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Sandahl M, Lassen AT, Stenager E, Østervang C. Pathways and transitions for patients admitted to an emergency department after self-harming events. Int J Ment Health Nurs 2024; 33:1129-1138. [PMID: 38500171 DOI: 10.1111/inm.13314] [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: 12/13/2023] [Revised: 02/06/2024] [Accepted: 02/16/2024] [Indexed: 03/20/2024]
Abstract
The frequency of people presented in emergency departments (EDs) after self-harming events is increasing. Previous studies have shown that the complexity of the disorders of patients admitted to the ED after self-harming events can be overwhelming for ED healthcare professionals (HCPs) to handle. The objective of this study was to observe and investigate the pathways for patients admitted to the ED after self-harming events to either transition or discharge. Participant observation and interviews were selected as the methods to generate insight into the pathways of patients admitted to the ED after self-harming events. The data were analysed using interpretative phenomenological analysis. A sample size of 20 patients was analysed, and a total of 213 h of observation took place during the data collection. Three main themes appeared: (1) patients' mental stress versus high expectations, (2) uncertainty about how to address the self-harming event and (3) a system of chaos. Patients admitted to the ED after self-harming events struggle with difficult mental stress. Despite this, they face high expectations that they will fit in and cooperate in the ED. The healthcare system is organised with unclear responsibilities and without systematic ways to care for self-harm patients and so provides chaotic patient pathways. There is a need for improved cross-sectional competencies, mutual agreements and systematic communication for discharge, transitions and follow-up care between those involved in the patient's pathway and care.
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Affiliation(s)
- Malene Sandahl
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Annmarie Touborg Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Mental Health Research Unit, Children and Adult Psychiatry, Region of South Denmark, Aabenraa, Denmark
- Department of Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Christina Østervang
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Ross EL, Bossarte RM, Dobscha SK, Gildea SM, Hwang I, Kennedy CJ, Liu H, Luedtke A, Marx BP, Nock MK, Petukhova MV, Sampson NA, Zainal NH, Sverdrup E, Wager S, Kessler RC. Estimated Average Treatment Effect of Psychiatric Hospitalization in Patients With Suicidal Behaviors: A Precision Treatment Analysis. JAMA Psychiatry 2024; 81:135-143. [PMID: 37851457 PMCID: PMC10585585 DOI: 10.1001/jamapsychiatry.2023.3994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/17/2023] [Indexed: 10/19/2023]
Abstract
Importance Psychiatric hospitalization is the standard of care for patients presenting to an emergency department (ED) or urgent care (UC) with high suicide risk. However, the effect of hospitalization in reducing subsequent suicidal behaviors is poorly understood and likely heterogeneous. Objectives To estimate the association of psychiatric hospitalization with subsequent suicidal behaviors using observational data and develop a preliminary predictive analytics individualized treatment rule accounting for heterogeneity in this association across patients. Design, Setting, and Participants A machine learning analysis of retrospective data was conducted. All veterans presenting with suicidal ideation (SI) or suicide attempt (SA) from January 1, 2010, to December 31, 2015, were included. Data were analyzed from September 1, 2022, to March 10, 2023. Subgroups were defined by primary psychiatric diagnosis (nonaffective psychosis, bipolar disorder, major depressive disorder, and other) and suicidality (SI only, SA in past 2-7 days, and SA in past day). Models were trained in 70.0% of the training samples and tested in the remaining 30.0%. Exposures Psychiatric hospitalization vs nonhospitalization. Main Outcomes and Measures Fatal and nonfatal SAs within 12 months of ED/UC visits were identified in administrative records and the National Death Index. Baseline covariates were drawn from electronic health records and geospatial databases. Results Of 196 610 visits (90.3% men; median [IQR] age, 53 [41-59] years), 71.5% resulted in hospitalization. The 12-month SA risk was 11.9% with hospitalization and 12.0% with nonhospitalization (difference, -0.1%; 95% CI, -0.4% to 0.2%). In patients with SI only or SA in the past 2 to 7 days, most hospitalization was not associated with subsequent SAs. For patients with SA in the past day, hospitalization was associated with risk reductions ranging from -6.9% to -9.6% across diagnoses. Accounting for heterogeneity, hospitalization was associated with reduced risk of subsequent SAs in 28.1% of the patients and increased risk in 24.0%. An individualized treatment rule based on these associations may reduce SAs by 16.0% and hospitalizations by 13.0% compared with current rates. Conclusions and Relevance The findings of this study suggest that psychiatric hospitalization is associated with reduced average SA risk in the immediate aftermath of an SA but not after other recent SAs or SI only. Substantial heterogeneity exists in these associations across patients. An individualized treatment rule accounting for this heterogeneity could both reduce SAs and avert hospitalizations.
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Affiliation(s)
- Eric L. Ross
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington
| | - Robert M. Bossarte
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa
| | | | - Sarah M. Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Chris J. Kennedy
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
| | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brian P. Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Matthew K. Nock
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Erik Sverdrup
- Graduate School of Business, Stanford University, Stanford, California
| | - Stefan Wager
- Graduate School of Business, Stanford University, Stanford, California
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Weiss JR, Sharobeam M, Faden J. "The Demons Made Me Do It": When Delusions of Possession Lead to Attempted Inpatient Suicide. J Nerv Ment Dis 2024; 212:68-69. [PMID: 38166184 DOI: 10.1097/nmd.0000000000001720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Affiliation(s)
- Jacob R Weiss
- Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, Pennsylvania
| | - Monica Sharobeam
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Justin Faden
- Clinical Psychiatry and Behavioral Science, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Alrisi K, Alnasif N, Nazeer A, Shareef J, Latif F. Risk of suicide in children and adolescents in the emergency department-is universal screening the answer? Arch Dis Child 2023; 108:970-974. [PMID: 36927622 DOI: 10.1136/archdischild-2022-325122] [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: 11/14/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Suicide is a leading cause of death among children and adolescents. Suicide risk screening tools can detect the risk of suicide among patients presenting to healthcare settings. The aim of this review was to describe the effectiveness of universal suicide risk screening (all patients) compared with selective screening (behavioural health patients only) in children and adolescents in emergency departments (EDs). METHOD A literature search was conducted on PubMed for articles related to suicide risk screening in paediatric EDs between January 2016 and February 2022. RESULTS 8 studies met the selection criteria. The review showed that 46%-93% of patients that screened positive for suicide risk had presented with a medical concern. These patients would have been missed without universal suicide risk screening. In both selective and universal screening scenarios, use of a suicide risk screening tool was better at detecting suicide risk compared with use of presenting problem alone. Suicide risk screening was found to be acceptable without increasing length of stay in the ED. CONCLUSION Based on this review, using a suicide screening tool can help detect patients at risk who would otherwise have been missed.
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Affiliation(s)
- Khalid Alrisi
- Psychiatry, Sidra Medical and Research Center, Doha, Qatar
| | - Naim Alnasif
- Emergency Medicine, Sidra Medical and Research Center, Doha, Qatar
| | - Ahsan Nazeer
- Psychiatry, Sidra Medical and Research Center, Doha, Qatar
- Psychiatry, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Jauhar Shareef
- Emergency Medicine, Sidra Medical and Research Center, Doha, Qatar
| | - Finza Latif
- Psychiatry, Sidra Medical and Research Center, Doha, Qatar
- Psychiatry, Weill Cornell Medicine - Qatar, Doha, Qatar
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Azizi H, Fakhari A, Farahbakhsh M, Davtalab Esmaeili E, Chattu VK, Ali Asghari N, Nazemipour M, Mansournia MA. Prevention of Re-attempt Suicide Through Brief Contact Interventions: A Systematic Review, Meta-analysis, and Meta-regression of Randomized Controlled Trials. JOURNAL OF PREVENTION (2022) 2023; 44:777-794. [PMID: 37707696 DOI: 10.1007/s10935-023-00747-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/15/2023]
Abstract
Brief contact intervention (BCI) is a low-cost intervention to prevent re-attempt suicide. This meta-analysis and meta-regression study aimed to evaluate the effect of BCI on re-attempt prevention following suicide attempts (SAs). We systematically searched using defined keywords in MEDLINE, Embase, and Scopus up to April, 2023. All randomized controlled trials (RCTs) were eligible for inclusion after quality assessment. Random-effects model and subgroup analysis were used to estimate pooled risk difference (RD) and risk ratio (RR) between BCI and re-attempt prevention with 95% confidence intervals (CIs). Meta-regression analysis was carried out to explore the potential sources of heterogeneity. The pooled estimates were (RD = 4%; 95% CI 2-6%); and (RR = 0.62; 95% CI 0.48-0.77). Subgroup analysis demonstrated that more than 12 months intervention (RR = 0.46; 95% CI 0.10-0.82) versus 12 months or less (RR = 0.67; 95% CI 0.54-0.80) increased the effectiveness of BCI on re-attempt suicide reduction. Meta-regression analysis explored that BCI time (more than 12 months), BCI type, age, and female sex were the potential sources of the heterogeneity. The meta-analysis indicated that BCI could be a valuable strategy to prevent suicide re-attempts. BCI could be utilized within suicide prevention strategies as a surveillance component of mental health since BCI requires low-cost and low-educated healthcare providers.
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Affiliation(s)
- Hosein Azizi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Fakhari
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Vijay Kumar Chattu
- Department of OS & OT, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1V7, Canada
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 600077, India
| | - Nasrin Ali Asghari
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Nazemipour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, P.O. Box 14155-6446, Tehran, Iran.
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Jaffar A, Mohd Sidik S, Rashid MRA, Lugova H. Editorial: Self-harm behaviors from young adults to the elderly: prevalence, prevention and treatment following the COVID-19 pandemic. Front Psychiatry 2023; 14:1331376. [PMID: 38106997 PMCID: PMC10722496 DOI: 10.3389/fpsyt.2023.1331376] [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: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Aida Jaffar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, Sg Besi, Wilayah Persekutuan, Malaysia
| | - Sherina Mohd Sidik
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - M. Radzniwan A. Rashid
- Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Halyna Lugova
- Faculty of Medicine and Health Sciences, UCSI University (Springhill Campus), Port Dickson, Negeri Sembilan, Malaysia
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Fedorowicz S, Dempsey RC, Ellis NJ, Mulvey O, Gidlow CJ. Quantitative content analysis of Freedom of Information requests examining the extent and variations of tools and training for conducting suicide risk assessments in NHS Trusts across England. BMJ Open 2023; 13:e072004. [PMID: 37884387 PMCID: PMC10603533 DOI: 10.1136/bmjopen-2023-072004] [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: 01/31/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES Determining the risk for suicide is a difficult endeavour. Clinical guidance in the UK explicitly advises against using risk assessment tools and scales to determine suicide risk. Based on Freedom of Information (FoI) requests made to NHS Trusts in England, this study provides an overview of suicide risk assessment tools in use, training provided in how to use such assessments, and explores implementation of suicide risk assessment guidance in practice in English NHS Trusts. DESIGN A cross-sectional survey of suicide risk assessment tools and training gathered via FoI requests and subjected to a content analysis. SETTING FoI requests were submitted to NHS Trusts across England. RESULTS A wide variety of suicide risk assessments tools were identified as being used in practice, with several trusts reported using more than one tool to determine suicide risk. Forty-one trusts reported using locally developed, unvalidated, tools to assess risk of suicide and 18 stated they do not use a tool. Ten trusts stated they do not train their staff in suicide risk assessment while 13 reported use of specific suicide risk assessment training. Sixty-two trusts stated they do not centrally record the number of assessments conducted or how many individuals are identified as at risk. Content analysis indicated the frequent wider assessment of risk not restricted to suicide risk. CONCLUSIONS There is wide variation in suicide risk assessment tools being used in practice and some lack of specific training for healthcare staff in determining suicide risk. Few trusts routinely record the number of assessments being conducted or the number of individuals identified at high risk. Implementation of specific training is necessary for the suicide risk assessment process to identify patient needs and develop therapeutic engagement. Routinely recording how many assessments are conducted is a crucial step in improving suicide prevention.
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Affiliation(s)
- Sophia Fedorowicz
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Robert C Dempsey
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Naomi J Ellis
- Faculty of Health Sciences, Staffordshire University, Stoke-on-Trent, UK
| | - Olivia Mulvey
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Christopher J Gidlow
- Centre for Sport, Health and Exercise Research, Staffordshire University, Stoke on Trent, UK
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Higgins K, Woods B, Haskell B, Bullock M, Rogers R, Izuegbunam N. Utility of the Counseling Center Assessment of Psychological Symptoms Screen in a Collegiate Athlete Population. J Athl Train 2023; 58:740-746. [PMID: 36913631 PMCID: PMC11215739 DOI: 10.4085/1062-6050-0579.22] [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: 03/15/2023]
Abstract
CONTEXT Mental health screening as a part of collegiate athletic preparticipation evaluations is becoming increasingly common, but effective and efficient screening depends on a screening tool that can accurately identify mental health symptoms and the need for mental health intervention. DESIGN Case-control study. SETTING Archival clinical records review. PATIENTS OR OTHER PARTICIPANTS Two cohorts of incoming National Collegiate Athletics Association Division I collegiate athletes (N = 353). MAIN OUTCOME MEASURE(S) Athletes completed the Counseling Center Assessment of Psychological Symptoms (CCAPS) Screen as a part of their preparticipation evaluation. These data were then matched with basic demographic data and mental health treatment history from clinical records, and the utility of the CCAPS Screen in determining a future or ongoing need for mental health services was analyzed. RESULTS Score differences for each of the 8 CCAPS Screen scales (Depression, Generalized Anxiety, Social Anxiety, Academic Distress, Eating Concerns, Frustration, Family Distress, and Alcohol Use) were found based on several demographic variables. Logistic regression analysis demonstrated that female sex, team sport participation, and the Generalized Anxiety scale score predicted future participation in mental health treatment. Decision tree testing of the CCAPS scales showed low utility in classifying those who received mental health treatment versus those who did not. CONCLUSIONS The CCAPS Screen did not appear to differentiate well between those who eventually received mental health services and those who did not. This should not be taken to mean that mental health screening is not useful but rather that a 1-time, state-based screening is not sufficient for athletes who experience intermittent but recurring stressors in a dynamic environment. A proposed model for improving the current standard of practice for mental health screening is provided as a focus of future research.
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Affiliation(s)
- Kate Higgins
- Sport Psychology, University of Nebraska-Lincoln Athletics
| | - Brett Woods
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City
| | - Brett Haskell
- Sport Psychology, University of Nebraska-Lincoln Athletics
| | - Mariah Bullock
- Sport Psychology, University of Nebraska-Lincoln Athletics
| | - Rachel Rogers
- Department of Statistics, University of Nebraska-Lincoln
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Knettel BA, Amiri I, Minja L, Martinez AJ, Knippler ET, Madundo K, Staton C, Vissoci JRN, Mwobobia J, Mmbaga BT, Kaaya S, Relf MV, Goldston DB. Brief Report: Task-Shifting "Gold Standard" Clinical Assessment and Safety Planning for Suicide Risk Among People Living With HIV: A Feasibility and Fidelity Evaluation in Tanzania. J Acquir Immune Defic Syndr 2023; 93:374-378. [PMID: 37159427 PMCID: PMC10524299 DOI: 10.1097/qai.0000000000003217] [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] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Suicide is a leading cause of death among people living with HIV (PLWH) worldwide, with suicide deaths occurring twice as frequently among PLWH than among the general public. In Tanzania, resources for mental health care are sorely lacking, with 55 psychiatrists and psychologists providing treatment for 60 million people. In light of this shortage, nonspecialists play a crucial role. The objective of this study was to assess feasibility of implementing task-shifted screening, assessment, and safety planning for suicide risk among PLWH. SETTING Two adult HIV clinics in Kilimanjaro, Tanzania. METHODS Registered professional nurses in the HIV clinics were trained to administer brief screening of suicidal ideation in the past month. Patients experiencing suicidal ideation were referred to bachelor's-level counselors for further assessment and safety planning, supervised by specialist providers who reviewed audio recordings for quality assurance. RESULTS During 180 days of implementation, nurses screened patients attending 2745 HIV appointments. Sixty-one (2.2%) endorsed suicidal ideation and were linked to further assessment and safety planning. We cross-checked screening with clinic attendance logs on 7 random days and found high fidelity to screening (206 of 228 screened, 90%). Quality assurance ratings demonstrated key assessment pieces were consistently completed (mean = 9.3/10 possible), with "Good" to "Excellent" counseling skills (mean = 23.7/28) and "Good" to "Excellent" quality (mean = 17.1/20), including appropriate referral for higher levels of care. CONCLUSIONS Brief screening can be implemented and paired with task-shifted counseling to facilitate high-quality assessment of suicide risk. This model shows excellent potential to extend mental health services for PLWH in low-resource settings.
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Affiliation(s)
- Brandon A. Knettel
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Ismail Amiri
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Elizabeth T. Knippler
- Duke University School of Nursing, Durham, NC, USA
- Duke Center for AIDS Research, Durham, NC, USA
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Catherine Staton
- Duke Global Health Institute, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | - Joao Ricardo N. Vissoci
- Duke Global Health Institute, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | | | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael V. Relf
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
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Yook V, Choi YH, Gu MJ, Lee D, Won H, Woo SY, Lee DH, Jeon HJ. Suicide Screening Questionnaire-Self-Rating (SSQ-SR): Development, reliability, and validity in a clinical sample of Korean adults. Compr Psychiatry 2023; 121:152360. [PMID: 36508776 DOI: 10.1016/j.comppsych.2022.152360] [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: 03/20/2022] [Revised: 11/25/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
The goal of the present study was to evaluate the psychometric properties of the Suicide Screening Questionnaire-Self-Rating (SSQ-SR). A 25-item SSQ-SR is a newly developed suicide screening tool that measures suicide risk factors, including a history of suicidal thoughts and behaviors (STBs), life stress, and mental health problems. To investigate the reliability and validity of the SSQ-SR, we conducted a longitudinal case-control study with adults with and without STBs in the past six months. A total of 176 participants were recruited through 12 hospital-based Crisis Response Centers across South Korea. At the baseline, we administered the SSQ-SR, the Beck Scale for Suicide Ideation (BSSI), and the Patient Health Questionnaire-9 (PHQ-9). In a 6-months follow-up, we investigated whether the participants engaged in suicidal ideation, plan, or attempt since the baseline assessment. As a result, the SSQ-SR demonstrated a strong internal consistency (Cronbach's alpha coefficient = 0.96). In addition, the total score of SSQ-SR had concurrent validity compared to the total scores of the BSSI and the PHQ-9. In comparing the suicidal groups with the control group, the ROC analysis indicated the optimal cut point at 31 with a sensitivity rate of 0.97 and a specificity rate of 0.98. Through explanatory factor analysis, two factors were identified: Mental Health and Environmental Factors and Active Suicidal Thoughts and Behaviors. The SSQ-SR total and sub-factor scores were prospectively associated with subsequent suicidal ideation, plan, and attempt. These findings support that the SSQ-SR is a promising tool in prospectively screening those who are at risk of suicidal thoughts, plans, and nonfatal attempts.
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Affiliation(s)
- Vidal Yook
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Hwan Choi
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Jeong Gu
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, Republic of Korea
| | - Deokhee Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, Republic of Korea
| | - Hojeong Won
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Republic of Korea
| | - Sook-Young Woo
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Republic of Korea
| | - Dong Hun Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
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11
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Tyler S, Gunn K, Esterman A, Clifford B, Procter N. Suicidal Ideation in the Australian Construction Industry: Prevalence and the Associations of Psychosocial Job Adversity and Adherence to Traditional Masculine Norms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315760. [PMID: 36497834 PMCID: PMC9738943 DOI: 10.3390/ijerph192315760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Suicide in the Australian Construction Industry (ACI) is a significant issue, however minimal understanding of suicidal ideation prevalence, as well as the potential role psychosocial job adversity and increased adherence to traditional masculine norms may play in its presence, is apparent. METHOD A representative sample of Australian men (n = 11,132) were used to create initial understandings of prevalence of suicidal ideation (past two weeks), psychosocial job adversities and level of adherence to traditional masculine norms for the ACI (n = 1721) in comparison to a general population comprised of the remaining employed males from Other Industries (n = 9411). Additionally, due to their reported increased suicide vulnerability investigation of associations between suicidal ideation, psychosocial job adversities and adherence to traditional masculine norms for the ACI were undertaken. RESULTS No difference in suicidal ideation prevalence was reported between the ACI and those employed in Other Industries (p > 0.05), however, increased prevalence of psychosocial job adversities (p ≤ 0.001) and adherence to traditional masculine norms (p ≤ 0.001) for the ACI was seen. Significant multivariate associations between suicidal ideation, psychosocial job adversities (OR = 1.79, 95%CI [1.12-2.85]) and two domains of traditional masculine norms, self-reliance (OR = 1.29, 95%CI [1.09-1.51]) and risk-taking (OR = 1.20, 95%CI [1.01-1.41]), were reported. CONCLUSION Results suggest need for increased understanding of later stage suicidal trajectory drivers in the ACI. Findings indicate need for prevention group/industry concentration on mitigation of psychosocial job adversities, as well as a more nuanced and increased discussion of the negative role of self-reliance and risk-taking domains of traditional masculine norms may play in ACI suicidal ideation, as opposed to the construct as a whole.
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Affiliation(s)
- Simon Tyler
- Mental Health and Suicide Prevention Research and Education Group, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
| | - Kate Gunn
- Department of Rural Health, University of South Australia, Adelaide, SA 5001, Australia
| | - Adrian Esterman
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA 5001, Australia
| | - Bob Clifford
- MATES in Construction South Australia, Adelaide, SA 5034, Australia
| | - Nicholas Procter
- Mental Health and Suicide Prevention Research and Education Group, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
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Rheinberger D, Wang J, McGillivray L, Shand F, Torok M, Maple M, Wayland S. Understanding Emergency Department Healthcare Professionals' Perspectives of Caring for Individuals in Suicidal Crisis: A Qualitative Study. Front Psychiatry 2022; 13:918135. [PMID: 35770060 PMCID: PMC9234140 DOI: 10.3389/fpsyt.2022.918135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022] Open
Abstract
Help seekers regularly present to Emergency Departments (EDs) when in suicidal crisis for intervention to ensure their immediate safety, which may assist in reducing future attempts. The emergency health workforce have unique insights that can inform suicide prevention efforts during this critical junction in an individual's experience with suicide. This paper explores the treatment and care delivery experiences of 54 health professionals working in EDs within one of the LifeSpan suicide prevention trial sites in Australia. Data was collected via six focus groups and six interviews. Thematic analysis resulted in three themes: (1) physicality of the emergency department, (2) juggling it all-the bureaucracy, practicalities, and human approach to care, and (3) impact of care delivery on ED staff. Findings highlight the need for workplace training that incorporates responding to the uncertainty of suicidal crisis, to compliment the solution-focused medical model of care. Broader policy changes to the ED system are also considered to ensure better outcomes for health professionals and help-seekers alike.
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Affiliation(s)
- Demee Rheinberger
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Jessica Wang
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Myfanwy Maple
- Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Sarah Wayland
- Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
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Choi YH, Yook V, Yang K, Cho Y, Lee DH, Lee HJ, Lee DH, Jeon HJ. Development and validation study of the suicide screening questionnaire-observer rating (SSQ-OR). Front Psychiatry 2022; 13:945051. [PMID: 36032221 PMCID: PMC9411983 DOI: 10.3389/fpsyt.2022.945051] [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: 05/16/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Observer rating scales are necessary to evaluate the risk of suicide because individuals at risk for suicide are often unwilling to seek help on their own. Reliability and validity were evaluated for the newly developed Suicide Screening Questionnaire-Observer Rating (SSQ-OR). METHODS Preliminary items were assessed by 251 experts online and 25 questions were selected. 328 individuals at high-risk and 661 controls from 12 Crisis Response Centers and 5 university counseling centers were recruited to complete SSQ-OR, Beck Scale for Suicide Ideation (BSSI) and Patient Health Questionnaire-9 (PHQ-9). In a 6 months follow-up, we reached out to 176 participants to ask whether they had experienced a suicidal thought, plan, or attempt since the baseline assessment. Cronbach's α, Mann-Whitney U test, Spearman's correlation, factor analyses, Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to verify the SSQ-OR. RESULTS Structural validity was supported by a two-factor solution using exploratory and confirmatory factor analyses. Excellent model fit indices for the two-factor structure using exploratory factor analysis were confirmed (RMSEA = 0.033, TLI = 0.980, CFI = 0.983). The SSQ-OR demonstrated strong internal consistency. The concurrent validity based on the correlations with other self-reported indicators of suicidal potential-BSSI and PHQ-9- revealed substantial relationships. The high-risk group was effectively characterized by a cut-off point of 4, with a sensitivity of 0.73 and a specificity of 0.79. The SSQ-OR scores were significant predictors of suicidal thoughts and behaviors within 6 months. CONCLUSIONS The SSQ-OR exhibits sound psychometric properties, and could be used as a complement to a self-report or clinical-administered scale to screen suicide risk comprehensively.
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Affiliation(s)
- Young-Hwan Choi
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Vidal Yook
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyojin Yang
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yaehee Cho
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Deok Hee Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, South Korea
| | - Hwa Jung Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, South Korea
| | - Dong Hun Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
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