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Meyerhoff J, Kruzan KP, Kim KYA, Van Orden K, Mohr DC. Exploring the Safety of a General Digital Mental Health Intervention to Effect Symptom Reduction among Individuals with and without Suicidal Ideation: A Secondary Analysis. Arch Suicide Res 2023; 27:966-983. [PMID: 35822235 PMCID: PMC9834433 DOI: 10.1080/13811118.2022.2096520] [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] [Indexed: 01/14/2023]
Abstract
Trials of digital mental health interventions (DMHIs) often exclude individuals with suicide-related thoughts and behaviors precluding an understanding of whether DMHIs for affective disorders are safe for, and perform similarly within, this high-risk group. We explore the safety and performance of a DMHI for depression in participants with and without suicidal ideation (SI) at baseline. Three hundred and one participants were included in this secondary data analysis from a trial of an 8-week DMHI comprising 14 smartphone apps. We found that SI decreased across the study among participants with baseline SI and that baseline SI status did not attenuate depression treatment effects. Through a case study of the IntelliCare platform, we find that DMHIs for general affective disorders can be safe.
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Affiliation(s)
- Jonah Meyerhoff
- Feinberg School of Medicine, Northwestern University, Department of Preventive Medicine, Center for Behavioral Intervention Technologies (CBITs), 750 North Lake Shore Drive, 10 Floor, Chicago, IL 60611
| | - Kaylee P. Kruzan
- Feinberg School of Medicine, Northwestern University, Department of Preventive Medicine, Center for Behavioral Intervention Technologies (CBITs), 750 North Lake Shore Drive, 10 Floor, Chicago, IL 60611
| | - Kwang-Youn A. Kim
- Feinberg School of Medicine, Northwestern University, Department of Preventive Medicine, 750 North Lake Shore Drive, 10 Floor, Chicago, IL 60611
| | - Kimberly Van Orden
- University of Rochester Medical Center, Department of Psychiatry, 300 Crittenden Blvd. Rochester, NY 14642
| | - David C. Mohr
- Feinberg School of Medicine, Northwestern University, Department of Preventive Medicine, Center for Behavioral Intervention Technologies (CBITs), 750 North Lake Shore Drive, 10 Floor, Chicago, IL 60611
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Hornstein S, Zantvoort K, Lueken U, Funk B, Hilbert K. Personalization strategies in digital mental health interventions: a systematic review and conceptual framework for depressive symptoms. Front Digit Health 2023; 5:1170002. [PMID: 37283721 PMCID: PMC10239832 DOI: 10.3389/fdgth.2023.1170002] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Personalization is a much-discussed approach to improve adherence and outcomes for Digital Mental Health interventions (DMHIs). Yet, major questions remain open, such as (1) what personalization is, (2) how prevalent it is in practice, and (3) what benefits it truly has. Methods We address this gap by performing a systematic literature review identifying all empirical studies on DMHIs targeting depressive symptoms in adults from 2015 to September 2022. The search in Pubmed, SCOPUS and Psycinfo led to the inclusion of 138 articles, describing 94 distinct DMHIs provided to an overall sample of approximately 24,300 individuals. Results Our investigation results in the conceptualization of personalization as purposefully designed variation between individuals in an intervention's therapeutic elements or its structure. We propose to further differentiate personalization by what is personalized (i.e., intervention content, content order, level of guidance or communication) and the underlying mechanism [i.e., user choice, provider choice, decision rules, and machine-learning (ML) based approaches]. Applying this concept, we identified personalization in 66% of the interventions for depressive symptoms, with personalized intervention content (32% of interventions) and communication with the user (30%) being particularly popular. Personalization via decision rules (48%) and user choice (36%) were the most used mechanisms, while the utilization of ML was rare (3%). Two-thirds of personalized interventions only tailored one dimension of the intervention. Discussion We conclude that future interventions could provide even more personalized experiences and especially benefit from using ML models. Finally, empirical evidence for personalization was scarce and inconclusive, making further evidence for the benefits of personalization highly needed. Systematic Review Registration Identifier: CRD42022357408.
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Affiliation(s)
- Silvan Hornstein
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kirsten Zantvoort
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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Tepe ÇŞ, Eker F. Content analysis of suicide prevention web pages from perspective of preventive psychiatric approaches. CURRENT PSYCHOLOGY 2023:1-8. [PMID: 37359652 PMCID: PMC10008009 DOI: 10.1007/s12144-023-04496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/13/2023]
Abstract
Suicide is a serious public health problem; however, suicides are preventable with evidence-based and often low-cost interventions. This study analyzes the online content of suicide prevention and helps websites in the context of preventive psychiatry. The universe and sample of the research consisted of 147 web pages whose links can be found on the most widely used international social media platforms and websites dedicated to suicide prevention. To conduct the content analysis, the crisis hotline guide prepared by the World Health Organization for suicide prevention and the guide prepared for media professionals were used in the data collection form created by the researchers. The majority of the websites were of European origin and were prepared by mental health and suicide prevention associations for suicide prevention and crisis intervention. Telephone helplines were the most common means of communicating with consultants via the web page. On the basis of the research findings, suggestions were generated regarding the scope, content, and sustainability of web pages for crisis intervention and suicide prevention prepared at the national and international levels.
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Affiliation(s)
- Çiğdem Şen Tepe
- Faculty of Health Sciences, Department of Psychiatric Nursing, Sakarya University, Sakarya, Turkey
| | - Fatma Eker
- Faculty of Health Sciences, Department of Nursing, Cyprus International University, Nicosia, North Cyprus
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Chammas F, Januel D, Bouaziz N. Inpatient suicide in psychiatric settings: Evaluation of current prevention measures. Front Psychiatry 2022; 13:997974. [PMID: 36386981 PMCID: PMC9650354 DOI: 10.3389/fpsyt.2022.997974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2022] Open
Abstract
The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.
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Affiliation(s)
- Francesca Chammas
- Centre de Recherche Clinique, EPS Ville-Evrard, Neuilly-sur-Marne, France
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Alvarez M. “Life is about trying to find a better place to live”: Discourses of dwelling in a pro-recovery suicide forum. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2022. [DOI: 10.4081/qrmh.2022.10437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In the two decades since the advent of Web 2.0, scholars of cybersuicide have identified many beneficial and harmful uses of the internet. However, the discursive meanings interactionally created by suicide website users have scarcely been attended to. The present study uses the theory and method of cultural discourse analysis (CuDA) to arrive at meanings about place that radiate from online communication among users of SuicideForum.com (SF), a pro-recovery website. Analyses of 2,119 posts across 131 threads reveal two overarching discursive themes. The first speaks to problematic discourses about place, including the role of placelessness and entrapment in the genesis of suicidality and its affective states, leading to further diminution of experiential worlds. The second theme taps into participants’ notions of what constitutes safe spaces, such as the presence of empathetic others who respect one’s timetable for personal disclosure, and the freedom to experiment with new ways of inhabiting the world. The study has numerous implications for clinical practice, including recasting psychological disturbances in terms of self-world relations and reconsidering involuntary psychiatric hospitalization in light of forum participants’ preoccupation with entrapment.
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Skaczkowski G, van der Kruk S, Loxton S, Hughes-Barton D, Howell C, Turnbull D, Jensen N, Smout M, Gunn K. Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review. JMIR Ment Health 2022; 9:e31018. [PMID: 35133281 PMCID: PMC8864526 DOI: 10.2196/31018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/23/2021] [Accepted: 08/12/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A large number of Australians experience mental health challenges at some point in their lives. However, in many parts of Australia, the wait times to see general practitioners and mental health professionals can be lengthy. With increasing internet use across Australia, web-based interventions may help increase access to timely mental health care. As a result, this is an area of increasing research interest, and the number of publicly available web-based interventions is growing. However, it can be confusing for clinicians and consumers to know the resources that are evidence-based and best meet their needs. OBJECTIVE This study aims to scope out the range of web-based mental health interventions that address depression, anxiety, suicidal ideation, or general mental well-being and are freely available to Australian adults, along with their impact, acceptability, therapeutic approach, and key features. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews (PRISMA-ScR [PRISMA extension for Scoping Reviews]) guided the review process. Keywords for the search were depression, anxiety, suicide, and well-being. The search was conducted using Google as well as the key intervention databases Beacon, Head to Health, and e-Mental Health in Practice. Interventions were deemed eligible if they targeted depression, anxiety, suicidal ideation, or general mental well-being (eg, resilience) in adults; and were web-based, written in English, interactive, free, and publicly available. They also had to be guided by an evidence-based therapeutic approach. RESULTS Overall, 52 eligible programs were identified, of which 9 (17%) addressed depression, 15 (29%) addressed anxiety, 13 (25%) addressed general mental well-being, and 13 (25%) addressed multiple issues. Only 4% (2/52) addressed distress in the form of suicidal ideation. The most common therapeutic approach was cognitive behavioral therapy. Half of the programs guided users through exercises in a set sequence, and most programs enabled users to log in and complete the activities on their own without professional support. Just over half of the programs had been evaluated for their effectiveness in reducing symptoms, and 11% (6/52) were being evaluated at the time of writing. Program evaluation scores ranged from 44% to 100%, with a total average score of 85%. CONCLUSIONS There are numerous web-based programs for depression, anxiety, suicidal ideation, and general well-being, which are freely and publicly available in Australia. However, identified gaps include a lack of available web-based interventions for culturally and linguistically diverse populations and programs that use newer therapeutic approaches such as acceptance and commitment therapy and dialectical behavior therapy. Despite most programs included in this review being of good quality, clinicians and consumers should pay careful attention when selecting which program to recommend and use, as variations in the levels of acceptability and impact of publicly available programs do exist.
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Affiliation(s)
- Gemma Skaczkowski
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Shannen van der Kruk
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Sophie Loxton
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Donna Hughes-Barton
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Cate Howell
- Australian Medical Placements Health Education and Training, Adelaide, Australia
- Torrens University, Adelaide, Australia
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemasons Centre for Male Health and Wellbeing, Adelaide, Australia
| | - Neil Jensen
- Freemasons Centre for Male Health and Wellbeing, Adelaide, Australia
| | - Matthew Smout
- Justice and Society, University of South Australia, Adelaide, Australia
| | - Kate Gunn
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- Freemasons Centre for Male Health and Wellbeing, Adelaide, Australia
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Abstract
OBJECTIVE Suicide is a complex phenomenon, with numerous factors contributing to an individual's risk of suicide. The aim of the present study was to explore how risk and protective factors for suicide interact with one another in a network sense and to determine which factors were most central to a network of these factors. METHOD Using an online survey, cross-sectional data were collected from a sample of 515 individuals who lived in New Zealand, Australia, the United Kingdom, and the United States of America. Participants were recruited through either social media or Prolific Academic. A network of 18 risk and protective factors for suicide was estimated using network analysis. Analyses were preregistered on the Open Science Framework. RESULTS Factors that had the highest strength centrality were feeling depressed, feeling hopeless, perceived burdensomeness, self-esteem, and social support. Factors that were directly associated with suicidal ideation included feeling depressed, perceived burdensomeness, feeling hopeless, self-esteem, resilience, access to mental health services and a positive attitude toward these services. CONCLUSION This research demonstrates the importance of examining protective factors as well as risk factors when estimating an individual's suicide risk. The results suggest that interventions targeting depression may be particularly beneficial in reducing suicide risk, but further longitudinal research is required.HIGHLIGHTSThe network analyses estimated depression to be the most central risk factor.Depression and perceived burdensomeness were risk factors for suicidal ideation.Self-esteem and resilience were protective against suicidal ideation.
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van Bentum JS, van Bronswijk SC, Sijbrandij M, Lemmens LHJM, Peeters FFPML, Drukker M, Huibers MJH. Cognitive therapy and interpersonal psychotherapy reduce suicidal ideation independent from their effect on depression. Depress Anxiety 2021; 38:940-949. [PMID: 33755280 PMCID: PMC8451935 DOI: 10.1002/da.23151] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/05/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical guidelines suggest that psychological interventions specifically aimed at reducing suicidality may be beneficial. We examined the impact of two depression treatments, cognitive therapy (CT) and interpersonal psychotherapy (IPT) on suicidal ideation (SI) and explored the temporal associations between depression and SI over the course of therapy. METHODS Ninety-one adult (18-65) depressed outpatients from a large randomized controlled trial who were treated with CT (n = 37) and IPT (n = 54) and scored at least ≥1 on the Beck Depression Inventory II (BDI-II) suicide item were included. Linear (two-level) mixed effects models were used to evaluate the impact of depression treatments on SI. Mixed-effects time-lagged models were applied to examine temporal relations between the change in depressive symptoms and the change in SI. RESULTS SI decreased significantly during treatment and there were no differential effects between the two intervention groups (B = -0.007, p = .35). Depressive symptoms at the previous session did not predict higher levels of SI at the current session (B = 0.016, p = .16). However, SI measured at the previous session significantly predicted depressive symptoms at the current session (B = 2.06, p < .001). CONCLUSIONS Both depression treatments seemed to have a direct association with SI. The temporal association between SI and depression was unidirectional with SI predicting future depressive symptoms during treatment. Our findings suggest that it may be most beneficial to treat SI first.
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Affiliation(s)
- Jaël S. van Bentum
- Department of Clinical, Neuro‐ and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Suzanne C. van Bronswijk
- Department of Clinical Psychological Science, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro‐ and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
- World Health Organization Collaborating Centre for Research and Dissemination of Psychological InterventionsVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Lotte H. J. M. Lemmens
- Department of Clinical Psychological Science, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Frenk F. P. M. L. Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Marcus J. H. Huibers
- Department of Clinical, Neuro‐ and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Finlayson BT, Jones E, Pickens JC. Solution Focused Brief Therapy Telemental Health Suicide Intervention. CONTEMPORARY FAMILY THERAPY 2021; 45:49-60. [PMID: 34393359 PMCID: PMC8353437 DOI: 10.1007/s10591-021-09599-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 12/01/2022]
Abstract
One of the innumerable impacts of the coronavirus has been the change in how individuals provide services. For mental health providers, the pandemic required a sudden shift from in person to online service delivery. As therapists learn and embrace a new modality for providing therapy, crisis situations may present with some anxiety. With the pandemic increasing crisis situations for so many individuals, and teletherapy as a mode of service delivery being unlikely to go away after the pandemic, therapists require support in navigating crises situations online, in a medium that feels like the therapist has less control with their clients due to being in different physical locations. The authors believe that regardless of the primary model(s) therapists utilize in session, solution-focused brief therapy is an integrative model that uniquely captures client's resources and reasons for living and when clients are in crisis. The purpose of this paper is to present recommendations for applying solution-focused language in teletherapy practice, to provide ethical, evidenced based care for clients in crisis. A clinical vignette is used to illustrate the application of solution focused brief therapy for working with clients in crisis. Future directions and limitations are discussed.
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Affiliation(s)
- Benjamin T. Finlayson
- Department of Community, Family, & Addiction Sciences, Texas Tech University, Lubbock, TX USA
| | - Ethan Jones
- Department of Community, Family, & Addiction Sciences, Texas Tech University, Lubbock, TX USA
| | - Jaclyn Cravens Pickens
- Department of Community, Family, & Addiction Sciences, Texas Tech University, Lubbock, TX USA
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Mahoney AEJ, Haskelberg H, Mason E, Millard M, Newby J. Comorbid personality difficulties are not associated with poorer outcomes for online cognitive behaviour therapy for symptoms of anxiety and depression. Personal Ment Health 2021; 15:173-185. [PMID: 33650772 DOI: 10.1002/pmh.1506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/13/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
Little is known about the prevalence and impact on treatment of comorbid personality disorders for adults undertaking online cognitive behaviour therapy (internet-delivered or internet-based cognitive behaviour therapy (iCBT)) for anxiety and depressive disorders. This study explored how common comorbid personality difficulties were in a large sample of consecutive patients (N = 1 132) seeking iCBT for their symptoms of anxiety and depression in routine care settings. Patients completed the Standardized Assessment of Personality-abbreviated Scale Self-Report prior to commencing an iCBT programme, as well as completing assessments of anxiety and depression symptom severity and psychological distress pre-iCBT and post-iCBT. Consistent with previous studies, a high proportion of the sample (62.6%) reported experiencing comorbid personality difficulties. However, comorbid personality difficulties were not significantly associated with poorer treatment adherence or higher post-treatment symptom severity or psychological distress (controlling for baseline symptom severity, demographic characteristics and treatment variables). Current findings support an inclusive approach to iCBT provision where comorbid personality difficulties do not appear to be a contraindication for treatment. © 2021 John Wiley & Sons, Ltd.
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Affiliation(s)
- Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Mason
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Jill Newby
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Black Dog Institute, Sydney, New South Wales, Australia
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Rassy J, Bardon C, Dargis L, Côté LP, Corthésy-Blondin L, Mörch CM, Labelle R. Information and Communication Technology Use in Suicide Prevention: Scoping Review. J Med Internet Res 2021; 23:e25288. [PMID: 33820754 PMCID: PMC8132980 DOI: 10.2196/25288] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The use of information and communication technology (ICT) in suicide prevention has progressed rapidly over the past decade. ICT plays a major role in suicide prevention, but research on best and promising practices has been slow. OBJECTIVE This paper aims to explore the existing literature on ICT use in suicide prevention to answer the following question: what are the best and most promising ICT practices for suicide prevention? METHODS A scoping search was conducted using the following databases: PubMed, PsycINFO, Sociological Abstracts, and IEEE Xplore. These databases were searched for articles published between January 1, 2013, and December 31, 2018. The five stages of the scoping review process were as follows: identifying research questions; targeting relevant studies; selecting studies; charting data; and collating, summarizing, and reporting the results. The World Health Organization suicide prevention model was used according to the continuum of universal, selective, and indicated prevention. RESULTS Of the 3848 studies identified, 115 (2.99%) were selected. Of these, 10 regarded the use of ICT in universal suicide prevention, 53 referred to the use of ICT in selective suicide prevention, and 52 dealt with the use of ICT in indicated suicide prevention. CONCLUSIONS The use of ICT plays a major role in suicide prevention, and many promising programs were identified through this scoping review. However, large-scale evaluation studies are needed to further examine the effectiveness of these programs and strategies. In addition, safety and ethics protocols for ICT-based interventions are recommended.
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Affiliation(s)
- Jessica Rassy
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Research Center, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
- School of Nursing, Université de Sherbrooke, Longueuil, QC, Canada
- Quebec Network on Nursing Intervention Research, Montréal, QC, Canada
| | - Cécile Bardon
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Luc Dargis
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
| | - Louis-Philippe Côté
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Laurent Corthésy-Blondin
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Carl-Maria Mörch
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
- Algora Lab, Université de Montréal, Montréal, QC, Canada
- Mila, Quebec Artificial Intelligence Institute, Montréal, QC, Canada
| | - Réal Labelle
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Research Center, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
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12
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Bukuluki P, Wandiembe S, Kisaakye P, Besigwa S, Kasirye R. Suicidal Ideations and Attempts Among Adolescents in Kampala Urban Settlements in Uganda: A Case Study of Adolescents Receiving Care From the Uganda Youth Development Link. FRONTIERS IN SOCIOLOGY 2021; 6:646854. [PMID: 34368292 PMCID: PMC8334726 DOI: 10.3389/fsoc.2021.646854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/26/2021] [Indexed: 05/21/2023]
Abstract
There is an increasing recognition that suicidal ideation is a major public health concern in sub-Saharan Africa. We employed a case study design, taking a case study of adolescents currently under the care of Uganda Youth Development Link (UYDEL). The data analyzed were collected from 219 female and male adolescents (13-19 years) recruited through UYDEL in Kampala, Uganda. A Poisson regression model with robust variance was used to assess the risk factors associated with suicidality. The prevalence of suicidal ideation in the past 4 weeks and attempt within the past 6 months among adolescents was 30.6% (95% CI: 24.8, 38.0%) and 24.2% (95% CI: 18.7, 30.4%), respectively. The most stressful precursors of suicidal ideation or attempt included financial difficulties (59.5%), family breakdown or conflicts (37.4%), and trauma (23.1%). Suicidal ideation in the past 1 week preceding the survey was as high as 13.3% (95% CI: 9.0, 18.6%), of which 75.0% (95% CI: 55.1%, 89.3%) had a suicide plan. Prevalence of suicidal ideation in the past 4 weeks was significantly higher among respondents with moderate psychological distress [Prevalence Ratio (PRR) = 2.74; 95% CI: 0.96, 7.84] and severe psychological distress (PRR = 4.75; 95% CI: 1.72, 13.08) but lower among adolescents who knew where to obtain professional psychological care (PRR = 0.51; 95% CI: 0.30, 0.87). Similarly, suicidal attempt was significantly higher among respondents with moderate psychological distress (PRR = 4.72; 95% CI: 1.01, 12.03) and severe psychological distress (PRR = 11.8; 95% CI: 4.66, 32.37), and who abuse drugs or substances (PRR = 2.13; 95% CI: 1.13, 4.01). Therefore, suicidal ideation is a major public health issue among adolescents living in poor urban settlements in Kampala, Uganda. Psychological distress due to financial difficulties, unemployment, and family breakdown are major facilitators of suicidality among adolescents in urban poor settlements in Kampala. Interventions aimed at preventing suicide among vulnerable adolescents in urban settlements in Kampala, Uganda should incorporate this unique risk factor profile.
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Affiliation(s)
- Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
- *Correspondence: Paul Bukuluki
| | - Symon Wandiembe
- Department of Statistical Methods, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Peter Kisaakye
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Samuel Besigwa
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - Rogers Kasirye
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
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13
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Richardson CG, Slemon A, Gadermann A, McAuliffe C, Thomson K, Daly Z, Salway T, Currie LM, David A, Jenkins E. Use of Asynchronous Virtual Mental Health Resources for COVID-19 Pandemic-Related Stress Among the General Population in Canada: Cross-Sectional Survey Study. J Med Internet Res 2020; 22:e24868. [PMID: 33315583 PMCID: PMC7775378 DOI: 10.2196/24868] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/27/2020] [Accepted: 12/11/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in profound mental health impacts among the general population worldwide. As many in-person mental health support services have been suspended or transitioned online to facilitate physical distancing, there have been numerous calls for the rapid expansion of asynchronous virtual mental health (AVMH) resources. These AVMH resources have great potential to provide support for people coping with negative mental health impacts associated with the pandemic; however, literature examining use prior to COVID-19 illustrates that the uptake of these resources is consistently low. OBJECTIVE The aim of this paper is to examine the use of AVMH resources in Canada during the COVID-19 pandemic among the general population and among a participant subgroup classified as experiencing an adverse mental health impact related to the pandemic. METHODS Data from this study were drawn from the first wave of a large multiwave cross-sectional monitoring survey, distributed from May 14 to 29, 2020. Participants (N=3000) were adults living in Canada. Descriptive statistics were used to characterize the sample, and bivariate cross-tabulations were used to examine the relationships between the use of AVMH resources and self-reported indicators of mental health that included a range of emotional and coping-related responses to the pandemic. Univariate and fully adjusted multivariate logistic regression models were used to examine associations between sociodemographic and health-related characteristics and use of AVMH resources in the subgroup of participants who reported experiencing one or more adverse mental health impacts identified in the set of self-reported mental health indicators. RESULTS Among the total sample, 2.0% (n=59) of participants reported accessing AVMH resources in the prior 2 weeks to cope with stress related to the COVID-19 pandemic, with the highest rates of use among individuals who reported self-harm (n=5, 10.4%) and those who reported coping "not well" with COVID-19-related stress (n=22, 5.5%). Within the subgroup of 1954 participants (65.1% of the total sample) who reported an adverse mental health impact related to COVID-19, 54 (2.8%) reported use of AVMH resources. Individuals were more likely to have used AVMH resources if they had reported receiving in-person mental health supports, were connecting virtually with a mental health worker or counselor, or belonged to a visible minority group. CONCLUSIONS Despite substantial government investment into AVMH resources, uptake is low among both the general population and individuals who may benefit from the use of these resources as a means of coping with the adverse mental health impacts of the COVID-19 pandemic. Further research is needed to improve our understanding of the barriers to use.
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Affiliation(s)
- Chris G Richardson
- Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, St Paul's Hospital, Vancouver, BC, Canada
| | - Allie Slemon
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, St Paul's Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Corey McAuliffe
- Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, St Paul's Hospital, Vancouver, BC, Canada
| | - Kimberly Thomson
- Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, St Paul's Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Zachary Daly
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Leanne M Currie
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Anita David
- Patient Voices Network, Vancouver, BC, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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14
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Etzelmueller A, Vis C, Karyotaki E, Baumeister H, Titov N, Berking M, Cuijpers P, Riper H, Ebert DD. Effects of Internet-Based Cognitive Behavioral Therapy in Routine Care for Adults in Treatment for Depression and Anxiety: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e18100. [PMID: 32865497 PMCID: PMC7490682 DOI: 10.2196/18100] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/06/2020] [Accepted: 06/03/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited. OBJECTIVE This study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety. METHODS The acceptability (uptake, participants' characteristics, adherence, and satisfaction), effectiveness, and negative effects (deterioration) of nonrandomized pre-post designs conducted under routine care conditions were synthesized using systematic review and meta-analytic approaches. RESULTS A total of 19 studies including 30 groups were included in the analysis. Despite high heterogeneity, individual effect sizes of investigated studies indicate clinically relevant changes, with effect sizes ranging from Hedges' g=0.42-1.88, with a pooled effect of 1.78 for depression and 0.94 for anxiety studies. Uptake, participants' characteristics, adherence, and satisfaction indicate a moderate to high acceptability of the interventions. The average deterioration across studies was 2.9%. CONCLUSIONS This study provides evidence supporting the acceptability and effectiveness of guided iCBT for the treatment of depression and anxiety in routine care. Given the high heterogeneity between interventions and contexts, health care providers should select interventions that have been proven in randomized controlled clinical trials. The successful application of iCBT may be an effective way of increasing health care in multiple contexts.
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Affiliation(s)
- Anne Etzelmueller
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- GET.ON Institute GmbH, Hamburg, Germany
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands
| | - Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Department of Global Health and Social Medicine, Harvard Medical School, USA, Boston, MA, United States
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Nickolai Titov
- eCentre Clinic Department of Psychology, Macquarie University, Sydney, Australia
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands
- Community Mental Health Centre GGZ inGeest, Amsterdam, Netherlands
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- GET.ON Institute GmbH, Hamburg, Germany
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
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15
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Titzler I, Berking M, Schlicker S, Riper H, Ebert DD. Barriers and Facilitators for Referrals of Primary Care Patients to Blended Internet-Based Psychotherapy for Depression: Mixed Methods Study of General Practitioners' Views. JMIR Ment Health 2020; 7:e18642. [PMID: 32673213 PMCID: PMC7463410 DOI: 10.2196/18642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/04/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent and often managed by general practitioners (GPs). GPs mostly prescribe medication and show low referral rates to psychotherapy. Many patients remain untreated. Blended psychotherapy (bPT) combines internet-based interventions with face-to-face psychotherapy and could increase treatment access and availability. Effectively implementing bPT in routine care requires an understanding of professional users' perspectives and behavior. OBJECTIVE This study aims to identify barriers and facilitators perceived by GPs in referring patients to bPT. Explanations for variations in referral rates were examined. METHODS Semistructured interviews were conducted with 12 of 110 GPs participating in a German randomized controlled trial (RCT) to investigate barriers to and facilitators for referrals to bPT for MDD (10 web-based modules, app-based assessments, and 6 face-to-face sessions). The interview guide was based on the theoretical domains framework. The interviews were audio recorded and transcribed verbatim, and the qualitative content was analyzed by 2 independent coders (intercoder agreement, k=0.71). A follow-up survey with 12 interviewed GPs enabled the validation of emergent themes. The differences in the barriers and facilitators identified between groups with different characteristics (eg, GPs with high or low referral rates) were described. Correlations between referrals and characteristics, self-rated competences, and experiences managing depression of the RCT-GPs (n=76) were conducted. RESULTS GPs referred few patients to bPT, although varied in their referral rates, and interviewees referred more than twice as many patients as RCT-GPs (interview-GPs: mean 6.34, SD 9.42; RCT-GPs: mean 2.65, SD 3.92). A negative correlation was found between GPs' referrals and their self-rated pharmacotherapeutic competence, r(73)=-0.31, P<.001. The qualitative findings revealed a total of 19 barriers (B) and 29 facilitators (F), at the levels of GP (B=4 and F=11), patient (B=11 and F=9), GP practice (B=1 and F=3), and sociopolitical circumstances (B=3 and F=6). Key barriers stated by all interviewed GPs included "little knowledge about internet-based interventions" and "patients' lack of familiarity with technology/internet/media" (number of statements, each k=22). Key facilitators were "perceived patient suitability, e.g. well-educated, young" (k=22) and "no conflict with GP's role" (k=16). The follow-up survey showed a very high agreement rate of at least 75% for 71% (34/48) of the identified themes. Descriptive findings indicated differences between GPs with low and high referral rates in terms of which and how many barriers (low: mean 9.75, SD 1.83; high: mean 10.50, SD 2.38) and facilitators (low: mean 18.25, SD 4.13; high: mean 21.00; SD 3.92) they mentioned. CONCLUSIONS This study provides insights into factors influencing GPs' referrals to bPT as gatekeepers to depression care. Barriers and facilitators should be considered when designing implementation strategies to enhance referral rates. The findings should be interpreted with care because of the small and self-selected sample and low response rates.
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Affiliation(s)
- Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Sandra Schlicker
- Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Heleen Riper
- Faculty of Behavioral and Movement Sciences, Section of Clinical Psychology, VU University Amsterdam, Amsterdam, Netherlands
- Department of Research and Innovation, GGZinGeest, Amsterdam, Netherlands
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nürnberg, Erlangen, Germany
- Faculty of Behavioral and Movement Sciences, Section of Clinical Psychology, VU University Amsterdam, Amsterdam, Netherlands
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16
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Arshad U, Farhat‐ul‐Ain, Gauntlett J, Husain N, Chaudhry N, Taylor PJ. A Systematic Review of the Evidence Supporting Mobile- and Internet-Based Psychological Interventions For Self-Harm. Suicide Life Threat Behav 2020; 50:151-179. [PMID: 31448847 PMCID: PMC7027458 DOI: 10.1111/sltb.12583] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/08/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Internet- and mobile phone-based psychological interventions have the potential to overcome many of the barriers associated with accessing traditional face-to-face therapy. Self-injurious thoughts and behaviors (STB) are prevalent global health problems that may benefit from Internet- and mobile-based interventions. We provide a systematic review and meta-analysis of studies evaluating mobile- and Internet-based interventions for STB, including nonsuicidal self-injury (NSSI). METHODS Online databases (PsycINFO, Web of Science, Medline) were searched up to March 2019 for single-arm and controlled trials of Internet- or mobile-based interventions for STB. The potential for bias was assessed using the Cochrane risk of bias tool. RESULTS Twenty-two eligible trials were identified. The research was limited by a lack of controlled designs and small samples. Evidence supports the acceptability of interventions. There is preliminary evidence that these interventions are associated with a decline in STB. A meta-analysis suggested a positive treatment effect on suicidal ideation when compared to treatment as usual, but not when trials with active controls were also considered. CONCLUSIONS Overall, Internet- and mobile-based interventions show promise and further controlled trials are warranted, focusing on behavioral outcomes (NSSI, suicidal behavior). This review was preregistered with PROSPERO (CRD42017074065).
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Affiliation(s)
- Usman Arshad
- Pakistan Institute of Living & LearningKarachiPakistan
| | - Farhat‐ul‐Ain
- Pakistan Institute of Living & LearningKarachiPakistan
| | - Jessica Gauntlett
- Division of Psychology & Mental HealthManchester Academic Health Sciences CentreSchool of Health SciencesUniversity of ManchesterManchesterUK
| | - Nusrat Husain
- Division of Psychology & Mental HealthManchester Academic Health Sciences CentreSchool of Health SciencesUniversity of ManchesterManchesterUK
| | | | - Peter James Taylor
- Division of Psychology & Mental HealthManchester Academic Health Sciences CentreSchool of Health SciencesUniversity of ManchesterManchesterUK
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17
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De Jaegere E, van Landschoot R, van Heeringen K, van Spijker BAJ, Kerkhof AJFM, Mokkenstorm JK, Portzky G. The online treatment of suicidal ideation: A randomised controlled trial of an unguided web-based intervention. Behav Res Ther 2019; 119:103406. [PMID: 31176889 DOI: 10.1016/j.brat.2019.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/24/2019] [Accepted: 05/13/2019] [Indexed: 12/11/2022]
Abstract
Suicide is a major public health issue, and treatment of suicidal thoughts may contribute to its prevention. Provision of online treatment of suicidal ideation may reduce barriers that suicidal individuals experience in face-to-face treatment. We therefore aimed at evaluating the effectiveness of a web-based intervention targeting a reduction of suicidal ideation. We carried out a two-arm, parallel-design, randomised controlled trial in the general population in Flanders (Belgium) (registered as NCT03209544). Participants who were 18 years or older and experienced suicidal ideation were included. The intervention group (n = 365) received access to the unguided web-based intervention, and the control group (n = 359) was placed on a waitlist. Assessments were carried out at baseline and at 6 and 12 weeks. Participants reported high levels of suicidal ideation, depression, hopelessness, worrying, and anxiety at baseline. Compared to the control group, participants in the intervention group experienced a significant decline in suicidal ideation, depression, hopelessness, worrying, and anxiety both at post-test and at follow-up. An important limitation of the study was a high dropout rate, in particular in the intervention group. Our findings suggest that the online self-help intervention was more effective in reducing suicidal ideation and suicide-related symptoms than a waitlist control in a severely affected population. It can help in filling the gap between crisis help and face-to-face treatment.
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Affiliation(s)
- Eva De Jaegere
- Flemish Centre of Expertise in Suicide Prevention, Ghent University, Corneel Heymanslaan 10, entr. 17, 9000, Ghent, Belgium.
| | - Renate van Landschoot
- Flemish Centre of Expertise in Suicide Prevention, Ghent University, Corneel Heymanslaan 10, entr. 17, 9000, Ghent, Belgium
| | - Kees van Heeringen
- Flemish Centre of Expertise in Suicide Prevention, Ghent University, Corneel Heymanslaan 10, entr. 17, 9000, Ghent, Belgium
| | - Bregje A J van Spijker
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia
| | - Ad J F M Kerkhof
- Department of Clinical Neuro and Developmental Psychology, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands
| | - Jan K Mokkenstorm
- 113 Suicide Prevention, Paasheuvelweg 25, 1105BP, Amsterdam, Netherlands; Amsterdam Public Health, Department of Psychiatry, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Gwendolyn Portzky
- Flemish Centre of Expertise in Suicide Prevention, Ghent University, Corneel Heymanslaan 10, entr. 17, 9000, Ghent, Belgium
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18
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Méndez-Bustos P, Calati R, Rubio-Ramírez F, Olié E, Courtet P, Lopez-Castroman J. Effectiveness of Psychotherapy on Suicidal Risk: A Systematic Review of Observational Studies. Front Psychol 2019; 10:277. [PMID: 30837920 PMCID: PMC6389707 DOI: 10.3389/fpsyg.2019.00277] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 01/28/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Suicidal behavior is a major public health concern worldwide, and the interest in the development of novel and more efficient treatment strategies and therapies to reduce suicidal risk is increasing. Some recent studies have summarized the results of randomized clinical trials (RCTs) assessing the efficacy of psychotherapeutic tools designed to treat patients at suicidal risk. However, observational studies, which reflect real-world effectiveness and may use original approaches, have not been reviewed. Method: The aim of this study is to systematically review the available scientific evidence issued from observational studies on the clinical effectiveness of psychotherapeutic tools designed to treat patients at suicide risk. We have thus performed a systematic search of PubMed and Web of Science databases. Results: Out of 1578 papers, 40 original observational studies fulfilled our selection criteria. The most used psychotherapeutic treatments were dialectical behavioral therapy (DBT, 27.5%) and cognitive behavioral therapy (CBT, 15.0%) in patients with a diagnosis of borderline personality disorder (32.5%) and depression (15.0%). Despite the between-study heterogeneity, interventions lead to a reduction in suicidal outcomes, i.e., suicidal ideation (55.0%) and suicide attempts (37.5%). The content and reporting quality varied considerably between the studies. Conclusion: DBT and CBT are the most widely used psychotherapeutic interventions and show promising results in existing observational studies. Some of the included studies provide innovative approaches. Group therapies and internet-based therapies, which are cost-effective methods, are promising treatments and would need further study.
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Affiliation(s)
| | - Raffaella Calati
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | | | - Emilie Olié
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,FondaMental Foundation, Créteil, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Philippe Courtet
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,FondaMental Foundation, Créteil, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Jorge Lopez-Castroman
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France
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19
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O’Connor RC, Portzky G. Looking to the Future: A Synthesis of New Developments and Challenges in Suicide Research and Prevention. Front Psychol 2018; 9:2139. [PMID: 30538647 PMCID: PMC6277491 DOI: 10.3389/fpsyg.2018.02139] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/17/2018] [Indexed: 12/13/2022] Open
Abstract
Suicide and attempted suicide are major public health concerns. In recent decades, there have been many welcome developments in understanding and preventing suicide, as well as good progress in intervening with those who have attempted suicide. Despite these developments, though, considerable challenges remain. In this article, we explore both the recent developments and the challenges ahead for the field of suicide research and prevention. To do so, we consulted 32 experts from 12 countries spanning four continents who had contributed to the International Handbook of Suicide Prevention (2nd edition). All contributors nominated, in their view, (i) the top 3 most exciting new developments in suicide research and prevention in recent years, and (ii) the top 3 challenges. We have synthesized their suggestions into new developments and challenges in research and practice, giving due attention to implications for psychosocial interventions. This Perspective article is not a review of the literature, although we did draw from the suicide research literature to obtain evidence to elucidate the responses from the contributors. Key new developments and challenges include: employing novel techniques to improve the prediction of suicidal behavior; testing and applying theoretical models of suicidal behavior; harnessing new technologies to monitor and intervene in suicide risk; expanding suicide prevention activities to low and middle-income countries; moving toward a more refined understanding of sub-groups of people at risk and developing tailored interventions. We also discuss the importance of multidisciplinary working and the challenges of implementing interventions in practice.
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Affiliation(s)
- Rory C. O’Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Gwendolyn Portzky
- Unit for Suicide Research, Flemish Centre of Expertise in Suicide Prevention, Ghent University, Ghent, Belgium
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20
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Padmanathan P, Biddle L, Carroll R, Derges J, Potokar J, Gunnell D. Suicide and Self-Harm Related Internet Use. CRISIS 2018; 39:469-478. [PMID: 29848080 PMCID: PMC6263311 DOI: 10.1027/0227-5910/a000522] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The rise in Internet use adds a new dimension to suicide prevention. We investigated suicide/self-harm (S/Sh)-related Internet use among patients presenting to hospital with self-harm. METHOD We asked 1,198 adult and 315 child and adolescent patients presenting to hospital following self-harm in a city in South West England about Internet use associated with their hospital presentation. Associations between Internet use and sociodemographic and clinical characteristics were investigated using multivariable logistic regression models. Focus groups with clinicians explored the acceptability and utility of asking about Internet use. RESULTS The prevalence of S/Sh-related Internet use was 8.4% (95% CI: 6.8-10.1%) among adult hospital presentations and 26.0% (95% CI = 21.3-31.2%) among children's hospital presentations. In both samples, S/Sh-related Internet use was associated with higher levels of suicidal intent. Mostly, clinicians found it acceptable to ask about Internet use during psychosocial assessments and believed this could inform perceptions of risk and decision-making. LIMITATIONS It is unclear whether the findings in this study are applicable to the general self-harm patient population because only those who had psychosocial assessments were included. CONCLUSION S/Sh-related Internet use is likely to become increasingly relevant as the Internet-native generation matures. Furthermore, Internet use may be a proxy marker for intent.
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Affiliation(s)
- Prianka Padmanathan
- 1 School of Social and Community Medicine, University of Bristol, Bristol, UK.,2 Avon and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Lucy Biddle
- 1 School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Robert Carroll
- 1 School of Social and Community Medicine, University of Bristol, Bristol, UK.,3 Real World Evidence, Evidera, London, UK
| | - Jane Derges
- 1 School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Potokar
- 1 School of Social and Community Medicine, University of Bristol, Bristol, UK.,4 University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - David Gunnell
- 1 School of Social and Community Medicine, University of Bristol, Bristol, UK.,5 NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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21
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Ebert DD, Van Daele T, Nordgreen T, Karekla M, Compare A, Zarbo C, Brugnera A, Øverland S, Trebbi G, Jensen KL, Kaehlke F, Baumeister H. Internet- and Mobile-Based Psychological Interventions: Applications, Efficacy, and Potential for Improving Mental Health. EUROPEAN PSYCHOLOGIST 2018. [DOI: 10.1027/1016-9040/a000318] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract. The majority of mental health disorders remain untreated. Many limitations of traditional psychological interventions such as limited availability of evidence-based interventions and clinicians could potentially be overcome by providing Internet- and mobile-based psychological interventions (IMIs). This paper is a report of the Taskforce E-Health of the European Federation of Psychologists’ Association and will provide an introduction to the subject, discusses areas of application, and reviews the current evidence regarding the efficacy of IMIs for the prevention and treatment of mental disorders. Meta-analyses based on randomized trials clearly indicate that therapist-guided stand-alone IMIs can result in meaningful benefits for a range of indications including, for example, depression, anxiety, insomnia, or posttraumatic stress disorders. The clinical significance of results of purely self-guided interventions is for many disorders less clear, especially with regard to effects under routine care conditions. Studies on the prevention of mental health disorders (MHD) are promising. Blended concepts, combining traditional face-to-face approaches with Internet- and mobile-based elements might have the potential of increasing the effects of psychological interventions on the one hand or to reduce costs of mental health treatments on the other hand. We also discuss mechanisms of change and the role of the therapist in such approaches, contraindications, potential limitations, and risk involved with IMIs, briefly review the status of the implementation into routine health care across Europe, and discuss confidentiality as well as ethical aspects that need to be taken into account, when implementing IMIs. Internet- and mobile-based psychological interventions have high potential for improving mental health and should be implemented more widely in routine care.
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Affiliation(s)
- David D. Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Tom Van Daele
- Department of Applied Psychology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia, Republic of Cyprus
| | - Angelo Compare
- Human Factors and Technology in Healthcare, University of Bergamo, Bergamo, BG, Italy
| | - Cristina Zarbo
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | - Agostino Brugnera
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | | | - Glauco Trebbi
- Trebbipsicologie, Luxembourg & Societé Luxembourgeoise de Psychologie SLP, Luxembourg
| | | | - Fanny Kaehlke
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
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Muñoz-Sánchez JL, Delgado C, Parra-Vidales E, Franco-Martín M. Facilitating Factors and Barriers to the Use of Emerging Technologies for Suicide Prevention in Europe: Multicountry Exploratory Study. JMIR Ment Health 2018; 5:e7. [PMID: 29367183 PMCID: PMC5803527 DOI: 10.2196/mental.7784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/05/2017] [Accepted: 10/29/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study provides an analysis on the use of emerging technologies for the prevention of suicide in 8 different European countries. OBJECTIVE The objective of this study was to analyze the potentiality of using emerging technologies in the area of suicide prevention based on the opinion of different professionals involved in suicide prevention. METHODS Opinions of 3 groups of stakeholders (ie, relevant professionals in suicide field) were gathered using a specifically designed questionnaire to explore dimensions underlying perceptions of facilitating factors and barriers in relation to the use of emerging technologies for suicide prevention. RESULTS Goal 1 involved facilitating factors for the use of emerging technologies in suicide prevention. Northern European countries, except for Belgium, attach greater relevance to those that optimize implementation and benefits. On the other hand, Southern European countries attach greater importance to professionally oriented and user-centered facilitating factors. According to different stakeholders, the analysis of these facilitating factors suggest that professionals in the field of social work attach greater relevance to those that optimize implementation and benefits. However, professionals involved in the area of mental health, policy makers, and political decision makers give greater importance to professionally oriented and user-centered facilitating factors. Goal 2 was related to barriers to the usability of emerging technologies for suicide prevention. Both countries and stakeholders attach greater importance to barriers associated with resource constraints than to those centered on personal limitations. There are no differences between countries or between stakeholders. Nevertheless, there is a certain stakeholders-countries interaction that indicates that the opinions on resource constraints expressed by different stakeholders do not follow a uniform pattern in different countries, but they differ depending on the country. CONCLUSIONS Although all countries and stakeholders agree in identifying resource constraints as the main barrier to the use of emerging technologies, factors facilitating their use in suicide prevention differ among countries and among stakeholders.
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Affiliation(s)
| | - Carmen Delgado
- Faculty of Psychology, Universidad Pontificia de Salamanca, Salamanca, Spain
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23
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Backenstrass M, Wolf M. Internetbasierte Therapie in der Versorgung von Patienten mit depressiven Störungen: Ein Überblick. ACTA ACUST UNITED AC 2018. [DOI: 10.1024/1661-4747/a000339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Internet- und mobilbasierten Interventionen wird großes Potenzial in der Behandlung von Menschen mit depressiver Symptomatik zugeschrieben. Diese Einschätzung hat sich in den letzten Jahren vor dem Hintergrund mehrerer Programmentwicklungen und einer Vielzahl von Studien zur Wirksamkeitsprüfung der zumeist auf der kognitiven Verhaltenstherapie basierten Angebote etabliert. Ziel der vorliegenden Übersichtsarbeit ist es, zu prüfen, inwieweit sich aus der empirischen Befundlage wissenschaftlich fundierte Empfehlungen für die Versorgungsbereiche Prävention, Primärversorgung, ambulante Psychotherapie, fachärztliche Versorgung sowie die stationäre Behandlung ableiten lassen. Hierfür werden die Ergebnisse ausgewählter Studien, die in den genannten Versorgungsbereichen angesiedelt sind und die Erhebung der Diagnose depressive Störung auf ein Expertenurteil stützen, kritisch bewertet. In der Schlussfolgerung ermöglicht die gegenwärtige Studienlage keine eindeutige Empfehlung zum Einsatz von internetbasierten Behandlungsprogrammen in den genannten Versorgungsbereichen.
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Affiliation(s)
- Matthias Backenstrass
- Institut für Klinische Psychologie, Klinikum Stuttgart, Deutschland, und Psychologisches Institut, Arbeitseinheit für Klinische Psychologie und Psychotherapie, Universität Heidelberg, Deutschland
| | - Markus Wolf
- Psychologisches Institut, Klinische Psychologie mit Schwerpunkt Psychotherapieforschung, Universität Zürich, Schweiz
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Witt K, Spittal MJ, Carter G, Pirkis J, Hetrick S, Currier D, Robinson J, Milner A. Effectiveness of online and mobile telephone applications ('apps') for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis. BMC Psychiatry 2017; 17:297. [PMID: 28810841 PMCID: PMC5558658 DOI: 10.1186/s12888-017-1458-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Online and mobile telephone applications ('apps') have the potential to improve the scalability of effective interventions for suicidal ideation and self-harm. The aim of this review was therefore to investigate the effectiveness of digital interventions for the self-management of suicidal ideation or self-harm. METHODS Seven databases (Applied Science & Technology; CENTRAL; CRESP; Embase; Global Health; PsycARTICLES; PsycINFO; Medline) were searched to 31 March, 2017. Studies that examined the effectiveness of digital interventions for suicidal ideation and/or self-harm, or which reported outcome data for suicidal ideation and/or self-harm, within a randomised controlled trial (RCT), pseudo-RCT, or observational pre-test/post-test design were included in the review. RESULTS Fourteen non-overlapping studies were included, reporting data from a total of 3,356 participants. Overall, digital interventions were associated with reductions for suicidal ideation scores at post-intervention. There was no evidence of a treatment effect for self-harm or attempted suicide. CONCLUSIONS Most studies were biased in relation to at least one aspect of study design, and particularly the domains of participant, clinical personnel, and outcome assessor blinding. Performance and detection bias therefore cannot be ruled out. Digital interventions for suicidal ideation and self-harm may be more effective than waitlist control. It is unclear whether these reductions would be clinically meaningful at present. Further evidence, particularly with regards to the potential mechanisms of action of these interventions, as well as safety, is required before these interventions could recommended.
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Affiliation(s)
- Katrina Witt
- Population Health, Turning Point, Eastern Health Clinical School, Monash University, 54-62 Gertrude Street, Fitzroy, Victoria, 3065, Australia.
| | - Matthew J. Spittal
- 0000 0001 2179 088Xgrid.1008.9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
| | - Gregory Carter
- 0000 0000 8831 109Xgrid.266842.cCentre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales Australia
| | - Jane Pirkis
- 0000 0001 2179 088Xgrid.1008.9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
| | - Sarah Hetrick
- 0000 0001 2179 088Xgrid.1008.9Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria Australia
| | - Dianne Currier
- 0000 0001 2179 088Xgrid.1008.9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
| | - Jo Robinson
- 0000 0001 2179 088Xgrid.1008.9Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria Australia
| | - Allison Milner
- 0000 0001 2179 088Xgrid.1008.9Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
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25
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Muñoz-Sánchez JL, Delgado C, Sánchez-Prada A, Pérez-López M, Franco-Martín MA. Use of New Technologies in the Prevention of Suicide in Europe: An Exploratory Study. JMIR Ment Health 2017; 4:e23. [PMID: 28655705 PMCID: PMC5506332 DOI: 10.2196/mental.7716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/23/2017] [Accepted: 05/29/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND New technologies are an integral component of today's society and can complement existing suicide prevention programs. Here, we analyzed the use of new technologies in the prevention of suicide in 8 different European countries. OBJECTIVE The aim of this paper was to assess the opinions of professionals in incorporating such resources into the design of a suicide prevention program for the region of Zamora in Spain. This investigation, encompassed within the European project entitled European Regions Enforcing Actions against Suicide (EUREGENAS), includes 11 regions from 8 different countries and attempts to advance the field of suicide prevention in Europe. METHODS Using a specifically designed questionnaire, we assessed the opinions of 3 different groups of stakeholders regarding the use, frequency of use, facilitators, content, and format of new technologies for the prevention of suicide. The stakeholders were comprised of policy and public management professionals, professionals working in the area of mental health, and professionals related to the social area and non-governmental organizations (NGOs). A total of 416 participants were recruited in 11 regions from 8 different European countries. RESULTS The utility of the new technologies was valued positively in all 8 countries, despite these resources being seldom used in those countries. In all the countries, the factors that contributed most to facilitating the use of new technologies were accessibility and free of charge. Regarding the format of new technologies, the most widely preferred formats for use as a tool for the prevention of suicide were websites and email. The availability of information about signs of alarm and risk factors was the most relevant content for the prevention of suicide through the use of new technologies. The presence of a reference mental health professional (MHP) was also considered to be a key aspect. The countries differed in the evaluations given to the different formats suggesting that the cultural characteristics of the country should be taken into account. CONCLUSIONS New technologies are much appreciated resources; however they are not often underused in the field of suicide prevention. The results of this exploratory study show that new technologies are indeed useful resources and should be incorporated into suicide prevention programs.
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26
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Andrews G, Hobbs MJ, Newby JM. Computerised cognitive behaviour therapy for major depression: a reply to the REEACT trial. EVIDENCE-BASED MENTAL HEALTH 2016; 19:43-5. [PMID: 26993366 PMCID: PMC10699423 DOI: 10.1136/eb-2015-102293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/04/2016] [Accepted: 02/18/2016] [Indexed: 11/03/2022]
Abstract
Computerised cognitive behavioural therapy (CCBT) has been shown to be an efficacious treatment for depression. A recent meta-analysis of 9 studies showed a large mean effect size superiority over control group (effect size=0.86, number needed to treat=2), good adherence (69%) and benefits were evident at follow-up at a median of 26 weeks. In contrast, REEACT, a major study which compared usual general practitioner (GP) care versus usual GP care plus access to 1 of 2 pioneering CCBT courses detected no differences between the groups. We present the results and discuss possible explanations for these findings. In all 3 groups, usual care was extensive (9 visits in 12 months, 80% on medication, 8-23% getting psychological sessions). Adherence to CCBT courses was very poor (17%). Perhaps the surfeit of services meant there was no need for CCBT. Perhaps neither of the 2 CCBT courses encouraged adherence. What is certain is that this study did not test the potential of these CCBT courses to produce change in patients with depression presenting in primary care.
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Affiliation(s)
- Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Megan J Hobbs
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Jill M Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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Mewton L, Andrews G. Cognitive behavioral therapy for suicidal behaviors: improving patient outcomes. Psychol Res Behav Manag 2016; 9:21-9. [PMID: 27042148 PMCID: PMC4780394 DOI: 10.2147/prbm.s84589] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This systematic review provides an overview of the effectiveness of cognitive behavioral therapy (CBT) in reducing suicidal cognitions and behavior in the adult population. We identified 15 randomized controlled trials of CBT for adults (aged 18 years and older) that included suicide-related cognitions or behaviors as an outcome measure. The studies were identified from PsycINFO searches, reference lists, and a publicly available database of psychosocial interventions for suicidal behaviors. This review identified some evidence of the use of CBT in the reduction of both suicidal cognitions and behaviors. There was not enough evidence from clinical trials to suggest that CBT focusing on mental illness reduces suicidal cognitions and behaviors. On the other hand, CBT focusing on suicidal cognitions and behaviors was found to be effective. Given the current evidence, clinicians should be trained in CBT techniques focusing on suicidal cognitions and behaviors that are independent of the treatment of mental illness.
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Affiliation(s)
- Louise Mewton
- National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, NSW, Australia
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