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Grumet JG, Jobes DA. Zero Suicide - What About "Treat"? CRISIS 2024; 45:167-172. [PMID: 38698717 DOI: 10.1027/0227-5910/a000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
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2
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Oakey-Frost N, Divers R, Moscardini EH, Pardue-Bourgeois S, Gerner J, Robinson A, Breaux E, Crapanzano KA, Calamia M, Jobes DA, Tucker RP. Factor Structure and Measurement Invariance of the Suicide Status Form-IV. Assessment 2024; 31:574-587. [PMID: 37138520 DOI: 10.1177/10731911231170150] [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: 05/05/2023]
Abstract
The Suicide Status Form-IV (SSF-IV) is the measure used in the Collaborative Assessment and Management of Suicidality (CAMS). The SSF-IV Core Assessment measures various domains of suicide risk. Previous studies established a two-factor solution in small, homogeneous samples; no investigations have assessed measurement invariance. The current investigation sought to replicate previous factor analyses and used measurement invariance to identify differences in the Core Assessment by race and gender. Adults (N = 731) were referred for a CAMS consultation after exhibiting risk for suicide. Confirmatory factor analyses indicated good fit for both one- and two-factor solutions while the two-factor solution is potentially redundant. Configural, metric, and scalar invariance held across race and gender. Ordinal logistic regression models indicated that neither race nor gender significantly moderated the relationship between the Core Assessment total score and clinical outcomes. Findings support a measurement invariant, one-factor solution for the SSF-IV Core Assessment.
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Affiliation(s)
| | - Ross Divers
- Louisiana State University, Baton Rouge, USA
| | | | | | | | | | | | | | - Matthew Calamia
- Louisiana State University, Baton Rouge, USA
- LSU Health New Orleans, Baton Rouge, USA
| | - David A Jobes
- The Catholic University of America, Washington, DC, USA
| | - Raymond P Tucker
- Louisiana State University, Baton Rouge, USA
- LSU Health New Orleans, Baton Rouge, USA
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3
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Becker-Haimes EM, Schaechter T, Green KL, Bridges K, Jager-Hyman S. Mobile Crisis Services: A Clinician Survey of Current Suicide Prevention Practices and Barriers to Care Delivery. Community Ment Health J 2024; 60:562-571. [PMID: 37982974 DOI: 10.1007/s10597-023-01208-9] [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: 05/11/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
Mobile crisis teams (MCTs) deploy clinicians to assist individuals in acute crisis in the community. Little is known about the extent to which these teams provide evidence-based practices (EBPs) for suicide prevention nor the barriers they face. We surveyed 120 MCT clinicians across the United States about their: (1) use of suicide risk screening and assessment tools; (2) strategies used to address suicide risk (both EBPs and non-EBPs); and (3) perceived barriers to high-quality MCT services. Nearly all clinicians reported use of validated suicide screening tools and generic "safety planning." However, a sizeable minority also reported use of non-EBPs. Open-ended responses suggested many client/family-, clinician-, and systems-level barriers to MCT use of EBPs for suicide prevention. We identified several targets for future implementation efforts, including the need for de-implementation strategies to reduce use of ineffective and potentially harmful practices, and unique aspects of MCTs that require tailored implementation supports.
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Affiliation(s)
- Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Temma Schaechter
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Kelly L Green
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | | | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
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4
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Anestis JC, Halkitis PN, Cordeiro A, Lanman MJ, Passannante MR. ARRIVE Together: A Qualitative Process Evaluation of the New Jersey State Police Co-responding Pilot Program. Behav Med 2024:1-10. [PMID: 38449435 DOI: 10.1080/08964289.2024.2324793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Law enforcement personnel are often first to respond to calls involving behavioral health emergencies. However, encounters with law enforcement are more dangerous and lethal for people with behavioral health conditions. Co-responding models, wherein law enforcement and behavioral health professionals respond to calls together, are among the top programs developed to improve responding to behavioral health crises. The current study describes a qualitative process evaluation of a co-responding pilot program in New Jersey: "Alternative Responses to Reduce Instances of Violence & Escalation" (ARRIVE Together). The evaluation centered on the experience of the co-responding team as to their perceptions of specific deployments and of the program implementation overall. Semi-structured interviews were conducted following 10 consecutive encounters (three interviews per encounter; February-March 2022). Transcripts were transcribed and thematically analyzed by two trained researchers independently. Once thematically analyzed, researchers determined a consensus and developed a SWOT analysis report. Thematic analysis produced six major themes: communication, staffing, training, resources, community outreach, and deployments with minors. Overall, participants were enthusiastic about the program, but they shared numerous observations about ways in which the program could be improved. Sample size, the brief follow-up window, and lack of generalizability to other contexts were among the most limiting factors. Further research should include an effectiveness evaluation and extend to urban and suburban communities and communities of color. Future research should also explore after-response affects including accessibility to follow-up care. The current study gives insight into piloting a co-responding model for approaching behavioral health crisis calls.
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Affiliation(s)
- Joye C Anestis
- Department of Health Behavior, Society, & Policy, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Perry N Halkitis
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Alana Cordeiro
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, USA
| | - Melissa J Lanman
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Marian R Passannante
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
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Oakey-Frost N, Crapanzano KA, Gerner J, Cowan T, Jobes DA, Tucker RP. An observational pilot of the collaborative assessment and management of suicidality brief intervention (CAMS-BI) for adult inpatients. Gen Hosp Psychiatry 2024; 87:146-147. [PMID: 37777346 DOI: 10.1016/j.genhosppsych.2023.09.009] [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] [Received: 08/23/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Nicolas Oakey-Frost
- Louisiana State University A&M College, 236 Audubon Hall, Baton Rouge, LA 70803, USA.
| | - Kathleen A Crapanzano
- Louisiana State University Health Sciences Center, 5246 Brittany Drive, Baton Rouge, LA 70808, USA
| | - Jessica Gerner
- Louisiana State University A&M College, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Tovah Cowan
- Louisiana State University A&M College, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - David A Jobes
- Catholic University of America, O'Boyle Hall, Washington, DC 20064, USA
| | - Raymond P Tucker
- Louisiana State University A&M College, 236 Audubon Hall, Baton Rouge, LA 70803, USA; Louisiana State University Health Sciences Center, 5246 Brittany Drive, Baton Rouge, LA 70808, USA
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6
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Mournet AM, Kleiman EM. A systematic review and meta-analysis on the efficacy of sleep interventions to treat suicidal ideation. J Sleep Res 2024:e14133. [PMID: 38164094 DOI: 10.1111/jsr.14133] [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: 08/21/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
Researchers at the intersection of sleep and suicide research have advocated for investigation of sleep disturbances as a therapeutic target for the purposes of treating and preventing suicide. This study aims to provide the first systematic review and meta-analysis on the efficacy of sleep interventions to treat suicidal ideation. This systematic review and meta-analysis, registered with the International Prospective Register of Systematic Reviews, was conducted in PsycINFO, through Ovid. A sample of eight articles were deemed eligible and a total of 21 effect sizes were included. Egger's test suggested that no publication bias was present (b = 0.3695; p = 0.0852). The pooled effect size for sleep treatments on suicidal ideation was small (g = -0.0931, p = 0.3047). Significant heterogeneity was present (I2 = 44.13%), indicating the need for moderator analyses. Treatment type (medication versus psychotherapy; g = -0.2487, p = 0.3368), sex (g = -0.0007; p = 0.9263), and race (g = -0.0081; p = 0.1624) were all considered as moderators and were all found to be insignificant. This meta-analysis revealed that initial studies exploring the efficacy of sleep interventions on suicidal ideation demonstrate small effect sizes. Despite this, the handful of studies included in this review nonetheless highlight this as an important area for continued exploration. The use of larger and more diverse samples, as well as intentionally designing sleep-related interventions to improve ideation and behaviour, have the potential to enhance the efficacy of sleep interventions for this novel purpose.
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Affiliation(s)
| | - Evan M Kleiman
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Becker-Haimes EM, Brady M, Jamison J, Jager-Hyman S, Reilly ME, Patel E, Brown GK, Mandell DS, Oquendo MA. An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER). Implement Sci Commun 2023; 4:148. [PMID: 38001478 PMCID: PMC10675939 DOI: 10.1186/s43058-023-00530-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Clinicians often report that their own anxiety and low self-efficacy inhibit their use of evidence-based suicide prevention practices, including gold-standard screening and brief interventions. Exposure therapy to reduce clinician maladaptive anxiety and bolster self-efficacy use is a compelling but untested approach to improving the implementation of suicide prevention evidence-based practices (EBPs). This project brings together an interdisciplinary team to leverage decades of research on behavior change from exposure theory to design and pilot test an exposure-based implementation strategy (EBIS) to target clinician anxiety to improve suicide prevention EBP implementation. METHODS We will develop, iteratively refine, and pilot test an EBIS paired with implementation as usual (IAU; didactic training and consultation) in preparation for a larger study of the effect of this strategy on reducing clinician anxiety, improving self-efficacy, and increasing use of the Columbia Suicide Severity Rating Scale and the Safety Planning Intervention in outpatient mental health settings. Aim 1 of this study is to use participatory design methods to develop and refine the EBIS in collaboration with a stakeholder advisory board. Aim 2 is to iteratively refine the EBIS with up to 15 clinicians in a pilot field test using rapid cycle prototyping. Aim 3 is to test the refined EBIS in a pilot implementation trial. Forty community mental health clinicians will be randomized 1:1 to receive either IAU or IAU + EBIS for 12 weeks. Our primary outcomes are EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention statistics. Secondary outcomes are the engagement of target implementation mechanisms (clinician anxiety and self-efficacy related to implementation) and preliminary effectiveness of EBIS on implementation outcomes (adoption and fidelity) assessed via mixed methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews). DISCUSSION Outcomes from this study will yield insight into the feasibility and utility of directly targeting clinician anxiety and self-efficacy as mechanistic processes informing the implementation of suicide prevention EBPs. Results will inform a fully powered hybrid effectiveness-implementation trial to test EBIS' effect on implementation and patient outcomes. TRIAL REGISTRATION Clinical Trials Registration Number: NCT05172609 . Registered on 12/29/2021.
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Affiliation(s)
- Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA.
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA.
| | - Megan Brady
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Jesslyn Jamison
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Megan E Reilly
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Esha Patel
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Gregory K Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
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Delaney KR. The Future of the Psychiatric Mental Health Nursing Workforce: Using Our Skill Set to Address Incongruities in Mental Health Care Delivery. Issues Ment Health Nurs 2023; 44:933-943. [PMID: 37734065 DOI: 10.1080/01612840.2023.2252498] [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] [Indexed: 09/23/2023]
Abstract
The USA is dealing with well-documented issues around mental health and its treatment. The Psychiatric Mental Health (PMH) workforce is growing and practicing in a variety of roles within the mental health system. How will PMH nurses address instances when the structure of services does not meet the mental health needs of the population? In this piece, I argue that to some degree the future of the PMH workforce will be determined by how well we use our capacity and capabilities to address incongruities in service structure and population needs. Five areas of concern with mental health services are outlined; they all involve factors that can be addressed with innovative approaches and optimum utilization of the PMH workforce. Included are suggestions on how PMH nurses might direct efforts toward these service issues, particularly by using their skill set and presence in the mental health system. Strategies include forging a tighter connection between the work of advanced practice and registered nurses in delivering care. Broadly, these efforts should be directed at building models of patient-centered care that address the needs of populations, reducing disparities, and demonstrating how engagement is a critical lever of effective inpatient and community-based care.
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Affiliation(s)
- Kathleen R Delaney
- Department of Community Mental Health and Systems, Rush College of Nursing, Chicago, Illinois, USA
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Keiller E, Masood S, Wong BHC, Avent C, Bediako K, Bird RM, Boege I, Casanovas M, Dobler VB, James M, Kiernan J, Martinez-Herves M, Ngo TVT, Pascual-Sanchez A, Pilecka I, Plener PL, Prillinger K, Lim IS, Saour T, Singh N, Skouta E, Steffen M, Tolmac J, Velani H, Woolhouse R, Zundel T, Ougrin D. Intensive community care services for children and young people in psychiatric crisis: an expert opinion. BMC Med 2023; 21:303. [PMID: 37563713 PMCID: PMC10413710 DOI: 10.1186/s12916-023-02986-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Children and young people's (CYP) mental health is worsening, and an increasing number are seeking psychiatric and mental health care. Whilst many CYPs with low-to-medium levels of psychiatric distress can be treated in outpatient services, CYPs in crisis often require inpatient hospital treatment. Although necessary in many cases, inpatient care can be distressing for CYPs and their families. Amongst other things, inpatient stays often isolate CYPs from their support networks and disrupt their education. In response to such limitations, and in order to effectively support CYPs with complex mental health needs, intensive community-based treatment models, which are known in this paper as intensive community care services (ICCS), have been developed. Although ICCS have been developed in a number of settings, there is, at present, little to no consensus of what ICCS entails. METHODS A group of child and adolescent mental health clinicians, researchers and academics convened in London in January 2023. They met to discuss and agree upon the minimum requirements of ICCS. The discussion was semi-structured and used the Dartmouth Assertive Community Treatment Fidelity Scale as a framework. Following the meeting, the agreed features of ICCS, as described in this paper, were written up. RESULTS ICCS was defined as a service which provides treatment primarily outside of hospital in community settings such as the school or home. Alongside this, ICCS should provide at least some out-of-hours support, and a minimum of 90% of CYPs should be supported at least twice per week. The maximum caseload should be approximately 5 clients per full time equivalent (FTE), and the minimum number of staff for an ICCS team should be 4 FTE. The group also confirmed the importance of supporting CYPs engagement with their communities and the need to remain flexible in treatment provision. Finally, the importance of robust evaluation utilising tools including the Children's Global Assessment Scale were agreed. CONCLUSIONS This paper presents the agreed minimum requirements of intensive community-based psychiatric care. Using the parameters laid out herein, clinicians, academics, and related colleagues working in ICCS should seek to further develop the evidence base for this treatment model.
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Affiliation(s)
| | | | | | - Cerian Avent
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Isabel Boege
- Medical University Graz & ZfP Südwürttemberg, Graz, Austria
| | | | | | - Maya James
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Jane Kiernan
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | | | | | | | | | | | | | | | | | - Nidhita Singh
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Eirini Skouta
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | | | - Jovanka Tolmac
- Central and North West London NHS Foundation Trust, London, UK
| | - Hemma Velani
- Central and North West London NHS Foundation Trust, London, UK
| | | | - Toby Zundel
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Dennis Ougrin
- East London NHS Foundation Trust & Queen Mary University of London, London, UK
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Arango A, Czyz EK, Magness CS, Hong V, Smith T, Kettley J, Ewell Foster C. Predictors of suicide coping self-efficacy among youth presenting to a psychiatric emergency department. Suicide Life Threat Behav 2023; 53:586-596. [PMID: 37157179 DOI: 10.1111/sltb.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Low levels of youth-reported self-efficacy to cope with suicidal urges have been shown to prospectively predict repeat emergency department (ED) visits and suicide attempts, yet little is known about how self-efficacy may change following receipt of crisis services or about factors that may strengthen self-efficacy. Protective factors (e.g., parent-reported youth competence, parent-family connectedness, and receipt of mental health services) were examined in relation to self-efficacy at the time of a psychiatric ED visit and 2 weeks later. METHODS Participants were 205 youth (ages 10-17), presenting to a psychiatric ED due to a suicide-related concern. Youth primarily identified as biological female (63%) and White (87%). Multivariate hierarchical linear regressions were used to examine candidate protective factors in relation to initial and follow-up suicide coping self-efficacy. RESULTS Self-efficacy significantly improved in the 2 weeks following the ED visit. Parent-family connectedness was positively related to suicide coping self-efficacy at the time of the ED visit. Parent-family connectedness and receipt of inpatient psychiatric care following the ED visit were associated with higher follow-up suicide coping self-efficacy. CONCLUSIONS During the adolescent developmental period when suicidal thoughts and behaviors notably increase, study findings highlight potential malleable intervention targets, including parent-family connectedness, that may strengthen suicide coping self-efficacy.
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Affiliation(s)
- Alejandra Arango
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Ewa K Czyz
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Victor Hong
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Tayla Smith
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - John Kettley
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Shields MC, Hollander MAG, Busch AB, Kantawala Z, Rosenthal MB. Patient-centered inpatient psychiatry is associated with outcomes, ownership, and national quality measures. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad017. [PMID: 38756837 PMCID: PMC10986256 DOI: 10.1093/haschl/qxad017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 05/18/2024]
Abstract
Following discharge from inpatient psychiatry, patients experience elevated suicide risk, unplanned readmission, and lack of outpatient follow-up visits. These negative outcomes might relate to patient-centered care (PCC) experiences while hospitalized. We surveyed 739 former patients of inpatient psychiatric settings to understand the relationship between PCC and changes in patients' trust, willingness to engage in care, and self-reported 30-day follow-up visits. We also linked PCC measures to facility-level quality measures in the Inpatient Psychiatric Facility Quality Reporting program. Relative to patients discharged from facilities in the top quartile of PCC, those discharged from facilities in the bottom quartile were more likely to experience reduced trust (predicted probability [PP] = 0.77 vs 0.46; P < .001), reduced willingness to go to the hospital voluntarily (PP = 0.99 vs 0.01; P < .001), and a lower likelihood of a 30-day follow-up (PP = 0.71 vs 0.92; P < .001). PCC was lower among patients discharged from for-profits, was positively associated with facility-level quality measures of 7- and 30-day follow-up and medication continuation, and was inversely associated with restraint use. Findings underscore the need to introduce systematic measurement and improvement of PCC in this setting.
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Affiliation(s)
- Morgan C Shields
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, United States
| | - Mara A G Hollander
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, United States
| | - Alisa B Busch
- Department of Health Care Policy, Harvard University, Harvard Medical School, Boston, MA 02115, United States
- McLean Hospital, Belmont, MA 02478, United States
| | - Zohra Kantawala
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, United States
| | - Meredith B Rosenthal
- Department of Health Policy and Management, Harvard University, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States
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12
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Rozek DC, Tyler H, Fina BA, Baker SN, Moring J, Smith NB, Baker JC, Bryan AO, Bryan CJ, Dondanville KA. Suicide Intervention Practices: What Is Being Used by Mental Health Clinicians and Mental Health Allies? Arch Suicide Res 2023; 27:1034-1046. [PMID: 35943133 PMCID: PMC9908767 DOI: 10.1080/13811118.2022.2106923] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Implementation of evidence-based suicide prevention is critical to prevent death by suicide. Contrary to previously held beliefs, interventions including contracting for safety, no-harm contracts, and no-suicide contracts are not best practices and are considered contraindicated. Little is known about the current use of best practices and contraindicated interventions for suicide prevention in community settings. METHODS Data were collected from 771 individuals enrolled in a suicide prevention training. Both mental health clinicians (n = 613) and mental health allies (e.g., teachers, first responders) (n = 158) reported which best practices (i.e., safety plan, crisis response plan) and contraindicated interventions (i.e., contracting for safety, no-harm contract, no-suicide contract) they use with individuals who presents with risk for suicide. RESULTS The majority of both mental health clinicians (89.7%) and mental health allies (67.1%) endorsed using at least one evidence-based practice. However, of those who endorsed using evidence-based interventions, ∼40% of both mental health clinicians and allies endorsed using contraindicated interventions as well. CONCLUSION Contraindicated interventions are being used at high rates and suicide prevention trainings for evidence-based interventions should include a focus on de-implementation of contraindicated interventions. This study examined only a snapshot of what clinicians and allies endorsed using. Additional in depth information about each intervention and when it is used would provide helpful information and should be considered in future studies. Future research is needed to ensure only evidence-based interventions are being used to help prevent death by suicide.Highlights:The majority of both mental health clinicians and mental health allies use evidence-based practices for suicide prevention. This indicates good implementation rates of evidence-based interventions for suicide prevention.Approximately 40% of both mental health clinicians and mental health allies who endorsed using evidence-based practices for suicide preventions also endorsed using contraindicated interventions.A focus on de-implementation of contraindicated suicide interventions is warranted and should be part of the focus on suicide prevention efforts.
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Affiliation(s)
- David C. Rozek
- UCF RESTORES & Department of Psychology, University of Central Florida
| | - Hannah Tyler
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio
| | - Brooke A. Fina
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio
| | - Shelby N. Baker
- UCF RESTORES & Department of Psychology, University of Central Florida
| | - John Moring
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio
| | - Noelle B. Smith
- Northeast Program Evaluation Center, Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Justin C. Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center
| | - Annabelle O. Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center
| | - Craig J. Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio
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Hugunin J, Davis M, Larkin C, Baek J, Skehan B, Lapane KL. Established Outpatient Care and Follow-Up After Acute Psychiatric Service Use Among Youths and Young Adults. Psychiatr Serv 2023; 74:2-9. [PMID: 36223162 PMCID: PMC9812848 DOI: 10.1176/appi.ps.202200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study explored follow-up after hospitalization and emergency room (ER) use for mental health among youths and young adults with private insurance. METHODS The IBM MarketScan commercial database (2013-2018) was used to identify people ages 12-27 with a mental health hospitalization (N=95,153) or ER use (N=108,576). Factors associated with outpatient mental health follow-up within 7 and 30 days of discharge were determined via logistic models with generalized estimating equations that accounted for state variation. RESULTS Of those hospitalized, 42.7% received follow-up within 7 days (67.4% within 30 days). Of those with ER use, 28.6% received follow-up within 7 days (46.4% within 30 days). Type of established outpatient care predicted follow-up after hospitalization and ER use. Compared with people with no established care, the likelihood of receiving follow-up within 7 days was highest among those with mental health and primary care (hospitalization, adjusted odds ratio [AOR]=2.81, 95% confidence interval [CI]=2.68-2.94; ER use, AOR=4.06, 95% CI=3.72-4.42), followed by those with mental health care only (hospitalization, AOR=2.57, 95% CI=2.45-2.70; ER use, AOR=3.48, 95% CI=3.17-3.82) and those with primary care only (hospitalization, AOR=1.20, 95% CI=1.15-1.26; ER use, AOR=1.22, 95% CI=1.16-1.28). Similar trends were observed within 30 days of discharge. CONCLUSIONS Follow-up rates after acute mental health service use among youths and young adults were suboptimal. Having established mental health care more strongly predicted receiving follow-up than did having established primary care. Improving engagement with outpatient mental health care providers may increase follow-up rates.
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Affiliation(s)
- Julie Hugunin
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Maryann Davis
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Celine Larkin
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Jonggyu Baek
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Brian Skehan
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Kate L Lapane
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
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Rozel JS, Toohey T, Amin P. Legal Considerations in Emergency Psychiatry. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:3-7. [PMID: 37205030 PMCID: PMC10172539 DOI: 10.1176/appi.focus.20220071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Emergency psychiatry stands at the fulcrum between the general principles of autonomy and liberty balanced against illnesses that both subvert autonomy and amplify risks for violence and suicide. Although all specialties of medicine must operate in adherence with the law, emergency psychiatry is particularly constrained and guided by state and federal laws. Routine matters of emergency psychiatric care-including involuntary assessment, admission and treatment, management of agitation, medical stabilization and transfer, confidentiality, voluntary and involuntary commitment, and duties to third parties-all occur within carefully delimited legal boundaries, rules, and processes. This article provides a basic overview of critical legal principles relevant to the practice of emergency psychiatry.
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Affiliation(s)
- John S Rozel
- Department of Psychiatry (Rozel, Amin) and School of Law (Rozel), University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania (Rozel, Amin); Department of Psychiatry, University of Hawaii, Honolulu (Toohey)
| | - Tara Toohey
- Department of Psychiatry (Rozel, Amin) and School of Law (Rozel), University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania (Rozel, Amin); Department of Psychiatry, University of Hawaii, Honolulu (Toohey)
| | - Priyanka Amin
- Department of Psychiatry (Rozel, Amin) and School of Law (Rozel), University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania (Rozel, Amin); Department of Psychiatry, University of Hawaii, Honolulu (Toohey)
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15
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Kruzan KP, Williams KD, Meyerhoff J, Yoo DW, O'Dwyer LC, De Choudhury M, Mohr DC. Social media-based interventions for adolescent and young adult mental health: A scoping review. Internet Interv 2022; 30:100578. [PMID: 36204674 PMCID: PMC9530477 DOI: 10.1016/j.invent.2022.100578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/18/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Mental health conditions are common among adolescents and young adults, yet few receive adequate mental health treatment. Many young people seek support and information online through social media, and report preferences for digital interventions. Thus, digital interventions deployed through social media have promise to reach a population not yet engaged in treatment, and at risk of worsening symptoms. Objective In this scoping review, we aimed to identify and review empirical research on social media-based interventions aimed at improving adolescent and young adult mental health. A secondary objective was to identify the features and functionalities of platforms described as social media. Methods Adhering to the PRISMA-ScR guidelines for scoping reviews, the search was conducted in PubMed MEDLINE; Embase Central Register of Controlled Trials (Wiley); PsycINFO (Ebsco); Scopus; Web of Science; IEEE Xplore; ACM Digital Library; and ClinicalTrials.gov from inception until November 2021. Studies were included if they involved adolescents or young adults (10-26 years of age) that meet clinical, or subclinical, levels of a mental health condition and include a pre- and post-assessment of mental health outcomes. Results Among the 18,380 references identified, 15 met full inclusion criteria and were published between 2017 and 2021-this included four randomized controlled trials, seven non-randomized pre-post trials, and four were experimental or quasi-experimental designs. Just five studies were delivered through an existing social media site (Facebook or Pixtori), with the remainder focused on purpose-built networks. Three studies involved adolescents or young adults who self-reported a mental health condition, seven involved young people diagnosed with a mental health condition by a clinician or who scored above a clinical threshold on valid clinical measure, three involved college students without a mental health inclusion criterion, and two studies focused on young people with a cancer diagnosis. Conclusions The review highlights innovations in the delivery of mental health interventions, provides preliminary evidence of the ability of social media interventions to improve mental health outcomes, and underscores the need for, and merit of, future work in this area. We discuss opportunities and challenges for future research, including the potential to leveragei existing peer networks, the use of just-in-time interventions, and scaling interventions to meet need.
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Affiliation(s)
- Kaylee Payne Kruzan
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N. Lakeshore Drive, Chicago, IL 60611, USA
| | - Kofoworola D.A. Williams
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N. Lakeshore Drive, Chicago, IL 60611, USA
| | - Jonah Meyerhoff
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N. Lakeshore Drive, Chicago, IL 60611, USA
| | - Dong Whi Yoo
- School of Interactive Computing, Georgia Institute of Technology, 85 5th St NW, Atlanta, GA 30308, USA
| | - Linda C. O'Dwyer
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N. Lakeshore Drive, Chicago, IL 60611, USA
| | - Munmun De Choudhury
- School of Interactive Computing, Georgia Institute of Technology, 85 5th St NW, Atlanta, GA 30308, USA
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N. Lakeshore Drive, Chicago, IL 60611, USA
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16
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Chen BC, Lui JHL, Benson LA, Lin YJR, Ponce NA, Innes-Gomberg D, Lau AS. After the Crisis: Racial/Ethnic Disparities and Predictors of Care Use Following Youth Psychiatric Emergencies. JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY 2022; 52:360-375. [DOI: 10.1080/15374416.2022.2127103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
| | - Joyce H. L. Lui
- Department of Psychology, University of California
- Department of Psychology, University of Maryland
| | | | | | | | | | - Anna S. Lau
- Department of Psychology, University of California
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17
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Dani A, Balachandran S, McGill K, Whyte I, Carter G. Prevalence of Depression and Predictors of Discharge to a Psychiatric Hospital in Young People with Hospital-Treated Deliberate Self-Poisoning at an Australian Sentinel Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15753. [PMID: 36497828 PMCID: PMC9737120 DOI: 10.3390/ijerph192315753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Hospital treated deliberate self-poisoning is common in young people. Internationally, estimates of rates of depression in this population are very wide (14.6% to 88%). The aims of this study were to determine the prevalence of depression and the independent predictors of referral for psychiatric hospitalisation in young people (aged 16 to 25 years) following an index episode of hospital treated deliberate self-poisoning. METHOD A retrospective cohort study design (n = 1410), with data drawn from a population-based clinical case register. Unadjusted and adjusted estimates of predictors of referral for psychiatric admission (after-care) used logistic regression models. RESULTS Prevalence of any depression diagnosis was 35.5% (n = 500); and 25.4% (n = 358) were referred for a psychiatric admission. The adjusted estimates for predictors of psychiatric inpatient referral were: high suicidal level (OR 118.21: CI 95% 63.23-220.99), low/moderate suicidal level (14.27: 9.38-21.72), any depression (2.88: 1.97-4.22), any psychosis (4.06; 1.15-14.36), older age (1.12: 1.04-1.21), and number of support people (0.88: 0.78-0.98). CONCLUSION Depression was diagnosed in more than a third and was an independent predictor of psychiatric inpatient referral, so service providers need to account for this level of need in the provision of assessment and after-care services. Evidence-based guidelines for psychiatric inpatient after-care for deliberate self-poisoning and/or depression in young people are limited. Our explanatory model included suicidal level, depression, psychosis, older age, and available support persons, suggesting that the treating clinicians were making these discharge decisions for admission in keeping with those limited guidelines, although the balance of benefits and harms of psychiatric hospitalisation are not established. Future research examining patient experiences, effectiveness of psychiatric hospitalisation, and alternatives to hospitalisation is warranted.
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Affiliation(s)
- Anitha Dani
- Child and Adolescent Mental Health Service, Hunter New England Mental Health Service, Newcastle, NSW 2302, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Srilaxmi Balachandran
- Child and Adolescent Mental Health Service, Hunter New England Mental Health Service, Newcastle, NSW 2302, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Katie McGill
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Research Evaluation and Dissemination (MH-READ), Hunter New England Mental Health Service, Newcastle, NSW 2298, Australia
| | - Ian Whyte
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Greg Carter
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
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18
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McGill K, Salem A, Hanstock TL, Heard TR, Garvey L, Leckning B, Whyte I, Page A, Carter G. Indigeneity and Likelihood of Discharge to Psychiatric Hospital in an Australian Deliberate Self-Poisoning Hospital-Treated Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12238. [PMID: 36231541 PMCID: PMC9566708 DOI: 10.3390/ijerph191912238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Hospital-treated self-harm rates for Aboriginal and Torres Strait Islander (Indigenous) people are at least double those for other Australians. Despite this, limited research has explored the relationship between Indigeneity and the clinical management of hospital-treated deliberate self-harm. A retrospective clinical cohort study (2003-2012) at a regional referral centre (NSW) for deliberate self-poisoning was used to explore the magnitude and direction of the relationship between Indigeneity and discharge destination (psychiatric hospital vs. other) using a series of logistic regressions. There were 149 (4%) Indigenous and 3697 (96%) non-Indigenous deliberate self-poisoning admissions during the study period. One-third (31%) were referred to the psychiatric hospital at discharge; Indigenous 21% (n = 32) vs. non-Indigenous 32% (n = 1175). Those who identified as Indigenous were less likely to be discharged to the psychiatric hospital, OR 0.59 (0.40-0.87) at the univariate level, with little change after sequential adjustment; and AOR 0.34 (0.21-0.73) in the fully adjusted model. The Indigenous cohort had a lower likelihood of psychiatric hospital discharge even after adjustment for variables associated with discharge to the psychiatric hospital highlighting the need for further investigation of the reasons accounting for this differential pattern of clinical management and the effectiveness of differential after-care allocation.
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Affiliation(s)
- Katie McGill
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Healthy Minds, Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
- Mental Health-Research, Evaluation and Dissemination (MH-READ), Hunter New England Local Health District, Newcastle, NSW 2298, Australia
| | - Amir Salem
- School of Psychological Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Tanya L. Hanstock
- School of Psychological Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Todd R. Heard
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Healthy Minds, Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
- Wiyillin Ta Child and Adolescent Mental Health Service, Hunter New England Local Health District, Newcastle, NSW 2300, Australia
| | - Leonie Garvey
- Aboriginal Health, Hunter New England Local Health District, Wallsend, NSW 2287, Australia
| | - Bernard Leckning
- Black Dog Institute, University of New South Wales, Sydney, NSW 1466, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia
| | - Ian Whyte
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Calvary Mater Newcastle, Newcastle, NSW 2298, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia
| | - Greg Carter
- Healthy Minds, Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
- Calvary Mater Newcastle, Newcastle, NSW 2298, Australia
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19
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Nesi J, Burke TA, Caltabiano A, Spirito A, Wolff JC. Digital media-related precursors to psychiatric hospitalization among youth. J Affect Disord 2022; 310:235-240. [PMID: 35533775 PMCID: PMC10042225 DOI: 10.1016/j.jad.2022.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022]
Abstract
Digital media, including smartphones and social media, are central in youths' lives. This study aimed to examine the role of digital media in psychiatric hospital admissions among adolescents. 343 psychiatrically-hospitalized youth (Mage = 15.2; 70.3% White, 13.7% Black, 33.9% Hispanic; 48.7% female) completed self-report measures of potential digital media-related reasons for hospitalization, patterns of digital media use, and clinical symptoms (internalizing, externalizing, suicidal ideation and attempts). Digital media-related reasons for hospitalization were common, with over 40% of the sample endorsing at least one such reason; 24.8% endorsed having their phone taken away as a reason for admission. Younger adolescents and youth with addictive patterns of phone use were more likely to endorse digital media-related reasons for hospitalization, including phone restriction and negative social media experiences. In addition, youth endorsing suicide-related social media engagement (e.g., posting or messaging about suicide) as a precursor to admission reported more severe suicidal ideation and greater likelihood of a recent suicide attempt. Limitations of the study include a reliance on self-report measures and cross-sectional design. Findings highlight the need to identify youth who may be especially vulnerable to digital media experiences that contribute to risk for psychiatric hospitalization.
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Affiliation(s)
- Jacqueline Nesi
- Alpert Medical School of Brown University, Providence, RI, United States of America; Rhode Island Hospital, Providence, RI, United States of America.
| | - Taylor A Burke
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Anna Caltabiano
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Anthony Spirito
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Jennifer C Wolff
- Alpert Medical School of Brown University, Providence, RI, United States of America; Rhode Island Hospital, Providence, RI, United States of America
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20
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Becker-Haimes EM, Klein CC, Frank HE, Oquendo MA, Jager-Hyman S, Brown GK, Brady M, Barnett ML. Clinician Maladaptive Anxious Avoidance in the Context of Implementation of Evidence-Based Interventions: A Commentary. FRONTIERS IN HEALTH SERVICES 2022; 2:833214. [PMID: 36382152 PMCID: PMC9648711 DOI: 10.3389/frhs.2022.833214] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022]
Abstract
This paper posits that a clinician's own anxious reaction to delivering specific evidence-based interventions (EBIs) should be better accounted for within implementation science frameworks. A key next step for implementation science is to delineate the causal processes most likely to influence successful implementation of evidence-based interventions (EBIs). This is critical for being able to develop tailored implementation strategies that specifically target mechanisms by which implementation succeeds or fails. First, we review the literature on specific EBIs that may act as negatively valenced stimuli for clinicians, leading to a process of clinician maladaptive anxious avoidance that can negatively impact EBI delivery. In the following sections, we argue that there are certain EBIs that can cause emotional distress or discomfort in a clinician, related to either: (1) a clinicians' fear of the real or predicted short-term distress the EBI can cause patients, or (2) fears that the clinician will inadvertently cause the patient harm and/or face liability. This distress experienced by the clinician can perpetuate a cycle of maladaptive anxious avoidance by the clinician, contributing to lack of or suboptimal EBI implementation. We illustrate how this cycle of maladaptive anxious avoidance can influence implementation by providing several examples from leading EBIs in the psychosocial literature. To conclude, we discuss how leveraging decades of treatment literature aimed at mitigating maladaptive anxious avoidance can inform the design of more tailored and effective implementation strategies for EBIs that are negatively valenced.
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Affiliation(s)
- Emily M. Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, United States
| | - Corinna C. Klein
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Hannah E. Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Bradley Hospital, Lifespan Health System, Riverside, RI, United States
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Gregory K. Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Megan Brady
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Miya L. Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA, United States
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21
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Aboussouan A, Moscardini EH, Cerel J, Tucker RP. Experiences of hospitalization for suicide ideation and suicide attempt in gender diverse adults. Suicide Life Threat Behav 2022; 52:427-438. [PMID: 35083785 DOI: 10.1111/sltb.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/17/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study sought to investigate general perceptions of suicide-related hospital-based care that Transgender/Gender Diverse (TGD) adults have experienced as well as correlates of their perceived usefulness of this care. METHODS Data were collected via a cross-sectional online survey of N = 3718 self-identified TGD individuals. Single-item self-report measures of all constructs of interest were used. RESULTS A total of n = 1056 participants indicated hospitalization for either a past suicide attempt (SA) or suicidal ideation (SI). Irrespective of being hospitalized for SI or SA, perceived usefulness of hospital-based care was low with 50% or more of participants rating their care as some degree of unhelpful. Older age, general trust in mental healthcare providers, and voluntary admission were related to higher perceived helpfulness of care for both SI and SA admissions. Higher pride in TGD identity was positively related to perceived helpfulness of care but only for admissions related to SAs. CONCLUSION Improving perceived usefulness of hospital-based care may be important for improving subsequent suicide-related help-seeking. Increasing training and provision of care that improves trust with mental healthcare providers and potentially reduces need for involuntary admission may help improve hospital-based, suicide-related care in TGD adults.
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Affiliation(s)
| | | | - Julie Cerel
- University of Kentucky, Lexington, Kentucky, USA
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22
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Jones N, Gius BK, Shields M, Collings S, Rosen C, Munson M. Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help-seeking in pathways to care. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2017-2027. [PMID: 33751175 PMCID: PMC10105343 DOI: 10.1007/s00127-021-02048-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Few studies have focused on the experience of involuntary psychiatric hospitalization among youth, especially the impact of these experiences on engagement with mental health services post-discharge. In this study, we contribute to a deeper understanding of youth experiences of involuntary hospitalization (IH) and its subsequent impacts on trust, help-seeking, and engagement with clinicians. METHODS The study utilized a grounded theory approach, conducting in-depth interviews with 40 youth and young adults (ages 16-27) who had experienced at least one prior involuntary hospitalization. RESULTS Three quarters of the youth reported negative impacts of IH on trust, including unwillingness to disclose suicidal feelings or intentions. Selective non-disclosure of suicidal feelings was reported even in instances in which the participant continued to meet with providers following discharge. Factors identified as contributing to distrust included perceptions of inpatient treatment as more punitive than therapeutic, staff as more judgmental than empathetic, and hospitalization overall failing to meet therapeutic needs. Conversely, participants reporting more mixed experiences of hospitalization and simultaneously strong indirect benefits, including greater family support, diminished family judgement members and greater access to care. CONCLUSION Findings draw attention to the ways in which coercive experiences may impact youth pathways to and through care. Additional research is needed to understand the impact of these experiences across larger samples, and their influence on downstream outcomes including engagement and long-term wellbeing. Finally, these data may inform the development and testing of inpatient and post-discharge interventions designed to mitigate potential harm.
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Affiliation(s)
- Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 4202 East Fowler Ave, Tampa, FL, 33620, USA.
| | - Becky K Gius
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Morgan Shields
- Department of Psychiatry, Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Shira Collings
- Department of Counseling, Troy University, Tampa, FL, USA
| | - Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Michelle Munson
- Silver School of Social Work, New York University, New York, NY, USA
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23
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Obegi JH. How Common is Recent Denial of Suicidal Ideation among Ideators, Attempters, and Suicide Decedents? A Literature Review. Gen Hosp Psychiatry 2021; 72:92-95. [PMID: 34358807 DOI: 10.1016/j.genhosppsych.2021.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE It is sometimes stated that most people who die by suicide deny suicidal thoughts before their deaths. This narrative review examines the empirical basis for this assertion. METHODS Studies from 2000 to 2021 that examined the prevalence of the denial of suicidal thoughts among ideators in general, denial before suicide, and denial before and immediately after a suicide attempt were reviewed. Twenty-two papers met the inclusion criteria. RESULTS About 50% of ideators denied suicidal ideation (SI) during interviews. In addition, about half of decedents denied SI in the previous week or month before suicide, whereas about 30% denied SI in the previous week or month before a suicide attempt. CONCLUSIONS The denial of SI among ideators, attempters, and suicide decedents is an alarmingly common occurrence. Findings support the clinical wisdom that denial of SI is, by itself, an inadequate indicator of suicide risk.
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Affiliation(s)
- Joseph H Obegi
- California Department of Corrections and Rehabilitation, California Correctional Health Care Services, Statewide Mental Health Program, Bldg. G, P.O. Box 588500, Elk Grove, CA 95758, United States of America.
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