley Child Development Center, Indiana University School of Medicine, Indianapolis, IN, United States.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Amber Hunt
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Emily R Coleman
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Brett A Enneking
- Division of Child Development, Department of Pediatrics, Riley Child Development Center, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Rebecca McNally Keehn
- Division of Child Development, Department of Pediatrics, Riley Child Development Center, Indiana University School of Medicine, Indianapolis, IN, United States
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Lundin Å, Bergenheim A. Encountering suicide in primary healthcare rehabilitation: the experiences of physiotherapists. BMC Psychiatry 2020; 20:597. [PMID: 33375943 PMCID: PMC7771061 DOI: 10.1186/s12888-020-03004-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/07/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Suicide is a serious public health issue and one of the most common causes of death globally. Suicide has long-lasting impact on personal, relational, community and societal levels. Research has shown that patients often seek help in the primary healthcare system preceding a suicide. Studies exploring the experiences of encountering patients at risk for suicide have been performed among various categories of healthcare personnel, such as nurses and psychiatry residents as well as emergency room staff. There is a lack of research regarding primary healthcare rehabilitation staff, despite the fact that physiotherapists are the third largest health profession in the Western hemisphere and often work with patients experiencing mental health symptoms. The aim of this study was to explore the experiences of encountering patients at risk for suicide among physiotherapists working in a primary healthcare rehabilitation setting. METHODS Semi-structured interviews were conducted with 13 physiotherapists working in primary healthcare rehabilitation clinics in the Gothenburg area, Sweden. The interviews were recorded on audio and transcribed into written text. A qualitative content analysis was performed on the material collected. RESULTS The analysis of the material revealed an overarching theme, Through barriers and taboos - the physiotherapist finds a way, with five main categories: possibilities for identification, obstacles in meeting suicide, workplace environment matters, where does the patient belong? and education and experience are keys. CONCLUSIONS The present study indicates that physiotherapists in the primary healthcare system encounter patients experiencing suicidality, and they expressed a strong desire to care for both the physical and mental wellbeing of the patients. Despite reporting many barriers, the physiotherapists often found a way to form a meaningful therapeutic alliance with the patient and to ask about possible suicidality in their clinical practice. The result suggests that physiotherapists could play a larger role in working with patients experiencing suicidality in a primary healthcare setting and that they could be viewed as possible gatekeepers in identification as well as referral of these patients into other parts of the healthcare system.
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Affiliation(s)
- Åse Lundin
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
- Närhälsan Rehabilitation Centres, Region Västra Götaland, Gothenburg, Sweden.
| | - Anna Bergenheim
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Rehabilitation Centres, Region Västra Götaland, Gothenburg, Sweden
- Research, Development and Education Centre Fyrbodal, Region Västra Götaland, Vänersborg, Sweden
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John A, DelPozo-Banos M, Gunnell D, Dennis M, Scourfield J, Ford DV, Kapur N, Lloyd K. Contacts with primary and secondary healthcare prior to suicide: case-control whole-population-based study using person-level linked routine data in Wales, UK, 2000-2017. Br J Psychiatry 2020; 217:717-724. [PMID: 32744207 PMCID: PMC7705668 DOI: 10.1192/bjp.2020.137] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Longitudinal studies of patterns of healthcare contacts in those who die by suicide to identify those at risk are scarce. AIMS To examine type and timing of healthcare contacts in those who die by suicide. METHOD A population-based electronic case-control study of all who died by suicide in Wales, 2001-2017, linking individuals' electronic healthcare records from general practices, emergency departments and hospitals. We used conditional logistic regression to calculate odds ratios, adjusted for deprivation. We performed a retrospective continuous longitudinal analysis comparing cases' and controls' contacts with health services. RESULTS We matched 5130 cases with 25 650 controls (5 per case). A representative cohort of 1721 cases (8605 controls) were eligible for the fully linked analysis. In the week before their death, 31.4% of cases and 15.6% of controls contacted health services. The last point of contact was most commonly associated with mental health and most often occurred in general practices. In the month before their death, 16.6 and 13.0% of cases had an emergency department contact and a hospital admission respectively, compared with 5.5 and 4.2% of controls. At any week in the year before their death, cases were more likely to contact healthcare services than controls. Self-harm, mental health and substance misuse contacts were strongly linked with suicide risk, more so when they occurred in emergency departments or as emergency admissions. CONCLUSIONS Help-seeking occurs in those at risk of suicide and escalates in the weeks before their death. There is an opportunity to identify and intervene through these contacts.
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Affiliation(s)
- Ann John
- Department of Population Psychiatry, Suicide and Informatics, Swansea University Medical School; and Public Health Wales NHS Trust, UK,Correspondence: Ann John.
| | | | - David Gunnell
- Department of Population Health Sciences, Bristol Medical School; and NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | | | | | | | - Nav Kapur
- Division of Psychology and Mental Health, University of Manchester; and Greater Manchester Mental Health NHS Foundation Trust; and NIHR Greater Manchester Patient Safety Translational Research Centre, UK
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Stallman HM. Online needs‐based and strengths‐focused suicide prevention training: Evaluation of Care · Collaborate · Connect. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Helen M. Stallman
- School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia,
- Basil Hetzel Institute, The Queen Elizabeth Hospital Woodville South, South Australia, Australia,
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Ferguson M, Reis J, Rabbetts L, McCracken T, Loughhead M, Rhodes K, Wepa D, Procter N. The impact of suicide prevention education programmes for nursing students: A systematic review. Int J Ment Health Nurs 2020; 29:756-771. [PMID: 32567201 DOI: 10.1111/inm.12753] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 12/14/2022]
Abstract
The purpose of this systematic review was to locate and synthesize peer-reviewed evidence regarding the effectiveness of providing suicide prevention education to nursing students. Systematic searches were conducted in seven databases (EMBASE, EmCare, Joanna Briggs, MEDLINE, PsycINFO, Scopus, and Web of Science). Results were screened in duplicate at two stages: title and abstract, and full text. Critical appraisal and data extraction were also completed in duplicate. Initial database searching yielded 303 results. Following the addition of seven records from relevant reference lists, and the removal of duplicates, a total of 118 results were included for screening. Eight articles were deemed eligible for inclusion in this review; most (n = 5) were quantitative. While all were conducted within university settings, half were stand-alone education sessions, while the remaining were integrated with existing programmes/courses. The types of education programmes varied considerably across studies, with only three being established, evidence-based programmes. The studies explore a range of outcomes, which have been narratively categorized as enhanced skills, abilities, and self-confidence; development of positive attitudes and beliefs; acquisition of knowledge; and programme experience and evaluation. While there is a small body of evidence indicating that suicide prevention education programmes contribute to improvements in skills, abilities, self-confidence, and attitudes among nursing students, the variability in educational interventions and outcomes, coupled with short-term evaluation time frames, makes it difficult to fully understand the impact of this important suicide prevention strategy.
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Affiliation(s)
- Monika Ferguson
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Julie Reis
- School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Port Macquarie, New South Wales, Australia
| | - Lyn Rabbetts
- UniSA Clinical and Health Sciences, University of South Australia, Mount Gambier, South Australia, Australia
| | - Tara McCracken
- UniSA Clinical and Health Sciences, University of South Australia, Mount Gambier, South Australia, Australia
| | - Mark Loughhead
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Kate Rhodes
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Dianne Wepa
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Nicholas Procter
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Laanani M, Imbaud C, Tuppin P, Poulalhon C, Jollant F, Coste J, Rey G. Contacts with Health Services During the Year Prior to Suicide Death and Prevalent Conditions A Nationwide Study. J Affect Disord 2020; 274:174-182. [PMID: 32469801 DOI: 10.1016/j.jad.2020.05.071] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study was designed to describe contacts with health services during the year before suicide death in France, and prevalent mental and physical conditions. METHODS Data were extracted from the French National Health Data System (SNDS), which comprises comprehensive claims data for inpatient and outpatient care linked to the national causes-of-death registry. Individuals aged ≥15 years who died from suicide in France in 2013-2015 were included. Medical consultations, emergency room visits, and hospitalisations during the year preceding death were collected. Conditions were identified, and standardised prevalence ratios (SPRs) were estimated to compare prevalence rates in suicide decedents with those of the general population. RESULTS The study included 19,144 individuals. Overall, 8.5% of suicide decedents consulted a physician or attended an emergency room on the day of death, 34.1% during the week before death, 60.9% during the month before death. Most contacts involved a general practitioner or an emergency room. During the month preceding suicide, 24.4% of individuals were hospitalised at least once. Mental conditions (36.8% of cases) were 7.9-fold more prevalent in suicide decedents than in the general population. The highest SPRs among physical conditions were for liver/pancreatic diseases (SPR=3.3) and epilepsy (SPR=2.7). LIMITATIONS The study population was restricted to national health insurance general scheme beneficiaries (76% of the population living in France). CONCLUSIONS Suicide decedents have frequent contacts with general practitioners and emergency departments during the last weeks before death. Improving suicide risk identification and prevention in these somatic healthcare settings is needed.
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Affiliation(s)
- Moussa Laanani
- Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France; Strategy and Research Department, French National Health Insurance, Paris, France.
| | - Claire Imbaud
- Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France
| | - Philippe Tuppin
- Strategy and Research Department, French National Health Insurance, Paris, France
| | - Claire Poulalhon
- Centre of Research in Epidemiology and Statistics, Inserm, Villejuif, France
| | - Fabrice Jollant
- Université de Paris, Paris, France; GHU Paris Psychiatrie et Neurosciences, Sainte-Anne hospital, Paris, France; McGill Group for suicide studies, McGill University, Montréal, Canada; Nîmes university hospital (CHU), Nîmes, France
| | - Joël Coste
- Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Biostatistics and Epidemiology unit, Cochin Hospital, Paris, France; French National Public Health Agency, Saint-Maurice, France
| | - Grégoire Rey
- Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France
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Ward-Ciesielski EF, Wilks CR. Conducting Research with Individuals at Risk for Suicide: Protocol for Assessment and Risk Management. Suicide Life Threat Behav 2020; 50:461-471. [PMID: 31702077 PMCID: PMC7148174 DOI: 10.1111/sltb.12602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Suicide prediction, prevention, and intervention are urgent research areas. One barrier for research with high-risk populations is limited resources to manage risk in a research setting. We describe using the University of Washington Risk Assessment Protocol (UWRAP) to assess and manage suicide risk during phone-administered eligibility assessments in two clinical trials. METHOD Study 1 (N = 151) recruited suicidal adults who were not engaged in mental health treatment and Study 2 (N = 135) recruited suicidal adults who used alcohol to regulate emotions. Pre- and postassessment ratings of stress, urge to harm self, urge to use drugs/alcohol, and intent to harm self were compared and strategies to manage increased suicide risk following screening interviews were implemented, as indicated. RESULTS In both studies, average postassessment ratings were significantly lower than pre-assessment. A minority of participants reported higher ratings on one or more domains; however, following more thorough suicide risk assessment, risk was appropriately managed by providing low-level interventions (e.g., validation). CONCLUSIONS Suicide risk in research involving community participants can be managed by using appropriate risk protocols.
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Management in primary care at the time of a suicide attempt and its impact on care post-suicide attempt: an observational study in the French GP sentinel surveillance system. BMC FAMILY PRACTICE 2020; 21:55. [PMID: 32213164 PMCID: PMC7098086 DOI: 10.1186/s12875-020-01126-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/11/2020] [Indexed: 11/17/2022]
Abstract
Background We aimed to describe primary care management at the time of a suicide attempt (SA) and after the SA. Methods An observational (cross-sectional) study was conducted among 166 sentinel GPs within France (a non-gatekeeping country) between 2013 and 2017 for all GP’s patients who attempted suicide. Measurements: frequency of patients 1) managed by the GP at the time of the SA, 2) addressed to an emergency department (ED), 3) without care at the time of the SA, and 4) managed by the GP after the SA and factors associated with GP management at the time of and after the SA. Results Three hundred twenty-one SAs were reported, of which N = 95 (29.6%) were managed by the GP at the time of the SA, N = (70.5%) were referred to an ED, and N = (27.4%) remained at home. Forty-eight (14.9%) patients did not receive any care at the time of the SA and 178 (55.4%) were managed directly by an ED. GPs were more likely to be involved in management of the patient at the time of the SA if they were younger (39.2% for patients < 34 years old; 22.9% for those 35 to 54 years old, and 30.3% for those more than 55 years old p = 0.02) or the SA involved a firearm or self-cutting (51.9%) versus those involving drugs (23.7%); p = 0.006). After the SA, GPs managed 174 patients (54.2%), more often (60%) when they provided care at home at the time of the SA, p = 0.04; 1.87 [1.07; 3.35]. No other factor was associated with management by GPs after the SA. Conclusions The study faced limitations: data were not available for patients managed solely by specialists during their SA and results may not be generalisable to countries with a stronger gatekeeping system. We concluded that GPs are involved in the management of patients at the time of a SA for a third of patients. EDs are the major provider of care at that time. Half patients consulted GPs after the SA and connections between GPs and ED upon discharge should be improved.
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Zia B, Heisel MJ, Peckham SB, Rosen S. A Psychometric Assessment of the Suicidal Behaviors Questionnaire (SBQ-5) and Geriatric Suicide Ideation Scale-Screen (GSIS-screen) in Middle-Aged and Older Men. Clin Gerontol 2020; 43:46-60. [PMID: 31854266 DOI: 10.1080/07317115.2019.1656695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives. To investigate the psychometric properties of the five-item Suicidal Behaviors Questionnaire (SBQ-5) and the Geriatric Suicide Ideation Scale-Screen (GSIS-Screen, submitted) among community-residing middle-aged and older men.Methods. The SBQ-5 and GSIS-Screen were administered to 93 men, 55 years or older, who participated in an eligibility assessment (Time 1) for an upstream psychological intervention study to prevent the onset of suicide ideation among men struggling to transition to retirement. Eligible participants later completed the full GSIS and measures of depression and hopelessness at a pre-group assessment (Time 2).Results. The SBQ-5 was positively associated with the GSIS-Screen at the eligibility assessment. Internal consistency for both measures was low but acceptable. Time 1 scores on both screens predicted suicide ideation at Time 2, controlling for the intervening time lag and for baseline cognitive and physical functioning. Only the GSIS-Screen uniquely predicted future depression and hopelessness ratings.Conclusions. The SBQ-5 and the GSIS-Screen have acceptable psychometric properties among middle-aged and older community-residing men; the GSIS-Screen is more closely associated with later-life suicide risk factors.Clinical Implications. Brief screening tools may be of use in effectively identifying suicide ideation in community-residing middle-aged and older men.
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Affiliation(s)
- Belal Zia
- Department of Psychology, The University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marnin J Heisel
- Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry and Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Ontario, Canada.,Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, New York, USA
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Wilson R, Hepgul N, Higginson IJ, Gao W. End-of-life care and place of death in adults with serious mental illness: A systematic review and narrative synthesis. Palliat Med 2020; 34:49-68. [PMID: 31608768 DOI: 10.1177/0269216319867847] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND People with serious mental illness have greater mortality risk than the general population. They experience health care inequalities throughout life; it is not clear if this persists to end of life. AIM Assess the empirical evidence describing end-of-life care and place of death for people with serious mental illness. DESIGN A systematic review of original, peer-reviewed research, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analysed using a narrative synthesis approach. DATA SOURCES Five online databases (Embase, PsycArticles, PsycINFO, Medline, PubMed) and additional sources were searched (without time restriction) for primary research reporting health care utilisation in the last year of life or place of death in adults with serious mental illness. RESULTS After full-text screening, 23 studies were included. We found studies reporting hospital admissions, emergency department care, palliative care, and general practitioner (GP) visits at end of life. We found conflicting evidence for the association between serious mental illness and end-of-life care, although different patient groups, settings and measures were used across studies. People with serious mental illness were more likely to die in care homes than the general population. There were no patterns for other places of death. CONCLUSIONS The evidence was sparse and heterogeneous, demonstrating variability in patterns and reporting of health care use and with little consensus on where people with serious mental illness are likely to die. Given that people with serious mental illness have increased mortality risk, this gap in the knowledge around end-of-life care outcomes is concerning; this area of research needs further development.
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Affiliation(s)
- Rebecca Wilson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Nugent AC, Ballard ED, Park LT, Zarate CA. Research on the pathophysiology, treatment, and prevention of suicide: practical and ethical issues. BMC Psychiatry 2019; 19:332. [PMID: 31675949 PMCID: PMC6824024 DOI: 10.1186/s12888-019-2301-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/20/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite decades of research, the rate of death from suicide is rising in the United States. Suicide is a complex and multifactorial phenomenon and, to date, no validated biomarkers that predict suicidal behavior have been identified. Only one FDA-approved drug to prevent suicide exists, and it is approved only for patients with schizophrenia. Although anti-suicide psychotherapeutic techniques exist, treatment takes time, and only preliminary data exist for rapid-acting therapies. DISCUSSION While more research into suicidal ideation and acute suicidal behavior is clearly needed, this research is fraught with both practical and ethical concerns. As a result, many investigators and bioethicists have called for restrictions on the types of research that individuals with suicidal behavior can participate in, despite the fact that the available empirical evidence suggests that this research can be done safely. This manuscript presents background information on the phenomenology of suicide, discusses the current state of treatment and prevention strategies, and reviews the practical and ethical issues surrounding suicide research in the context of available empirical data. Currently, the causes of suicide are poorly understood, in part due to the fact that very few studies have investigated the acute suicidal crisis. Although some biomarkers for predicting risk have been developed, none have been sufficiently validated. The most successful current interventions involve means restriction. However, while numerous hurdles face researchers, these are not insurmountable. The available evidence suggests that research into suicide can be conducted both safely and ethically.
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Affiliation(s)
- Allison C. Nugent
- 0000 0004 0464 0574grid.416868.5Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA ,0000 0004 0464 0574grid.416868.5Magnetoencephalography Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth D. Ballard
- 0000 0004 0464 0574grid.416868.5Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | - Lawrence T. Park
- 0000 0004 0464 0574grid.416868.5Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | - Carlos A. Zarate
- 0000 0004 0464 0574grid.416868.5Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
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Williams AA. The Next Step in Integrated Care: Universal Primary Mental Health Providers. J Clin Psychol Med Settings 2019; 27:115-126. [PMID: 31087238 DOI: 10.1007/s10880-019-09626-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Current models of mental health care often do not address three barriers to mental health: the binary view of mental illness (healthy vs. mentally ill), stigma, and prevention. Care models where some patients are selected for referral or consultation with a mental health professional can reinforce this binary view and the stigma associated with seeing mental health services. By only selecting patients who currently are experiencing mental health problems, current integrated care models do not offer sufficient avenues for prevention. To address these barriers, this article proposes building on current models through the development of primary mental health providers (PMHPs). PMHPs-like primary care providers-would provide regular check-ups, assessments, prevention interventions, first-line treatment, or referral to more specialized professionals. This universal approach will help decrease the binary view of mental health, decrease the stigma of seeing a mental health professional through universal access, and improve prevention efforts.
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Affiliation(s)
- Adrienne A Williams
- Department of Family Medicine, University of Illinois at Chicago College of Medicine, 1919 W Taylor St., MCC 663, Chicago, IL, 60612, USA.
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Elzinga E, Gilissen R, Donker GA, Beekman ATF, de Beurs DP. Discussing suicidality with depressed patients: an observational study in Dutch sentinel general practices. BMJ Open 2019; 9:e027624. [PMID: 31023763 PMCID: PMC6501984 DOI: 10.1136/bmjopen-2018-027624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This paper aims to describe the degree to which general practitioners (GPs) explore suicidal behaviour among depressed patients in the Netherlands. DESIGN An observational study of consultations between GPs and depressed patients. SETTING 39 sentinel GP practices within the Netherlands in 2017. PARTICIPANTS Patients with a registration of depression. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measure is suicide exploration by the GP. Secondary outcome measures at patient level, assessed by surveying GPs, include prevalence and severity of suicidal thoughts. Secondary outcome measures at GP level include follow-up actions of GP and reasons not to explore suicidality. RESULTS A total of 1034 questionnaires were included in the analyses. GPs assessed and explored suicidality in 44% of patients with depression (66% in patients with a new episode of depression). GPs explored suicidal feelings more often in patients with a new episode of depression (OR 4.027, p<0.001, 95% CI 2.924 to 5.588), male patients (OR 1.709, p<0.001, 95% CI 1.256 to 2.330) or younger patients (OR 1.017, p<0.001, 95% CI 1.009 to 1.026). Multilevel analysis showed that 22% of the variation in suicide exploration is due to differences in GP practice. Thirty-eight per cent of the patients who were asked by their GP, reported (severe) suicidal ideation. Most GPs (68%) did not explore suicidal feelings because they thought the patient would not be suicidal. CONCLUSION GPs explored suicidal thoughts in less than half of all depressed patients and in two-thirds of patients with a new episode of depression. Suicide prevention training is recommended to enhance suicide exploration.
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Affiliation(s)
- Elke Elzinga
- 113 Suicide Prevention, Amsterdam, The Netherlands
| | | | - Gé A Donker
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Aartjan T F Beekman
- Psychiatry, Amsterdam Public Health (research institute), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Derek P de Beurs
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Conner KR, Bridge JA, Davidson DJ, Pilcher C, Brent DA. Metaanalysis of Mood and Substance Use Disorders in Proximal Risk for Suicide Deaths. Suicide Life Threat Behav 2019; 49:278-292. [PMID: 29193261 PMCID: PMC8378507 DOI: 10.1111/sltb.12422] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/07/2017] [Indexed: 11/30/2022]
Abstract
Evidence for proximal risk factors for suicide is based on case-control psychological autopsy studies, with these reports showing that mood and substance use disorders are the most prevalent mental disorders among suicide decedents worldwide and are associated with marked risk. However, moderators of risk and the degree of risk associated with (nonalcohol) drug use disorder are unknown. A comprehensive search was used to identify 35 case-control psychological autopsy studies published worldwide over a 30-year period that were metaanalyzed using random effects models. Major depression, odds ratio (95% confidence interval) = 9.14 (5.53, 15.09), and drug use disorder, OR (95% CI) = 7.18 (3.22, 16.01), had large effect sizes, among other results. Risk estimates associated with major depression were greater in studies with a larger proportion of women and those conducted in Asia compared with other regions. There was no evidence of publication bias or that any one study had a disproportionate impact on findings. Risk for suicide associated with major depression appears to be moderated by sex and/or world region. Drug use disorder is a potent risk factor, illustrating the importance of assessing drug use in clinical risk assessment.
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Affiliation(s)
| | - Jeffrey A. Bridge
- Nationwide Children's Hospital; Columbus OH USA
- Ohio State University; Columbus OH USA
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Annor FB, Bayakly RA, Morrison RA, Bryan MJ, Gilbert LK, Ivey-Stephenson AZ, Holland KM, Simon TR. Suicide Among Persons With Dementia, Georgia, 2013 to 2016. J Geriatr Psychiatry Neurol 2019; 32:31-39. [PMID: 30477384 PMCID: PMC6690600 DOI: 10.1177/0891988718814363] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Findings from studies examining the relationship between dementia and suicide have been inconsistent. This study examined the characteristics, precipitants, and risk factors for suicide among persons with dementia. METHODS Data from the Georgia Alzheimer's Disease and Related Dementia registry were linked with 2013 to 2016 data from Georgia Vital Records and Georgia Violent Death Reporting System. Descriptive statistics were calculated and logistic regression was used to examine risk factors for suicide. RESULTS Ninety-one Georgia residents with dementia who died by suicide were identified. Among decedents with known circumstances, common precipitants included depressed mood (38.7%) and physical health problems (72.6%). Suicide rate among persons with dementia was 9.3 per 100 000 person-years overall and substantially higher among those diagnosed in the past 12 months (424.5/100 000 person-years). Being male, dementia diagnosis before age 65, and a recent diagnosis of dementia independently predicted suicide, but not depression or cardiovascular diseases. CONCLUSION Prevention strategies that identify at-risk individuals, provide support, and ensure continuity of care for persons diagnosed with dementia may help reduce suicide in this population.
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Affiliation(s)
- Francis B. Annor
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Leah K. Gilbert
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Asha Z. Ivey-Stephenson
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristin M. Holland
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas R. Simon
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ferguson M, Dollman J, Jones M, Cronin K, James L, Martinez L, Procter N. Suicide Prevention Training – Improving the Attitudes and Confidence of Rural Australian Health and Human Service Professionals. CRISIS 2019; 40:15-26. [DOI: 10.1027/0227-5910/a000524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: Suicide rates are higher in rural and remote areas of Australia compared with major cities. Aim: To evaluate the impact of a brief, community-based suicide prevention educational intervention on the attitudes and confidence of rural South Australian health and human service professionals. Method: Participants attended a 1-day suicide prevention education program, and completed a survey at four time points: baseline (T1), immediately pretraining (T2), immediately posttraining (T3), and 4-month follow-up (T4). Main outcome measures were self-reported attitudes and confidence when working with people vulnerable to suicide. Results: A total of 248 people attended the training, with 213 participants completing the survey at T1, 236 at T2, 215 at T3, and 172 at T4. There were significant improvements in 11 of the 14 attitude items between T2 and T3 (immediate change), and between T1 and T4 (maintained change). Further, there were significant improvements in all four confidence items between T2 and T3, and T1 and T4. Limitations: Despite the repeated-measures design, findings are limited by the lack of a control group. Conclusion: Findings extend the international evidence by indicating the value of brief suicide prevention education for improving health and human service professionals' attitudes and confidence in rural Australia.
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Affiliation(s)
- Monika Ferguson
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia
| | - James Dollman
- University Department of Rural Health, University of South Australia, Adelaide, SA, Australia
| | - Martin Jones
- University Department of Rural Health, University of South Australia, Adelaide, SA, Australia
| | - Kathryn Cronin
- Country Health South Australia Local Health Network, Port Lincoln, SA, Australia
| | - Lynne James
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia
| | - Lee Martinez
- University Department of Rural Health, University of South Australia, Adelaide, SA, Australia
| | - Nicholas Procter
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia
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The future of population medicine: Investigating the role of advanced practice providers and simulation education in special patient populations. Dis Mon 2018; 65:221-244. [PMID: 30583793 DOI: 10.1016/j.disamonth.2018.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advanced practice providers (APPs) have come to play an increasingly significant role in the United States healthcare system in the past five decades, particularly in primary care. The first portion of this paper will explore the utilization of APPs in specific patient populations: pediatrics, obstetrics, geriatrics, and psychiatry. After a brief discussion of the demand for these specialties, the authors will outline the educational preparation and competencies that nurse practitioners and physician assistants must achieve before working with these special populations. Finally, the authors will discuss the current and future roles of APPs in pediatric, obstetric, geriatric, and psychiatric populations. Simulated patient interactions and scenarios have become integrated into clinical education for many health care providers. Although traditionally utilized only in emergency medicine education, medical simulation has grown to become a staple of training in nearly every area of medicine. Healthcare providers of all levels can benefit from both individual and team-based training designed to improve everything from patient communication to procedural competence. The flexible nature of simulation training allows for customized teaching that is directly relevant to a specific specialty. The second half of this paper will demonstrate simulation's versatilite applications in the specialty areas of urgent care, pediatrics, mental health, geriatrics, and obstetrics.
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Muñoz-Sánchez JL, Sánchez-Gómez MC, Martín-Cilleros MV, Parra-Vidales E, de Leo D, Franco-Martín MA. Addressing Suicide Risk According to Different Healthcare Professionals in Spain: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102117. [PMID: 30261622 PMCID: PMC6210587 DOI: 10.3390/ijerph15102117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/21/2018] [Accepted: 09/23/2018] [Indexed: 12/25/2022]
Abstract
This study analyzes the views of four groups of healthcare professionals who may play a role in the management of suicidal behavior. The goal was to identify key factors for suicide prevention in different areas of the healthcare system. Qualitative research was conducted using focus groups made up of different healthcare professionals who participated in the identification, management, and prevention of suicidal behavior. Professionals included were primary care physicians, psychologists, psychiatrists, and emergency physicians. 'Suicide' was amongst the most relevant terms that came up in discussions most of the times it appeared associated with words such as 'risk', danger', or 'harm'. In the analysis by categories, the four groups of professionals agreed that interventions in at-risk behaviors are first in importance. Prevention was the second main concern with greater significance among psychiatrists. Primary care professionals call for more time to address patients at risk for suicide and easier access to and communication with the mental health network. Emergency care professionals have a lack of awareness of their role in the detection of risk for suicide in patients who seek attention at emergency care facilities for reasons of general somatic issues. Mental health care professionals are in high demand in cases of self-harm, but they would like to receive specific training in dealing with suicidal behavior.
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Affiliation(s)
- Juan-Luis Muñoz-Sánchez
- Psychiatry and Mental Health Department, Hospital Universitario Río Hortega, C/ Dulzaina, 2, 47012 Valladolid, Spain.
| | - María Cruz Sánchez-Gómez
- Departamento de Didáctica, Organización y Métodos de Investigación, Facultad de Educación, Universidad de Salamanca, Paseo de Canalejas 169, 37008 Salamanca, Spain.
| | - María Victoria Martín-Cilleros
- Departamento de Didáctica, Organización y Métodos de Investigación, Facultad de Educación, Universidad de Salamanca, Paseo de Canalejas 169, 37008 Salamanca, Spain.
| | | | - Diego de Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Manuel A Franco-Martín
- Psychiatry and Mental Health Department, Hospital Universitario Río Hortega, C/ Dulzaina, 2, 47012 Valladolid, Spain.
- Departamento de Personalidad, Evaluación y Tratamiento psicológico, Facultad de Psicología, Universidad de Salamanca, Campus Ciudad Jardín, 37005 Salamanca, Spain.
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Wand APF, Peisah C, Draper B, Brodaty H. Why Do the Very Old Self-Harm? A Qualitative Study. Am J Geriatr Psychiatry 2018; 26:862-871. [PMID: 29627192 DOI: 10.1016/j.jagp.2018.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine the perspectives of people aged 80 years or older who self-harmed regarding their reasons for self-harm and its consequences, and their perceptions of care. DESIGN A qualitative study using in-depth interviews. SETTING Participants were recruited from two teaching hospitals and associated community services. PARTICIPANTS People aged 80 years or older who had self-harmed within the previous month. METHODS Structured psychiatric assessment including cognitive testing, DSM-5 diagnosis, and an in-depth qualitative interview focusing upon the reasons for and consequences of self-harm. Narrative enquiry was used to guide the discussion. All interviews were undertaken by a geriatric psychiatrist, audio recorded, transcribed verbatim, and subjected to thematic analysis using N-VIVO. RESULTS Themes that emerged for the reasons for self-harm included "enough is enough"; "loneliness"; "disintegration of self"; "being a burden"; "cumulative adversity"; "hopelessness and endless suffering"; "helplessness with rejection"; and "the untenable situation". Themes for the consequences of self-harm were "becoming engaged with or distanced from family"; "the problem was solved"; "gaining control"; "I"m worse off now"; "rejection by health professionals"; and "tension in the role of the inpatient clinical environment". CONCLUSIONS Self-harm may communicate a need that cannot otherwise be expressed. An individualized person-centered approach is required to respond to self-harm, including a combination of practical, medical, and psychological approaches as indicated. Involvement of families in the process of understanding the meaning of and responding to self-harm through education and family therapy, as well as education of healthcare professionals beyond risk factor notation may be indicated.
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Affiliation(s)
- Anne P F Wand
- Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia; School of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia.
| | - Carmelle Peisah
- School of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Brian Draper
- Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia; School of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia; Dementia Centre for Research Collaboration and Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
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Draper B, Krysinska K, Snowdon J, De Leo D. Awareness of Suicide Risk and Communication Between Health Care Professionals and Next-of-Kin of Suicides in the Month Before Suicide. Suicide Life Threat Behav 2018. [PMID: 28640962 DOI: 10.1111/sltb.12365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Based on psychological autopsy data, the study compared awareness of suicide risk in the deceased among next-of-kin (NOK) and health care professionals (HCPs), and communication between these two groups in the month before death. The NOKs had significantly more knowledge about the decedent's suicide warning signs than the HCPs (90.5% vs. 44.6%). Contact between NOK and HCP was initiated more often by the family than the HCPs (29.4% vs. 5.9%). The study found communication gaps between HCPs and NOK and stresses the need for suicide prevention strategies strengthening communication between these two groups.
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Affiliation(s)
- Brian Draper
- School of Psychiatry, University of NSW, Sydney, NSW, Australia
| | | | - John Snowdon
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Qld, Australia
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Vedana KGG, Pereira CCM, Dos Santos JC, Ventura C, Moraes SM, Miasso AI, Zanetti ACG, Borges TL. The meaning of suicidal behaviour from the perspective of senior nursing undergraduate students. Int J Ment Health Nurs 2018; 27:1149-1161. [PMID: 29282843 DOI: 10.1111/inm.12431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 11/27/2022]
Abstract
The meaning ascribed to suicidal behaviours may influence the quality of the care provided to people at risk of suicide. Such a phenomenon has yet to be properly investigated amongst nursing undergraduate students, the aim of this study being to gain an understanding of the meanings of suicidal behaviour for a particular group of nurses. The study, which utilized grounded theory, was conducted in Brazil in 2016-2017 with 30 undergraduate students. The findings indicated that suicidal behaviour, classified according to the individual beliefs and judgements of the participants, presented a significant barrier to the delivery of care and was complex and multifaceted care phenomenon. Participants were often reluctant to discuss the topic, seemingly wanting to distance themselves from the care of persons exhibiting suicidal behaviour, and to avoid professional engagements relating to suicide prevention. Significant work is required in raising both an awareness and knowledge of suicidal behaviour befitting the promotion of tolerance, emotional competency, resilience, and empathy amongst nursing students.
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Affiliation(s)
- Kelly G G Vedana
- Department of Psychiatric Nursing and Human Sciences, The Ribeirao Preto Nursing School, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Camila C M Pereira
- Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Carla Ventura
- Department of Psychiatric Nursing and Human Sciences, The Ribeirao Preto Nursing School, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sabrina M Moraes
- Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Adriana I Miasso
- Department of Psychiatric Nursing and Human Sciences, The Ribeirao Preto Nursing School, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana Carolina G Zanetti
- Department of Psychiatric Nursing and Human Sciences, The Ribeirao Preto Nursing School, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Tatiana L Borges
- Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Graves JM, Mackelprang JL, Van Natta SE, Holliday C. Suicide Prevention Training: Policies for Health Care Professionals Across the United States as of October 2017. Am J Public Health 2018; 108:760-768. [PMID: 29672147 DOI: 10.2105/ajph.2018.304373] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify and compare state policies for suicide prevention training among health care professionals across the United States and benchmark state plan updates against national recommendations set by the surgeon general and the National Action Alliance for Suicide Prevention in 2012. METHODS We searched state legislation databases to identify policies, which we described and characterized by date of adoption, target audience, and duration and frequency of the training. We used descriptive statistics to summarize state-by-state variation in suicide education policies. RESULTS In the United States, as of October 9, 2017, 10 (20%) states had passed legislation mandating health care professionals complete suicide prevention training, and 7 (14%) had policies encouraging training. The content and scope of policies varied substantially. Most states (n = 43) had a state suicide prevention plan that had been revised since 2012, but 7 lacked an updated plan. CONCLUSIONS Considerable variation in suicide prevention training for health care professionals exists across the United States. There is a need for consistent polices in suicide prevention training across the nation to better equip health care providers to address the needs of patients who may be at risk for suicide.
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Affiliation(s)
- Janessa M Graves
- Janessa M. Graves, Carrie Holliday, and Sara Van Natta are with the College of Nursing, Washington State University, Spokane. Jessica L. Mackelprang is with the Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia. Sara E. Van Natta is also with Seattle Children's Hospital, Seattle, WA
| | - Jessica L Mackelprang
- Janessa M. Graves, Carrie Holliday, and Sara Van Natta are with the College of Nursing, Washington State University, Spokane. Jessica L. Mackelprang is with the Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia. Sara E. Van Natta is also with Seattle Children's Hospital, Seattle, WA
| | - Sara E Van Natta
- Janessa M. Graves, Carrie Holliday, and Sara Van Natta are with the College of Nursing, Washington State University, Spokane. Jessica L. Mackelprang is with the Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia. Sara E. Van Natta is also with Seattle Children's Hospital, Seattle, WA
| | - Carrie Holliday
- Janessa M. Graves, Carrie Holliday, and Sara Van Natta are with the College of Nursing, Washington State University, Spokane. Jessica L. Mackelprang is with the Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia. Sara E. Van Natta is also with Seattle Children's Hospital, Seattle, WA
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Suicidal ideation and subsequent completed suicide in both psychiatric and non-psychiatric populations: a meta-analysis. Epidemiol Psychiatr Sci 2018; 27:186-198. [PMID: 27989254 PMCID: PMC6998965 DOI: 10.1017/s2045796016001049] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Several authors claimed that expression of suicidal ideation is one of the most important predictors of completed suicide. However, the strength of the association between suicidal ideation and subsequent completed suicide has not been firmly established in different populations. Furthermore, the absolute suicide risk after expression of suicidal ideation is unknown. In this meta-analysis, we examined whether the expression of suicidal ideation predicted subsequent completed suicide in various populations, including both psychiatric and non-psychiatric populations. METHODS A meta-analysis of cohort and case-control studies that assessed suicidal ideation as determinant for completed suicide in adults. Two independent reviewers screened 5726 articles for eligibility and extracted data of the 81 included studies. Pooled risk ratios were estimated in a random effects model stratified for different populations. Meta-regression analysis was used to determine suicide risk during the first year of follow-up. RESULTS The risk for completed suicide was clearly higher in people who had expressed suicidal ideation compared with people who had not, with substantial variation between the different populations: risk ratio ranging from 2.35 (95% confidence interval (CI) 1.43-3.87) in affective disorder populations to 8.00 (95% CI 5.46-11.7) in non-psychiatric populations. In contrast, the suicide risk after expression of suicidal ideation in the first year of follow-up was higher in psychiatric patients (risk 1.40%, 95% CI 0.74-2.64) than in non-psychiatric participants (risk 0.23%, 95% CI 0.10-0.54). Past suicide attempt-adjusted risk ratios were not pooled due to large underreporting. CONCLUSIONS Assessment of suicidal ideation is of priority in psychiatric patients. Expression of suicidal ideation in psychiatric patients should prompt secondary prevention strategies to reduce their substantial increased risk of suicide.
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45
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De Berardis D, Martinotti G, Di Giannantonio M. Editorial: Understanding the Complex Phenomenon of Suicide: From Research to Clinical Practice. Front Psychiatry 2018; 9:61. [PMID: 29545757 PMCID: PMC5839093 DOI: 10.3389/fpsyt.2018.00061] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/12/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Domenico De Berardis
- NHS, Psychiatric Service of Diagnosis and Treatment, Department of Mental Health, Hospital "G. Mazzini", ASL 4, Teramo, Italy.,Department of Neurosciences and Imaging, Università degli Studi "G. d'Annunzio" Chieti, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, Università degli Studi "G. d'Annunzio" Chieti, Chieti, Italy.,Department of Pharmacy, Pharmachology and Clinical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Università degli Studi "G. d'Annunzio" Chieti, Chieti, Italy
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Siau CS, Wee LH, Ibrahim N, Visvalingam U, Yeap LLL, Wahab S. Gatekeeper Suicide Training's Effectiveness Among Malaysian Hospital Health Professionals: A Control Group Study With a Three-Month Follow-Up. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:227-234. [PMID: 30036213 DOI: 10.1097/ceh.0000000000000213] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION There is a lack of suicide-related training in the nonpsychiatric health professional's basic education. We suggest that a continuing education through a brief gatekeeper suicide training program could be a suitable platform to improve suicide-related knowledge, self-efficacy, and attitudes. This study aimed at examining the effectiveness of the Question, Persuade, Refer gatekeeper program on improving the knowledge, self-efficacy in suicide prevention, and understanding of/willingness to help suicidal patients of Malaysian hospital health professionals. METHODS The Question, Persuade, Refer program materials were translated and adapted for implementation in the hospital setting for nonpsychiatric health professionals. There were 159 (mean age = 35.75 years; SD = 12.26) participants in this study. Most participants were female (84.9%), staff/community nurses (52.2%), who worked in the general medical department (30.2%) and had no experience managing suicidal patients (64.2%). Intervention participants (n = 53) completed a survey questionnaire at pretraining, immediately after training, and after three months. Control participants (n = 106) were not exposed to the training program and completed the same questionnaire at baseline and three months later. RESULTS Significant improvement occurred among intervention participants in terms of perceived knowledge, self-efficacy, and understanding of/willingness to help suicidal patients immediately after training and when compared with the control participants 3 months later. Improvements in declarative knowledge were not maintained at the 3-month follow-up. DISCUSSION This study confirmed the short-term effectiveness of the gatekeeper training program. Gatekeeper suicide training is recommended for implementation for nonpsychiatric health professionals nationwide.
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Affiliation(s)
- Ching Sin Siau
- Ms. Siau and Dr. Ibrahim: Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia. Dr. Wee: Associate Professor, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia. Dr. Visvalingam: Putrajaya Hospital, Ministry of Health Malaysia, Putrajaya, Malaysia. Ms. Yeap: Stats Consulting Pvt. Ltd., Kuala Lumpur, Malaysia. Dr. Wahab: UKM Medical Centre, Kuala Lumpur, Malaysia
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Stene-Larsen K, Reneflot A. Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scand J Public Health 2017; 47:9-17. [DOI: 10.1177/1403494817746274] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To examine rates of contact with primary and mental health care prior to suicide in men and women and across a range of age categories. Method: The authors performed a systematic review of 44 studies from 2000 to 2017 of which 36 reported rates on contact with primary health care and 14 reported on contact with mental health care prior to suicide. Results: Contact with primary health care was highest in the year prior to suicide with an average contact rate of 80%. At one month, the average rate was 44%. The lifetime contact rate for mental health care was 57%, and 31% in the final 12 months. In general, women and those over 50 years of age had the highest rates of contact with health care prior to suicide. Conclusions: Contact with primary health care prior to suicide is common even in the final month before death. The findings presented in this study highlight the importance of placing suicide prevention strategies and interventions within the primary health care setting.
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Affiliation(s)
- Kim Stene-Larsen
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, Norway
| | - Anne Reneflot
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, Norway
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Giacchero Vedana KG, Magrini DF, Zanetti ACG, Miasso AI, Borges TL, Dos Santos MA. Attitudes towards suicidal behaviour and associated factors among nursing professionals: A quantitative study. J Psychiatr Ment Health Nurs 2017; 24:651-659. [PMID: 28741801 DOI: 10.1111/jpm.12413] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2017] [Indexed: 11/27/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Self-confident health professionals with positive and understanding attitudes can take better care of people with suicidal behaviour, but the factors associated with these attitudes are not known. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The majority of nursing professionals had no experience or training in mental health or suicide. They were less self-confident and had more negative attitudes. Nurses and nursing assistants who worked before in mental health services were more understanding with people with suicidal behaviour. Nurses and nursing assistants who were working in prehospital services were less self-confident to taking care of people with suicidal behaviour. Some members of the nursing team had already seriously considered committing suicide. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The practicing, support and training in mental health may improve the nurses' attitudes and emotional competencies. It is important to know why few nurses had suicide-related training, despite the relevance of this issue. Training in mental health or suicide need to include attitudinal and emotional competencies. It is important to offer emotional support to emergency nursing professionals. ABSTRACT Background The attitudes towards suicide of emergency nurses may affect the care provided. However, the factors associated with these attitudes remain unclear. Objective To investigate attitudes towards suicidal behaviour and associated factors among nursing professionals working in emergency settings. Methods A cross-sectional observational study including 28 nurses and 118 who were nursing assistants employed at two emergency services in Brazil was conducted. Data were collected in 2015 using a self-administered sociodemographic questionnaire and the Suicide Behavior Attitude Questionnaire (SBAQ). Results The majority of participants reported having no experience or training in mental health or suicide. They reported more negative feelings towards the patient and a lower self-perception of professional competence regarding suicidal behaviours, and these attitudes seemed to reinforce each other. Nurses who worked in mental health services reported less moralistic/judgemental attitudes. Working in prehospital services was associated with having a lower self-perception of professional competence. There were professionals who reported thinking seriously about committing suicide. Conclusion When combined with support and training, practicing mental health nursing may serve as an opportunity to develop favourable attitudes and emotional competences, and these issues need to be addressed in suicide education strategies.
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Affiliation(s)
- K G Giacchero Vedana
- Ribeirao Preto College of Nursing, University of Sao Paulo, Ribeirao Preto, Brazil
| | - D F Magrini
- Ribeirao Preto College of Nursing, University of Sao Paulo, Ribeirao Preto, Brazil
| | - A C G Zanetti
- Ribeirao Preto College of Nursing, University of Sao Paulo, Ribeirao Preto, Brazil
| | - A I Miasso
- Ribeirao Preto College of Nursing, University of Sao Paulo, Ribeirao Preto, Brazil
| | - T L Borges
- Ribeirão Preto School of Nursing, University of São Paulo-USP, Sao Paulo, Brazil
| | - M A Dos Santos
- Faculty of Philosophy, Sciences and Letters, University of Sao Paulo, Ribeirão Preto, Brazil
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49
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Han J, Batterham PJ, Calear AL, Randall R. Factors Influencing Professional Help-Seeking for Suicidality. CRISIS 2017; 39:175-196. [PMID: 29052431 DOI: 10.1027/0227-5910/a000485] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence suggests that the majority of people with suicidality do not seek help. Little systematic evaluation of factors influencing professional help-seeking has been done. AIMS To systematically evaluate the factors that influence professional help-seeking for suicidality. METHOD Published quantitative and qualitative studies in Medline and PsycInfo databases were reviewed following PRISMA. RESULTS In all, 55 relevant studies were identified. Of these, 15 studies examined professional help-seeking intentions for perceived suicidal ideation, among people with or without suicidality; 21 studies examined professional help-seeking behavior among people with suicidality; and 19 studies examined suicidal decedents' health services use. Several potential important barriers were identified including high self-reliance, lack of perceived need for treatment, and stigmatizing attitudes toward suicide, toward mental health issues, and toward seeking professional treatment. The presence of suicidality and mental health issues was found to generally decrease help-seeking intentions for perceived suicidal ideation while facilitating actual service use. Social support and informal support from family and friends also played an important role in professional help-seeking. LIMITATIONS Although the majority of the included studies were of sound quality, some of the factors identified in the review were assessed in relatively few studies, and most of the included studies were conducted in industrialized countries. CONCLUSION Further quantitative and qualitative studies examining the potential important factors in broader community samples, especially in developing countries, are needed.
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Affiliation(s)
- Jin Han
- 1 Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia
| | - Philip J Batterham
- 1 Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia
| | - Alison L Calear
- 1 Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia
| | - Rebecca Randall
- 1 Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia
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Abstract
Major depression is a common condition seen in the primary care setting. This article describes the suicide risk assessment of a depressed patient, including practical aspects of history-taking, consideration of factors in deciding if a patient requires immediate transfer for inpatient care and measures to be taken if the patient is not hospitalised. It follows on our earlier article about the approach to management of depression in primary care.
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Affiliation(s)
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore
| | - Yin Ping Ng
- Penang Medical College, Penang, Malaysia.,Penang Adventist Hospital, Penang, Malaysia
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