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Diefenbach GJ, Lord KA, Stubbing J, Rudd MD, Levy HC, Worden B, Sain KS, Bimstein JG, Rice TB, Everhardt K, Gueorguieva R, Tolin DF. Brief Cognitive Behavioral Therapy for Suicidal Inpatients: A Randomized Clinical Trial. JAMA Psychiatry 2024:2823589. [PMID: 39259550 PMCID: PMC11391362 DOI: 10.1001/jamapsychiatry.2024.2349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Importance Suicide risk is elevated after discharge from inpatient level of care. Empirically supported inpatient suicide prevention treatments are needed. Objective To determine whether adding an inpatient version of brief cognitive behavioral therapy for suicide prevention to treatment as usual reduces postdischarge suicide attempts, suicidal ideation, and psychiatric readmissions and to determine whether substance use disorder moderates treatment effects. Design, Setting, and Participants This randomized clinical trial compared treatment as usual (n = 106) to treatment as usual plus brief cognitive behavioral therapy for inpatients (n = 94) at a private psychiatric hospital in Connecticut. Follow-up assessments were completed monthly for 6 months postdischarge. Participants were enrolled from January 2020 through February 2023. Inpatients admitted following a suicidal crisis (past-week suicide attempt or ideation with plan on admission and attempt within previous 2 years) were included. Medical records of consecutive admissions (n = 4137) were screened, 213 were study eligible and randomized, and 200 were analyzed. A total of 114 participants (57.0%) completed 6-month follow-up assessments. Data from medical records were also obtained through 6-month follow-up. Intervention Up to 4 individual sessions of brief cognitive behavioral therapy for suicide prevention designed for inpatients. Main Outcomes and Measures Suicide attempts and readmissions were assessed via blind interviews and medical record review. Suicidal ideation was assessed via self-report. Results The mean (SD) age among 200 analyzed participants was 32.8 (12.6) years; 117 participants were female and 83 were male. Brief cognitive behavioral therapy-inpatient reduced the occurrence of suicide attempt over 6 months postdischarge by 60% (odds ratio, 0.40; 95% CI, 0.20-0.80; number needed to treat, 7) in the entire patient group, and the rate of psychiatric readmissions by 71% (rate ratio, 0.29; 95% CI, 0.09-0.90) in those without a substance use disorder. The effect of treatment condition on suicidal ideation was less clear, although post hoc analyses indicated less severe suicidal ideation following brief cognitive behavioral therapy-inpatient vs treatment as usual at 1 and 2 months postdischarge. Conclusions and Relevance Brief cognitive behavioral therapy-inpatient reduced 6-month postdischarge suicide reattempts and rate of readmissions when added to treatment as usual. Substance use disorder moderated the treatment's effect on readmission rates. Treatment effects on suicidal ideation were less clear. Implementation research is needed to facilitate dissemination. Additional research is also needed to optimize outcomes for individuals with substance use disorders. Trial Registration ClinicalTrials.gov Identifier: NCT04168645.
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Affiliation(s)
- Gretchen J Diefenbach
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Kayla A Lord
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut
| | - Jessica Stubbing
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut
- Now with The University of Auckland, Koi Tu: the Centre for Informed Futures Auckland, Auckland, New Zealand
| | - M David Rudd
- Department of Psychology, University of Memphis, Memphis, Tennessee
| | - Hannah C Levy
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut
| | - Blaise Worden
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut
| | - Kimberly S Sain
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut
| | - Jessica G Bimstein
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut
- Now with Crime and Justice Policy Lab, University of Pennsylvania, Philadelphia
| | - Tyler B Rice
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut
- Now with Department of Psychology, Florida State University, Tallahassee
| | - Kate Everhardt
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut
- Now with Department of Psychology, San Jose State University, San Jose, California
| | - Ralitza Gueorguieva
- School of Public Health, Yale University School of Medicine, New Haven, Connecticut
| | - David F Tolin
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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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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3
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Arnon S, Shahar G, Brunstein Klomek A. Continuity of care in suicide prevention: current status and future directions. Front Public Health 2024; 11:1266717. [PMID: 38259744 PMCID: PMC10800998 DOI: 10.3389/fpubh.2023.1266717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Continuity of Care (CoC) is central to suicide prevention. The present study aims to review contemporary definitions, operationalization in research, and key components of CoC in the prevention of suicide. Methods The present study is a narrative review. A thorough search of available literature on CoC and suicidality was conducted. Studies published between 1995 and 2021 were reviewed and selected based on relevance to CoC and suicidality. Selected research was subsequently summarized to outline definitions of CoC, its operationalization in research, and key components for suicide prevention. Results The definition, measurement, and operationalization of CoC in suicide prevention varies tremendously, derailing clinical practice. Key elements of CoC identified across the literature include (1) CoC across multiple levels of care, (2) the role of primary care providers and case managers in CoC of suicidal patients, (3) the importance of follow up contact with suicidal patients post-treatment, and (4) the role of national and institutional guidelines for CoC of suicidal patients. Limitations: There is a dearth of randomized controlled trials and insufficient evidence on specific populations. Conclusion CoC refers to a wide, complex concept that must be broken down into specific categories that can provide more nuanced guidance of research and clinical implications.
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Affiliation(s)
- Shay Arnon
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Golan Shahar
- Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Ramos-Martín J, Gómez Sánchez-Lafuente C, Martínez-García AI, Castillo-Jiménez P, Guzmán-Parra J, Moreno-Küstner B. Suicidal behavior in persons attended in out-of-hospital emergency services in Spain. Front Psychiatry 2023; 14:1235583. [PMID: 37654995 PMCID: PMC10466888 DOI: 10.3389/fpsyt.2023.1235583] [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: 06/06/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Background The aims of this study were to describe the use of health services by patients attended for suicidal behavior by out-of-hospital emergency services and to identify the variables associated with the repetition of this behavior in Spain. Methods An analytical, observational, retrospective study was carried out. A total of 554 patients attended by the mobile teams of the Primary Care Emergency (mt-PCES) of the Malaga Health District (Spain), after being coordinated by the 061 Emergency Coordination Center (ECC) were analyzed. Results Of the total, 61.9% of the patients were women and the mean age was 43.5 years. Ninety-six percent (N = 532) of the patients attended by mt-PCES were transferred to hospital emergency services. Regarding clinical decision, of those transferred 436 persons (82%) were discharged home. Of the total sample 25.5% (N = 141) were referred to primary care, while 69% (N = 382) were referred to outpatient mental health care. Regarding follow up in the 6 months after being seen by emergency services, among those referred to a mental health facility, 64.4% (N = 246) attended the follow-up appointment while out of the total sample only 50.5% (N = 280) attended a follow-up appointment with an outpatient mental health service. Finally, it should be noted that 23.3% presented a relapse of suicidal behavior in the 6 months following index episode. The variables associated with repetition of suicidal behavior were older age, greater number of previous suicide attempts and having any contact with mental health services in the following 6 months. Conclusion We believe that selective suicide prevention initiatives should be designed to target the population at risk of suicide, especially those receiving both out-of-hospital and in-hospital emergency services.
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Affiliation(s)
- Javier Ramos-Martín
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Málaga, Spain
| | - Carlos Gómez Sánchez-Lafuente
- Instituto de Investigación Biomedicina de Málaga (IBIMA), Málaga, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ana I. Martínez-García
- Unidad de Gestión Clínica (UGC) del Servicio de Urgencias de Atención Primaria (SUAP) del Distrito Sanitario Málaga, Málaga, Spain
- Grupo Andaluz de Investigación Psicosocial (GAP) (CTS-945), Málaga, Spain
| | - Pilar Castillo-Jiménez
- Unidad de Gestión Clínica (UGC) del Servicio de Urgencias de Atención Primaria (SUAP) del Distrito Sanitario Málaga, Málaga, Spain
| | - José Guzmán-Parra
- Instituto de Investigación Biomedicina de Málaga (IBIMA), Málaga, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Berta Moreno-Küstner
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomedicina de Málaga (IBIMA), Málaga, Spain
- Grupo Andaluz de Investigación Psicosocial (GAP) (CTS-945), Málaga, Spain
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Methemoglobinemia in a Patent Presenting with an Undisclosed Intentional Overdose. Harv Rev Psychiatry 2022; 30:361-368. [PMID: 36534838 DOI: 10.1097/hrp.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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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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7
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Malakouti SK, Nojomi M, Ghanbari B, Rasouli N, Khaleghparast S, Farahani IG. Aftercare and Suicide Reattempt Prevention in Tehran, Iran. CRISIS 2021; 43:18-27. [PMID: 33563037 DOI: 10.1027/0227-5910/a000754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: A previous suicide attempt is one of the strongest risk factors for subsequent suicide. Effective care following a suicide attempt may reduce the risk of suicide reattempts. Aims: We aimed to investigate the effect of a brief educational intervention and contact program on suicide reattempts. Method: This study was performed as a randomized clinical trial (RCT) recruiting 305 individuals who had attempted suicide (brief intervention and contact = 153 individuals, BIC; treatment as usual = 152 individuals, TAU) who were referred to Baharlu Hospital in Tehran. The SUPRE-MISS questionnaire and a discharge follow-up questionnaire were used for data collection. Cox proportional hazard models and log-rank tests were used to assess the association of the variable with the event (reattempt). Kaplan-Meier curves were used to depict the time to the event of reattempt. Results: In the BIC group, 11% of the individuals had attempted suicide once, and 25% of the TAU group had attempted suicide once (12.4%), twice (9.3%), and three times (3.8%), respectively. The results of Kaplan-Meier analysis indicated the mean time of reattempt in the BIC (0.76) and TAU groups (0.25) as the fourth and second months of follow-up, respectively (log rank, χ2 = 12.48, p < .001). The hazard ratio for the TAU group was 2.57 (95% CI [1.4, 5.9]). Limitations: Loss to follow-up due to stigma is one of the serious problems of follow-up services. Conclusion: Implementing a brief educational intervention and contact program on suicide reattempts is feasible and effective in reducing the rate of reattempt; however, it should be accommodated within the mental health services of the county.
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Affiliation(s)
- Seyed Kazem Malakouti
- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Department of Community and Family Medicine, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Ghanbari
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nafee Rasouli
- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Shiva Khaleghparast
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Matarazzo BB, Gerard GR, Jankovsky MC, Oslin DW, Brenner LA. Feasibility and Acceptability of the HOME Program for Veterans Recently Discharged from a Psychiatric Hospitalization. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:974-982. [PMID: 33523330 DOI: 10.1007/s10488-021-01109-7] [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] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
Enrollment in the Home-Based Mental Health Evaluation (HOME) Program is associated with higher rates of treatment engagement following psychiatric hospitalization discharge, as compared to enhanced care as usual. We aim to describe feasibility and acceptability data related to implementation of the HOME Program at two Department of Veterans Affairs Medical Centers (VAMCs) to inform future program refinement and implementation. Process evaluation data regarding feasibility and acceptability were collected in the context of an interventional multi-site trial. Data regarding enrollment in the study and the intervention were collected by study staff. Additional acceptability and feasibility data were obtained via the Client Satisfaction Questionnaire-8 (CSQ-8) and Narrative Evaluation of Intervention Interview (NEII). Between 82 and 91% of enrolled Veterans participated in at least one post-discharge telephone contact. Site differences existed with respect to completion of home visits. CSQ-8 results suggested high levels of satisfaction with the HOME Program. Themes identified via the NEII reflect that as a result of participation in the HOME Program, Veterans felt hopeful and cared for and learned how to keep themselves safe following hospital discharge. Process evaluation data from a clinical trial of the HOME Program demonstrated that the intervention was feasible to implement at two VAMCs and was acceptable to participants. These data inform considerations for future research and implementation efforts.Trial Registration ClinicalTrials.gov Identifier: NCT03347552.
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Affiliation(s)
- Bridget B Matarazzo
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, US Department of Veterans Affairs, 1700 N. Wheeling St, Aurora, CO, 80045, USA.
- Department of Psychiatry, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA.
| | - Georgia R Gerard
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, US Department of Veterans Affairs, 1700 N. Wheeling St, Aurora, CO, 80045, USA
| | - Molly C Jankovsky
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, US Department of Veterans Affairs, 1700 N. Wheeling St, Aurora, CO, 80045, USA
| | - David W Oslin
- Veterans Integrated Service Network (VISN) 4 MIRECC, US Department of Veterans Affairs, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa A Brenner
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, US Department of Veterans Affairs, 1700 N. Wheeling St, Aurora, CO, 80045, USA
- Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
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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
A prior meta-analysis found that the World Health Organization Brief Intervention and Contact Program (WHO BIC) significantly reduces suicide risk. WHO BIC has not been studied in high-income countries. We piloted an adapted version of WHO BIC on an inpatient mental health unit in the United States. We assessed the feasibility and acceptability. We also evaluated changes in suicidal ideation, hopelessness, and connectedness using a repeated measures analysis of variance. Of 13 eligible patients, 9 patients enrolled. Patients experienced significant improvements in suicidal ideation, hopelessness, and connectedness at 1 and 3 months (Beck Scale for Suicidal Ideation, F(2,16) = 14.96, p < 0.01; Beck Hopelessness Scale, F(2,16) = 5.88, p < 0.05; perceived burdensomeness subscale, F(2,16) = 10.97, p < 0.013; and thwarted belongingness subscale, F(2,16) = 4.77, p < 0.03). Patients were highly satisfied. An adapted version of WHO BIC may be feasible to implement in a high-resource setting, but trials need to confirm efficacy.
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