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Gager CT, Gunn JF, Goldstein SE, Martinez SM. Thwarted Belonging and Perceived Burdensomeness During Middle and Older Adulthood: The Role of Generativity. Int J Aging Hum Dev 2024; 99:25-46. [PMID: 38291615 DOI: 10.1177/00914150231208688] [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] [Indexed: 02/01/2024]
Abstract
Using a sample of middle-aged and older adults, this research explores associations between generativity and two key risk factors for suicide: thwarted belonging (T.B.) and perceived burdensomeness (P.B.). These variables are typically studied as predictors of suicide; the current study is unique in examining their psychosocial correlates. Erikson described, generativity as a psychosocial construct that characterizes adult well-being in mid-life, conceptualized as the sense one has successfully guided and contributed to the younger generation through mentoring. Using the Midlife in the United States Survey (MIDUS), the current analyses indicate that generativity is associated with lower levels of P.B. and T.B., even after accounting for measures of hopelessness, depressive symptoms, financial stability, perceived neighborhood quality, chronic health conditions, and respondent's demographic characteristics including gender and age. Results are discussed in terms of applications for suicide-risk prevention, and with regard to the promotion of positive psychosocial development across the lifespan.
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Affiliation(s)
- Constance T Gager
- Department of Family Science & Human Development, Montclair State University, Montclair, NJ, USA
| | - John F Gunn
- Department of Arts & Sciences, Gwynedd Mercy University, Gwynedd Valley, PA, USA
| | - Sara E Goldstein
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
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Steinberg R, Amini J, Sinyor M, Mitchell RHB, Schaffer A. Implementation of caring contacts using patient feedback to reduce suicide-related outcomes following psychiatric hospitalization. Suicide Life Threat Behav 2024. [PMID: 38934489 DOI: 10.1111/sltb.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Suicide risk is substantially elevated following discharge from a psychiatric hospitalization. Caring Contacts (CCs) are brief communications delivered post-discharge that can help to improve mental health outcomes. METHOD This three-phase, mixed-method quality-improvement study revised an existing CC intervention using iterative patient and community feedback. Inpatients (n = 2) and community members (n = 13) participated in focus groups to improve existing CC messages (phases 1 and 2). We piloted these messages among individuals with a suicide-related concern following discharge from an inpatient psychiatric hospitalization (n = 27), sending CCs on days 2 and 7 post-discharge (phase 3). Phase 3 participants completed mental health symptom measures at baseline and day 7, and provided feedback on these messages. RESULTS Phase 1 and 2 focus group participants indicated preferences for shorter, more visually appealing messages that featured personalized, recovery-focused content. Phase 3 participants demonstrated reductions in depressive symptoms at day-7 post-discharge (-6.4% mean score on Hopkins-Symptom-Checklist, -9.0% mean score on Entrapment-Scale). Most participants agreed that CC messages helped them feel more connected to the hospital and encouraged help-seeking behavior post-discharge. CONCLUSION This study supports the use of an iterative process, including patient feedback, to improve CC messages and provides further pilot evidence that CC can have beneficial effects.
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Affiliation(s)
- Rosalie Steinberg
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Psychiatry, St. John's Rehab, Toronto, Ontario, Canada
| | - Jasmine Amini
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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König D, Gleiss A, Vyssoki B, Harrer C, Trojer A, Groemer M, Weber S, Glahn A, Sommer L, Listabarth S, Wippel A. Suicide risk after discharge from in-patient psychiatric care: A 15-year retrospective cohort study of individual patient data. J Affect Disord 2024; 354:416-423. [PMID: 38479514 DOI: 10.1016/j.jad.2024.03.046] [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: 10/22/2023] [Revised: 03/05/2024] [Accepted: 03/09/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Suicide rates are known to be increased in patients after discharge from in-patient psychiatric treatment. However, evidence on risk factors for suicide within this patient group are contradictory. Thus, this study aims to investigate suicide after discharge from a sizeable psychiatric care facility to determine associated risk factors. METHODS Data on individual patient level from a 15-year single-centre cohort were linked to data from the national death registry and cumulative incidence rates were calculated applying competing risk models. Independent variables included the patients' sex, age at admission, diagnosis, and length of admission. For each of these factors, subdistribution hazards ratios were calculated using a Fine-Gray model. RESULTS In our sample of 18,425 discharges, when using patients with the diagnosis of substance-use-disorders as a comparator, a significant increase in hazard of post-discharge suicide for male sex (SHR = 1.67;p = 0.037) as well as the discharge diagnoses of affective disorders (SHR = 3.56;p = 0.017) and neurotic stress and somatoform disorders (SHR = 3.73;p = 0.024) were found. Interestingly, the hazard of suicide significantly decreased in more recent discharges (SHR = 0.93;p = 0.006). No statistically significant association of the length of admission with the suicide risk was found (SHR = 0.98;p = 0.834). LIMITATIONS Suicides may have been mis-identified as natural death in the national death register. CONCLUSION Male sex and distinct diagnoses were associated with an increased risk for suicide after discharge from a psychiatric care institution. The markedly increased suicide risk within this patient collective highlights the need for the development of tools to assess suicidal behaviour in this group of patients reliably.
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Affiliation(s)
- Daniel König
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Institute of Clinical Biometrics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Benjamin Vyssoki
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christine Harrer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Armin Trojer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Magdalena Groemer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Sabine Weber
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Glahn
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical University of Hannover, Hannover, Germany
| | - Lea Sommer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Listabarth
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Wippel
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
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Madsen T, Erlangsen A, Egilsdottir E, Andersen PK, Nordentoft M. The effect of the SAFE intervention on post-discharge suicidal behavior: a quasi-experimental study using propensity score matching. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1053-1061. [PMID: 37993566 PMCID: PMC11116169 DOI: 10.1007/s00127-023-02585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES The risk of suicidal behavior after discharge from psychiatric admission is high. The aim of this study was to examine whether the SAFE intervention, an implementation of a systematic safer discharge procedure, was associated with a reduction in suicidal behavior after discharge. METHODS The SAFE intervention was implemented at Mental Health Center Copenhagen in March 2018 and consisted of three systematic discharge procedures: (1) A face-to-face meeting between patient and outpatient staff prior to discharge, (2) A face-to-face meeting within the first week after discharge, and (3) Involvement of relatives. Risk of suicide attempt at six-month post-discharge among patients discharged from the SAFE intervention was compared with patients discharged from comparison mental health centers using propensity score matching. RESULTS 7604 discharges took place at the intervention site, which were 1:1 matched with discharges from comparison sites. During the six months of follow-up, a total of 570 suicide attempts and 25 suicides occurred. The rate of suicide attempt was 11,652 per 100,000 person-years at the SAFE site, while it was 10,530 at comparisons sites. No observable difference in suicide attempt 1.10 (95% CI: 0.89-1.35) or death by suicide (OR = 1.27; 95% CI:0.58-2.81) was found between sites at 6-month follow-up. CONCLUSION No difference in suicidal behavior between the sites was found in this pragmatic study. High rates of suicidal behavior were found during the 6-months discharge period, which could suggest that a preventive intervention should include support over a longer post-discharge period than the one-week follow-up offered in the SAFE intervention.
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Affiliation(s)
- Trine Madsen
- Danish Research Institute for Suicide Prevention, CORE- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark.
- Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, CORE- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Eybjørg Egilsdottir
- Danish Research Institute for Suicide Prevention, CORE- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Per Kragh Andersen
- Section of Biostatistics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, CORE- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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DelPozo-Banos M, Rodway C, Lee SC, Rouquette OY, Ibrahim S, Lloyd K, Appleby L, Kapur N, John A. Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case-control, whole-population-based study using person-level linked routine data in Wales, UK during 2000-2015. BJPsych Open 2024; 10:e108. [PMID: 38725371 PMCID: PMC11094447 DOI: 10.1192/bjo.2024.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND People under the care of mental health services are at increased risk of suicide. Existing studies are small in scale and lack comparisons. AIMS To identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with mental health services. METHOD This population-based study includes people who died by suicide in the year following a mental health services contact in Wales, 2001-2015 (cases), paired with similar patients who did not die by suicide (controls). We linked the National Confidential Inquiry into Suicide and Safety in Mental Health and the Suicide Information Database - Cymru with primary and secondary healthcare records. We present results of conditional logistic regression. RESULTS We matched 1031 cases with 5155 controls. In the year before their death, 98.3% of cases were in contact with healthcare services, and 28.5% presented with self-harm. Cases had more emergency department contacts (odds ratio 2.4, 95% CI 2.1-2.7) and emergency hospital admissions (odds ratio 1.5, 95% CI 1.4-1.7), but fewer primary care contacts (odds ratio 0.7, 95% CI 0.6-0.9) and out-patient appointments (odds ratio 0.2, 95% CI 0.2-0.3) than controls. Odds ratios were larger in females than males for injury and poisoning (odds ratio: 3.3 (95% CI 2.5-4.5) v. 2.6 (95% CI 2.1-3.1)). CONCLUSIONS We may be missing existing opportunities to intervene, particularly in emergency departments and hospital admissions with self-harm presentations and with unattributed self-harm, especially in females. Prevention efforts should focus on strengthening routine care contacts, responding to emergency contacts and better self-harm care. There are benefits to enhancing clinical audit systems with routinely collected data.
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Affiliation(s)
| | - Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | | | | | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | | | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | - Navneet Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK; NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, UK; and Mersey Care NHS Foundation Trust, Prescot, UK
| | - Ann John
- Swansea University Medical School, UK
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Wang AG, Lahoz T, Hvid M, Grufstedt HK, Jørgensen LM. The Amager Project IV: suicidal behavior and aftercare: real world data (RWD) from a prospective observational project. Nord J Psychiatry 2024; 78:267-271. [PMID: 38339969 DOI: 10.1080/08039488.2024.2315163] [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: 09/28/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND In an RCT study, OPAC (outreach, problem solving, adherence, continuity) approach to aftercare after suicide attempts had an effect. The present study used the OPAC method in a clinical setting on Amager Copenhagen to patients after suicide attempt (Group 1) and patients with suicide ideation (Group 2) in a real-world data (RWD) study. AIM To study whether the OPAC method could provide real world evidence (RWE) for results from the RCT study and long-time prospects. METHOD This RWD study included 506 patients and followed them for 5 years. Kaplan-Meyer showed 5 years results. Risk factors for 5 years were calculated. RESULTS 206 males (mean age 37.9) and 300 females (mean age 35.2) participated. A decline in survival accelerated after 3 years. After a 2-year follow-up, Group 1 had an attempted suicide rate of 12,2% and Group 2 5,4%. After 5 years the numbers were 18% and 10%. There were 3 completed suicides. Risk factors were: earlier suicide attempts, one or both parents or they themselves were alcohol/drug abusers, and a poor social network. Group 1 showed the same result as the intervention group in our earlier RCT study. Group 2 did better. Both groups did better than the control group from our RCT study. CONCLUSION The OPAC effect was translated into the daily clinic. Risk factors were previous suicide attempts, alcohol and drug abuse and poor social networks. More specific therapy is needed for some patients to prevent relapse. Focus on enhancing a sense of belongingness and/or treating substance abuse.
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Affiliation(s)
- August G Wang
- Centre of Psychiatry Amager, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health Science, University of Faroe Islands, Torshavn, Faroe Islands
| | - Titia Lahoz
- Centre of Psychiatry Amager, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Hvid
- Centre of Psychiatry Amager, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heidi K Grufstedt
- Centre of Psychiatry Amager, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene M Jørgensen
- Centre of Psychiatry Amager, Copenhagen University Hospital, Copenhagen, Denmark
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Shah N, O'Keeffe S, Hayward S, Suzuki M, McCabe R. Re-imagining crisis care: experiences of delivering and receiving the Assured brief psychological intervention for people presenting to Emergency Departments with self-harm. Front Psychiatry 2024; 15:1271674. [PMID: 38600980 PMCID: PMC11004764 DOI: 10.3389/fpsyt.2024.1271674] [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: 08/02/2023] [Accepted: 02/12/2024] [Indexed: 04/12/2024] Open
Abstract
Background Risk of suicide is increased immediately following emergency department (ED) attendance for self-harm. Evidence suggests that brief psychological interventions delivered in EDs are effective for self-harm. The Assured intervention comprises an enhanced biopsychosocial assessment in the ED, collaborative safety planning and three rapid solution focused follow-up sessions. Aim We addressed the following research questions: What were ED mental health liaison practitioners' and patients' experiences of the Assured intervention? What were the barriers and facilitators? What might the mechanisms be for improving experiences and outcomes? Methods We conducted a feasibility study of the Assured intervention in four EDs in Southeast England. Semi-structured interviews were conducted with 13 practitioners and 27 patients. Interviews were transcribed, coded line-by-line in Nvivo and thematically analysed using an inductive approach. Inter-rater reliability was calculated with a kappa coefficient of 0.744.
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Affiliation(s)
- Neha Shah
- School of Health and Psychological Science, City, University of London, London, United Kingdom
| | - Sally O'Keeffe
- Population Health Sciences Institute, Newcastle University, Newcastle-Upon-Tyne, United Kingdom
| | - Sam Hayward
- School of Health and Psychological Science, City, University of London, London, United Kingdom
| | - Mimi Suzuki
- School of Health and Psychological Science, City, University of London, London, United Kingdom
| | - Rose McCabe
- School of Health and Psychological Science, City, University of London, London, United Kingdom
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Fu T, Liu H, Chen C, Zhang B, Chen G, Bai Y, Li J, Hou F. Preventing post-discharge suicides in psychiatric patients: insights from patients, lay healthcare supporters, and mental health professionals-a qualitative analysis. BMC Public Health 2024; 24:64. [PMID: 38166746 PMCID: PMC10762919 DOI: 10.1186/s12889-023-17475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Discharged psychiatric patients are at higher risk of suicide due to various risk factors in their lives compared to the general population. However, specific problems and needs of these patients after discharge remain unclear. This research constitutes a segment of a broader implementation study designed to formulate an interventional strategy targeting post-discharge suicide among Chinese psychiatric patients. The present study seeks to qualitatively investigate the problems and needs from the perspectives of patients, their lay healthcare supporters (LHSs), and mental health professionals (MPs), aiming to enhance the efficacy of the interventional strategy. METHODS This study is part of a larger implementation study based on Shenzhen Kangning Hospital (SKH) in Shenzhen, Guangdong, China. Under the community-based participatory research framework, we recruited discharged psychiatric patients, their LHSs, and MPs as a collaborative community team, and we conducted individual in-depth interviews for patients and LSHs and focus group interviews with MPs. We utilized a thematic analysis approach to identify sub-themes and themes from interviews through systematically coding and analyzing the data. RESULTS A total of 45 participants were recruited for interviews, comprising 17 patients, 8 LHSs, and 20 MPs. We conducted 25 individual in-depth interviews and 3 focus group interviews. Through the interviews, we identified three themes of post-discharge problems: problems related to self, family-related problems, societal and community-related problems. We also identified four themes related to reducing post-discharge suicide: proactive self-management, multifunctional relatives, multifunctional MP group, and a warm society. The tangible support from LHSs and emotional support from MPs are strongly emphasized. Follow-up interventions were identified as the most significant way to addressing these unmet needs. Instrumental support from the community and a caring and non-discriminatory environment for individuals with mental disorders are essential for reducing suicide risk. CONCLUSIONS Establishing an integrated mental health care service network that connects psychiatric patients, LHSs, and MPs cross community and societal sectors, with patient-centered follow-up care at its core, is a practical approach to better address patients' needs and reduce post-discharge suicide. TRIAL REGISTRATION Registration number: NCT04907669. Date of registration: May 26th,2021.
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Affiliation(s)
- Tiantian Fu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No. 74 Zhongshan 2Nd Road, Guangzhou, 510080, Guangdong, China
- Sun Yat-Sen University Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Huiming Liu
- Department of Public Health, Shenzhen Mental Health Center/Shenzhen Kangning Hospital, No.1080, Cuizhu Road, Shenzhen, 518020, Guangdong, China
| | - Chang Chen
- Department of Public Health, Shenzhen Mental Health Center/Shenzhen Kangning Hospital, No.1080, Cuizhu Road, Shenzhen, 518020, Guangdong, China
| | - Bin Zhang
- Department of Public Health, Shenzhen Mental Health Center/Shenzhen Kangning Hospital, No.1080, Cuizhu Road, Shenzhen, 518020, Guangdong, China
| | - Guanjie Chen
- Department of Public Health, Shenzhen Mental Health Center/Shenzhen Kangning Hospital, No.1080, Cuizhu Road, Shenzhen, 518020, Guangdong, China
| | - Yuanhan Bai
- Department of Bipolar Disorders, Shenzhen Mental Health Center, Shenzhen Kangning Hospital (Pingshan Campus), Shenzhen, Guangdong Province, China
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No. 74 Zhongshan 2Nd Road, Guangzhou, 510080, Guangdong, China.
- Sun Yat-Sen University Global Health Institute, Sun Yat-Sen University, Guangzhou, China.
| | - Fengsu Hou
- Department of Public Health, Shenzhen Mental Health Center/Shenzhen Kangning Hospital, No.1080, Cuizhu Road, Shenzhen, 518020, Guangdong, China.
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Shan JC, Tseng MCM, Chang CH. Association of suicide with psychiatric hospitalization in Taiwan. Asia Pac Psychiatry 2023; 15:e12546. [PMID: 37604694 DOI: 10.1111/appy.12546] [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: 05/31/2023] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION A knowledge gap exists in the relationship between suicide and psychiatric hospitalization in Asia. This study investigated inpatient service utilization before suicide and suicide risk at different periods of hospitalization in Taiwan. METHODS Using the National Health Insurance Research Database, we applied a nested case-control design with controls being alive on the date each case died by suicide. RESULTS A total of 56 939 suicide cases and 1 138 780 controls were included (2:1 male-to-female ratio). Only 5.7% of suicide cases had a history of psychiatric hospitalization in the preceding year. Patients with a history of psychiatric hospitalization were associated with a higher risk of inpatient and postdischarge suicide than those without prior hospitalization. The risk was greatest in the first postdischarge week, decreased gradually, and remained significantly elevated over 7 years after discharge. The suicide risk increased more in females. Patients with affective disorders had higher inpatient and postdischarge suicide risks than those with schizophrenia spectrum disorders. DISCUSSION A low rate of psychiatric hospitalization before suicide implies that inpatient treatment of psychiatric disorders could be enhanced. Community-based approaches to suicide prevention can improve the treatment utilization of those with suicide risk and bridge continuous care from hospital to community.
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Affiliation(s)
- Jia-Chi Shan
- Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Mei-Chih Meg Tseng
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
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Soderlund PD, Cheung EH, Cadiz MP, Siddiq H, Yerstein M, Lee S, Wells K, Heilemann MV. Bridging the gap: a qualitative study of providers' perceptions of a partnered crisis follow-up program for suicidal patients post-emergency department discharge. BMC Psychiatry 2023; 23:854. [PMID: 37978360 PMCID: PMC10655296 DOI: 10.1186/s12888-023-05106-y] [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: 01/20/2023] [Accepted: 08/11/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Effective interventions are needed to address suicide risk following discharge from the hospital emergency department or inpatient setting. Studies that examine follow-up contact methods show promise, but little is known about how follow-up programs are implemented in the real world and who is benefitting. The purpose of this formative evaluation and analysis was to gain insight about the usefulness and value of a partnered suicide prevention follow-up program (academic medical center emergency department partnered with a regional suicide prevention center) from the standpoint of psychiatry resident physicians providing direct care and suicide prevention center crisis counselors making follow-up outreach telephone calls to patients. METHODS A qualitative thematic analysis was conducted with focus group data from a convenience sample of psychiatry residents who performed consultations in the emergency department setting and counselors at the suicide prevention center crisis follow-up program. Focus group sessions, using semi-structured question guides, were completed at each participant group's workplace. Grounded theory techniques were used to guide coding and analytic theme development. RESULTS Analyses resulted in four overarching themes: valuing the program's utility and benefit to patients, desiring to understand what happens from emergency department discharge to program follow-up, having uncertainty about which patients would benefit from the program, and brainstorming to improve the referral process. Psychiatry residents appreciated the option of an "active" referral service (one that attempts to actively engage a patient after discharge through outreach), while suicide prevention crisis counselors valued their ability to offer a free and immediate service that had potential for fostering meaningful relationships. Both participant groups desired a better understanding of their partner's program operations, a uniform and smooth referral process, and awareness of who may or may not benefit from program services. CONCLUSION Results revealed the need for improved communication and implementation, such as expanded inter-agency contacts, consistent provider training, more documentation of the requirements and rules, a consistent message about program logistics for patients, and coordination between the program elements.
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Affiliation(s)
- Patricia D Soderlund
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, 624 East 1St St, Duluth, MN, 20155805, USA.
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, National Clinician Scholars Program, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA.
| | - Erick H Cheung
- David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Madonna P Cadiz
- Luskin School of Public Affairs, University of California Los Angeles, 337 Charles E Young Dr E, Los Angeles, CA, 90095, USA
| | - Hafifa Siddiq
- Charles R. Drew University College of Nursing, 1731 E. 120th St., Los Angeles, CA, 90059, USA
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
| | - Maria Yerstein
- Boston University School of Medicine, St. Elizabeth's Medical Center, 736 Cambridge St, Brighton, MA, 02135, USA
| | - Sae Lee
- Didi Hirsch Mental Health Services, 4760 S. Sepulveda Blvd, Culver City, CA. 90230, USA
| | - Kenneth Wells
- David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
- Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Suite 17.369B, Los Angeles, CA, 90024, USA
- David Geffen School of Medicine, National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
- Department of Mental Health, Veterans Affairs Greater Los Angeles HealthCare System, 11301 Wilshire Boulevard, Los Angeles, CA, 90073, USA
| | - MarySue V Heilemann
- School of Nursing, Factor Building, University of California Los Angeles, Box 6919, Los Angeles, CA, 90095, USA
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, National Clinician Scholars Program, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
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11
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Yen S, Suazo N, Doerr J, Macrynikola N, Villarreal LS, Sodano S, O’Brien KHM, Wolff JC, Breault C, Gibb BE, Elwy R, Kahler CW, Ranney M, Jones R, Spirito A. Skills to Enhance Positivity in adolescents at risk for suicide: Protocol for a randomized controlled trial. PLoS One 2023; 18:e0287285. [PMID: 37862324 PMCID: PMC10588868 DOI: 10.1371/journal.pone.0287285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Suicide and suicidal behavior during adolescence have been steadily increasing over the past two decades. The preponderance of interventions focuses on crisis intervention, underlying psychiatric disorders, regulating negative affect, and reducing cognitive distortions. However, low positive affectivity may be a mechanism that contributes to adolescent suicidal ideation and behaviors independent of other risk factors. Skills to Enhance Positivity (STEP) is an acceptance-based intervention, designed to increase attention to, and awareness of, positive affect and positive experiences. Results from a pilot RCT demonstrated engagement of the target (positive affect) and a decrease in clinical outcomes (suicidal events; i.e., either a suicide attempt or an emergency intervention for an acute suicidal crisis), providing support to test the clinical effectiveness of STEP in a larger clinical trial with clinical staff implementing the intervention. OBJECTIVE To test the effectiveness of STEP, compared to Enhanced Treatment as Usual (ETAU), in reducing suicidal events and ideation in adolescents admitted to inpatient psychiatric care due to suicide risk. We hypothesize that those randomized to STEP, compared to ETAU, will have lower rates of suicide events, active suicidal ideation (SI), and depressed mood over the 6-month follow-up period. We hypothesize that those randomized to STEP, compared to ETAU, will demonstrate greater improvement in the hypothesized mechanisms of attention to positive affect stimuli and gratitude and satisfaction with life. METHODS Participants will be randomized to either STEP or ETAU. STEP consists of four in-person sessions focused on psychoeducation regarding positive and negative affect, mindfulness meditation, gratitude, and savoring. Mood monitoring prompts and skill reminders will be sent via text messaging daily for the first month post-discharge and every other day for the following two months. The ETAU condition will receive text-delivered reminders to use a safety plan provided at discharge from the hospital and healthy habits messages, matched in frequency to the STEP group. This trial was registered on 6 August 2021 (ClinicalTrials.gov NCT04994873). RESULTS The STEP protocol was approved by the National Institute of Mental Health (NIMH) Data and Safety Monitoring Board on March 4, 2022. The RCT is currently in progress. DISCUSSION The STEP protocol is an innovative, adjunctive treatment that has the potential to have positive effects on adolescent suicidal ideation and attempts beyond that found for standard treatment alone.
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Affiliation(s)
- Shirley Yen
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Massachusetts Mental Health Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Nazaret Suazo
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Jackson Doerr
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Natalia Macrynikola
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | | | - Sophia Sodano
- Bradley Hospital, Providence, RI, United States of America
| | - Kimberly H. M. O’Brien
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Boston Children’s Hospital, Boston, MA, United States of America
| | - Jennifer C. Wolff
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
- Bradley Hospital, Providence, RI, United States of America
- Rhode Island Hospital, Providence, RI, United States of America
| | - Christopher Breault
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States of America
| | - Brandon E. Gibb
- Department of Psychology, Binghamton University, Binghamton, NY, United States of America
| | - Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Christopher W. Kahler
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Megan Ranney
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Richard Jones
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
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12
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Hsu CY, Chang SS, Large M, Chang CH, Tseng MCM. Cause-specific mortality after discharge from inpatient psychiatric care in Taiwan: A national matched cohort study. Psychiatry Clin Neurosci 2023; 77:290-296. [PMID: 36624927 DOI: 10.1111/pcn.13528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/24/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
AIMS We aimed to investigate the trajectories of absolute and relative risks of cause-specific mortality among patients discharged from inpatient psychiatric services. METHODS We conducted a national matched cohort study (2002-2013) using data from the Taiwan National Health Insurance database linked to national cause-of-death data files. Patients discharged from inpatient psychiatric care without prior psychiatric hospitalizations were individually matched to 20 comparison individuals based on sex and age. The rates, rate differences, and relative risks (hazard ratios, HRs) of cause-specific mortality were calculated at six follow-up periods post-discharge. Cumulative mortality incidence was assessed at 5 years of follow-up. RESULTS The mortality risks of all causes were increased among patients (n = 158 065) relative to comparison individuals (n = 3 161 300). Mortality rate differences were greater for natural causes, while relative risks (HRs) were higher for unnatural causes. Suicide was the leading cause of death within the first year of discharge, while circulatory and respiratory diseases were the leading causes of death from the second year. The mortality rates and HRs for all causes of death (except homicide) were highest during the first 3 months. The elevated risk of unnatural-cause mortality declined rapidly after discharge but remained high in the long term; in contrast, risk elevation for natural-cause mortality was more stable over time. Approximately one-eighth of patients (12.9%, 95% confidence interval 12.7-13.7%) died within 5 years of follow-up. CONCLUSIONS Integrated physical and mental health care is needed to reduce excess mortality, particularly during the first 3 months post-discharge, among psychiatric patients.
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Affiliation(s)
- Chia-Yueh Hsu
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Sen Chang
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Behaviors and Community Sciences and Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Matthew Large
- School of Psychiatry, University of NSW, Sydney, New South Wales, Australia
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Chih Meg Tseng
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan
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13
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Gibson M, Moreau N, Balzamo E, Crompton D. Peer Intervention following Suicide-Related Emergency Department Presentation: Evaluation of the PAUSE Pilot Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3763. [PMID: 36834458 PMCID: PMC9960257 DOI: 10.3390/ijerph20043763] [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: 01/19/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
The risk for future suicidal behaviours is elevated following suicide attempts, particularly for those with complex needs or those who are disconnected from healthcare systems. The PAUSE program was designed to address this gap using peer workers to provide continuity and coordination of care following suicide-related emergency presentations. This study aimed to evaluate the pilot program's effect on suicidal ideation and hope, and to explore the acceptability and participants' experiences. A mixed-methods design was employed with pre- and post-evaluation questionnaires, including the GHQ-28-SS (general health questionnaire suicide scale), AHS (adult hope scale), and K10 (Kessler psychological distress scale). Participant engagement rates and semi-structured interviews were used to explore program acceptability. In total, 142 people were engaged with the PAUSE pilot between 24 August 2017 and 11 January 2020. There were no significant gender differences in engagement. The suicidal ideation scores decreased, and the hope scores increased after participation in PAUSE. A thematic analysis revealed that participants identified that the key program mechanisms were holistic and responsive support, ongoing social connectedness, and having peer workers who understood their experiences and treated them like people rather than clients. The small number of participants and lack of a control group limited the result generalizability. The findings suggest that PAUSE was an effective and acceptable model for supporting people following suicide-related hospitalisations in this pilot sample.
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Affiliation(s)
- Mandy Gibson
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia
| | - Nick Moreau
- Brook Red Mental Health Charity Ltd., Brisbane, QLD 4122, Australia
| | | | - David Crompton
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia
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14
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Loving RT. Admission to a psychiatric hospital independently increases suicide risk. Arch Psychiatr Nurs 2022; 41:103-104. [PMID: 36428036 DOI: 10.1016/j.apnu.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/14/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Richard T Loving
- Sharp Mesa Vista Hospital, San Diego, CA, United States of America.
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15
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Ilgen MA, Price AM, Coughlin LN, Pfeiffer PN, Stewart HJ, Pope E, Britton PC. Encouraging the use of the Veterans Crisis Line among high-risk Veterans: A randomized trial of a Crisis Line Facilitation intervention. J Psychiatr Res 2022; 154:159-166. [PMID: 35940001 DOI: 10.1016/j.jpsychires.2022.07.047] [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: 03/18/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
The Veterans Crisis Line (VCL) is a core component of VA's suicide prevention strategy. Despite the availability and utility of the VCL, many Veterans do not utilize this resource during times of crisis. A brief, psychoeducational behavioral intervention (termed Crisis Line Facilitation [CLF]) was developed to increase utilization of the VCL and reduce suicidal behaviors in high-risk Veterans. The therapist-led session includes educational information regarding the VCL, as well as a chance to discuss the participant's perceptions of contacting the VCL during periods of crisis. The final component of the session is a practice call placed to the VCL by both the therapist and the participant. The CLF intervention was compared to Enhanced Usual Care (EUC) during a multi-site randomized clinical trial for 307 Veteran participants recently hospitalized for a suicidal crisis who reported no contact with the VCL in the prior 12 months. Initial analyses indicated that participants randomized to the CLF intervention were less likely to report suicidal behaviors, including suicide attempts compared to participants randomized to receive EUC over 12-months of follow-up (χ2 = 18.48/p < 0.0001), however this effect was not sustained when analyses were conducted on an individual level. No significant differences were found between conditions on VCL utilization. Initial evidence suggests a brief CLF intervention has an impact on preventing suicidal behaviors in Veterans treated in inpatient mental health programs; however, it may not change use of the VCL. This brief intervention could be easily adapted into clinical settings to be delivered by standard clinical staff.
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Affiliation(s)
- Mark A Ilgen
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Amanda M Price
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lara N Coughlin
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Paul N Pfeiffer
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Haylie J Stewart
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Peter C Britton
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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16
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Zakharova N, Bravve L, Mamedova G, Kaydan M, Ershova E, Martynov A, Veiko N, Kostyuk S. Telomere Length as a Marker of Suicidal Risk in Schizophrenia. CONSORTIUM PSYCHIATRICUM 2022; 3:37-47. [PMID: 39045115 PMCID: PMC11262099 DOI: 10.17816/cp171] [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: 03/29/2022] [Accepted: 05/30/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Schizophrenia and suicidal behavior are associated with shortening in the length of telomeres. The aim of the study was to compare the content (pg/mcg) of telomeric repeat in DNA isolated from peripheral blood cells in three groups of subjects: patients with schizophrenia and a history of suicide attempts, patients with schizophrenia without suicidal tendencies, and healthy control volunteers. METHODS Relapses according to gender and age were examined in 47 patients with schizophrenia with suicidal behavior, 47 patients without self-destructive conditions, and 47 volunteers with healthy control and maintenance for the content of telomeric and the number of copies of mitochondrial DNA (mtDNA) in peripheral blood leukocytes. RESULTS Analysis of determining the content of telomeric repeat (TR) in the DNA of massive weight gain in the series: patients with schizophrenia and suicidal attempts - patients with schizophrenia without suicidal observations - healthy controls (225±28.4 (227 [190; 250]) vs. 243±21 (245 [228; 260]) vs. 255±17.9 (255 [242; 266]), p <0.005. The same trend is observed for the number of mtDNA copies (257±101.5 (250 [194; 297])) vs. 262.3±59.3 (254 [217; 312]) vs. 272±79.9 (274 [213; 304]); p=0.012), but no significant differences were recorded. CONCLUSIONS For the first time, the phenomenon of telomere shortening was discovered in schizophrenics with suicidal risk. The length of the telomere corresponds to the parameter of a biological marker - an objectively measured indicator of normal or pathological processes, but gaining an idea of its reliability is still necessary for verification with an assessment of its sensitivity, specificity, and positive and negative predictive value. The telomere may be considered a putative predictive indicator of suicidal risk.
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17
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Shalaby R, Spurvey P, Knox M, Rathwell R, Vuong W, Surood S, Urichuk L, Snaterse M, Greenshaw AJ, Li XM, Agyapong VIO. Clinical Outcomes in Routine Evaluation Measures for Patients Discharged from Acute Psychiatric Care: Four-Arm Peer and Text Messaging Support Controlled Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073798. [PMID: 35409483 PMCID: PMC8997547 DOI: 10.3390/ijerph19073798] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/10/2022]
Abstract
Background: Peer support workers (PSW) and text messaging services (TxM) are supportive health services that are frequently examined in the field of mental health. Both interventions have positive outcomes, with TxM demonstrating clinical and economic effectiveness and PSW showing its utility within the recovery-oriented model. Objective: To evaluate the effectiveness of PSW and TxM in reducing psychological distress of recently discharged patients receiving psychiatric care. Methods: This is a prospective, rater-blinded, pilot-controlled observational study consisting of 181 patients discharged from acute psychiatric care. Patients were randomized into one of four conditions: daily supportive text messages only, peer support only, peer support plus daily text messages, or treatment as usual. Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM), a standardized measure of mental distress, was administered at four time points: baseline, six weeks, three months, and six months. MANCOVA was used to assess the impact of the interventions on participants’ scores on four CORE-OM subscales across the three follow-up time points. Recovery, clinical change, and reliable change in CORE-OM all-item analysis were examined across the four groups, and the prevalence of risk symptoms was measured. Results: A total of 63 patients completed assessments at each time point. The interaction between PSW and TxM was predictive of differences in scores on the CORE-OM functioning subscale with a medium effect size (F1,63 = 4.19; p = 0.045; ηp2 = 0.07). The PSW + TxM group consistently achieved higher rates of recovery and clinical and reliable improvement compared to the other study groups. Additionally, the text message group and the PSW + TxM group significantly reduced the prevalence of risk of self/other harm symptoms after six months of intervention, with 27.59% (χ2(1) = 4.42, p = 0.04) and 50% (χ2(1) = 9.03, p < 0.01) prevalence reduction, respectively. Conclusions: The combination of peer support and supportive text messaging is an impactful intervention with positive clinical outcomes for acute care patients. Adding the two interventions into routine psychiatric care for patients after discharge is highly recommended.
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Affiliation(s)
- Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
| | - Pamela Spurvey
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Michelle Knox
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Rebecca Rathwell
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Wesley Vuong
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Shireen Surood
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Liana Urichuk
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Mark Snaterse
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Andrew J. Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
| | - Xin-Min Li
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Correspondence:
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18
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Hospital-Based Suicides: Challenging Existing Myths. Psychiatr Q 2022; 93:1-13. [PMID: 33169312 DOI: 10.1007/s11126-020-09856-w] [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] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
Myths are widely held and often based on false beliefs. To improve patient safety and speed the translation of research to clinical practice, we highlight and then debunk 10 common myths regarding the assessment, treatment, and management of hospitalized patients at risk for suicide. Myths regarding hospital-based suicides are examined and empirical evidence that counters each myth is offered. Ten common myths regarding hospital-based suicides are found to be untrue or unsupported based on existing empirical evidence. Rethinking common beliefs and practices that lack empirical support and seeking alternatives based on research evidence is consistent with an emphasis on evidence-based practices leading to improved patient care and protection.
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19
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Grandison G, Karatzias T, Fyvie C, Hyland P, O'Connor RC, Dickson A. Suicidal Histories in Adults Experiencing Psychological Trauma: Exploring Vulnerability and Protective Factors. Arch Suicide Res 2022; 26:155-168. [PMID: 32348712 DOI: 10.1080/13811118.2020.1758262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aimed to identify vulnerability and protective factors for suicidal histories among adults experiencing psychological trauma. METHOD Adults seeking treatment for psychological trauma (N = 113) completed self-report questionnaires measuring childhood trauma history, self-concept, relational functioning, emotion regulation, living arrangements, employment status, marital status, and suicidal history. Independent samples t-tests were used to determine variables on which those with and without suicidal histories differed significantly. These variables were then entered into a binary logistic regression model to identify factors which independently distinguished between those with and without a suicidal history. RESULTS Univariate differences were found for childhood emotional abuse (CEA), childhood emotional neglect (CEN), emotion deactivation, and employment status, with those in the suicidal history group scoring higher on all of these. CEA (OR = 1.13, 95% CI = 1.01-1.27) and employment status (OR = 4.12, 95% CI = 1.23-13.73) remained significant predictors of suicidal status in the multivariable logistic regression. CONCLUSIONS CEA was an independent vulnerability factor for suicidal risk, highlighting the need for clinicians to assess exposure to such trauma in those presenting with proximal traumatic experiences. Being in employment was an independent protective factor against suicidal risk, highlighting the importance of social buffers or networks when faced with traumatic situations.
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20
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Liu H, Chen G, Li J, Hao C, Zhang B, Bai Y, Song L, Chen C, Xie H, Liu T, Caine ED, Hou F. Sequential multiple assignment randomised trial of a brief contact intervention for suicide risk management among discharged psychiatric patients: an implementation study protocol. BMJ Open 2021; 11:e054131. [PMID: 34836907 PMCID: PMC8628333 DOI: 10.1136/bmjopen-2021-054131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The postdischarge suicide risk among psychiatric patients is significantly higher than it is among patients with other diseases and general population. The brief contact interventions (BCIs) are recommended to decrease suicide risk in areas with limited mental health service resources like China. This study aims to develop a postdischarge suicide intervention strategy based on BCIs and evaluate its implementability under the implementation outcome framework. METHODS AND ANALYSIS This study will invite psychiatric patients and family members, clinical and community mental health service providers as the community team to develop a postdischarge suicide intervention strategy. The study will recruit 312 patients with psychotic symptoms and 312 patients with major depressive disorder discharged from Shenzhen Kangning Hospital (SKH) in a Sequential Multiple Assignment Randomised Trial. Participants will be initially randomised into two intervention groups to receive BCIs monthly and weekly, and they will be rerandomised into three intervention groups to receive BCIs monthly, biweekly and weekly at 3 months after discharge according to the change of their suicide risk. Follow-ups are scheduled at 1, 3, 6 and 12 months after discharge. With the intention-to-treat approach, generalised estimating equation and survival analysis will be applied. This study will also collect qualitative and quantitative information on implementation and service outcomes from the community team. ETHICS/DISSEMINATION This study has received ethical approval from the Ethics Committee Review Board of SKH. All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations. A project report will be submitted to the National Natural Science Foundation of China as the concluding report of this funded project, and to the mental health authorities in the Shenzhen to refine and apply evidence-based and pragmatic interventions into health systems for postdischarge suicide prevention. TRIAL REGISTRATION NUMBER NCT04907669.
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Affiliation(s)
- Huiming Liu
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Guanjie Chen
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Jinghua Li
- Sun Yat-sen Global Health Institute, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Chun Hao
- Sun Yat-sen Global Health Institute, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Bin Zhang
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Yuanhan Bai
- Department of Bipolar Disorders, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Liangchen Song
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Chang Chen
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Haiyan Xie
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Tiebang Liu
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Eric D Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Fengsu Hou
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
- Sun Yat-sen Global Health Institute, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
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21
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O'Connell PH, Durns T, Kious BM. Risk of suicide after discharge from inpatient psychiatric care: a systematic review. Int J Psychiatry Clin Pract 2021; 25:356-366. [PMID: 32749183 DOI: 10.1080/13651501.2020.1800043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The period following discharge from inpatient psychiatric care is recognised as an especially high-risk time for patient suicide. Astonishingly, there is a dearth of comprehensive studies examining risk and protective factors in this specific population. The aim of this study was to establish the protective and risk factors for suicide in the first year post-discharge (PD) from psychiatric facilities and their utility in categorising patients as high or low risk in a meaningful way to benefit clinical care and improve patient outcomes. METHODS A methodical search of three databases (PubMed, EMBASE, and PsychINFO) was used to identify reports describing risk factors for suicide after psychiatric discharge. RESULTS Predominantly, male sex, a history of self-harm, a history of suicide attempts, admission with suicidal ideation or suicidal behaviour, and hopelessness were identified as being associated with death by suicide after discharge. Lithium appeared to be protective against suicide in the studies reviewed. Other variables examined showed mixed results. CONCLUSIONS The findings of this review suggest that significant suicide predictors both common and unique to those established for suicide in the general population exist and can be utilised in a clinically meaningful way, despite the difficulties inherent in studying this population.KEY POINTSThe risk of suicide after psychiatric hospitalisation is high.Factors that predict suicide after psychiatric hospitalisation overlap only partially with risk factors for suicide in general.Important risk factors for suicide in the post-discharge period include male sex, a history of self-harm, a history of suicide attempts, the presence of suicidal ideation during the admission, and hopelessness.The conclusions that can be drawn from the existing literature are limited by small study sizes, different study populations, and different follow-up periods; additional research in this domain is needed.
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Affiliation(s)
| | - Tyler Durns
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Brent M Kious
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
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Riblet NB, Stevens SP, Watts BV, Gui J, Forehand J, Cornelius S, Powell R, Lewicki K, Wasserman D, Shiner B. A Pilot Randomized Trial of a Brief Intervention to Prevent Suicide After Inpatient Psychiatric Discharge. Psychiatr Serv 2021; 72:1320-1323. [PMID: 33979200 DOI: 10.1176/appi.ps.202000537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Risk for suicide is high after psychiatric hospitalization. The World Health Organization's Brief Intervention and Contact (BIC) program has shown efficacy in preventing suicide. A version adapted for the U.S. Department of Veterans Affairs (VA) was studied to determine preliminary effects. METHODS Patients receiving psychiatric hospitalization because of acute risk for self-harm were randomly assigned to the VA BIC or standard care alone. Effect sizes (Hedges' g) for suicidal ideation (primary outcome), social connectedness (measured as thwarted belongingness and perceived burdensomeness), hopelessness, and engagement were calculated at 1 and 3 months. RESULTS Patients were randomly assigned to the VA BIC (N=10) or standard care (N=9). The VA BIC had a medium or large effect on most measures at 1 month (suicidal ideation, g=0.45). Effects diminished at 3 months, except for thwarted belongingness (g=0.81). CONCLUSIONS The VA BIC had meaningful effects on suicide-related outcomes. The largest effect was seen in the first month.
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Affiliation(s)
- Natalie B Riblet
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Susan P Stevens
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Bradley V Watts
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Jiang Gui
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Jenna Forehand
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Sarah Cornelius
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Robert Powell
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Karen Lewicki
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Danuta Wasserman
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Brian Shiner
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
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Lombardo F, Daly M. Analyzing suicide life stories on Wikipedia with Highway_star and other textual visualization tools. SN SOCIAL SCIENCES 2021; 1:268. [PMID: 34729497 PMCID: PMC8553402 DOI: 10.1007/s43545-021-00272-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022]
Abstract
Being responsible for a death every 40s, suicide is a major public health concern (Brunier et al. 2019). Even if many of its risk factors are social (Van Orden et al. 2010), there are surprisingly few qualitative sociological studies about the phenomenon. This study aim is to provide a life-story sociological analysis of suicidal trajectories. Two challenges are identified: gathering suicidal narrative and maintaining a quantitative foreground in order to deepen and rationalize the interpretation of data. They are both faced using a self-made, free to use, open access, algorithm: Highway_star (https://github.com/matheo-daly/highway_star). Two corpora of Wikipedia biographies of people who died by suicide in the 1920s (N = 82) and 2020s (N = 49) are gathered. Following an application of Fritze Schütze's methodology (Schütze, 2014), classical textual visualizations are produced. A Hierarchical Descending Classification, a Factorial Correspondence Analysis and a Similarity Analysis reveal five narration categories centered around different topics: cinema, death, family, poetry and politics. As none of those visualizations focuses on the developmental aspect of the biography, they offer limited interest for a life-story investigation. The second functionality of the Highway_star tool, which represents a narrative's unfolding with a Sankey Diagram, allows completing the analysis. It shows interesting differences between decades or gender. An example of the last being that men narratives tend to be more complex and achievement focused, while the women ones are more linear and family centered. The study's range has limitations. A major one is related to the corpus and the inability to identify clearly which parts of the narratives are associated to fame and which to suicide. Another one is linked to the Highway_star tool that sometimes lack of flexibility.
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Waliski A, Matthieu MM, Townsend JC, McGaugh J, Adkins DA, Skaggs EM, Allison MK, Kirchner J. Characteristics and Context of Veterans Experiencing Serious Suicidal Ideation or Suicide Attempt by Firearm which led to Hospitalization. Arch Suicide Res 2021; 27:818-828. [PMID: 34547986 DOI: 10.1080/13811118.2021.1974625] [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: 10/20/2022]
Abstract
OBJECTIVE Suicide by former United States military service members is of great public health concern, and one area, veterans' suicide attempts involving firearms, is understudied. One group that has a unique perspective on this are veterans with a psychiatric admission following a firearm-related suicide crisis, such as making a suicide plan or a suicide rehearsal with a firearm within the preceding 72 hours. This study seeks to address this gap in the literature by describing the characteristics and context of non-fatal suicide events involving firearms among veterans. METHOD This convergent parallel mixed-methods design study collected both quantitative and qualitative data from male veterans (N = 15) who were hospitalized due to a suicide attempt or serious ideation using a firearm. Veterans admitted to a Veterans Affairs Medical Center (VAMC) were interviewed and asked to complete a survey. Qualitative data on characteristics and context were analyzed using a thematic analysis. RESULTS The fifteen male U.S. military veterans described their personal characteristics, such as their beliefs, family beliefs and structure, emotions, and employment status. Most participants were unemployed (n = 10; 67%), divorced (n = 7; 47%) or married (n = 5; 33%). Seven themes related to context emerged from qualitative interviews to include: combat trauma, non-combat trauma and negative life event(s), current and past suicide attempt(s), firearms, substance use, known deaths by suicide, and protective factors for suicide. CONCLUSION Results suggest that engaging support networks and communities is essential when developing programs to promote identification of early warning signs and implementation of interventions or programs for reducing veteran suicide.
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Simões RMP, Dos Santos JCP, Martinho MJCM. Adolescents with suicidal behaviours: A qualitative study about the assessment of Inpatient Service and Transition to Community. J Psychiatr Ment Health Nurs 2021; 28:622-631. [PMID: 33113225 DOI: 10.1111/jpm.12707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/25/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Only a small number of adolescents with suicidal behaviour receives any follow-up treatment. The implementation of recurrent behaviour prevention strategies is crucial in the period following suicide attempts and should take into account adolescents' opinions to be effective and congruent. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper shows that the 33 adolescent participants in the study identified the following protective factors of recurrent suicidal behaviour: family, friends and other trusted persons, as well as the self and newly learned strategies. The adolescents described their family as a constant presence and reported wishing that their parents maintain their current family support. Psychological support, health professionals and occupational activities are what the adolescents value most about hospitalization, and some criticisms are related to the environment, activities and health professionals. The adolescents also emphasize the need to maintain contact with the nurses after hospital discharge and make suggestions for service improvement related to the environment and the interventions implemented. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Knowing the protective factors of recurrent suicidal behaviours, perception of the impact of the intervention, the expectation of future support and healthcare follow-up is crucial for adapting suicide prevention strategies to be put in place by health services for better quality care delivery. The results obtained allow us to define as specific implications the implementation of psychoeducational intervention directed at the adolescent's family with suicidal behaviour during hospitalization and the definition of strategies for maintaining contact and follow-up with the adolescent after discharge. This study emphasizes the need to reinforce training in suicidology for all health professionals for the improvement of clinical practice. ABSTRACT INTRODUCTION: The prevention of recurrent suicidal behaviours in adolescents should consider their perceptions, needs and expectations. AIM/QUESTION To identify the protective factors of recurrent suicidal behaviours in adolescents; To describe the family and the expectations for future involvement; To know the most important aspects of hospitalization and discuss expectations of nursing care follow-up after hospital discharge. METHOD A descriptive, qualitative and exploratory study was carried out in a sample of 33 adolescents with suicidal behaviours. Data were collected through semi-structured interviews, and the data processing used the content analysis technique. RESULTS Findings arising from data allowed identifying the protective factors: family, friends and other trusted persons. During the hospitalization, the adolescents reinforce the knowledge about themselves and the newly learnt coping strategies. Psychological support and health professionals are what they value most about hospitalization and emphasize the need to maintain contact with the nurses after discharge. DISCUSSION Knowing the needs and expectations of adolescents with suicidal behaviour will make nursing psychotherapeutic interventions more effective and congruent in this vulnerable group. IMPLICATIONS FOR PRACTICE Ensuring psychoeducational intervention to the families of adolescents with suicidal behaviour and continuity of care after discharge, and reinforcing the training in suicidology for all health professionals.
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Weinstein JH, Kroska EB, Walser RD. The empowerment plan: Enhancing the safety plan with a CBS approach to repertoire expansion. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Wright AM, Lee SJ, Rylatt D, Henderson K, Cronje HM, Kehoe M, Stafrace S. Coordinated assertive aftercare: Measuring the experience and impact of a hybrid clinical/non-clinical post-suicidal assertive outreach team. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Barnes SM, Borges LM, Smith GP, Walser RD, Forster JE, Bahraini NH. Acceptance and Commitment Therapy to Promote Recovery from suicidal crises: A Randomized Controlled Acceptability and Feasibility Trial of ACT for life. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Large M, Corderoy A, McHugh C. Is suicidal behaviour a stronger predictor of later suicide than suicidal ideation? A systematic review and meta-analysis. Aust N Z J Psychiatry 2021; 55:254-267. [PMID: 32579030 DOI: 10.1177/0004867420931161] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Suicidal ideation and suicidal behaviour are both regarded as important risk factors for suicide, but it is usually believed that suicidal ideation is less strongly linked to suicide than suicidal behaviours. In this study, we assessed and compared the strengths of the associations that suicidal ideation and suicidal behaviour have with later suicide using meta-analysis of primary studies reporting both these independent variables and the dependent variable of suicide. METHODS A total of 51 English language publications describing cohort or controlled studies that reported on both the association between suicidal ideation and suicide and the association between suicidal behaviours and suicide were located using searches for titles in PubMed containing variants of the word suicide (suicid*). Suicides were considered to include reported suicides and open verdicts from mortality registers. The strengths of the two associations were examined in separate random effects meta-analyses and were then compared using mixed effects meta-regression. Subgroups were examined according to study characteristics including the definitions of suicidal ideation or behaviour used, setting (psychiatric or non-psychiatric), diagnostic mix of the study population, study design (cohort or control) and study quality. RESULTS Suicidal ideation (odds ratio = 3.11, 95% confidence interval = 2.51, 3.86) and suicidal behaviours (odds ratio = 4.09, 95% confidence interval = 3.05, 5.49) were both significantly associated with suicide but there was no significant difference in the strengths of association (p = 0.14). Nor were there significant differences in the strengths of the two associations in multiple subgroup analyses. CONCLUSION Suicidal ideation and suicidal behaviour are both moderately associated with suicide. Existing data cannot conclusively demonstrate that suicidal behaviours are more strongly associated with suicide than suicidal ideation. Clinicians should not strongly prioritise suicidal behaviour over suicidal ideation when considering suicide risk.
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Affiliation(s)
- Matthew Large
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Amy Corderoy
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Catherine McHugh
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
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Sreedaran P, Beniwal RP, Chari U, Smitha T S, Vidhya Shree S V, Gupta V, Bhatia T, Deshpande SN. A Randomized Controlled Trial to Assess Feasibility and Acceptability of Telephone-Based Psychosocial Interventions in Individuals who Attempted Suicide. Indian J Psychol Med 2021; 43:144-149. [PMID: 34376890 PMCID: PMC8313454 DOI: 10.1177/0253717620939272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Brief contact interventions such as telephone-based contacts appear to be useful in individuals who attempted suicide. Most studies of telephone-based contacts in such individuals typically consisted of frequent phone reminders for adherence to treatment and seeking help for mental health issues. Telephone-based psychosocial interventions that incorporate elements of supportive and problem-solving strategies are of interest in Indian settings due to their potential application in mitigating the wide mental health gap. Feasibility studies of telephone-based psychosocial interventions could help ascertain the difficulties that arise in the implementation of such treatments. METHODS A multicentric randomized controlled trial (RCT) is currently underway in general hospital settings in two Indian cities to study the efficacy of telephone-based psychosocial interventions in individuals with a recent suicide attempt, with routine telephone contacts (TCs) serving as the comparator. Prior to that RCT, this feasibility study was conducted to assess the acceptability of the telephone-based intervention and telephone contacts. Feasibility was assessed using dropout rates. Acceptability was assessed using participant-rated Likert-based visual analog scores from 0 to 10, with higher scores indicating greater acceptability. RESULTS Dropout rates and mean acceptability scores for telephone-based psychosocial interventions were 38.5% and 8.63, while those for TCs were 41.7% and 7.57, respectively. CONCLUSIONS Telephone-based psychosocial interventions are feasible and acceptable in individuals with a recent suicide attempt.
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Affiliation(s)
- Priya Sreedaran
- Dept. of Psychiatry, St John’s Medical
College, Bengaluru, Karnataka, India
| | - Ram Pratap Beniwal
- Dept. of Psychiatry, Centre of
Excellence in Mental Health, ABVIMS & Dr RML Hospital, New Delhi, India
| | - Uttara Chari
- Dept. of Clinical Psychology, St John’s
MEDICAL college, Bengaluru, Karnataka, India
| | - Smitha T S
- Dept. of Psychiatry, St John’s Medical
College, Bengaluru, Karnataka, India
| | - Vidhya Shree S V
- Dept. of Psychiatry, St John’s Medical
College, Bengaluru, Karnataka, India
| | - Varsha Gupta
- Dept. of Psychiatry, Centre of
Excellence in Mental Health, ABVIMS & Dr RML Hospital, New Delhi, India
| | - Triptish Bhatia
- Dept. of Psychiatry, Centre of
Excellence in Mental Health, ABVIMS & Dr RML Hospital, New Delhi, India
| | - Smita N Deshpande
- Dept. of Psychiatry, Centre of
Excellence in Mental Health, ABVIMS & Dr RML Hospital, New Delhi, India
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Ward-Ciesielski EF, Rizvi SL. The potential iatrogenic effects of psychiatric hospitalization for suicidal behavior: A critical review and recommendations for research. ACTA ACUST UNITED AC 2021. [DOI: 10.1111/cpsp.12332] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Munasinghe S, Page A, Mannan H, Ferdousi S, Peek B. Determinants of treatment disengagement among those at risk of suicide referred to primary mental health care services in Western Sydney, Australia. Aust N Z J Psychiatry 2021; 55:277-288. [PMID: 33032444 DOI: 10.1177/0004867420963738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Continued engagement with primary mental health services has been associated with the prevention of subsequent suicidal behaviour; however, there are few studies that identify determinants of treatment disengagement among those at risk of suicide in primary care settings. This study investigated determinants of treatment disengagement of those at risk of suicide who were referred to primary mental health care services in Western Sydney, Australia. METHOD This study used routinely collected data of those referred for suicide prevention services provided through primary mental health care services between July 2012 and June 2018. Associations between sociodemographic, diagnostic, referral- and service-level factors and treatment non-attendance and early treatment cessation were investigated using a series of multivariable generalised estimation equations. RESULTS There were 1654 suicidal referrals for 1444 people during the study period. Those identified with a risk of suicide were less likely to never attend treatments (16.14% vs 19.77%), but were more likely to disengage earlier from subsequent service sessions (16.02% vs 12.41%), compared to those with no risk of suicide. A higher likelihood of non-attendance to any primary mental health care service sessions was associated with those aged 25-44, lower socioeconomic status, a presentation for substance use and a referral from acute care (either emergency department or hospital). Among those who attended an initial treatment session, younger age (18-24 years) and a longer waiting time for an initial follow-up appointment were associated with a higher likelihood of early treatment cessation from primary mental health care services. CONCLUSION These findings can inform potential strategies in routine primary mental health care practice to improve treatment engagement among those at risk of suicidal behaviour. Youth-specific interventions, behavioural engagement strategies and prompt access to services are policy and service priorities.
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Affiliation(s)
- Sithum Munasinghe
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,Western Sydney Primary Health Network, Blacktown, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Haider Mannan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Shahana Ferdousi
- Western Sydney Primary Health Network, Blacktown, NSW, Australia
| | - Brendan Peek
- Royal Australasian College of Dental Surgeons, Sydney, NSW, Australia
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McManama O'Brien KH, Almeida J, View L, Schofield M, Hall W, Aguinaldo L, Ryan CA, Maneta E. A Safety and Coping Planning Intervention for Suicidal Adolescents in Acute Psychiatric Care. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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The development and evaluation of a brief intervention for male partners of women hospitalized for perinatal distress. J Affect Disord 2021; 280:26-33. [PMID: 33202335 DOI: 10.1016/j.jad.2020.10.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/24/2020] [Accepted: 10/31/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Perinatal distress (PD) is a term used to describe mood and anxiety disorders experienced during pregnancy or in the postpartum period. In acute cases of PD, inpatient hospitalization may be indicated. Although hospitalization tends to result in improved immediate safety outcomes, many patients are discharged when they are still experiencing acute symptomology. Interpersonal and environmental factors, particularly those that exist within intimate relationships, can significantly help or hinder patient progress. Partners are also affected by the patient's symptoms and often lacks the skills or knowledge to offer support. METHODS The aim of the present investigation is to address PD through a dyadic lens by integrating partners into treatment. In this feasibility study, 20 partners of women hospitalized for PD were recruited to participate in an individually delivered, 90-minute intervention designed to improve partner understanding and support behaviors. RESULTS Qualitative feedback from partners suggests that the intervention was acceptable and the high recruitment rates demonstrate strong feasibility. Additionally, partners reported significant gains in the context of their support self-efficacy for assisting patients to cope with distress. Patients reported that they were significantly more satisfied with the support that their partners were providing. LIMITATIONS This was a feasibility study and as such, there was no control group, thereby limiting causal inferences about the intervention. CONCLUSIONS These findings suggest that this intervention may serve to enhance the recovery of women hospitalized for PD by empowering partners through offering psychoeducation and skills for offering support.
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Corke M, Mullin K, Angel-Scott H, Xia S, Large M. Meta-analysis of the strength of exploratory suicide prediction models; from clinicians to computers. BJPsych Open 2021; 7:e26. [PMID: 33407984 PMCID: PMC8058929 DOI: 10.1192/bjo.2020.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide prediction models have been formulated in a variety of ways and are heterogeneous in the strength of their predictions. Machine learning has been a proposed as a way of improving suicide predictions by incorporating more suicide risk factors. AIMS To determine whether machine learning and the number of suicide risk factors included in suicide prediction models are associated with the strength of the resulting predictions. METHOD Random-effect meta-analysis of exploratory suicide prediction models constructed by combining two or more suicide risk factors or using clinical judgement (Prospero Registration CRD42017059665). Studies were located by searching for papers indexed in PubMed before 15 August 2020 with the term suicid* in the title. RESULTS In total, 86 papers reported 102 suicide prediction models and included 20 210 411 people and 106 902 suicides. The pooled odds ratio was 7.7 (95% CI 6.7-8.8) with high between-study heterogeneity (I2 = 99.5). Machine learning was associated with a non-significantly higher odds ratio of 11.6 (95% CI 6.0-22.3) and clinical judgement with a non-significantly lower odds ratio of 4.7 (95% CI 2.1-10.9). Models including a larger number of suicide risk factors had a higher odds ratio when machine-learning studies were included (P = 0.02). Among non-machine-learning studies, suicide prediction models including fewer risk factors performed just as well as those including more risk factors. CONCLUSIONS Machine learning might have the potential to improve the performance of suicide prediction models by increasing the number of included suicide risk factors but its superiority over other methods is unproven.
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Affiliation(s)
- Michelle Corke
- School of Psychiatry, University of New South Wales, Australia
| | - Katherine Mullin
- South Eastern Sydney Local Health District and School of Medicine, University of Notre Dame, Australia
| | | | - Shelley Xia
- South Eastern Sydney Local Health District, Australia
| | - Matthew Large
- South Eastern Sydney Local Health District, Australia; and School of Medicine, University of Notre Dame, Australia
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Madsen T, Egilsdottir E, Damgaard C, Erlangsen A, Nordentoft M. Assessment of Suicide Risks During the First Week Immediately After Discharge From Psychiatric Inpatient Facility. Front Psychiatry 2021; 12:643303. [PMID: 33959051 PMCID: PMC8093514 DOI: 10.3389/fpsyt.2021.643303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The suicide rate in first week after psychiatric discharge is alarmingly high. Although a risk assessment prior to discharge is standard praxis, it can be difficult to take into consideration the obstacles that patient will meet once discharged. A follow-up-visit during the first week after discharge is an opportunity to reevaluate whether a person may be at risk of suicide. Aim: To determine how many patients, of those who were assessed, were evaluated to be at elevated risk of suicide during the first week after psychiatric discharge and secondarily to identify predictors of this and predictors for receiving a follow-up visit during first week after discharge. Methods: All patients discharged between March 1st 2018 to January 17th 2019 were offered a home visit including a systematic risk assessment. Socio-demographics and clinical variables were obtained from medical records and logistic regression analyses were used to identify predictors of a higher suicide risk assessment as well as receiving a follow-up visit. Results: Information from 1905 discharges were included. Of these, 1,052 were seen in follow-up meetings. Risk assessments was conducted in a total of 567 discharge procedures, of which 28 (5%) had an elevated risk of suicide. A history of suicide attempt, suicide risk having been the reason for admission, a first diagnosis of a psychiatric disorder was associated with an elevated risk of suicide after discharge. Conclusion: Follow-up visits could serve as an important tool to identify people whose suicidal risk were overlooked at discharge or exposed to severe stressors after discharge.
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Affiliation(s)
- Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark
| | - Eybjørg Egilsdottir
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark
| | - Chanette Damgaard
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Research School of Public Health, Center of Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark.,Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital - Mental Health Services, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abstract
OBJECTIVE Resolution of suicidal ideation for patients with major depressive disorder is an important public health challenge. We aimed to determine whether electroconvulsive therapy (ECT) or fluoxetine was more efficacious in resolving suicidal ideation and achieving long-term protective effect against suicidality. METHODS The data used in this study were drawn from 2 open-label trials for major depressive disorder patients receiving ECT or fluoxetine for acute treatment, together with continuation medication in the 12-week follow-up. We compared the effects of ECT and fluoxetine on suicidal ideation as scored by the suicide item on the 17-item Hamilton Rating Scale for Depression. RESULTS The differences between these 2 groups in time to resolution of suicidal ideation (suicide item = 0) in the acute treatment period, and time to relapse of suicidal ideation (suicide item score ≥1 or rehospitalization for suicidality) in the follow-up period were analyzed. Electroconvulsive therapy-treated patients (n = 111) had significantly shorter time to resolution of suicidal ideation than fluoxetine-treated patients (n = 114) during acute treatment. However, there was no statistically significant difference in time to relapse of suicidal ideation between 2 groups in the 12-week follow-up period. CONCLUSIONS Electroconvulsive therapy was superior to fluoxetine in resolving suicidal ideation during acute treatment. Therefore, ECT should be an early consideration for suicidal patients. Electroconvulsive therapy and fluoxetine were equally effective in preventing recurrence of suicidal ideation in the 12-week follow-up period. Routine suicide risk assessments from hospital care to outpatient care are required to identify any signs of suicidal relapse.
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Morgiève M, Genty C, Azé J, Dubois J, Leboyer M, Vaiva G, Berrouiguet S, Courtet P. A Digital Companion, the Emma App, for Ecological Momentary Assessment and Prevention of Suicide: Quantitative Case Series Study. JMIR Mhealth Uhealth 2020; 8:e15741. [PMID: 33034567 PMCID: PMC7584985 DOI: 10.2196/15741] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/08/2020] [Accepted: 06/03/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Many suicide risk factors have been identified, but traditional clinical methods do not allow for the accurate prediction of suicide behaviors. To face this challenge, emma, an app for ecological momentary assessment (EMA), ecological momentary intervention (EMI), and prediction of suicide risk in high-risk patients, was developed. OBJECTIVE The aim of this case report study was to describe how subjects at high risk of suicide use the emma app in real-world conditions. METHODS The Ecological Mental Momentary Assessment (EMMA) study is an ongoing, longitudinal, interventional, multicenter trial in which patients at high risk for suicide are recruited to test emma, an app designed to be used as a self-help tool for suicidal crisis management. Participants undergo clinical assessment at months 0, 1, 3, and 6 after inclusion, mainly to assess and characterize the presence of mental disorders and suicidal thoughts and behaviors. Patient recruitment is still ongoing. Some data from the first 14 participants who already completed the 6-month follow-up were selected for this case report study, which evaluated the following: (1) data collected by emma (ie, responses to EMAs), (2) metadata on emma use, (3) clinical data, and (4) qualitative assessment of the participants' experiences. RESULTS EMA completion rates were extremely heterogeneous with a sharp decrease over time. The completion rates of the weekly EMAs (25%-87%) were higher than those of the daily EMAs (0%-53%). Most patients (10/14, 71%) answered the EMA questionnaires spontaneously. Similarly, the use of the Safety Plan Modules was very heterogeneous (2-75 times). Specifically, 11 patients out of 14 (79%) used the Call Module (1-29 times), which was designed by our team to help them get in touch with health care professionals and/or relatives during a crisis. The diversity of patient profiles and use of the EMA and EMI modules proposed by emma were highlighted by three case reports. CONCLUSIONS These preliminary results indicate that patients have different clinical and digital profiles and needs that require a highly scalable, interactive, and customizable app. They also suggest that it is possible and acceptable to collect longitudinal, fine-grained, contextualized data (ie, EMA) and to offer personalized intervention (ie, EMI) in real time to people at high risk of suicide. To become a complementary tool for suicide prevention, emma should be integrated into existing emergency procedures. TRIAL REGISTRATION ClinicalTrials.gov NCT03410381; https://clinicaltrials.gov/ct2/show/NCT03410381.
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Affiliation(s)
- Margot Morgiève
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,ICM - Brain and Spine Institute, hôpital de la Pitié-Salpêtrière, Paris, France.,GEPS - Groupement d'Étude et de Prévention du Suicide, Paris, France
| | - Catherine Genty
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Jérôme Azé
- LIRMM, UMR 5506, Montpellier University/CNRS, Montpellier, France
| | - Jonathan Dubois
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Marion Leboyer
- Fondation Fondamental, hôpital Albert-Chenevier, Créteil, France
| | - Guillaume Vaiva
- GEPS - Groupement d'Étude et de Prévention du Suicide, Paris, France.,CHU Lille, Hôpital Fontan, Department of Psychiatry, Lille, France.,Centre National de Ressources & Résilience pour les psychotraumatismes, Lille, France.,Université de Lille, CNRS UMR-9193, SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Sofian Berrouiguet
- GEPS - Groupement d'Étude et de Prévention du Suicide, Paris, France.,EA 7479 SPURBO, Université de Bretagne Occidentale, Brest, France.,IMT Atlantique, Lab-STICC, Brest, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Fondation Fondamental, hôpital Albert-Chenevier, Créteil, France
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Young JT, Borschmann R, Heffernan E, Spittal MJ, Brophy L, Ogloff JRP, Moran P, Armstrong G, Preen DB, Kinner SA. Contact with Mental Health Services After Acute Care for Self-Harm Among Adults Released from Prison: A Prospective Data Linkage Study. Suicide Life Threat Behav 2020; 50:990-1006. [PMID: 32359122 DOI: 10.1111/sltb.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the care pathway and rate and predictors of mental health care contact within seven days of discharge from acute care following self-harm. METHOD In a representative cohort of adults released from prisons in Queensland, Australia, we probabilistically linked person-level, statewide ambulance, emergency department, and hospital records, both prospectively and retrospectively, and community mental health service and Medicare records prospectively, to baseline survey data. We fit multivariate modified log-linked Poisson regression models to examine the association between sociodemographic, health, and criminal justice factors and mental health care contact after self-harm. RESULTS Of 217 discharges from acute care following self-harm, 55% (n = 119) received mental health care within seven days of discharge. Mental health care contact was associated with substance use disorder (adjusted relative risk (ARR) = 0.48; 95% CI: 0.27-0.85), dual diagnosis (ARR = 0.58; 95% CI: 0.41-0.82), physical health-related functioning (ARR = 0.98; 95% CI: 0.97-0.99), being female (ARR = 1.39; 95% CI: 1.02-1.90), being identified as at risk of self-harm by correctional authorities (ARR = 1.50; 95% CI: 1.07-2.09), and prior engagement with state-funded mental health care (ARR = 1.55; 95% CI: 1.08-2.22). CONCLUSION Our findings highlight the need to improve the integration of community mental health care for people who present to acute care following self-harm with a recent history of incarceration, particularly for men and those with substance use disorder or dual diagnosis.
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Affiliation(s)
- Jesse T Young
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Vic., Australia.,School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Rohan Borschmann
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Vic., Australia.,Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry, The University of Melbourne, Parkville, Vic., Australia
| | - Ed Heffernan
- School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia
| | - Lisa Brophy
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Mind Australia, Heidelberg, Vic., Australia.,School of Allied Health, La Trobe University, Bundoora, Vic., Australia
| | - James R P Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology & Victorian Institute of Forensic Mental Health, Alphington, Vic., Australia
| | - Paul Moran
- Department of Population Health Sciences, Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gregory Armstrong
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Stuart A Kinner
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Vic., Australia.,Mater Research Institute-UQ, University of Queensland, South Brisbane, Qld, Australia.,Griffith Criminology Institute, Griffith University, Mt Gravatt, Qld, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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40
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Bettis AH, Liu RT, Walsh BW, Klonsky ED. Treatments for Self-Injurious Thoughts and Behaviors in Youth: Progress and Challenges. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2020; 5:354-364. [PMID: 32923664 DOI: 10.1080/23794925.2020.1806759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Self-injurious thoughts and behaviors (SITBs) remain a common clinical problem in youth. This article reviews the state of knowledge regarding psychosocial treatments for SITBs in youth. Broadly speaking, psychosocial treatments that incorporate parents/family and that emphasize skills development (including emotion regulation and interpersonal skills) appear to produce the best outcomes. We also describe several challenges to the implementation of evidence-based psychotherapy, as well as potential solutions to these challenges, and provide an illustrative case example. Finally, because even evidence-based psychosocial treatments can take weeks to produce effects, increased attention has been given to biological approaches such as esketamine administration and transcranial direct current stimulation that have potential to yield rapid improvement for acute suicidal ideation, though evidence for the safety and efficacy of these approaches is in the early stages.
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Affiliation(s)
- Alexandra H Bettis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital; Department of Psychiatry, Harvard Medical School
| | - Barent W Walsh
- Executive Director Emeritus and Senior Clinical Consultant, Open Sky Community Services
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Rosebrock H, Chen N, Tye M, Mackinnon A, Calear AL, Batterham PJ, Maple M, Rasmussen VM, Schroeder L, Cutler H, Shand F. Study protocol for a mixed methods prospective cohort study to explore experiences of care following a suicidal crisis in the Australian healthcare system. BMJ Open 2020; 10:e033814. [PMID: 32801189 PMCID: PMC7430469 DOI: 10.1136/bmjopen-2019-033814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION For individuals presenting to the emergency department (ED) for a suicide attempt, the period after discharge from hospital is marked by heightened vulnerability for further suicide attempts. Effective care following a suicidal crisis has the potential to significantly decrease this risk. The current study aims to examine the impact of the LifeSpan multilevel suicide prevention model on experiences of care following a suicidal crisis. Perspectives from healthcare consumers (individuals who have presented to the ED following a suicidal crisis), carers, and health professionals will be explored. The LifeSpan model is currently being evaluated as a high-fidelity trial in four geographically defined regions in New South Wales, Australia. METHODS AND ANALYSIS This study will use a mixed methods prospective cohort design. Quantitative data collection includes a structured survey, administered to healthcare consumers from LifeSpan sites and control sites. Two cohorts of healthcare consumers will be recruited 12 months apart with baseline assessment occurring within 18 months of the ED presentation, and follow-up 12 months after the initial assessment. Survey participants will be recruited online and through participating EDs, mental health organisations and aftercare services. Qualitative interview data from healthcare consumers, carers who have accompanied a loved one to the ED following a suicidal crisis and health professionals who provide care to people at risk of suicide will be collected concurrently with the recruitment of the first cohort of survey participants. Purposive and convenience sampling techniques will be used for recruitment of interview participants. The primary outcome for this study will be healthcare consumers' experiences of service provided at the ED. Analysis will be undertaken of the change over time within LifeSpan sites, as well as between LifeSpan sites and control sites, using mixed effects repeated measures models as principal means of data analysis. ETHICS AND DISSEMINATION This research has been approved by the Hunter New England Human Research Ethics Committee (HREC/17/HNE/144). Results will be disseminated via conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12617000457347.
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Affiliation(s)
| | - Nicola Chen
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Michelle Tye
- Black Dog Institute, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | | | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Myfanwy Maple
- School of Health, University of New England, Armidale, New South Wales, Australia
| | | | - Liz Schroeder
- Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia
| | - Henry Cutler
- Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia
| | - Fiona Shand
- Black Dog Institute, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
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Choi Y, Nam CM, Lee SG, Park S, Ryu HG, Park EC. Association of continuity of care with readmission, mortality and suicide after hospital discharge among psychiatric patients. Int J Qual Health Care 2020; 32:569-576. [DOI: 10.1093/intqhc/mzaa093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/16/2020] [Accepted: 08/07/2020] [Indexed: 02/03/2023] Open
Abstract
Abstract
Objectives
The objective of this study was to identify the association between continuity of ambulatory psychiatric care after hospital discharge among psychiatric patients and readmission, mortality and suicide.
Design
Nationwide nested case-control study.
Settings
South Korea.
Participants
Psychiatric inpatients.
Interventions
Continuity of psychiatric outpatient care was measured from the time of hospital discharge until readmission or death occurred, using the continuity of care index.
Main Outcome Measures
Readmission, all-cause mortality and suicides within 1-year post-discharge.
Results
Of 18 702 psychiatric inpatients in the study, 8022 (42.9%) were readmitted, 355 (1.9%) died, and 108 (0.6%) died by suicide within 1 year after discharge. Compared with the psychiatric inpatients with a high continuity-of-care score, a significant increase in the readmission risk within 1 year after discharge was found in those with medium and low continuity of care scores. An increased risk of all-cause mortality within 1 year after hospital discharge was shown in the patients in the low continuity group, relative to those in the high-continuity group. The risk of suicide within 1 year after hospital discharge was higher in those with medium and low continuity of care than those with high continuity of care.
Conclusion
The results of this study provide empirical evidence of the importance of continuity of care when designing policies to improve the quality of mental health care, such as increasing patient awareness of the importance of continuity and implementation of policies to promote continuity.
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Affiliation(s)
- Young Choi
- Department of Health Care Management, Catholic University of Pusan, Busan 46265, South Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sang Gyu Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hwang-Gun Ryu
- Department of Health Care Administration,Kosin University, Busan 49267, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Bojanić L, Hunt IM, Baird A, Kapur N, Appleby L, Turnbull P. Early Post-Discharge Suicide in Mental Health Patients: Findings From a National Clinical Survey. Front Psychiatry 2020; 11:502. [PMID: 32581877 PMCID: PMC7296132 DOI: 10.3389/fpsyt.2020.00502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
Studies on suicide by recently discharged mental health patients have reported a high number of deaths in the early post-discharge period, which has led to recommendations of follow-up within 7 days (d). More recently, the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) proposed a more "stringent" follow-up period of 2-3 days (d) after discharge. Patients who died within this early time-frame post-discharge were more likely to die before the follow-up appointment occurred. They more often had a primary diagnosis of a personality disorder, self-discharged, and had a higher frequency of death by jumping from a height or in front of the vehicle compared to later deaths. This study provides practical implications for post-discharge management and safety planning. Clinicians should be aware of (1) the increased risk of immediate suicide in the post-discharge period by people with a diagnosis of personality disorder, (2) immediate suicide risk in patients who initiate their own discharge, and (3) the increased risk of death by jumping from a height or in front of the vehicle in the immediate post-discharge period. Our findings support the recent recommendation from NCISH that follow-up should occur within 3 d of discharge from in-patient care.
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Affiliation(s)
- Lana Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Isabelle M. Hunt
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Alison Baird
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Navneet Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Evaluate risk of suicide and suicide attempts following psychiatric hospitalization• Assess the relationship between suicide attempts and completed suicides BACKGROUND: Suicidal risks among psychiatric patients appear to be especially high soon after hospitalization. Given the importance of such outcomes, and the lack of recent reviews of post-discharge suicide attempt risks, we evaluated reported findings on the risk of suicide and attempts following psychiatric hospitalization. METHODS With systematic, computerized searching, we identified 48 studies (1964-2017) involving 1,700,785 subjects. Follow-up was limited to ≥12 months after discharge from psychiatric hospitalization to avoid inflation of annualized rates due to shorter exposure times. RESULTS The overall observed pooled, annualized rate of completed suicide was 241 (confidence interval, 238-243) per 100,000 person-exposure years in 41 studies, and for attempts, 722 (698-746) in 13 studies. In six studies (64,848 subjects) reporting on both suicides and attempts, the ratio of annualized rates for attempts/completed suicides was 8.79 (6.63-12.0). Among all 48 studies, cumulative distribution of suicidal events included 26.4% (25.9-26.9) within the initial month, 40.8% (40.2-41.4) within 3 months, and 73.2% (72.7-73.7) within 12 months of discharge. CONCLUSIONS Among patients recently discharged from psychiatric hospitalization, rates of suicide deaths and attempts were far higher than in the general population or even in unselected clinical samples of comparable patients, with a strong inverse association with time post-discharge. Improved monitoring and care of patients discharged from psychiatric hospitalization are needed, ideally with detailed planning and implementation of aftercare prior to discharge.
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Mellesdal L, Kroken R, Lutro O, Wentzel-Larsen T, Kjelby E, Oedegaard K, Jørgensen H, Mehlum L. Self-harm induced somatic admission after discharge from psychiatric hospital – a prospective cohort study. Eur Psychiatry 2020; 29:246-52. [DOI: 10.1016/j.eurpsy.2013.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/04/2013] [Accepted: 06/30/2013] [Indexed: 11/29/2022] Open
Abstract
AbstractBackground:Few studies have examined rate and predictors of self-harm in discharged psychiatric patients.Aims:To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission.Method:Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently.Results:During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis.Conclusions:Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data.
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Lam M, Li L, Anderson KK, Shariff SZ, Forchuk C. Evaluation of the transitional discharge model on use of psychiatric health services: An interrupted time series analysis. J Psychiatr Ment Health Nurs 2020; 27:172-184. [PMID: 31529589 DOI: 10.1111/jpm.12562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/06/2019] [Accepted: 09/12/2019] [Indexed: 10/26/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The period between hospital discharge and community reintegration is a vulnerable time for people with mental illness due to a lack of continuity of care. They are at a high risk of undesired outcomes, including return to hospital. Many transitional models have been developed. It is important to continue evaluating models for improvement and adaptability to different contexts. The transitional discharge model (TDM) is an intervention that incorporates both continued support from hospital staff after discharge and peer support to facilitate a smooth transition. Previous studies have reported positive outcomes such as increased discharges, decreased readmissions, reduced inpatient length of stay and improved quality of life. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Health service use outcomes were examined separately for acute and tertiary care psychiatric units. Previous TDM studies in Canada only examined tertiary care units, but many patients also receive care in acute care units. Although recent studies of different interventions generally reported decreased readmissions, the current study found readmissions increased after TDM and then decreased over time for acute care units, whereas no change was observed for tertiary care units. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Transitional discharge model evidence supports nursing practice based on interpersonal relations and strategies. Nurses need to be aware of peer support resources to facilitate this part of the model. The effectiveness of TDM may be increased by considering the differences in needs of distinct patient groups, such as those discharged from acute versus tertiary care units. ABSTRACT: Introduction The transitional discharge model (TDM) bridges hospital discharge and community living for people receiving psychiatric services. TDM, based on Peplau's theory of interpersonal relations, ensures continued support from hospital staff until a therapeutic relationship is established with community providers and formal peer support. Aim To compare temporal trends in psychiatric health services use before and after TDM implementation within acute and tertiary care psychiatric units in Ontario, Canada. Method Using health administrative databases, monthly discharges from psychiatric units 3 years prior to 2 years after TDM implementation were identified. Median inpatient length of stay (LOS), psychiatric readmission rates and mental health-related emergency department visit rates were compared using segmented regression analyses. Results Among acute care units, median LOS decreased significantly below the projected historical trend following TDM implementation, while readmissions increased significantly and declined thereafter. No significant changes were found for tertiary care units. Discussion Studies on various interventions have shown decreased readmission rates, whereas the trend differed between acute and tertiary care units in this study. Possible reasons include different patient needs and staff practices. Implications for Practice Needs of people from different unit types should be considered when implementing TDM. Nurses should recognize the development of therapeutic relationships and availability of peer support resources.
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Affiliation(s)
| | - Lihua Li
- ICES Western, London, ON, Canada
| | - Kelly K Anderson
- ICES Western, London, ON, Canada.,Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,Department of Psychiatry, Western University, London, ON, Canada
| | | | - Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
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Tseng MCM, Chang CH, Liao SC, Yeh YC. Length of stay in relation to the risk of inpatient and post-discharge suicides: A national health insurance claim data study. J Affect Disord 2020; 266:528-533. [PMID: 32056922 DOI: 10.1016/j.jad.2020.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/21/2020] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to compare the predictors of suicides among psychiatric inpatients and recently discharged patients and to examine the association between the length of stay and suicides. METHODS Data from psychiatric inpatients were extracted from the National Health Insurance databank and merged with information from the Cause of Death data using unique identification numbers. Poisson regression analyses were used to estimate the incidence rate ratio for inpatient and post-discharge suicides, which included the variables of sex, age, psychiatric diagnosis, and number of admissions in the preceding year. The associations between length of stay and inpatient and post-discharge suicide were examined using multivariate Poisson regression analyses that were adjusted for these variables. RESULTS A diagnosis of affective disorders and a higher number of previous admissions increased both inpatient and post-discharge suicides. Patients older than 15-24 years had a significantly lower inpatient suicide risk but were more likely to die by suicide post-discharge. The risk of suicide both during the inpatient stay and post-discharge statistically significantly decreased when the length of stay was longer. LIMITATIONS As there were variations in societal, environmental, and facility-level factors that might have influenced the association between length of stay and suicide, the generalization of our findings to different settings may be impeded. CONCLUSIONS This study provides additional evidence that hospitalization helps to reduce the suicide risk. It suggests that medical professionals should be alert to inpatient suicide and that they should determine the optimal length of stay considering post-discharge suicide.
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Affiliation(s)
- Mei-Chih Meg Tseng
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan; Department of Psychiatry, National Taiwan University College of Medicine, Taipei 10051, Taiwan; Department of Nursing, Oriental Institute of Technology, New Taipei City 22061, Taiwan.
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei 10055, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University College of Medicine, Taipei 10051, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Yi-Chun Yeh
- Department of Medical Research, National Taiwan University Hospital, Taipei 10055, Taiwan
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Shalev A, Merranko J, Gill MK, Goldstein T, Liao F, Goldstein BI, Hower H, Ryan N, Strober M, Iyengar S, Keller M, Yen S, Weinstock LM, Axelson D, Birmaher B. Longitudinal course and risk factors associated with psychosis in bipolar youths. Bipolar Disord 2020; 22:139-154. [PMID: 31749297 PMCID: PMC7085953 DOI: 10.1111/bdi.12877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To compare the longitudinal clinical course of youths with bipolar disorder (BD) spectrum with lifetime (past, intake, and/or follow-up) psychosis (BDP+) to youths with BD without lifetime psychosis (BDP-). Also, to identify risk factors associated with increased risk of first onset of psychosis during prospective follow-up. METHOD Bipolar disorder youths (BDP+ = 137, BDP- = 233), aged 7-17 years old, were followed on average every 7 months for 11.7 years and were evaluated using standardized instruments. Data were analyzed using linear and generalized linear models for the full sample, as well as for youths who developed first period of psychosis (n = 55). RESULTS After adjusting for confounders, BDP+ youths with one, and in particular ≥2 lifetime psychotic episodes, had higher rates and more severe mood and anxiety symptoms, higher rates of suicidality, psychiatric hospitalizations, and sexual/physical abuse, and poorer psychosocial functioning than BDP- youths. Even before the first onset of psychosis during follow-up, BDP+ youths showed more psychopathology and had more family history of psychiatric illness than those who never developed psychosis. First-onset psychosis was associated with low socioeconomic status (SES), living with one parent, bipolar disorder type one and type two, comorbid anxiety, history of hospitalizations, and family history of mania and suicidality. CONCLUSION BDP+ is associated with poor prognosis and worse clinical picture, even before the onset of psychosis, indicating the need for prompt identification and treatment of these youths. Studies aimed to treat acute symptoms of psychosis, as well as prevent the onset of psychosis, including risk factors amenable to change, are warranted.
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Affiliation(s)
- Amit Shalev
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The Herman Dana Division of Pediatric Psychiatry, Department of Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem Israel
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Tina Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Fangzi Liao
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Heather Hower
- Ontario, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Martin Keller
- Ontario, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Shirley Yen
- Ontario, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Lauren M. Weinstock
- Ontario, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - David Axelson
- Department of Psychiatry, Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Nicholas A, Pirkis J, Rossetto A, Jorm A, Spittal M, Reavley N. Confidence and Intentions to Help a Person at Risk of Suicide. Suicide Life Threat Behav 2020; 50:138-150. [PMID: 31339597 DOI: 10.1111/sltb.12575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 05/08/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We aimed to identify Australian adults' current level of confidence and intentions to help a person close to them in distress or at risk of suicide to inform the content and targeting of suicide prevention messages aimed at family and friends of those at risk. METHODS We conducted a nationally representative computer-assisted telephone survey of confidence and intentions to help someone in distress or at risk of suicide (n = 3,002). We used logistic regression to determine whether sociodemographic and exposure variables predicted confidence and intentions to help. RESULTS Confidence to help was high. About half of the respondents had intentions inconsistent with best practice. Listening and talking, and encouraging the person to seek professional help were the most common types of intended helping actions. Intentions to ask suicide risk assessment questions were least common. Men were more likely than women to have intentions to carry out nonrecommended actions, and less likely to have intentions to carry out recommended actions. CONCLUSIONS Suicide prevention messaging aimed at family and friends could encourage them to ask direct questions about suicide risk and could include messages about "what not to do." Suicide prevention messages aimed specifically at men are indicated.
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Affiliation(s)
- Angela Nicholas
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia
| | - Alyssia Rossetto
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia
| | - Anthony Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia
| | - Matthew Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia
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50
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Luxton DD, Smolenski DJ, Reger MA, Relova RMV, Skopp NA. Caring E-mails for Military and Veteran Suicide Prevention: A Randomized Controlled Trial. Suicide Life Threat Behav 2020; 50:300-314. [PMID: 31562660 DOI: 10.1111/sltb.12589] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/11/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this multisite study was to conduct a randomized controlled trial of an e-mail version of the caring letters (CL) suicide prevention intervention to determine whether the intervention is efficacious in preventing suicide behaviors among U.S. service members and veterans. METHOD Psychiatric inpatients (N = 1,318) were recruited from four military medical centers and two VA hospitals and randomized to receive either 13 caring e-mails over two years or usual care. RESULTS There were 10 deaths from any cause in the CL group (three suicides) and 14 in the usual care group (seven suicides) during the individual two-year follow-up intervals. There was no statistically significant difference in the rate of all-cause hospital readmission between the study groups (RR = 1.13; 95% CI = 0.94, 1.36). There were no differences observed between groups on self-reported psychiatric hospital readmissions, self-reported suicide attempts, or other measures associated with risk for suicide. CONCLUSIONS No firm conclusions about the efficacy of the intervention can be made because the study was inadequately powered. There were no adverse events associated with the intervention, and implementation of the procedures was feasible in the military and veteran hospital settings. These results provide important methodological considerations for caring contact trials in military populations.
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Affiliation(s)
- David D Luxton
- National Center for Telehealth & Technology, Joint Base Lewis-McChord, Tacoma, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Derek J Smolenski
- Defense Health Agency, Psychological Health Center of Excellence, Tacoma, WA, USA
| | - Mark A Reger
- National Center for Telehealth & Technology, Joint Base Lewis-McChord, Tacoma, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Rona Margaret V Relova
- VA Palo Alto Health Care System, Palo Alto, CA, USA.,Stanford University, Palo Alto, CA, USA
| | - Nancy A Skopp
- Defense Health Agency, Psychological Health Center of Excellence, Tacoma, WA, USA
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