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García-Fernández A, Bobes-Bascarán T, Martínez-Cao C, González-Blanco L, Fernández-Fernández J, Zurrón-Madera P, Seijo Zazo E, Jiménez-Treviño L, García-Portilla MP, Bobes J, Sáiz PA. Psychological interventions for suicidal behavior in adolescents: a comprehensive systematic review. Transl Psychiatry 2024; 14:438. [PMID: 39414779 DOI: 10.1038/s41398-024-03132-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/23/2024] [Accepted: 09/25/2024] [Indexed: 10/18/2024] Open
Abstract
BACKGROUND Recent evidence indicates that the risk of death by suicide in teenagers has increased significantly worldwide. Consequently, different therapeutic interventions have been proposed for suicidal behavior in this particular population. Therefore, the main objective of this study is to provide an updated review of the existing psychological interventions for the treatment of suicide attempts (SA) in adolescents and to analyze the efficacy of such interventions. METHODS A systematic review was conducted following PRISMA guidelines. The studies were identified by searching PubMed, PsychINFO, Web of Science, and Scopus databases from 2016 to 2022. According to the inclusion criteria, a total of 40 studies that tested the efficacy of different psychological interventions were selected. RESULTS Various psychological interventions for adolescents with suicidal behaviors were identified. Most of those present promising results. However, to summarize results from recent years, dialectical behavior therapy (DBT) was the most common and the only treatment shown to be effective for adolescents at high risk of suicide and SA. In contrast, empirical evidence for other psychological interventions focusing on deliberate self-harm (SH) is inconclusive. CONCLUSIONS Interventions specifically designed to reduce suicidal risk in adolescents have multiplied significantly in recent years. There are a few promising interventions for reducing suicidal behaviors in adolescents evaluated by independent research groups. However, replication and dismantling studies are needed to identify the effects of these interventions and their specific components. An important future challenge is to develop brief and effective interventions to reduce the risk of death by suicide among the adolescent population.
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Affiliation(s)
- Ainoa García-Fernández
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Teresa Bobes-Bascarán
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain.
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain.
- Department of Psychology, Universidad de Oviedo, Oviedo, Spain.
| | - Clara Martínez-Cao
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Leticia González-Blanco
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- CIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Paula Zurrón-Madera
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Elisa Seijo Zazo
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- CIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Jiménez-Treviño
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- CIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - María Paz García-Portilla
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- CIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Julio Bobes
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- CIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar A Sáiz
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
- CIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
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Moran P, Chandler A, Dudgeon P, Kirtley OJ, Knipe D, Pirkis J, Sinyor M, Allister R, Ansloos J, Ball MA, Chan LF, Darwin L, Derry KL, Hawton K, Heney V, Hetrick S, Li A, Machado DB, McAllister E, McDaid D, Mehra I, Niederkrotenthaler T, Nock MK, O'Keefe VM, Oquendo MA, Osafo J, Patel V, Pathare S, Peltier S, Roberts T, Robinson J, Shand F, Stirling F, Stoor JPA, Swingler N, Turecki G, Venkatesh S, Waitoki W, Wright M, Yip PSF, Spoelma MJ, Kapur N, O'Connor RC, Christensen H. The Lancet Commission on self-harm. Lancet 2024; 404:1445-1492. [PMID: 39395434 DOI: 10.1016/s0140-6736(24)01121-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 10/14/2024]
Affiliation(s)
- Paul Moran
- Centre for Academic Mental Health, Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
| | - Amy Chandler
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Pat Dudgeon
- Poche Centre for Indigenous Health, School of Indigenous Studies, University of Western Australia, Perth, WA, Australia
| | | | - Duleeka Knipe
- Centre for Academic Mental Health, Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane Pirkis
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Jeffrey Ansloos
- Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Melanie A Ball
- Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Kate L Derry
- Poche Centre for Indigenous Health, School of Indigenous Studies, University of Western Australia, Perth, WA, Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Veronica Heney
- Institute for Medical Humanities, Durham University, Durham, UK
| | - Sarah Hetrick
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Ang Li
- Department of Psychology, Beijing Forestry University, Beijing, China
| | - Daiane B Machado
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil; Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | | | - David McDaid
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Thomas Niederkrotenthaler
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Matthew K Nock
- Department of Psychology, Harvard University, Boston, MA, USA
| | - Victoria M O'Keefe
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Joseph Osafo
- Department of Psychology, University of Ghana, Accra, Ghana
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | - Soumitra Pathare
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Shanna Peltier
- Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Tessa Roberts
- Unit for Social and Community Psychiatry, Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jo Robinson
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Orygen, Melbourne, VIC, Australia
| | - Fiona Shand
- Black Dog Institute, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Stirling
- School of Health and Social Sciences, Abertay University, Dundee, UK
| | - Jon P A Stoor
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Natasha Swingler
- Orygen, Melbourne, VIC, Australia; Royal Children's Hospital, Melbourne, VIC, Australia
| | - Gustavo Turecki
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Svetha Venkatesh
- Applied Artificial Intelligence Institute, Deakin University, Geelong, VIC, Australia
| | - Waikaremoana Waitoki
- Faculty of Māori and Indigenous Studies, The University of Waikato, Hamilton, New Zealand
| | - Michael Wright
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Paul S F Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention and Department of Social Work and Social Administration, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Michael J Spoelma
- Black Dog Institute, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Navneet Kapur
- Centre for Mental Health and Safety and National Institute for Health Research Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; Mersey Care NHS Foundation Trust, Prescot, UK
| | - Rory C O'Connor
- Suicidal Behaviour Research Lab, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Christensen
- Black Dog Institute, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Langjord T, Pedersen G, Bovim T, Bremer K, Christensen TB, Hove O, Kildahl AN, Mork E, Norheim AB, Ramleth RK, Romm KL, Siqveland J, Schønning T, Stänicke LI, Torgersen T, Pettersen MS, Tveit T, Urnes Ø, Walby FA, Kvarstein EH. Evaluation of health services and treatment alliance among extensively hospitalized patients due to severe self-harm - results from the Extreme Challenges project. Nord J Psychiatry 2024; 78:591-602. [PMID: 39126325 DOI: 10.1080/08039488.2024.2376162] [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: 01/30/2024] [Revised: 04/23/2024] [Accepted: 06/30/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Extensive psychiatric hospitalization due to repeated severe self-harm (SH), is a poorly researched area, but a challenge within health services (HS). Recent studies have demonstrated high levels of involuntary treatment among patients with severe personality disorder (PD) and complex comorbidity. Keeping focus on extensively hospitalized SH patients, this study aimed to investigate patients' and clinicians' evaluation of HS and treatment alliance. METHOD A cross-sectional study with an inpatient sample (age >18 years) with frequent (>5) or long (>4 weeks) psychiatric hospital admissions last year due to SH or SA recruited from 12 hospitals across health regions (N = 42). Evaluation included patient and clinician report. RESULTS A minority of the patients (14%) were satisfied with HS before the current admission, 45% (patients) and 20% (clinicians) found the current admission helpful, and 46% (patients) and 14% (clinicians) worried about discharge. Treatment complaints were received in 38% of the cases. Outpatient mental HS were available after discharge for 68% and a majority of clinicians indicated satisfactory contact across HS. More intensive or specialized formats were unusual (structured outpatient treatment 35%, day treatment 21%, ambulatory services 32%, planned inpatient services 31%). Mutual problem understanding, aims, and confidence in therapists during the hospital stay were limited (patient-rated satisfactory mutual problem understanding: 39%, aims of stay: 50%, confidence: 50%). Patient and therapist alliance-ratings were in concordance for the majority. CONCLUSION The study highlights poor HS satisfaction, poor patient-therapist coherence, limited treatment alliance and limited follow-up in structured treatments addressing SH or intermediary supportive ambulatory/day/inpatient services.
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Affiliation(s)
- Tuva Langjord
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
| | - Geir Pedersen
- Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Tone Bovim
- Regional Centre - Violence, Trauma and Suicide Prevention, Oslo, Norway
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Kjetil Bremer
- Department for National and Regional Functions, National Advisory Unit Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Oddbjørn Hove
- Department of Research and Innovation, Helse Fonna Health Trust, Haugesund, Norway
| | - Arvid Nikolai Kildahl
- National Advisory Unit Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Nevsom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Erlend Mork
- Early Intervention in Psychosis Advisory Unit for Southeast Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Ruth-Kari Ramleth
- Department for Child and Adolescent Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Kristin Lie Romm
- Early Intervention in Psychosis Advisory Unit for Southeast Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johan Siqveland
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department for Research, Division of Mental Health and Addiction, Akershus University Hospital, Oslo, Norway
| | | | - Line Indrevoll Stänicke
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- Child and Adolescent Psychiatry, Nic Waal Institute, Lovisenberg Hospital, Oslo, Norway
| | - Terje Torgersen
- Department of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mona S Pettersen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tone Tveit
- Division of Mental Health and Addiction, Bergen University Hospital, Bergen, Norway
| | - Øyvind Urnes
- Department for National and Regional Functions, National Advisory Unit Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elfrida Hartveit Kvarstein
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Jerome L, Masood S, Henden J, Bird V, Ougrin D. Solution-focused approaches for treating self-injurious thoughts and behaviours: a scoping review. BMC Psychiatry 2024; 24:646. [PMID: 39354404 PMCID: PMC11443805 DOI: 10.1186/s12888-024-06101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 09/20/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Self-injurious thoughts and behaviours are a major global public health concern, not least because they are one of suicide's strongest predictors. Solution-focused approaches are a psychotherapeutic approach currently being used to treat individuals with self-injurious thoughts and behaviours but there is little published evidence of their use. We conducted a scoping review to provide a comprehensive overview of how solution-focused approaches are being used to treat self-injurious thoughts and behaviours. METHODS Publications describing a solution-focused approach being delivered to any individuals experiencing any form of self-injurious thought and/or behaviour were eligible for inclusion. Five databases were searched (EMBASE, PubMed, Web of Knowledge, PsycINFO, and Google Scholar) from inception to August 2024. Search terms contained keywords relating to both solution-focused and self-injurious thoughts and/or behaviours. Data were analysed using relevant steps from a narrative synthesis approach to summarise the participants, concepts, context and outcomes described in the included publications. RESULTS Twenty-four publications were included in the review. Publications demonstrated a global reach although the majority were published in the UK and USA. Five publications formally assessed and reported outcomes; two randomised controlled trials, one experimental pilot study, one case study, and one single group study. Only the Beck Depression Inventory was collected in more than one study (n = 4), with a range of other psychopathology and wellbeing-related measures. Three studies reported qualitative data, finding positive perceptions of the approaches by patients and clinicians. Fifty-one unique components were identified within solution-focused approaches. Often specific adaptations were described, or components were introduced, that specifically addressed suicide or self-harm. For example, identifying and working on goals related to reducing or stopping self-harm, or scaling questions that assess how suicidal someone currently feels on a 0 to 10 scale. CONCLUSIONS This review demonstrates the application of solution-focused approaches for treating individuals with self-injurious thoughts and behaviours. The findings provide a comprehensive overview of how these approaches are delivered. The lack of outcome data and empirical studies highlights a need for more formalised evidence.
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Affiliation(s)
- Lauren Jerome
- Youth Resilience Unit, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Saba Masood
- Youth Resilience Unit, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Victoria Bird
- Unit for Social and Community Psychiatry, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Dennis Ougrin
- Youth Resilience Unit, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Wang L, Xian X, Hu J, Liu M, Cao Y, Dai W, Tang Q, Han W, Qin Z, Wang Z, Huang X, Ye M. The relationship between future time perspective and suicide ideation in college students: Multiple mediating effects of anxiety and depression. Heliyon 2024; 10:e36564. [PMID: 39263109 PMCID: PMC11386029 DOI: 10.1016/j.heliyon.2024.e36564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 07/30/2024] [Accepted: 08/19/2024] [Indexed: 09/13/2024] Open
Abstract
Background Suicide ideation has high prevalence in adolescents, better future time perspective is considered a protective role for anxiety, depression, and suicide ideation. However, the impact of future time perspective on suicide ideation remains unclear, especially when anxiety and depression as mediating roles. Methods A cross-sectional study of college students was performed in Chongqing, China. There are 851 students enrolled in this study and we distribute questionnaires through the WeChat platform to obtain data in 2023. We conducted Pearson correlation analysis and descriptive statistics. Model 6 in PROCESS 4.0 was used to test the multiple mediating effect. Results College students who have higher future time perspective are associated with a lower risk of anxiety, depression, and suicide ideation. Future time perspective not only affects suicide ideation directly, but also influence it by means of two mediating pathways: ①depression, the mediation effect is 37.41 %; ②the multiple mediating effects of anxiety and depression with a mediating effect of 29.68 %. Conclusion Higher future time perspective functions as a protective role in anxiety, depression, and suicide ideation; future time perspective can affect and predict the occurrence of suicide ideation by influencing anxiety and depression in college students. This conclusion will be a novel and insightful part of adolescent mental health research, and provide a new perspective to prevent college students from committing suicide in the future.
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Affiliation(s)
- Liang Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xiaobing Xian
- The Thirteenth People's Hospital of Chongqing, Chongqing, China
- Chongqing Geriatrics Hospital, Chongqing, China
| | - Jingjie Hu
- Faculty of Science, Department of Statistics, The Chinese University of Hong Kong, China
| | - Meiling Liu
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yulin Cao
- School of the First Clinical, Chongqing Medical University, Chongqing, China
| | - Weizhi Dai
- School of the First Clinical, Chongqing Medical University, Chongqing, China
| | - Qiwei Tang
- School of the First Clinical, Chongqing Medical University, Chongqing, China
| | - Wenbei Han
- School of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Zhen Qin
- School of the First Clinical, Chongqing Medical University, Chongqing, China
| | - Zhe Wang
- School of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Xinting Huang
- Peking University Chongqing Research Institute of Big Data, Chongqing, China
| | - Mengliang Ye
- School of Public Health, Chongqing Medical University, Chongqing, China
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Lawrence-Sidebottom D, Huffman LG, Beam AB, McAlister K, Guerra R, Parikh A, Roots M, Huberty J. Using a Digital Mental Health Intervention for Crisis Support and Mental Health Care Among Children and Adolescents With Self-Injurious Thoughts and Behaviors: Retrospective Study. JMIR Form Res 2024; 8:e54816. [PMID: 39151166 PMCID: PMC11364954 DOI: 10.2196/54816] [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: 11/22/2023] [Revised: 02/16/2024] [Accepted: 06/17/2024] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND Self-injurious thoughts and behaviors (SITBs) are increasing dramatically among children and adolescents. Crisis support is intended to provide immediate mental health care, risk mitigation, and intervention for those experiencing SITBs and acute mental health distress. Digital mental health interventions (DMHIs) have emerged as accessible and effective alternatives to in-person care; however, most do not provide crisis support or ongoing care for children and adolescents with SITBs. OBJECTIVE To inform the development of digital crisis support and mental health care for children and adolescents presenting with SITBs, this study aims to (1) characterize children and adolescents with SITBs who participate in a digital crisis response service, (2) compare anxiety and depressive symptoms of children and adolescents presenting with SITBs versus those without SITBs throughout care, and (3) suggest future steps for the implementation of digital crisis support and mental health care for children and adolescents presenting with SITBs. METHODS This retrospective study was conducted using data from children and adolescents (aged 1-17 y; N=2161) involved in a pediatric collaborative care DMHI. SITB prevalence was assessed during each live session. For children and adolescents who exhibited SITBs during live sessions, a rapid crisis support team provided evidence-based crisis support services. Assessments were completed approximately once a month to measure anxiety and depressive symptom severity. Demographics, mental health symptoms, and change in the mental health symptoms of children and adolescents presenting with SITBs (group with SITBs) were compared to those of children and adolescents with no SITBs (group without SITBs). RESULTS Compared to the group without SITBs (1977/2161, 91.49%), the group with SITBs (184/2161, 8.51%) was mostly made up of adolescents (107/184, 58.2%) and female children and adolescents (118/184, 64.1%). At baseline, compared to the group without SITBs, the group with SITBs had more severe anxiety and depressive symptoms. From before to after mental health care with the DMHI, the 2 groups did not differ in the rate of children and adolescents with anxiety symptom improvement (group with SITBs: 54/70, 77% vs group without SITBs: 367/440, 83.4%; χ21=1.2; P=.32) as well as depressive symptom improvement (group with SITBs: 58/72, 81% vs group without SITBs: 255/313, 81.5%; χ21=0; P=.99). The 2 groups also did not differ in the amount of change in symptom severity during care with the DMHI for anxiety (t80.20=1.37; P=.28) and depressive (t83.75=-0.08; P=.99) symptoms. CONCLUSIONS This study demonstrates that participation in a collaborative care DMHI is associated with improved mental health outcomes in children and adolescents experiencing SITBs. These results provide preliminary insights for the use of pediatric DMHIs in crisis support and mental health care for children and adolescents presenting with SITBs, thereby addressing the public health issue of acute mental health crisis in children and adolescents.
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Affiliation(s)
| | | | | | | | | | - Amit Parikh
- Mental Fitness Clinic, Los Angeles, CA, United States
| | | | - Jennifer Huberty
- Bend Health, Inc, Madison, WI, United States
- FitMinded Inc, LLC, Phoenix, AZ, United States
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Cottrell D, Wright-Hughes A, Farrin A, Walwyn R, Mughal F, Truscott A, Diggins E, Irving D, Fonagy P, Ougrin D, Stahl D, Wright J. Reducing self-harm in adolescents: the RISA-IPD individual patient data meta-analysis and systematic review. Health Technol Assess 2024:1-42. [PMID: 39024118 DOI: 10.3310/gtnt6331] [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: 07/20/2024] Open
Abstract
Background Self-harm is common in adolescents and a major public health concern. Evidence for effective interventions is lacking. An individual patient data meta-analysis has the potential to provide more reliable estimates of the effects of therapeutic interventions for self-harm than conventional meta-analyses, to explore which treatments are best suited to certain groups. Method A systematic review and individual patient data meta-analysis of randomised controlled trials of therapeutic interventions to reduce repeat self-harm in adolescents who had a history of self-harm and presented to clinical services. Primary outcome was repetition of self-harm. The methods employed for searches, study screening and selection, and risk of bias assessment are described, with an overview of the outputs of the searching, selection and quality assessment processes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance is followed. Results We identified a total 39 eligible studies, from 10 countries, where we sought Individual Patient Data (IPD), of which the full sample of participants were eligible in 18 studies and a partial sample of participants were eligible in 21 studies. We obtained IPD from 26 studies of 3448 eligible participants. For our primary outcome, repetition of self-harm, only 6 studies were rated as low risk of bias with 10 rated as high risk (although 2 of these were for secondary outcomes only). Conclusions Obtaining individual patient data for meta-analyses is possible but very time-consuming, despite clear guidance from funding bodies that researchers should share their data appropriately. More attention needs to be paid to seeking appropriate consent from study participants for (pseudo) anonymised data-sharing and institutions need to collaborate on agreeing template data-sharing agreements. Researchers and funders need to consider issues of research design more carefully. Our next step is to analyse all the data we have collected to see if it will tell us more about how we might prevent repetition of self-harm in young people. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/117/11. A plain language summary of this research article is available on the NIHR Journals Library Website https://doi.org/10.3310/GTNT6331.
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Affiliation(s)
- David Cottrell
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Alex Wright-Hughes
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, School of Medicine, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, School of Medicine, University of Leeds, Leeds, UK
| | - Rebecca Walwyn
- Complex Interventions Division, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, School of Medicine, University of Leeds, Leeds, UK
| | - Faraz Mughal
- School of Medicine, Keele University, Keele, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Keele University, Keele, UK
| | - Alex Truscott
- Research Department of Clinical, Educational and Health Psychology, University College, London, UK
| | - Emma Diggins
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College, London, UK
| | - Dennis Ougrin
- Youth Resilience Unit, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Daniel Stahl
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Judy Wright
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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8
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Yang J, Zhao Y. Examining bidirectional relations between sleep problems and non-suicidal self-injury/suicidal behavior in adolescents: emotion regulation difficulties and externalizing problems as mediators. Eur Child Adolesc Psychiatry 2024; 33:2397-2411. [PMID: 38150149 DOI: 10.1007/s00787-023-02334-1] [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: 07/09/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023]
Abstract
Based on previous empirical evidences and theoretical framework, sleep problems and non-suicidal self-injury (NSSI)/suicidal behavior may bidirectionally related to one another. However, this still needs to be examined through longitudinal research. Moreover, the mediating mechanisms accounting for their potential bidirectional relations have yet to be fully investigated. This study thus aimed to evaluate whether sleep problems and NSSI/suicidal behavior promoted each other directly or indirectly through the mediating roles of emotion regulation difficulties (ERD) and externalizing problems. A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69; SD = 0.82; Age range = 11-16 years old at T1) completed self-report measures on 3-time points across 1 year. Cross-lagged panel models were used to examine the focal longitudinal associations. Results revealed a predictive effect of sleep problems on NSSI and a positive bidirectional relation between sleep problems and suicidal behavior. Moreover, sleep problems exerted an indirect effect on NSSI through ERD, and vice versa. Additionally, both ERD and externalizing problems served as mediators in the pathway from suicidal behavior to sleep problems. This study disentangled the differential mediating roles of ERD and externalizing problems in the longitudinal associations between sleep problems and NSSI/suicidal behavior, which may help provide a more holistic theoretical framework through which to precisely identify key targets for early prevention and intervention of sleep problems and NSSI/suicidal behavior in adolescents.
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Affiliation(s)
- Jiaping Yang
- Department of Psychology, Guangzhou University, 230 Wai Huan Xi Rd, 510006, Guangzhou, China.
| | - Yinqiu Zhao
- School of Psychology, South China Normal University, 510631, Guangzhou, People's Republic of China
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9
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Wang J, Han M, Xi Y, He X, Feng Y, Chen R. A longitudinal study of self-injurious thoughts and behaviors transitions and help-seeking intentions among young adults. Suicide Life Threat Behav 2024. [PMID: 38934487 DOI: 10.1111/sltb.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Engagement in self-injurious thoughts and behaviors (SITBs) is associated with low help-seeking intentions. Nevertheless, prior research has primarily relied on cross-sectional data, leaving uncertainties about the longitudinal dynamics between SITBs and help-seeking intentions. This study aims to investigate the longitudinal relationship between SITBs and help-seeking intentions for them. METHOD A one-year interval follow-up investigation was conducted among 1788 Chinese students (71.5% girls, Mage = 19.5). Changes in help-seeking intentions were initially analyzed among four SITBs transition groups. Subsequently, a cross-lagged model was employed to explore the possible bidirectional associations. RESULTS 232 participants (12.90%) experienced changes in SITBs, while 65 participants (3.60%) exhibited sustained SITBs between two measurement time points. Changes in help-seeking intentions varied across SITBs transition groups. Participants whose SITBs faded 1 year later showed a significant increase in help-seeking intentions, whereas those who experienced newly developed SITBs across two measurement time points demonstrated a significant decline. The cross-lagged analysis revealed that help-seeking intentions negatively predicted the subsequent risk of experiencing SITBs. CONCLUSIONS Greater help-seeking intentions predicted decreased SITBs 1 year later. Changes in help-seeking intentions serve as a valuable indicator for distinguishing between different types of SITBs transition. These findings underscore the importance of implementing prevention and intervention strategies targeted at enhancing help-seeking intentions to reduce SITBs.
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Affiliation(s)
- Juan Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Meng Han
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yingjun Xi
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiaoxiao He
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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10
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Syversen AM, Schønning V, Fjellheim GS, Elgen I, Wergeland GJ. Evaluation of dialectical behavior therapy for adolescents in routine clinical practice: a pre-post study. BMC Psychiatry 2024; 24:447. [PMID: 38877441 PMCID: PMC11177375 DOI: 10.1186/s12888-024-05876-z] [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: 03/22/2024] [Accepted: 05/29/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Self-harm and suicidal ideation are prevalent among adolescents, cause physical and psychosocial disability, and have potentially life-threatening consequences. Dialectical behavioral therapy for Adolescents (DBT-A) is an evidence-based intervention for reducing self-harm. However, few studies have investigated the effectiveness of DBT-A when delivered in routine clinical practice. METHODS A follow-up cohort study, based on data from a quality assessment register of DBT-A in child and adolescent mental health services including seven outpatient clinics. Inclusion criteria were ongoing or a history of self-harming behavior the last 6 months; current suicidal behavior; at least 3 criteria of DSM-IV Borderline personality disorder (BPD), or at least the self-destruction criterion of DSM-IV BPD, in addition to minimum 2 subthreshold criteria; and fluency in Norwegian. Participants received 20 weeks of DBT-A consisting of multifamily skills training groups and individual therapy sessions. Outcomes from 41 participants included frequency of self-harm, suicide attempts and hospitalizations caused by self-harm or suicide attempts, assessed pre-, during, and post-treatment by self-report and reviews of the patient's medical records. Suicidal ideation, urge to self-harm and perceived feelings of happiness and sadness were assessed by the patients' diary cards at week 1, 5, 10, 15 and 20 of the treatment program. RESULTS Participants attended an average of 17.9 (SD = 4.7) individual sessions, 14.7 (SD = 3.4) group-based skills training sessions and 4.6 (SD = 4.1) brief intersession telephone consultations. Moderate to large within-group effect sizes (ES) were found in self-harm from pre-treatment to 1-5 weeks (d = 0.64), 6-10 weeks (d = 0.84), 11-15 weeks (d = 0.99), 16-20 weeks (d = 1.26) and post-treatment (d = 1.68). Nine participants were admitted to hospitalization during DBT-A, whereas five had attempted suicide, but no suicides were completed. No statistically significant changes were found in suicidal ideation, urge to self-harm or perceived feelings of happiness or sadness from pre to post treatment. CONCLUSION The findings of the current study are promising as the participants reported considerably reduced self-harm behavior after DBT-A treatment in a child and adolescent mental health outpatient setting.
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Affiliation(s)
- Anne Mari Syversen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021, Bergen, Norway.
| | - Viktor Schønning
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Gro Sydnes Fjellheim
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Bergen, Norway
| | - Irene Elgen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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11
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Yoon NY, Yun I, Jung YH, Park EC, Jang SI. Associations between the type of help after sexual harm and adolescents' suicidal ideation. J Adolesc 2024; 96:684-695. [PMID: 36895155 DOI: 10.1002/jad.12160] [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: 07/01/2022] [Revised: 12/09/2022] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION This cross-sectional study aimed to determine the association between receiving external help after sexual harm and suicidal ideation among Korean adolescents. The help received was classified into professional and nonprofessional to test the strength of the association according to the type of help. METHODS Using data from the 2017-2019 Korean children and youth rights study, we analyzed a total of 18,740 middle and high school students. The dependent variable was suicidal ideation; the primary and secondary independent variable was experience of sexual harm and receiving help after sexual harm, respectively. Data were analyzed using χ2 tests and multivariable logistic regression analyses. RESULTS Experience of sexual harm was significantly associated with higher suicidal ideation, and receiving help after sexual harm was significantly associated with lower suicidal ideation compared with not receiving help, regardless of gender. Furthermore, lower suicidal ideation was more strongly associated with receiving professional help in female adolescents, and receiving nonprofessional help in male adolescents. CONCLUSIONS Receiving help after sexual harm was negatively associated with suicidal ideation, and the strength of this association varied with gender and the type of help received. These results can aid the development of evidence-based crisis intervention for victims of sexual harm.
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Affiliation(s)
- Na-Young Yoon
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Il Yun
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Yun Hwa Jung
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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12
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Bojke C, Cottrell D, Wright-Hughes A, Farrin A, Tubeuf S. Long-term cost-utility analysis of family therapy vs. treatment as usual for young people seen after self-harm. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:49. [PMID: 38811931 PMCID: PMC11138073 DOI: 10.1186/s12962-024-00546-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 04/16/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The joint evidence of the cost and the effectiveness of family-based therapies is modest. OBJECTIVE To study the cost-effectiveness of family therapy (FT) versus treatment-as-usual (TAU) for young people seen after self-harm combining data from an 18-month trial and hospital records up to 60-month from randomisation. METHODS We estimate the cost-effectiveness of FT compared to TAU over 5 years using a quasi-Markov state model based on self-harm hospitalisations where probabilities of belonging in a state are directly estimated from hospital data. The primary outcome is quality-adjusted life years (QALY). Cost perspective is NHS and PSS and includes treatment costs, health care use, and hospital attendances whether it is for self-harm or not. Incremental cost-effectiveness ratios are calculated and deterministic and probabilistic sensitivity analyses are conducted. RESULTS Both trial arms show a significant decrease in hospitalisations over the 60-month follow-up. In the base case scenario, FT participants incur higher costs (mean +£1,693) and negative incremental QALYs (-0.01) than TAU patients. The associated ICER at 5 years is dominated and the incremental health benefit at the £30,000 per QALY threshold is -0.067. Probabilistic Sensitivity Analysis finds the probability that FT is cost-effective is around 3 - 2% up to a maximum willingness to pay of £50,000 per QALY. This suggest that the extension of the data to 60 months show no difference in effectiveness between treatments. CONCLUSION Whilst extended trial follow-up from routinely collected statistics is useful to improve the modelling of longer-term cost-effectiveness, FT is not cost-effective relative to TAU and dominated in a cost-utility analysis.
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Affiliation(s)
- Chris Bojke
- Leeds Institute of Health Sciences, Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - David Cottrell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | | | - Amanda Farrin
- Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK
| | - Sandy Tubeuf
- Institute of Health and Society, Institute of Social and Economic Research, Université catholique de Louvain, Louvain-la-Neuve, Belgium
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13
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Lascelles KM, Davey Z, Jackson D, Aveyard H. Experiences and needs of adult informal carers of adults at risk of suicide: A systematic review with mixed methods analysis. J Adv Nurs 2024; 80:1686-1718. [PMID: 38010822 DOI: 10.1111/jan.15940] [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: 03/24/2023] [Revised: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
AIM To systematically review and synthesize primary research on experiences and needs of adult informal caregivers of adults at risk of suicide. DESIGN Systematic review with a data-based convergent synthesis. DATA SOURCES MEDLINE, PsychINFO and CINAHL were searched in April 2022 and February 2023. English language research focusing on experiences of adult carers of adults was included. METHODS Articles were screened by title (n = 9077) and abstract (n = 132) with additional articles (n = 6) obtained via citation and hand searching. Thirty-one included studies were quality assessed using the Mixed Methods Appraisal Tool and study data were systematically extracted prior to thematic synthesis. RESULTS Five interconnected themes resulted: transitions; living with fear and uncertainty; changing relationships; interface with healthcare professionals and services; what carers need and want. Caring impacts mental, physical and social wellbeing. Relationships are affected in ways which might not be evident when caring for a minor. Repeated suicidal behaviour is particularly challenging with ongoing hypervigilance contributing to burden, burnout and interpersonal strain. Poor carer support exacerbates negative effects; carers need to feel informed, educated, involved and holistically supported. CONCLUSION Timely support for carers is essential. Interventions should address emotional responses, relational changes and effective care recipient support. Longitudinal research is required to understand effects of ongoing caring where there are multiple suicide attempts. IMPLICATIONS Nurses can provide carers with early support and information and longer term psychosocial interventions. If carers are adequately equipped and supported patient safety and wellbeing will be improved. IMPACT Findings of this systematic review include relational changes due to carer hypervigilance reducing autonomy and living with the possibility of suicide. Clinician awareness of the potential for relational shifts will help them prepare and support carers. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution.
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Affiliation(s)
| | - Zoe Davey
- Oxford Institute of Nursing Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Debra Jackson
- University of Sydney, Sydney, New South Wales, Australia
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14
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Gryglewicz K, Orr VL, McNeil MJ, Taliaferro LA, Hines S, Duffy TL, Wisniewski PJ. Translating Suicide Safety Planning Components Into the Design of mHealth App Features: Systematic Review. JMIR Ment Health 2024; 11:e52763. [PMID: 38546711 PMCID: PMC11009854 DOI: 10.2196/52763] [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: 09/14/2023] [Revised: 12/19/2023] [Accepted: 12/31/2023] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Suicide safety planning is an evidence-based approach used to help individuals identify strategies to keep themselves safe during a mental health crisis. This study systematically reviewed the literature focused on mobile health (mHealth) suicide safety planning apps. OBJECTIVE This study aims to evaluate the extent to which apps integrated components of the safety planning intervention (SPI), and if so, how these safety planning components were integrated into the design-based features of the apps. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we systematically analyzed 14 peer-reviewed studies specific to mHealth apps for suicide safety planning. We conducted an analysis of the literature to evaluate how the apps incorporated SPI components and examined similarities and differences among the apps by conducting a comparative analysis of app features. An independent review of SPI components and app features was conducted by downloading the available apps. RESULTS Most of the mHealth apps (5/7, 71%) integrated SPI components and provided customizable features that expanded upon traditional paper-based safety planning processes. App design features were categorized into 5 themes, including interactive features, individualized user experiences, interface design, guidance and training, and privacy and sharing. All apps included access to community supports and revisable safety plans. Fewer mHealth apps (3/7, 43%) included interactive features, such as associating coping strategies with specific stressors. Most studies (10/14, 71%) examined the usability, feasibility, and acceptability of the safety planning mHealth apps. Usability findings were generally positive, as users often found these apps easy to use and visually appealing. In terms of feasibility, users preferred using mHealth apps during times of crisis, but the continuous use of the apps outside of crisis situations received less support. Few studies (4/14, 29%) examined the effectiveness of mHealth apps for suicide-related outcomes. Positive shifts in attitudes and desire to live, improved coping strategies, enhanced emotional stability, and a decrease in suicidal thoughts or self-harm behaviors were examined in these studies. CONCLUSIONS Our study highlights the need for researchers, clinicians, and app designers to continue to work together to align evidence-based research on mHealth suicide safety planning apps with lessons learned for how to best deliver these technologies to end users. Our review brings to light mHealth suicide safety planning strategies needing further development and testing, such as lethal means guidance, collaborative safety planning, and the opportunity to embed more interactive features that leverage the advanced capabilities of technology to improve client outcomes as well as foster sustained user engagement beyond a crisis. Although preliminary evidence shows that these apps may help to mitigate suicide risk, clinical trials with larger sample sizes and more robust research designs are needed to validate their efficacy before the widespread adoption and use.
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Affiliation(s)
- Kim Gryglewicz
- School of Social Work, University of Central Florida, Orlando, FL, United States
| | - Victoria L Orr
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Marissa J McNeil
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Lindsay A Taliaferro
- Department of Population Health Sciences, University of Central Florida, Orlando, FL, United States
| | - Serenea Hines
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Taylor L Duffy
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Pamela J Wisniewski
- Department of Computer Science, Vanderbilt University, Nashville, TN, United States
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15
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Josifovski N, Torok M, Batterham P, Wong Q, Beames JR, Theobald A, Holland S, Huckvale K, Riley J, Cockayne N, Christensen H, Larsen M. Efficacy of BrighterSide, a Self-Guided App for Suicidal Ideation: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e55528. [PMID: 38551212 PMCID: PMC11004607 DOI: 10.2196/55528] [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: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 04/02/2024] Open
Abstract
Background Self-guided digital interventions can reduce the severity of suicidal ideation, although there remain relatively few rigorously evaluated smartphone apps targeting suicidality. Objective This trial evaluated whether the BrighterSide smartphone app intervention was superior to a waitlist control group at reducing the severity of suicidal ideation. Methods A total of 550 adults aged 18 to 65 years with recent suicidal ideation were recruited from the Australian community. In this randomized controlled trial, participants were randomly assigned to receive either the BrighterSide app or to a waitlist control group that received treatment as usual. The app was self-guided, and participants could use the app at their own pace for the duration of the study period. Self-report measures were collected at baseline, 6 weeks, and 12 weeks. The primary outcome was severity and frequency of suicidal ideation, and secondary outcomes included psychological distress and functioning and recovery. Additional data were collected on app engagement and participant feedback. Results Suicidal ideation reduced over time for all participants, but there was no significant interaction between group and time. Similar improvements were observed for self-harm, functioning and recovery, days out of role, and coping. Psychological distress was significantly lower in the intervention group at the 6-week follow-up, but this was not maintained at 12 weeks. Conclusions The BrighterSide app did not lead to a significant improvement in suicidal ideation relative to a waitlist control group. Possible reasons for this null finding are discussed.
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Affiliation(s)
- Natasha Josifovski
- Black Dog Institute, Randwick, Australia
- The University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Torok
- Black Dog Institute, Randwick, Australia
- The University of New South Wales, Sydney, New South Wales, Australia
| | - Philip Batterham
- Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia
| | - Quincy Wong
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Joanne R Beames
- Black Dog Institute, Randwick, Australia
- The University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Kit Huckvale
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Jo Riley
- Coordinaire, Fairy Meadow, Australia
| | - Nicole Cockayne
- Black Dog Institute, Randwick, Australia
- The University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Christensen
- Black Dog Institute, Randwick, Australia
- The University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Larsen
- Black Dog Institute, Randwick, Australia
- The University of New South Wales, Sydney, New South Wales, Australia
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16
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Taussig HN, Fulginiti A, Racz SJ, Evans R, Cary Katz C. Long-term impact of the Fostering Healthy Futures for Preteens program on suicide-related thoughts and behaviors for youth in out-of-home care: A randomized controlled trial. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38436484 PMCID: PMC11371940 DOI: 10.1002/ajcp.12745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
Youth in out-of-home care are at high risk for suicide-related thoughts and behaviors (STB), yet there are no known efficacious interventions that reduce STB for this population. Fostering Healthy Futures for Preteens (FHF-P) is a 9-month community-based mentoring and skills training preventive intervention for children in out-of-home care. A randomized controlled trial enrolled 156 participants aged 9-11 years who were placed in out-of-home care over the prior year. Participants were 48.9% female, 54.1% Hispanic, 30.1% Black, and 27.1% American Indian. Follow-up interviews, conducted 7-12 years postintervention (85.2% retention rate), asked young adult participants, aged 18-22, to self-report lifetime STB as indexed by non-suicidal self-injury, suicidal thoughts, plans, and/or attempts. There was a nonsignificant reduction in the odds of STB for the intervention group at follow-up (OR = 0.74; CI, 0.32, 1.69). However, FHF-P significantly moderated the effect of baseline STB; control youth who reported baseline STB had 10 times the odds of young adult STB (OR = 10.44, CI, 2.28, 47.78), but there was no increase in the odds of adult-reported STB for intervention youth. Findings suggest that FHF-P buffers the impact of pre-existing STB on young adult STB for care-experienced youth. Further research is needed to identify mechanisms that may reduce STB in this population.
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Affiliation(s)
- Heather N Taussig
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
- Kempe Center, University of Colorado, Denver, Colorado, USA
| | - Anthony Fulginiti
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Sarah J Racz
- Department of Psychology, University of Maryland College Park, College Park, Maryland, USA
| | - Rhiannon Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Colleen Cary Katz
- Silberman School of Social Work, Hunter College, CUNY, New York, New York, USA
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Bianchini G, Bodell LP. An Open Trial of a Brief, Self-Compassion Intervention Targeting Thwarted Belongingness and Perceived Burdensomeness. Arch Suicide Res 2024:1-13. [PMID: 38329105 DOI: 10.1080/13811118.2024.2307894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Suicide is a global health concern and developing brief and accessible interventions that can reduce suicide risk is crucial. Thwarted belongingness (TB; i.e., feeling like one doesn't belong) and perceived burdensomeness (PB; i.e., feeling like one is a burden on others) are associated with suicidality, and changes in these constructs predict changes in suicidal thoughts and behaviors. Self-compassion is a multifaceted construct that involves being open and kind to oneself and can be taught through brief writing tasks. Low self-compassion has been associated with TB, PB, and suicidal ideation, suggesting that enhancing self-compassion may decrease suicide risk. Thus, we conducted an open trial of a brief, online self-compassion intervention targeting TB and PB. METHOD Undergraduate students (N = 132) viewed an educational video on self-compassion and completed self-compassion writing tasks over the course of one week. RESULTS Reactions to the intervention were positive, and participants reported significantly higher self-compassion scores following the intervention. However, TB and PB scores did not change from the baseline to the post-intervention assessment. CONCLUSIONS This open trial demonstrated the feasibility and acceptability of a fully online, brief self-compassion intervention, but its impact on reducing suicide risk should be assessed further using a randomized controlled design.
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Affiliation(s)
| | - Lindsay P Bodell
- Department of Psychology, University of Western Ontario, London, Canada
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Wang W, Wu M, Zhu Z, Ma L, Zhang L, Li H. Associations of mobile phone addiction with suicide ideation and suicide attempt: findings from six universities in China. Front Public Health 2024; 11:1338045. [PMID: 38312140 PMCID: PMC10834704 DOI: 10.3389/fpubh.2023.1338045] [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: 11/14/2023] [Accepted: 12/27/2023] [Indexed: 02/06/2024] Open
Abstract
Background Mobile phones are becoming indispensable for life and have changed various aspects of people's lives. The psychological impacts of excessive mobile phone use have emerged as an impressive problem among college students. However, little is known about the associations of mobile phone addiction with suicide ideation and suicide attempt. Methods A cross-sectional study was conducted with students from six universities in 2022. We collected the socio-demographic characteristics, suicide ideation, suicide attempt, psychosocial factors (depressive symptoms, social support, sleep quality), and health-related characteristics (smoking, drinking, body mass index). Mobile phone addiction was ascertained by the Mobile Phone Addiction Tendency Scale (MPATS). The associations of mobile phone addiction with suicide ideation and suicide attempt were estimated using binary logistic regression and restricted cubic splines regression. Results A total of 18,723 college students [6,531 males (34.9%) and 12,192 females (65.1%)] were included in the final analysis. Eleven percent of participants had a history of suicide ideation, and 1.8% of participants had engaged in suicide attempt. A total of 5,553 students (29.7%) met the criteria of mobile phone addiction (MPATS score ≥48), and the average score on the MPATS was 39.5 ± 13.0. After adjustment for potential covariates, mobile phone addiction was significantly associated with increased odds of suicide ideation (OR, 1.70; 95% CI, 1.53-1.88) and suicide attempt (OR, 1.48; 95% CI, 1.18-1.86). Gender did not affect the associations of mobile phone addiction with suicide ideation and suicide attempt (P for interaction > 0.05). The restricted cubic splines regression displayed a nonlinear dose-response association between MPATS score and risk of suicide ideation (P for non-linearity < 0.001), while a monotonically increasing risk of suicide attempt was found to be associated with an increasing MPATS score (P for non-linearity = 0.420). Conclusions Mobile phone addiction is associated with suicide ideation and suicide attempt among college students. The findings indicate that early examination, prevention, and intervention for mobile phone addiction may benefit the prevent and control of suicide.
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Affiliation(s)
- Wenhua Wang
- Department of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Shaanxi Provincial Health Industry Association Service Center, Xi'an, China
| | - Mingyang Wu
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhongliang Zhu
- Institute of Maternal and Infant health, Medical college of Northwest University, Xi'an, China
| | - Le Ma
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Lei Zhang
- Shaanxi Provincial Health Industry Association Service Center, Xi'an, China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Shaanxi Medical Association, Xi'an, China
| | - Hui Li
- Department of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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19
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Smith T, Magness C, Arango A, Finkelstein S, Kahsay E, Czyz E, Hong V, Kettley J, Smith PK, Ewell Foster C. Worsening Symptoms of Anxiety, Depression, and Sleep Problems in Caregivers Following Youth's Suicide-Related Emergency Department Visit. Arch Suicide Res 2024; 28:418-427. [PMID: 36691847 DOI: 10.1080/13811118.2023.2166439] [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: 01/25/2023]
Abstract
OBJECTIVE Although families assume considerable responsibility in caring for their child after a suicidal crisis, little is known about caregiver well-being following a suicide-related pediatric Emergency Department (ED) visit. This study aimed to (1) describe the course of caregiver distress symptoms (e.g., anxiety, depression, and negative affect) and sleep problems following their child's suicide-related ED visit and to (2) identify factors (e.g., parents' mental health history, youth suicide risk chronicity, and perception of feeling supported by the mental health system) hypothesized to be related to caregiver distress symptoms and sleep problems at follow-up using a diathesis-stress model framework. METHOD Participants included 118 caregiver/youth (ages 11-17) dyads presenting to a psychiatric ED due to youths' suicide-related concerns. Caregivers and youth were assessed during index ED visit and 2-weeks following discharge. RESULTS Caregivers' anxiety and depressive symptoms and sleep problems increased significantly from the time of the ED visit to 2-week follow-up. There was no significant change in caregiver negative affect. Caregivers with their own history of mental illness and those whose children had a previous ED visit due to a psychiatric concern, suggestive of chronic suicide risk, reported higher anxiety and depressive symptoms at follow-up. CONCLUSION In the 2 weeks following an ED visit for their child's suicidal crisis, caregivers reported significant increases in anxiety and depressive symptoms and sleep problems. Findings highlight the need to consider the mental health of caregivers whose children are at elevated risk for suicide.HighlightsCaregivers report increases in distress symptoms following youth's suicidal crisis.Caregiver mental health history and youth suicide chronicity impacted distress.Caregiver mental health should be considered when planning youth interventions.
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20
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Drago A. Genetic signatures of suicide attempt behavior: insights and applications. Expert Rev Proteomics 2024; 21:41-53. [PMID: 38315076 DOI: 10.1080/14789450.2024.2314143] [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: 09/21/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Every year about 800,000 complete suicide events occur. The identification of biologic markers to identify subjects at risk would be helpful in targeting specific support treatments. AREA COVERED A narrative review defines the meta-analytic level of current evidence about the biologic markers of suicide behavior (SB). The meta-analytic evidence gathered so far indicates that the hypothesis-driven research largely failed to identify the biologic markers of suicide. The most consistent and replicated result was reported for: 1) 5-HTR2A T102C, associated with SB in patients with schizophrenia (OR = 1.73 (1.11-2.69)) and 2) BDNF Val66Met (rs6265), with the Met-Val + Val-Val carriers found to be at risk for suicide in the Caucasian population (OR: 1.96 (1.58-2.43)), while Val-Val vs. Val-Met + Met carriers found to be at risk for suicide in the Asian populations (OR: 1.36 (1.04-1.78)). GWAS-based meta-analyses indicate some positive replicated findings regarding the DRD2, Neuroligin gene, estrogen-related genes, and genes involved in gene expression. EXPERT OPINION Most consistent results were obtained when analyzing sub-samples of patients. Some promising results come from the implementation of the polygenic risk score. There is no current consensus about an implementable biomarker for SB.
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Affiliation(s)
- Antonio Drago
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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21
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Goldstein TR, Merranko J, Rode N, Sylvester R, Hotkowski N, Fersch-Podrat R, Hafeman DM, Diler R, Sakolsky D, Franzen P, Birmaher B. Dialectical Behavior Therapy for Adolescents With Bipolar Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2024; 81:15-24. [PMID: 37703037 PMCID: PMC10500432 DOI: 10.1001/jamapsychiatry.2023.3399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023]
Abstract
Importance Early-onset bipolar disorder conveys substantial risk for suicide. No psychosocial intervention for this population expressly targets suicidal behavior. Objective To determine whether dialectical behavior therapy (DBT) for adolescents with bipolar spectrum disorder is more effective than standard of care (SOC) psychotherapy in decreasing suicide attempts over 1 year. Design, Settings, and Participants Adolescents aged 12 to 18 years diagnosed with bipolar spectrum disorder were recruited from a specialty outpatient psychiatric clinic between November 2014 and September 2019. Independent evaluators conducted quarterly assessments over 1 year with participants and parents. Data were analyzed from March 2021 to November 2022. Interventions Participants were randomly assigned to 1 year of DBT (36 sessions; n = 47) or SOC psychotherapy (schedule clinically determined; n = 53). All youth received medication management via a flexible algorithm. Main Outcomes and Measures Primary outcomes included suicide attempts over 1 year and mood symptoms and states (depression and hypomania/mania). Secondary analyses included moderation of DBT effects by history of suicide attempt and mediation through emotion dysregulation. Results Of 100 included participants, 85 (85%) were female, and the mean (SD) age was 16.1 (1.6) years. Participants were followed up over a mean (SD) of 47 (14) weeks. Both treatment groups demonstrated significant and similar improvement in mood symptoms and episodes over 1 year (standardized depression rating scale slope, -0.17; 95% CI, -0.31 to -0.03; standardized mania rating scale slope, -0.24; 95% CI, -0.34 to -0.14). DBT and SOC participants reported similar suicide attempt rates at intake as measured on the Adolescent Longitudinal Follow-Up Evaluation (ALIFE; mean [SD] attempts, 2.0 [4.5] vs 1.8 [3.9], respectively; P = .80). DBT participants reported slightly more suicide attempts at intake as measured on the Columbia-Suicide Severity Rating Scale Pediatric Version (C-SSRS; mean [SD] attempts, 1.4 [3.6] vs 0.6 [0.9]; P = .02). DBT participants reported significantly fewer suicide attempts over follow-up compared with SOC participants via the ALIFE (mean [SD] attempts per follow-up period, 0.2 [0.4] vs 1.1 [4.3], controlling for baseline attempts: P = .03) and the C-SSRS (mean [SD] attempts per follow-up period, 0.04 [0.2] vs 0.10 [0.3], controlling for baseline attempts; P = .03). DBT was significantly more effective than SOC psychotherapy at decreasing suicide attempts over 1 year (ALIFE: incidence rate ratio [IRR], 0.32; 95% CI, 0.11-0.96; C-SSRS: IRR, 0.13; 95% CI, 0.02-0.78). Decreased rate of suicide attempts in DBT was moderated by presence of lifetime history of suicide attempt and time (IRR, 0.23; 95% CI, 0.13-0.44) and mediated by improvement in emotion dysregulation (IRR, 0.61; 95% CI, 0.42-0.89), particularly for those with high baseline emotion dysregulation (standardized β, -0.59; 95% CI, -0.92 to -0.26). Conclusions and Relevance In this randomized clinical trial, DBT demonstrated efficacy in decreasing suicide attempts among the high-risk population of adolescents with bipolar spectrum disorder. Trial Registration ClinicalTrials.gov Identifier: NCT02003690.
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Affiliation(s)
- Tina R. Goldstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John Merranko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Noelle Rode
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Raeanne Sylvester
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nina Hotkowski
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rachael Fersch-Podrat
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Danella M. Hafeman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rasim Diler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Peter Franzen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Busby DR, Hughes JL, Walters M, Ihediwa A, Adeniran M, Goodman L, Mayes TL. Measurement Choices for Youth Suicidality. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01627-5. [PMID: 38147138 DOI: 10.1007/s10578-023-01627-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/27/2023]
Abstract
Suicide is among the leading causes of death among individuals ages 10-24, making suicidal thoughts and behaviors (STBs) a serious public health crisis among youth. Suicide risk screening and assessment are vital to addressing this public health crisis. In fact, many youths that screen positive for suicidal ideation do not have known mental health concerns and would have been missed if not asked directly. Medical settings are an optimal setting to detect suicidality early and provide appropriate follow-up monitoring and care as needed. To support effective and efficient screening and assessment of suicidal thoughts and behaviors, providers must choose measures with both strong psychometric properties and clinical utility. While measurement of STBs can vary across health settings, suicide risk screening and assessment typically involves gathering information about current suicidal ideation, suicidal behaviors, and suicidal plans via self-report questionnaires, clinical interviews, and/or computerized adaptive screens. In alignment with measurement-based care efforts, the current manuscript will provide a scoping review of measures of youth suicidal ideation, behavior, plans, and their risk factors. Specifically, the psychometric properties, clinical utility, and other key considerations for screening and assessment of adolescent suicide risk are discussed.
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Affiliation(s)
- Danielle R Busby
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA.
| | - Jennifer L Hughes
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital, College of Medicine, and the Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mallory Walters
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
| | - Adannaya Ihediwa
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
| | - Michel Adeniran
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
| | - Lynnel Goodman
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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23
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Looijmans M, van Bergen D, Popma A, van Eijk N, Mérelle S, van Veen S, Hawton K, Gilissen R. The self-perceived needs of adolescents with suicidal behaviour: a scoping review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02342-1. [PMID: 38147110 DOI: 10.1007/s00787-023-02342-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
Suicidal behaviour in adolescents is a major public health problem. Much research on this issue has focused on epidemiology and risk factors for suicidal behaviour, paying less attention to the self-perceived needs of adolescents. However, to increase engagement in suicide prevention, it is important to include the views of adolescents. A scoping review was performed to identify the available empirical study findings, of any study design, related to the self-perceived needs of adolescents with suicidal behaviour. The literature databases Medline, Embase, Psycinfo, CINAHL, ERIC, Scopus, and Web of Science were searched. Twenty-nine studies from 14 predominantly Anglo countries were included in the scoping review. The review showed that girls were overrepresented and that studies predominantly used qualitative approaches. The identified needs of adolescents with suicidal behaviour can broadly be grouped into needs related to the following areas: the importance of connecting with other people; adolescents' self-help strategies and personal growth after self-harm; mental healthcare; school or study programs; and needs related to society in relation to taboo on suicidal behaviour. Prevention of suicidal behaviour in adolescents will need to focus on development and strengthening of interventions fitting the needs of adolescents in these areas.
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Affiliation(s)
- Milou Looijmans
- Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands.
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Diana van Bergen
- Faculty of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
| | - Arne Popma
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nikki van Eijk
- Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands
| | - Saskia Mérelle
- Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands
| | - Sisco van Veen
- Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands
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Adrian M, McCauley E, Gallop R, Stevens J, Jobes DA, Crumlish J, Stanley B, Brown GK, Green KL, Hughes JL, Bridge JA. Advancing Suicide Intervention Strategies for Teens (ASSIST): study protocol for a multisite randomised controlled trial. BMJ Open 2023; 13:e074116. [PMID: 38086585 PMCID: PMC10729238 DOI: 10.1136/bmjopen-2023-074116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Brief interventions that reduce suicide risk following youth's experience with acute care due to suicidality are needed. METHODS AND ANALYSIS The study will use a three-arm randomised controlled trial designed to test the effectiveness of the Safety Planning Intervention with structured follow-up (SPI+) and the Collaborative Assessment and Management of Suicidality (CAMS) compared with enhanced usual care. The primary outcomes measure will be suicidal events, defined as death by suicide, attempted suicide, preparatory acts toward imminent suicidal behaviour or suicidal ideation resulting in a change in emergency evaluation or inpatient admission. Secondary measures will be the number of suicide attempts and severity of suicidal ideation. The experimental interventions, SPI+ and CAMS, consist of up to eight sessions over approximately 8 weeks that are designed to manage (SPI+) or treat (CAMS) patient-identified 'drivers' of suicidal thoughts and behaviours. Mechanisms and moderators of change will be evaluated to understand treatment impacts. ETHICS AND DISSEMINATION This study has been approved by the Seattle Children's Institutional Review Board and is monitored by external agencies including the University of Washington Institute for Translational Health Sciences, and a National Institute of Mental Health (NIMH)-appointed Data Safety and Monitoring Board. Trial results will help establish evidence towards safe and effective treatment strategies for youth transitioning from acute to outpatient care due to a suicidal crisis. The data will be shared with the NIMH Data Archives and disseminated through publications and conferences. TRIAL REGISTRATION NUMBER NCT05078970.
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Affiliation(s)
- Molly Adrian
- University of Washington, Seattle, Washington, USA
| | | | - Robert Gallop
- West Chester University, West Chester, Pennsylvania, USA
| | | | - David A Jobes
- The Catholic University of America, School of Arts and Sciences, Washington, DC, USA
| | - Jennifer Crumlish
- The Catholic University of America, School of Arts and Sciences, Washington, DC, USA
| | | | | | - Kelly L Green
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jeffrey A Bridge
- The Ohio State University College of Medicine, Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
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25
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Haregu T, Chen Q, Arafat SMY, Cherian A, Armstrong G. Prevalence, correlates and common methods of non-suicidal self-injury in South Asia: a systematic review. BMJ Open 2023; 13:e074776. [PMID: 37993150 PMCID: PMC10668266 DOI: 10.1136/bmjopen-2023-074776] [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: 04/18/2023] [Accepted: 10/27/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION The dynamics of self-harm vary substantially around the world, yet it is severely under-researched outside of a small number of high-income 'Western' countries. South Asia is disproportionately impacted by suicide, yet we know less about non-suicidal self-injury (NSSI) in the region. OBJECTIVE To review and summarise evidence on the prevalence, correlates and common methods of NSSI in South Asia. METHODS We searched Medline, Embase and PsycINFO for the period 1 January 2000 to 31 August 2023, for peer-reviewed observational studies. A total of 11 studies from eight South Asian countries that reported prevalence and/or correlates of NSSI were included in this review. We assessed the quality of the studies using the Study Quality Assessment Tools for Observational Cohort and Cross-Sectional Studies. We used meta-regression to describe the sources of heterogeneity. Abstracted data were summarised using thematic synthesis. RESULTS For non-clinical populations, the 12-month prevalence of NSSI ranged from 3.2% to 44.8%, and the lifetime prevalence ranged from 21% to 33%. For clinical populations, the 12-month prevalence of NSSI ranged from 5% to 16.4%, while the lifetime prevalence ranged from 2% to 27%. Male sex, unemployment, financial stress, history of suicidal behaviour and depression were associated with a higher risk of NSSI. Better access to counselling services, higher self-esteem and self-knowledge were associated with a lower risk of NSSI. CONCLUSION The burden of NSSI in South Asia appears to be high in both clinical and non-clinical populations. Further research, especially with general population samples, is needed to build evidence on the epidemiology, context and meaning of NSSI in South Asia to inform the design of context-specific interventions. PROSPERO REGISTRATION NUMBER CRD42022342536.
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Affiliation(s)
- Tilahun Haregu
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Quan Chen
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - S M Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Savar, Bangladesh
| | - Anish Cherian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Gregory Armstrong
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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26
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Ou W, Yang Y, Chen Y, Li Y, Yang S, Lu Y, Li L, Huang M, Ma M, Lv G, Zhao X, Qing Y, Ju Y, Zhang Y. Bridge symptoms between parenting styles and proximal psychological risk factors associated with adolescent suicidal thoughts: a network analysis. Child Adolesc Psychiatry Ment Health 2023; 17:129. [PMID: 37968724 PMCID: PMC10652451 DOI: 10.1186/s13034-023-00674-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/20/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Parenting styles and the associated proximal psychological factors are suggested to increase suicidal risks in adolescents. However, how the two factors interact and confer risks on the emergence of adolescent suicidal thoughts remains unclear. Herein, we used a network approach to investigate their interrelationship and explore whether the network properties predict adolescent suicidal thoughts. METHODS Self-report questionnaires were completed by 1171 students aged 12-16. Network analyses were performed by Gaussian graphical models estimating the adolescent psychosocial network structure of parenting styles and psychological variables including depression, anxiety, affective lability, rumination, and resilience. Furthermore, we re-examined the network by adding a variable measuring active suicidal thoughts. Moreover, we conducted linear regressions to examine the predictive utility of bridge symptoms for adolescent suicidal thoughts. RESULTS Resilience, Afraid, Rumination, Concentration, and affective lability (Anger) had the highest bridge strengths in the adolescent psychosocial network. Among the identified bridge symptoms, Resilience was negatively correlated with active suicidal thoughts (regularized edge weights = -0.181, bootstrapped 95% CIs: [-0.043, -0.155]), whereas affective lability (from Anxiety to Depression, Anger), Rumination, and Afraid were positively correlated with active suicidal thoughts, with edge weights (bootstrapped 95% CIs) ranging from 0.057 (0.001, 0.112) to 0.081(0.026, 0.136). Regression analysis showed that bridge strength was significantly correlated with active suicidal thoughts (R2 = 0.432, P = 0.001). CONCLUSION Negative parenting styles may drive and maintain suicidal thoughts by modifying the key proximal psychological variables. Our findings highlight the important role of bridge symptoms, which may serve as vital targets for triggering adolescent suicide.
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Affiliation(s)
- Wenwen Ou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yumeng Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yafei Chen
- Xiangya Medical School, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yunjing Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Siqi Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yimei Lu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Liang Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Mei Huang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Mohan Ma
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Guanyi Lv
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Xiaotian Zhao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yaqi Qing
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yumeng Ju
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
| | - Yan Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
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Aleva A, van den Berg T, Laceulle OM, van Aken MAG, Chanen AM, Betts JK, Hessels CJ. A smartphone-based intervention for young people who self-harm ('PRIMARY'): study protocol for a multicenter randomized controlled trial. BMC Psychiatry 2023; 23:840. [PMID: 37964199 PMCID: PMC10647141 DOI: 10.1186/s12888-023-05301-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Self-harm in young people is a public health concern connected with severe mental health problems, such as personality pathology. Currently, there are no specific evidence-based interventions available for young people who self-harm. Therefore, we developed PRe-Intervention Monitoring of Affect and Relationships in Youth (PRIMARY), a smartphone-based intervention, co-designed by clinicians and young people with lived experience of mental ill-health. PRIMARY combines the Experience Sampling Method (ESM) with weekly report sessions. The study aims to examine the effectiveness of PRIMARY with regard to reducing self-harm, and improving emotion regulation and quality of relationships. METHODS This study is a multicenter, parallel groups, randomized controlled trial (RCT) comparing the PRIMARY intervention to a waiting list control group. PRIMARY comprises 28 consecutive days of questionnaires five times each day (i.e., ESM) and four weekly report sessions. Participants will comprise 180 young people referred for treatment to the participating Dutch mental healthcare institutions and (1) are aged 12 to 25 years, and (2) engaged in ≥ 1 act of self-harm in the past year. Participants are randomly allocated to a study group after screening in a 1:1 ratio by an independent researcher using computer-generated randomization sequences with stratified block randomization by age (12 to 15 years / 16 to 25 years). Staff will conduct assessments with all participants at baseline (Wave 1), after 28 days (Wave 2), and in a subsample after 10 weeks of subsequent specialized treatment (Wave 3). The primary outcomes are self-harm, emotion regulation, and quality of relationships. Secondary outcomes include patient and clinician satisfaction. Exploratory analyses of ESM data will examine the relationship between emotions, social relationships, and self-harm. DISCUSSION The results of this trial will clarify whether an innovative smartphone-based intervention is effective for reducing self harm and improving emotion regulation and the quality of social relationships. It has the potential to fill a treatment gap of interventions specifically targeting self-harm. If proven effective, it would provide an accessible, easy-to-implement, low-cost intervention for young people. Furthermore, the ESM-data will allow detailed analyses into the processes underlying self-harm, which will contribute to theoretical knowledge regarding the behavior. TRIAL REGISTRATION ISRCTN42088538 ( https://doi.org/10.1186/ISRCTN42088538 ), retrospectively registered on the 26th of October 2022.
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Affiliation(s)
- Anouk Aleva
- HYPE Centre of Expertise on Early Intervention for Borderline Personality Disorder, GGz Centraal, Amersfoort, The Netherlands.
- Department of Developmental Psychology, Utrecht University, Utrecht, The Netherlands.
| | - Tessa van den Berg
- HYPE Centre of Expertise on Early Intervention for Borderline Personality Disorder, GGz Centraal, Amersfoort, The Netherlands
- Department of Developmental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Odilia M Laceulle
- HYPE Centre of Expertise on Early Intervention for Borderline Personality Disorder, GGz Centraal, Amersfoort, The Netherlands
- Department of Developmental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Marcel A G van Aken
- Department of Developmental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Andrew M Chanen
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Jennifer K Betts
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Christel J Hessels
- HYPE Centre of Expertise on Early Intervention for Borderline Personality Disorder, GGz Centraal, Amersfoort, The Netherlands
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Meza JI, Zullo L, Vargas SM, Ougrin D, Asarnow JR. Practitioner Review: Common elements in treatments for youth suicide attempts and self-harm - a practitioner review based on review of treatment elements associated with intervention benefits. J Child Psychol Psychiatry 2023; 64:1409-1421. [PMID: 36878853 DOI: 10.1111/jcpp.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Adopting a common elements approach, this practitioner review aims to highlight specific treatment elements that are common to interventions with demonstrated benefits in randomized controlled trials (RCTs) for reducing suicide attempts and self-harm in youth. Identification of common treatment elements among effective interventions offers a key strategy for clarifying the most robust features of effective interventions and improving our ability to implement effective treatment and decrease the lag between scientific advances and clinical care. METHODS A systematic search of RCTs evaluating interventions targeting suicide/self-harm in youth (ages 12-18) yielded a total of 18 RCTs assessing 16 different manualized interventions. An open coding process was used to identify common elements present within each intervention trial. Twenty-seven common elements were identified and classified into format, process, and content categories. All trials were coded for the inclusion of these common elements by two independent raters. RCTs were also classified into those where trial results supported improvements in suicide/self-harm behavior (n = 11 supported trials) and those without supported evidence (n = 7 unsupported trials). RESULTS Compared with unsupported trials, the 11 supported trials shared the following elements: (a) inclusion of therapy for both the youth and family/caregivers; (b) an emphasis on relationship-building and the therapeutic alliance; (c) utilization of an individualized case conceptualization to guide treatment; (d) provided skills training (e.g. emotion regulation skills) to both youth and their parents/caregivers; and (e) lethal means restriction counseling as part of self-harm monitoring and safety planning. CONCLUSIONS This review highlights key treatment elements associated with efficacy that community practitioners can incorporate in their treatments for youth presenting with suicide/self-harm behaviors.
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Affiliation(s)
- Jocelyn I Meza
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
- Departments of Psychology and Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lucas Zullo
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sylvanna M Vargas
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
- Departments of Psychology and Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dennis Ougrin
- Department of Child and Adolescent Psychiatry and Global Mental Health, Queen Mary University of London, London, UK
| | - Joan R Asarnow
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
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Abbott-Smith S, Ring N, Dougall N, Davey J. Suicide prevention: What does the evidence show for the effectiveness of safety planning for children and young people? - A systematic scoping review. J Psychiatr Ment Health Nurs 2023; 30:899-910. [PMID: 37052321 DOI: 10.1111/jpm.12928] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 04/14/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Suicide prevention is an international healthcare priority. There is an urgent need to use approaches that are helpful and follow research evidence. Safety planning is now widely used in suicide prevention; however, it was developed for use with adults, and little is known about its effectiveness for children/young people. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic scoping review brings together all research evidence since 2008 that reported how effective safety planning is for children/young people. Findings highlight that when healthcare professionals help children/young people who are suicidal, they need to ensure that the safety plan is completed collaboratively with healthcare professionals and children/young people and that it is appropriate for their age and development. There is also need for healthcare professionals to better recognize and respond to the needs of parents/carers who are caring for a child/young person with suicidal ideations/behaviours. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is some research indicating that safety planning is effective for use with children/young people, but such evidence has primarily been obtained from females and there is need for more evidence from male study populations. Further research on its use is needed for certain groups of children/young people including those who are care experienced, or identify as lesbian, gay, bisexual and transgender. This review highlighted that healthcare professionals need specific training before they deliver safety planning for children/young people. It was identified that parents/carers have additional needs and should be involved in safety planning. An additional resource specifically for parents/carers should be developed. ABSTRACT INTRODUCTION: Suicide is a leading cause of death for children and young people and its prevention is a global priority. Many Mental Health Services employ safety planning as a brief intervention. There is some evidence of safety planning effectiveness for adults, but little is known about its effectiveness with young people. AIM To synthesize research reporting safety planning effectiveness for children/young people with suicidal ideation and identify good practice recommendations. INCLUSION CRITERIA The review relates to safety planning around suicide prevention for children/young people aged less than 18 years, even if it was within a wider intervention. The review was inclusive of all clinical areas (including mental health, primary care, etc), any geographical location or social economic status and inclusivity around the method of delivery. METHODS A systematic scoping review of literature reporting effectiveness data for the use of safety planning with children/young people with suicidal ideation. The systematic scoping review protocol (pre-registered with Open Science Framework) followed Joanna Briggs Institute conduct guidance and PRISMA-ScR checklist. DATA ANALYSIS AND PRESENTATION Fifteen studies were reported during 2008-2021. Overall, there is promising, but limited, evidence of effectiveness for safety planning for children/young people but with complete evidence gaps for some demographic sub-groups. Evidence determined that healthcare professionals should deliver a safety planning intervention that is completed collaboratively, developmentally appropriate, and recognizes parental/carer involvement. DISCUSSION AND IMPLICATIONS FOR PRACTICE Further research is needed but current evidence suggests safety planning should be a routine part of care packages for children/young people with suicidal ideation proportionate to their needs. Developing/implementing these plans needs bespoke health professional training and additional support and resources for parents/carers should be developed.
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Affiliation(s)
- Susan Abbott-Smith
- NHS Lothian-CAMHS, Royal Hospital Children and Young People 50 Little France, Edinburgh, UK
- Edinburgh Napier University-Health and Social Care, Edinburgh, UK
| | - Nicola Ring
- Edinburgh Napier University-Health and Social Care, Edinburgh, UK
| | - Nadine Dougall
- Edinburgh Napier University-Health and Social Care, Edinburgh, UK
| | - Jill Davey
- Edinburgh Napier University-Health and Social Care, Edinburgh, UK
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Quitério A, Mendes Abreu J, Saura A, Borges MI, Corte Real A. A Case Report of Extreme Oral Lesions: A Rare Indicator of Bullying-Associated Non-suicidal Self-Injury. Cureus 2023; 15:e44713. [PMID: 37809120 PMCID: PMC10552680 DOI: 10.7759/cureus.44713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Bullying has reached epidemic proportions, affecting one in three students worldwide. A pervasive issue that carries profound physical, mental, and social consequences, significantly increasing the risk of non-suicidal self-injury (NSSI) and suicidal behaviors among those who experience this type of harassment and hazing. While physicians and most caregivers are fully aware and competent in identifying signs of self-harming behavior such as scratching, cutting, or burning the skin, oral self-injury is often overlooked as a potential indicator and is associated with unintentional soft tissue biting or specific conditions. We present a rare case of a 14-year-old male who sought medical attention due to severe bilateral tongue ulcers, leading to his admittance to the emergency department (ED) with excruciating pain and feeding difficulties. In the reported case, although the traumatic biting of the tongue emerged as the most probable etiological factor, a specific underlying motive and contextual comprehension were initially absent. It was only after successfully establishing a foundation of trust with the patient, enabling an honest response, that it became evident that the observed lesions represented a manifestation of bullying-induced non-suicidal self-injury. However, patients rarely openly acknowledge intentional self-inflicted lesions and/or their experiences of bullying, underscoring the necessity to maintain vigilance for alternative indicators such as behavioral changes or a noticeable decline in academic productivity. The significance of this case also goes beyond its presentation, highlighting the largely unexplored issue of how a patient's dentofacial features can serve as substantial catalysts for bullying. Therefore, it is only through equally prioritizing awareness of uncommon signs, symptoms, and context that one can expedite early diagnosis and intervention, emphasizing the essential need for comprehensive and timely management of such cases.
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Affiliation(s)
- Anabela Quitério
- Maxilofacial Surgery Department, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - João Mendes Abreu
- Stomatology Department, Clinical and Academic Centre of Coimbra, Coimbra, PRT
- Faculty of Medicine, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - André Saura
- Maxilofacial Surgery and Stomatology Department, Hospital Santo António - Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Maria Inês Borges
- Stomatology Department, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - Ana Corte Real
- Faculty of Medicine, Clinical and Academic Centre of Coimbra, Coimbra, PRT
- Forensic Dentistry Laboratory, University of Coimbra, Coimbra, PRT
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Van Meter AR, Knowles EA, Mintz EH. Systematic Review and Meta-analysis: International Prevalence of Suicidal Ideation and Attempt in Youth. J Am Acad Child Adolesc Psychiatry 2023; 62:973-986. [PMID: 36563876 DOI: 10.1016/j.jaac.2022.07.867] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/22/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Globally, rates of youth suicide vary considerably. Suicidal thoughts and behaviors (STB) are consistently associated with risk of death by suicide. However, international trends in STB have not yet been compared. To address this gap, an international meta-analysis of epidemiological and school-based studies that report on STB in youth was conducted. METHOD Systematic searches were conducted in PubMed and PsycINFO through April 2022. Eligible studies included prevalence of active suicidal ideation (SI) or suicide attempts (SA) in community youth younger than age 22. All studies were coded by 2 authors. Mixed models accounting for shared methods and including hypothesized moderators were conducted using the metafor package in R. RESULTS There were 371 effect sizes for SI, 94 for SI with a plan, and 316 for SA, representing 149 regions. Year of data collection ranged from 1981 to 2021. Participants were 6 to 21 years old. The prevalence of SI ranged across regions from 14.3% to 22.6%; the prevalence of SA ranged from 4.6% to 15.8%. Year was not associated with increasing STB prevalence except for studies from the United States, which showed increasing rates of SI and SA since 2007. CONCLUSION This is the most comprehensive meta-analysis of STB in youth, providing valuable data about how risk factors most commonly associated with suicide vary internationally and over time. International rates of STB among youth are not improving and may be getting worse in the United States, despite efforts to reduce suicide risk. Most studies did not report rates of SI or SA separately for LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others) youth and youth of color. A better understanding of proximal risk at the individual level will be important to informing future prevention efforts, especially for high-risk groups.
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Affiliation(s)
- Anna R Van Meter
- New York University Grossman School of Medicine, New York; Zucker Hillside Hospital, Queens, New York; Feinstein Institutes for Medical Research, Manhasset, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York.
| | - Ellen A Knowles
- Feinstein Institutes for Medical Research, Manhasset, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York
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McNicholas F, Parker S, Barrett E. A snapshot in time: a 1-month review of all referrals to paediatric liaison psychiatry services in Dublin following emergency department presentation. Ir J Psychol Med 2023; 40:378-386. [PMID: 33908338 DOI: 10.1017/ipm.2021.26] [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: 11/07/2022]
Abstract
INTRODUCTION An emerging picture has seen increasing numbers of young people with mental health crisis attend paediatric emergency departments in Ireland. Following paediatric review, many are referred to in-house paediatric liaison psychiatry (PLP) services. This pilot study describes referral patterns and practice over a 1-month period across three Dublin centres. METHODS Case notes of all referrals to PLP were reviewed to extract relevant clinical and administrative data. For those admitted, costs associated with length of stay were estimated. Clinical profile, management and intra-hospital pathway differences were explored. RESULTS Fifty-nine young people under 16 years presented to one of the three EDs with an acute MH presentation. The sample consisted of 39 females (66%) with a mean age of 13.7 years. The majority (n = 34, 58%) presented out of hours. A substantial portion of youths presenting (n = 37, 63%) were admitted, and had a mean duration of stay of 4.51 days. There were differences between hospitals in terms of frequency of presentation with self-harm, admission rates and length of stay. DISCUSSION Different PLP service configuration, staffing and funding streams may explain some of the differences observed across centres, although the findings should be interpreted with caution given the limited sample size. Standardisation of service provision and management is needed for PLP services. Additional community CAMHS resourcing is needed to support the development of alternative pathways for youth in need of urgent MH review.
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Affiliation(s)
- Fiona McNicholas
- Child and Adolescent Psychiatry, University College Dublin School of Medicine, Belfield, Dublin 4, Ireland
- Child and Adolescent Psychiatry, Lucena Clinic, Dublin 6, Ireland
| | - Sorcha Parker
- Child and Adolescent Psychiatry, University College Dublin School of Medicine, Belfield, Dublin 4, Ireland
| | - Elizabeth Barrett
- Child and Adolescent Psychiatry, University College Dublin School of Medicine, Belfield, Dublin 4, Ireland
- Child and Adolescent Liaison Psychiatry, Children's University Hospital, Temple St., Dublin 1, Ireland
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Law YW, Lok RHT, Chiang B, Lai CCS, Tsui SHM, Chung PYJ, Leung SC. Effects of Community-Based Caring Contact in Reducing Thwarted Belongingness Among Postdischarge Young Adults With Self-Harm: Randomized Controlled Trial. JMIR Form Res 2023; 7:e43526. [PMID: 37585260 PMCID: PMC10468708 DOI: 10.2196/43526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND For patients with self-harm behaviors, the urge to hurt themselves persists after hospital discharge, leading to costly readmissions and even death. Hence, postdischarge intervention programs that reduce self-harm behavior among patients should be part of a cogent community mental health care policy. OBJECTIVE We aimed to determine whether a combination of a self-help mobile app and volunteer support could complement treatment as usual (TAU) to reduce the risk of suicide among these patients. METHODS We conducted a pragmatic randomized controlled trial on discharged patients aged between 18 and 45 years with self-harm episodes/suicide attempts, all of whom were recruited from 4 hospital emergency departments in Hong Kong. Participants were randomly assigned to one of three groups: (1) mobile app + TAU ("apps"), (2) mobile app + volunteer support + TAU ("volunteers"), or (3) TAU only as the control group ("TAU"). They were asked to submit a mobile app-based questionnaire during 4 measurement time points at monthly intervals. RESULTS A total of 40 participants were recruited. Blending volunteer care with a preprogrammed mobile app was found to be effective in improving service compliance. Drawing upon the interpersonal-psychological theory of suicide, our findings suggested that a reduction in perceived burdensomeness and thwarted belongingness through community-based caring contact are linked to improvement in hopelessness, albeit a transient one, and suicide risk. CONCLUSIONS A combination of volunteer care with a self-help mobile app as a strategy for strengthening the continuity of care can be cautiously implemented for discharged patients at risk of self-harm during the transition from the hospital to a community setting. TRIAL REGISTRATION ClinicalTrials.gov NCT03081078; https://clinicaltrials.gov/study/NCT03081078.
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Affiliation(s)
- Yik Wa Law
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, Hong Kong
| | - Rita Hui Ting Lok
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Byron Chiang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Carmen Chui Shan Lai
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, Hong Kong
| | | | - Pui Yin Joseph Chung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - Siu Chung Leung
- Department of Emergency Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, Hong Kong
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Arango A, Czyz EK, Magness CS, Hong V, Smith T, Kettley J, Ewell Foster C. Predictors of suicide coping self-efficacy among youth presenting to a psychiatric emergency department. Suicide Life Threat Behav 2023; 53:586-596. [PMID: 37157179 DOI: 10.1111/sltb.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Low levels of youth-reported self-efficacy to cope with suicidal urges have been shown to prospectively predict repeat emergency department (ED) visits and suicide attempts, yet little is known about how self-efficacy may change following receipt of crisis services or about factors that may strengthen self-efficacy. Protective factors (e.g., parent-reported youth competence, parent-family connectedness, and receipt of mental health services) were examined in relation to self-efficacy at the time of a psychiatric ED visit and 2 weeks later. METHODS Participants were 205 youth (ages 10-17), presenting to a psychiatric ED due to a suicide-related concern. Youth primarily identified as biological female (63%) and White (87%). Multivariate hierarchical linear regressions were used to examine candidate protective factors in relation to initial and follow-up suicide coping self-efficacy. RESULTS Self-efficacy significantly improved in the 2 weeks following the ED visit. Parent-family connectedness was positively related to suicide coping self-efficacy at the time of the ED visit. Parent-family connectedness and receipt of inpatient psychiatric care following the ED visit were associated with higher follow-up suicide coping self-efficacy. CONCLUSIONS During the adolescent developmental period when suicidal thoughts and behaviors notably increase, study findings highlight potential malleable intervention targets, including parent-family connectedness, that may strengthen suicide coping self-efficacy.
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Affiliation(s)
- Alejandra Arango
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Ewa K Czyz
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Victor Hong
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Tayla Smith
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - John Kettley
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Boudreaux ED, Larkin C, Vallejo Sefair A, Ma Y, Li YF, Ibrahim AF, Zeger W, Brown GK, Pelletier L, Miller I. Effect of an Emergency Department Process Improvement Package on Suicide Prevention: The ED-SAFE 2 Cluster Randomized Clinical Trial. JAMA Psychiatry 2023; 80:665-674. [PMID: 37195676 PMCID: PMC10193260 DOI: 10.1001/jamapsychiatry.2023.1304] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/22/2023] [Indexed: 05/18/2023]
Abstract
Importance Suicide is a leading cause of deaths in the US. Although the emergency department (ED) is an opportune setting, ED-initiated interventions remain underdeveloped and understudied. Objective To determine if an ED process improvement package, with a subfocus on improving the implementation of collaborative safety planning, reduces subsequent suicide-related behaviors. Design, Setting, and Participants The Emergency Department Safety Assessment and Follow-up Evaluation 2 (ED-SAFE 2) trial, a stepped-wedge cluster randomized clinical trial conducted in 8 EDs across the US, used an interrupted time series design with three 12-month sequential phases: baseline, implementation, and maintenance. A random sample of 25 patients per month per site 18 years and older who screened positive on the Patient Safety Screener, a validated suicide risk screener, were included. The primary analyses focused on those who were discharged from the ED, while secondary analyses focused on all patients who screened positive, regardless of disposition. Data were collected on patients who presented for care from January 2014 to April 2018, and data were analyzed from April to December 2022. Interventions Each site received lean training and built a continuous quality improvement (CQI) team to evaluate the current suicide-related workflow in the ED, identify areas of improvement, and implement efforts to improve. Each site was expected to increase their universal suicide risk screening and implement collaborative safety planning for patients at risk of suicide who were discharged home from the ED. Site teams were centrally coached by engineers experienced in lean CQI and suicide prevention specialists. Main Outcomes and Measures The primary outcome was a composite comprising death by suicide or suicide-related acute health care visits, measured over a 6-month follow-up window. Results Across 3 phases, 2761 patient encounters were included in the analyses. Of these, 1391 (50.4%) were male, and the mean (SD) age was 37.4 (14.5) years. A total of 546 patients (19.8%) exhibited the suicide composite during the 6-month follow-up (9 [0.3%] died by suicide and 538 [19.5%] of a suicide-related acute health care visit). A significant difference was observed for the suicide composite outcome between the 3 phases (baseline, 216 of 1030 [21%]; implementation, 213 of 967 [22%]; maintenance, 117 of 764 [15.3%]; P = .001). The adjusted odds ratios of risk of the suicide composite during the maintenance phase was 0.57 (95% CI, 0.43-0.74) compared with baseline and 0.61 (0.46-0.79) compared with the implementation phase, which reflect a 43% and 39% reduction, respectively. Conclusions and Relevance In this multisite randomized clinical trial, using CQI methods to implement a department-wide change in suicide-related practices, including the implementation of a safety plan intervention, yielded a significant decrease in suicide behaviors in the maintenance period of the study. Trial Registration ClinicalTrials.gov Identifier: NCT02453243.
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Affiliation(s)
- Edwin D. Boudreaux
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Celine Larkin
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester
| | - Ana Vallejo Sefair
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Yunsheng Ma
- Independent consultant, Boylston, Massachusetts
| | - You Fu Li
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Ameer F. Ibrahim
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester
| | - Wesley Zeger
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha
| | - Gregory K. Brown
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
| | | | - Ivan Miller
- Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island
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Masland SR, Finch EF, Schnell SE. Effects of Group Psychotherapy for Nonsuicidal Self-Injury: A Meta-Analysis. Int J Group Psychother 2023; 73:183-201. [PMID: 38446601 DOI: 10.1080/00207284.2023.2191683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Nonsuicidal self-injury (NSSI) is prevalent and concerning among adolescents and adults. Although prior meta-analytic work has considered the efficacy of individual psychotherapy for reducing NSSI, the efficacy of group psychotherapy remains unclear. We conducted a systematic meta-analysis of group psychotherapy studies with NSSI measures. We identified a total of eight studies, including published articles (n = 6) or dissertations (n = 2) with 10 total effect sizes for group interventions. Overall, random-effects meta-analysis suggests that group psychotherapies have a significant small effect on NSSI. However, when corrected for publication bias, the effect is no longer significant. This meta-analysis cautiously suggests that group psychotherapies, which are cost-effective and efficient, hold promise for attenuating NSSI. The field would benefit from further study and treatment refinement, including consideration of what works for whom.
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Nair AU, Brekke-Riedl JA, DiMaggio-Potter ME, Carosella KA, Lasch C, Brower R, Papke V, Reigstad K, Klimes-Dougan B, Cullen KR. Clinical Trajectories in Adolescents with and without a History of Non-Suicidal Self-Injury: The BRIDGES Longitudinal Study. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2023; 8:e230007. [PMID: 37583447 PMCID: PMC10426765 DOI: 10.20900/jpbs.20230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Background Non-suicidal self-injury (NSSI) is a highly prevalent clinical concern in adolescents and is associated with impaired functioning and suicide risk. The BRIDGES (BRain Imaging Development of Girls' Emotion and Self) study was designed to collect longitudinal clinical and neurobiological data to advance our understanding of NSSI in adolescents. The purpose of this paper is to describe the clinical data collected as part of this study, including psychiatric diagnoses, depression symptoms, episodes of non-suicidal self-injury, suicidal thoughts and behaviors, childhood trauma, and personality domains. Methods The baseline sample included 164 adolescents aged 12-16 assigned female at birth (Mean age = 14.97, SD = 1.20) with NSSI histories ranging from none to severe. Participants and their parent/guardian were invited to provide data at three time points spaced approximately one year apart. Descriptive analyses were conducted to provide estimates of rates and trajectories of clinical data. Results Of the 164 study participants, 75.61% and 57.93% completed the second and third time points, respectively. Visual inspection of the data suggests an overall trend of decreasing severity of psychopathology over time, and adolescents with a history of NSSI appeared to have higher rates of psychopathology than those without. Conclusions This paper describes longitudinal clinical trajectories in adolescents with a range of NSSI histories and presents readers with an overview of the rich, publicly available dataset that we hope will inspire future research to advance the understanding of the neurodevelopmental trajectories associated with NSSI, depression, and suicide risk.
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Affiliation(s)
- Aparna U. Nair
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA
| | - Julia A. Brekke-Riedl
- Medical Scientist Training Program, University of Minnesota, Minneapolis, MN 55455, USA
| | | | | | - Carolyn Lasch
- Institute of Child Development, University of Minnesota, Minneapolis, MN 55455, USA
| | - Rylee Brower
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Victoria Papke
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kristina Reigstad
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA
| | | | - Kathryn R. Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA
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Tseng YC, Ditchman N. Non-suicidal self-injury in a college sample: Intrapersonal and family factors. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-10. [PMID: 37167593 DOI: 10.1080/07448481.2023.2209206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Objective: Adolescents and young adults are at risk for non-suicidal self-injury (NSSI) and suicidal behavior. This study examined intrapersonal (depressive symptoms, self-criticism) and family (perceived family functioning, parenting style, parental attachment) factors associated with reported history of NSSI in a college sample. Method: Participants included 111 undergraduate students (Mage = 20.2) from a private, nonprofit university. Data were collected via online survey. Hierarchical logistic regression analysis was conducted. Results: The final model was statically significant, Nagelkerke R2 = .40, suggesting a robust association between the predictors and history of NSSI. Self-criticism and unhealthy family functioning were significant predictors of NSSI behaviors after controlling for study variables and demographic characteristics. Reported history of engaging in NSSI was positively correlated with parent alienation, unhealthy family functioning, self-criticizing behaviors, and depressive symptoms. Conclusion: College mental health providers should be familiar with risk factors of NSSI as well as strategies to address self-criticism.
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Affiliation(s)
- Yen Chun Tseng
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Nicole Ditchman
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
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McAllister J, Skinner J, Hayhow R, Heron J, Wren Y. The Association Between Atypical Speech Development and Adolescent Self-Harm. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1600-1617. [PMID: 37080239 PMCID: PMC10457079 DOI: 10.1044/2023_jslhr-21-00652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/09/2022] [Accepted: 02/06/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Adolescent self-harm is a major public health issue internationally. Various factors associated with adolescent self-harm have been identified, including being bullied and experiencing mental health problems. Stuttering and speech sound disorder are associated with both of these factors. It was hypothesized that both stuttering and speech sound disorder would be associated with self-harm. This is the first study to explore the relationship between communication disorders and adolescent self-harm. METHOD Secondary analysis of a large, longitudinal, prospective, community sample, the Avon Longitudinal Study of Parents and Children, was carried out. Clinicians identified children who stuttered or exhibited speech sound disorder at the age of 8 years. When the cohort members were 16 years old, they were asked to complete a questionnaire about self-harm. Multinomial logistic regression was used to examine the associations between stuttering and speech sound disorder and the self-harm outcomes, adjusting for other relevant factors. RESULTS Of 3,824 participants with data for both speech status and self-harm, 94 (2.5%; 95% confidence interval [CI; 2.0, 3.0]) stuttered at 8 years of age and 127 (3.3%; 95% CI [2.8, 3.9]) displayed speech sound disorder. Speech sound disorder at the age of 8 years was associated with self-harm with suicidal intent in both unadjusted and adjusted models. Differences between the adjusted and unadjusted models were small, suggesting that speech sound disorder is largely an independent risk factor for self-harm with suicidal intent. Stuttering at the age of 8 years was not associated with adolescent self-harm, and there was no association between speech sound disorder and self-harm without suicidal intent. CONCLUSION Compared with individuals without speech sound disorder, adolescents with speech sound disorder at the age of 8 years have twice the risk of reporting self-harm with suicidal intent, even when other important predictors are taken into account. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22573030.
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Affiliation(s)
- Jan McAllister
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | - Jane Skinner
- Norwich Medical School, University of East Anglia, United Kingdom
| | - Rosemarie Hayhow
- Bristol Speech & Language Therapy Research Unit, North Bristol NHS Trust, United Kingdom
| | - Jon Heron
- Bristol School of Medicine,University of Bristol, United Kingdom
| | - Yvonne Wren
- Bristol Speech & Language Therapy Research Unit, North Bristol NHS Trust, United Kingdom
- Bristol Dental School, University of Bristol, United Kingdom
- Cardiff Metropolitan University, United Kingdom
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A meta-analysis of targeted interventions for reducing suicide-related behaviour and ideation in adolescents: Implications for trial design. Compr Psychiatry 2023; 122:152374. [PMID: 36758338 DOI: 10.1016/j.comppsych.2023.152374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Suicidality among young people is a significant societal issue. The current study conducted a meta-analysis of community and clinical interventions targeting suicide attempts, self-harm, and suicidal ideation in adolescents. METHODS Interventions targeting suicide attempts, self-harm and suicidal ideation were identified by searching PsychINFO, Medline, CINAHL and Embase in line with the PRISMA statement. Study quality was determined using a risk of bias tool. Meta-analyses examined the efficacy of the interventions. Effect sizes were calculated for suicidal ideation data (continuous data) using Hedge's g for standardised mean differences. Suicide attempts and self-harm (dichotomous data) were calculated using odds ratios (ORs). RESULTS Seventeen RCTs were included in the meta-analysis. No significant differences were found between treatment and control groups on measures of suicide attempts or self-harm. A small effect-size was observed on measures of suicidal ideation (g = 0.47). A secondary meta-analysis investigated change over time in treatment as usual conditions, finding significant large effect-sizes for suicide attempts (OR = 18.67), self-harm (OR = 12.77), and suicidal ideation (g = 0.86). LIMITATIONS The methodological decision to focus on specific outcomes over a broad definition of self-harm excluded some papers, which have been included in other reviews. It is unlikely to have significantly affected the overall results. The review was not preregistered. CONCLUSIONS These twin findings highlight the importance overcoming the methodological difficulty of discerning effective interventions during a period of baseline improvement. We suggest that future trials should move away from broadly addressing "suicidality/self-harm" and encourage a greater targeting of at-risk individuals.
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Waraan L, Siqveland J, Hanssen-Bauer K, Czjakowski NO, Axelsdóttir B, Mehlum L, Aalberg M. Family therapy for adolescents with depression and suicidal ideation: A systematic review and meta-analysis. Clin Child Psychol Psychiatry 2023; 28:831-849. [PMID: 36053279 PMCID: PMC10018060 DOI: 10.1177/13591045221125005] [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: 11/15/2022]
Abstract
OBJECTIVE To systematically review and meta-analyze the effectiveness of family therapy compared to other active treatments for adolescents with depressive disorders or suicidal ideation. METHOD We conducted a systematic search of The Cochrane Central Register of Controlled Trials, Medline, Embase, PsycINFO, AMED, CINAHL and Web of Science and performed two meta-analyses of outcomes for depressive symptoms and suicidal ideation. RESULTS We screened 5,940 records and identified 10 randomized controlled studies of family therapy for depressive disorder or suicidal ideation in adolescents with an active treatment comparison group. Nine studies reported outcome measures of depressive symptoms and four reported outcome measures of suicidal ideation. The meta-analysis showed no significant difference between family therapy and active comparison treatments for end-of-treatment levels of depression. For suicidal ideation our meta-analysis showed a significant effect in favour of family therapy over comparison treatments for suicidal ideation. CONCLUSIONS Based on the current body of research, we found that family therapy is not superior to other psychotherapies in the treatment of depressive disorder. However, family therapy leads to significantly improved outcomes for suicidal ideation, compared to other psychotherapies. The evidence for the treatment of depression is of low quality needs more research.
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Affiliation(s)
- Luxsiya Waraan
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Johan Siqveland
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- National Centre for Suicide Research and
Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ketil Hanssen-Bauer
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nikolai O Czjakowski
- Department of Mental Disorders, Norwegian Institute of Public
Health, Oslo, Norway
- PROMENTA Research Center, Department of
Psychology, University of Oslo, Oslo, Norway
| | - Brynhildur Axelsdóttir
- Regional Centre for Child and Adolescent
Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and
Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Aalberg
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
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Asarnow JR, Mehlum L. Practitioner Review: Treatment for Suicidal and Self-Harming Adolescents-Advances in Suicide Prevention Care. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:209-216. [PMID: 37201143 PMCID: PMC10172564 DOI: 10.1176/appi.focus.23021005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background Suicide is a leading cause of death globally in youths, and suicidal behavior and self-harm are major clinical concerns. This article updates the previous practitioner review (2012) with the aims of integrating new research evidence, including that reported in this Special Issue. Methods The article reviews scientific evidence related to steps in the care pathway for identifying and treating youths with elevated suicide/self-harm risk, specifically: (a) screening and risk assessment; (b) treatment; and (c) community-level suicide prevention strategies. Results Review of current evidence indicates that major advances have been achieved in knowledge regarding clinical and preventive practices for reducing suicide and self-harm risk in adolescents. The evidence supports the value of brief screeners for identifying youths with elevated suicide/self-harm risk and the efficacy of some treatments for suicidal and self-harm behavior. Dialectical behavior therapy currently meets Level 1 criteria (2 independent trials supporting efficacy) as the first well-established treatment for self-harm, and other approaches have shown efficacy in single randomized controlled trials. The effectiveness of some community-based suicide prevention strategies for reducing suicide mortality and suicide attempt rates has been demonstrated. Conclusions Current evidence can guide practitioners in delivering effective care for youth suicide/self-harm risk. Treatments and preventive interventions that address the psychosocial environment and enhance the ability of trusted adults to protect and support youths, while also addressing the psychological needs of youths appear to yield the greatest benefits. Although additional research is needed, our current challenge is to do our best to effectively utilize new knowledge to improve care and outcomes in our communities.Reprinted from J Child Psychol Psychiatry 2019; 60:1046-1054, with permission from John Wiley and Sons. Copyright © 2019.
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Affiliation(s)
- Joan Rosenbaum Asarnow
- Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA (Asarnow); National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway (Mehlum)
| | - Lars Mehlum
- Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA (Asarnow); National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway (Mehlum)
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Niu HM, Zhang ZM, Mu XM, Zhao HJ. The Characteristics and Influencing Factors of Nonsuicidal Self-Injury of Adolescents With Depressive Disorder in China: A Meta-analysis. J Nerv Ment Dis 2023; 211:448-452. [PMID: 36943328 DOI: 10.1097/nmd.0000000000001641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
ABSTRACT This study is a systematic review of characteristics and influencing factors of nonsuicidal self-injury behavior among adolescents with depressive disorder in China. PubMed, CNKI, WanFang Database, and VIP were searched for studies. Meta-analysis was performed using RevMan 5.1 software. Nineteen studies involving 707 subjects were included in the meta-analysis. Age, gender, only child or not, and residence were included in the analysis, of which age (I2 = 0%, p = 0.42) and residence (I2 = 0%, p = 0.84) were analyzed by fixed-effects model; gender (I2 = 75%, p = 0.003) and only child or not (I2 = 50%, p = 0.140) were analyzed by random-effects model. The evidence shows that, according to the common self-injury mode and location, the nonsuicidal self-injury behavior of young people with depressive disorder aged 15-18 years is paid attention to and guided, so as to achieve early detection and early diagnosis and treatment, and reduce the occurrence of serious harm.
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Affiliation(s)
- Hui-Ming Niu
- Department of Medical Clinical Psychology, The Third People's Hospital of Tianshui, Tianshui, China
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Ohlis A, Bjureberg J, Ojala O, Kerj E, Hallek C, Fruzzetti AE, Hellner C. Experiences of dialectical behaviour therapy for adolescents: A qualitative analysis. Psychol Psychother 2023; 96:410-425. [PMID: 36756991 DOI: 10.1111/papt.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/14/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To explore how former patients in dialectical behaviour therapy for adolescents (DBT-A) experience their treatment, and specifically if there were aspects of the treatment that they retrospectively identify as particularly meaningful, helpful or unhelpful. DESIGN From a larger sample of 75 former DBT-A patients 19 were selected for a qualitative semi-structured interview study. METHODS Young adults (N = 19; 18 females, one male), who as adolescents had been enrolled in DBT-A due to self-harming behaviours and features of borderline personality disorder, were interviewed up to 8 years (median 6.0; min 1.3; max 8.2) after end of treatment, at mean age 23 years (SD 2.5). Reflexive thematic analysis was implemented. RESULTS Six key themes were revealed; (1) The need to be seen, listened to and believed in, (2) the importance of teamwork between patient and therapist, (3) the value of group and structure, (4) therapy as lifesaving and life-changing, (5) the risks of feeling misplaced and (6) the risks of abrupt endings. CONCLUSION A trusting relationship with the therapist promoted commitment and motivation for treatment. This relationship was facilitated by the therapist showing explicit care and belief in the patient's own competence in changing their destructive behaviours. Meeting peers in group skill training offered a salient form of validation and was reported to be of particular value. The format of meeting peers and the importance of the dialectical therapeutic stance need to be studied further. Not all youth experienced DBT-A as suitable and the need for sufficient treatment dose was emphasized.
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Affiliation(s)
- Anna Ohlis
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan Bjureberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Psychology, Stanford University, Stanford, California, USA
| | - Olivia Ojala
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Emme Kerj
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Camilla Hallek
- DBT-unit, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Alan E Fruzzetti
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Clara Hellner
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Armstrong G, Sutherland G, Pross E, Mackinnon A, Reavley N, Jorm A. Effects of an Aboriginal and Torres Strait Islander Mental Health First Aid training programme for non-suicidal self-injury on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions: an uncontrolled trial with precourse and postcourse measurement and 6-month follow-up. BMJ Open 2023; 13:e066043. [PMID: 36631233 PMCID: PMC9835939 DOI: 10.1136/bmjopen-2022-066043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Non-suicidal self-injury (NSSI) is a complex issue affecting Aboriginal and/or Torres Strait Islander Peoples in Australia. We evaluated the effects of an Aboriginal and Torres Strait Islander Mental Health First Aid (AMHFA) training course on assisting an Aboriginal and/or Torres Strait Islander person engaging in NSSI, including the effects on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions. DESIGN Uncontrolled trial with precourse and postcourse measurement (n=49) and 6-month follow-up (n=17). SETTING Participants attended courses that were run in Queensland and Victorian communities and through one national organisation. PARTICIPANTS Participants were 49 adults who worked directly with Aboriginal and/or Torres Strait Islander Peoples. INTERVENTION The 5-hour 'Talking About Non-Suicidal Self-Injury' course was delivered by accredited AMHFA instructors and teaches people how to support an Aboriginal and/or Torres Strait Islander person who is engaging in NSSI. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome measures were stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a person engaging in NSSI. RESULTS Improvements were observed in stigmatising attitudes, with significant changes from precourse in both the 'weak-not-sick' (postcourse p<0.0623; follow-up p=0.0058) and 'dangerous/unpredictable' (postcourse p<0.0001; follow-up p=0.0036) subscales. Participants' confidence in ability to assist increased significantly both postcourse (p<0.0001) and at follow-up (p<0.0001). Despite a high level of endorsement for the nine recommended assisting actions at precourse, significant improvements (p<0.05) were observed in endorsement for six and four of the assisting actions postcourse and at follow-up, respectively. Course content was rated as being somewhat (3.4%), mostly (13.8%) or very (82.7%) culturally appropriate by participants who identified as Aboriginal and/or Torres Strait Islander. CONCLUSIONS The results of this uncontrolled trial were encouraging, suggesting that the Talking About Non-Suicidal Self-Injury course was able to improve participants' attitudes, confidence and intended assisting actions.
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Affiliation(s)
- Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georgina Sutherland
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Eliza Pross
- Mental Health First Aid Australia, Melbourne, Victoria, Australia
| | - Andrew Mackinnon
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Souza LC, Galvão LP, Paiva HS, Périco CDAM, Ventriglio A, Torales J, Castaldelli-Maia JM, Martins-da-Silva AS. Major depressive disorder as a risk factor for suicidal ideation for attendees of educational institutions: a meta-analysis and meta-regression. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2021344. [PMID: 36921167 PMCID: PMC10013990 DOI: 10.1590/1984-0462/2023/41/2021344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 05/29/2022] [Indexed: 03/18/2023]
Abstract
OBJECTIVE This study aimed to analyze the effect of major depressive disorder (MDD) as a risk factor for suicidal ideation in individuals whose ages varied from 11 to 24 years and who were attending educational institutions. DATA SOURCE A systematic review was carried out by searching in PubMed and Biblioteca Virtual em Saúde (BVS). Original studies conducted in educational institutions, including individuals whose age varied from 11 to 24 years, in English, Spanish, or Portuguese were included. DATA SYNTHESIS Eight studies were selected for the meta-analysis, including 35,443 youths, with an average age of 16.8 years, predominantly female (51.2%), and from middle-income Asian countries (91.6%). An odds ratio of MDD of 3.89 (95%CI 2.46-6.17) for suicide ideation in youth was found. Subgroup analysis showed higher effects in Asia (OR=4.71; 95%CI 3.22-6.89) than Americas (OR=1.71; 95%CI 1.44-2.03). The meta-regression model indicated that younger adolescents (coef=-0.63; 95%CI 1.09--0.18; p<0.01) and older studies (coef=-0.23; 95%CI 0.039--0.08; p<0.01) presented higher effects of MDD on suicidal ideation. CONCLUSIONS Early detection and treatment of MDD in youth patients are of utmost importance for preventing suicidal ideation. Educational institutions could play an important role in the early detection and intervention.
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Affiliation(s)
- Laura Costa Souza
- Secretaria de Saúde de São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
| | | | | | | | | | - Julio Torales
- National University of Asunción, School of Medical Sciences, San Lorenzo, Paraguay
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Zhao L, Zhou D, Hu J, He X, Peng X, Ma L, Liu X, Tao W, Chen R, Jiang Z, Zhang C, Liao J, Xiang J, Zeng Q, Dai L, Zhang Q, Hong S, Wang W, Kuang L. Changes in microstates of first-episode untreated nonsuicidal self-injury adolescents exposed to negative emotional stimuli and after receiving rTMS intervention. Front Psychiatry 2023; 14:1151114. [PMID: 37181884 PMCID: PMC10172670 DOI: 10.3389/fpsyt.2023.1151114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Background Nonsuicidal self-injury (NSSI) is a common mental health threat in adolescents, peaking in adolescence with a lifetime prevalence of ~17%-60%, making it a high-risk risk factor for suicide. In this study, we compared changes in microstate parameters in depressed adolescents with NSSI, depressed adolescents, and healthy adolescents during exposure to negative emotional stimuli, and further explored the improvement of clinical symptoms and the effect of microstate parameters of repetitive transcranial magnetic stimulation (rTMS) in depressed adolescents with NSSI, and more evidence was provided for potential mechanisms and treatment optimization for the occurrence of NSSI behaviors in adolescents. Methods Sixty-six patients with major depressive disorder (MDD) exhibiting NSSI behavior (MDD + NSSI group), 52 patients with MDD (MDD group), and 20 healthy subjects (HC group) were recruited to perform neutral and negative emotional stimulation task. The age range of all subjects was 12-17 years. All participants completed the Hamilton Depression Scale, the Patient Health Questionnaire-9, the Ottawa Self-Injury Scale and a self-administered questionnaire to collect demographic information. We provided two different treatments to 66 MDD adolescents with NSSI; 31 patients received medication and completed post-treatment scale assessments and EEG acquisitions, and 21 patients received medication combined with rTMS and completed post-treatment scale assessments and EEG acquisitions. Multichannel EEG was recorded continuously from 64 scalp electrodes using the Curry 8 system. EEG signal preprocessing and analysis was performed offline, using the EEGLAB toolbox in MATLAB. Use the Microstate Analysis Toolbox in EEGLAB for segmentation and computation of microstates, and calculate a topographic map of the microstate segmentation of the EEG signal for a single subject in each dataset, and four parameters were obtained for each microstate classification: global explained variance (GEV), mean duration (Duration), average number of occurrences per second (Occurrence), and average percentage of total analysis time occupied (Coverage), which were then statistically analyzed. Results Our results indicate that MDD adolescents with NSSI exhibit abnormalities in MS 3, MS 4, and MS 6 parameters when exposed to negative emotional stimuli compared to MDD adolescents and healthy adolescents. The results also showed that medication combined with rTMS treatment improved depressive symptoms and NSSI performance more significantly in MDD adolescents with NSSI compared to medication treatment, and affected MS 1, MS 2, and MS 4 parameters in MDD adolescents with NSSI, providing microstate evidence for the moderating effect of rTMS. Conclusion MDD adolescents with NSSI showed abnormal changes in several microstate parameters when receiving negative emotional stimuli, and compared to those not receiving rTMS treatment, MDD adolescents with NSSI treated with rTMS showed more significant improvements in depressive symptoms and NSSI performance, as well as improvements in EEG microstate abnormalities.
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Affiliation(s)
- Lin Zhao
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongdong Zhou
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Jinhui Hu
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoqing He
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Peng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingli Ma
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyi Liu
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Wanqing Tao
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Ran Chen
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenghao Jiang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Chenyu Zhang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Liao
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaojiao Xiang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Zeng
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Linxi Dai
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Zhang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su Hong
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wo Wang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Li Kuang,
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Liu RT. The epidemiology of non-suicidal self-injury: lifetime prevalence, sociodemographic and clinical correlates, and treatment use in a nationally representative sample of adults in England. Psychol Med 2023; 53:274-282. [PMID: 33960286 PMCID: PMC10324294 DOI: 10.1017/s003329172100146x] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although the clinical importance of non-suicidal self-injury (NSSI) has received increasing recognition, relatively little is known about its epidemiology. The objective of this study was to estimate the lifetime prevalence of NSSI in adults and its association with sociodemographic characteristics, psychiatric disorders, and lifetime treatment for NSSI. METHODS A nationally representative face-to-face survey was conducted with 7192 adults aged ≥18 years in England. Respondents were interviewed about engagement in NSSI, psychiatric illness, suicidal thoughts and behavior, and treatment history for this behavior. RESULTS The estimated lifetime prevalence rate of NSSI was 4.86%. Younger age, growing up without biological parents in the household, being unmarried, and impoverished backgrounds were associated with NSSI. The majority of respondents with lifetime NSSI (63.82%) had at least one current psychiatric disorder. Most psychiatric conditions were associated with greater odds of lifetime NSSI in multivariate models. NSSI was strongly associated with suicidal ideation and suicide attempts, respectively, even after accounting for psychiatric disorders and sociodemographic covariates. A substantial proportion of respondents with NSSI history (30.92%) have engaged in medically severe self-harm, as indexed by requiring medical attention for this behavior. The majority of respondents with NSSI (56.20%) had not received psychiatric care for this behavior. CONCLUSIONS NSSI is prevalent in the general population and associated with considerable psychiatric comorbidity. A high rate of unmet treatment needs is evident among those with this behavior. Those at the greatest lifetime risk for NSSI may also be particularly limited in their resources to cope with this behavior.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Na E, Lee K, Jeon BH, Jo C, Kwak UH, Jeon Y, Yang K, Lee EJ, Jeong J. Acceptance and Commitment Therapy for Destructive Experiential Avoidance (ACT-DEA): A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16434. [PMID: 36554315 PMCID: PMC9779048 DOI: 10.3390/ijerph192416434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
This study is a preliminary study on an acceptance and commitment therapy (ACT) program that mitigates destructive experiential avoidance (DEA) behaviors, including self-harm behavior and addiction; Methods: Twenty participants aged 15-25 years who had confirmed DEA behavior within the last month participated in a total of six sessions of ACT. Demographic characteristics, history of psychiatric illness, and TYPES and patterns of DEA behavior were confirmed in the baseline survey. The severity of clinical symptoms, frequency of DEA behavior and impulsivity, characteristics of experiential avoidance (EA) behavior, depression, and quality of life (QOL) were measured before and after the program for comparative statistical tests using the intention-to-treat method. Furthermore, the severity of clinical symptoms was evaluated after each program, along with the frequency of DEA behavior and trends in impulsivity, which were investigated based on the behavior log; Results: After the ACT program, both the frequency of DEA behavior and impulsivity and the severity of clinical symptoms, depression, and anxiety decreased significantly. Furthermore, among the EA characteristics, pain aversion, distraction and inhibition, and delayed behavior significantly improved. Moreover, the overall QOL, psychological and social relationships, and QOL regarding the environment also improved; Conclusions: The results of this feasibility study demonstrate the potential of the ACT program as an effective intervention in DEA behavior. The results of this study may be used as preliminary data for future large-scale randomized studies.
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Affiliation(s)
- Euihyeon Na
- Department of Neuropsychiatry, Presbyterian Medical Center, Jeonju 54987, Republic of Korea
| | - KangUk Lee
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Bong-Hee Jeon
- Mind with Mind Psychiatric Clinic, Changwon 51436, Republic of Korea
| | - Cheolrae Jo
- Maum Gonggam Psychiatric Clinic, Goyang 10497, Republic of Korea
| | - Uk-Hwan Kwak
- Mind with Mind Psychiatric Clinic, Changwon 51436, Republic of Korea
| | - Yujin Jeon
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Seoul 03181, Republic of Korea
| | - Kyojin Yang
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Eui Jin Lee
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Jin Jeong
- Jeong Jin Psychiatric Clinic, Suwon 16489, Republic of Korea
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50
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Muentner L, Stone KJ, Davis L, Shlafer R. Youth at the intersection of parental incarceration and foster care: Examining prevalence, disparities, and mental health. CHILD ABUSE & NEGLECT 2022; 134:105910. [PMID: 36182827 DOI: 10.1016/j.chiabu.2022.105910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND While there are various pathways by which children experience parental incarceration or foster care, involvement in either system is associated with adverse health outcomes. Despite co-occurring risk factors for parental incarceration and foster care, little is known about the prevalence or characteristics of youth navigating both of these experiences. OBJECTIVES This study details the prevalence of youth at the intersection of parental incarceration and foster care, their demographic characteristics, and heterogeneity in their mental health. PARTICIPANTS AND SETTING Data come from the 2019 Minnesota Student Survey with 112,157 eighth-, ninth-, and eleventh-grade students. METHODS Logistic regression with interactions between parental incarceration and foster care predict associated odds of youth's anxiety and depression; self-injurious behavior, suicidal ideation and attempt; and mental health diagnoses and treatment. RESULTS Nearly 2 % of students experienced both parental incarceration and foster care, with a disproportionate number of those identifying as youth of color, experiencing poverty, and/or living in rural communities. Both parental incarceration and foster care were separately linked with poor mental health, yet experiencing both was associated with higher odds of anxiety, depression, self-injury, suicidal ideation, suicide attempt, diagnosis, and treatment. Youth with proximal multiplicative exposure (recent foster care and current parental incarceration) reported the most adverse mental health symptoms. CONCLUSION The study emboldens what is known about the inequitable distribution of parental incarceration and foster care. These findings highlight the association between dual-systems-impacted youth and mental health indicators, with important implications for increasing access to mental health services while simultaneously calling for systems change.
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Affiliation(s)
- Luke Muentner
- Division of General Pediatrics and Adolescent Health, University of Minnesota, United States of America.
| | - Katie J Stone
- Division of Clinical Behavioral Neuroscience, University of Minnesota, United States of America
| | - Laurel Davis
- Division of General Pediatrics and Adolescent Health, University of Minnesota, United States of America
| | - Rebecca Shlafer
- Division of General Pediatrics and Adolescent Health, University of Minnesota, United States of America
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