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Brown GK, Wolk CB, Green KL, Nezir F, Mowery DL, Gallop R, Reilly ME, Stanley B, Mandell DS, Oquendo MA, Jager-Hyman S. Safety planning intervention and follow-up: A telehealth service model for suicidal individuals in emergency department settings: Study design and protocol. Contemp Clin Trials 2024; 140:107492. [PMID: 38484793 PMCID: PMC11071175 DOI: 10.1016/j.cct.2024.107492] [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: 11/11/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The Safety Planning Intervention with follow-up services (SPI+) is a promising suicide prevention intervention, yet many Emergency Departments (EDs) lack the resources for adequate implementation. Comprehensive strategies addressing structural and organizational barriers are needed to optimize SPI+ implementation and scale-up. This protocol describes a test of one strategy in which ED staff connect at-risk patients to expert clinicians from a Suicide Prevention Consultation Center (SPCC) via telehealth. METHOD This stepped wedge, cluster-randomized trial compares the effectiveness, implementation, cost, and cost offsets of SPI+ delivered by SPCC clinicians versus ED-based clinicians (enhanced usual care; EUC). Eight EDs will start with EUC and cross over to the SPCC phase. Blocks of two EDs will be randomly assigned to start dates 3 months apart. Approximately 13,320 adults discharged following a suicide-related ED visit will be included; EUC and SPCC samples will comprise patients from before and after SPCC crossover, respectively. Effectiveness data sources are electronic health records, administrative claims, and the National Death Index. Primary effectiveness outcomes are presence of suicidal behavior and number/type of mental healthcare visits and secondary outcomes include number/type of suicide-related acute services 6-months post-discharge. We will use the same data sources to assess cost offsets to gauge SPCC scalability and sustainability. We will examine preliminary implementation outcomes (reach, adoption, fidelity, acceptability, and feasibility) through patient, clinician, and health-system leader interviews and surveys. CONCLUSION If the SPCC demonstrates clinical effectiveness and health system cost reduction, it may be a scalable model for evidence-based suicide prevention in the ED.
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Affiliation(s)
- Gregory K Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly L Green
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Freya Nezir
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle L Mowery
- Department of Biostatistics, Epidemiology, & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gallop
- Department of Biostatistics, Epidemiology, & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Mathematics, West Chester University of Pennsylvania, West Chester, PA, USA
| | - Megan E Reilly
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Hode Y, Padovani R, Hikmat W, Guillard-Bouhet N, Attal J, Bralet MC, Biotteau M, Chereau Boudet I, Canceil O, Montagne Larmurier A, Roussel C, Lemestré S, Willard D. Family psychoeducation in schizophrenia and schizophrenia related disorder, treatment compliance, and suicidal risk reduction: questions about their relationship from a naturalistic observation. Front Psychiatry 2024; 15:1370566. [PMID: 38638418 PMCID: PMC11024790 DOI: 10.3389/fpsyt.2024.1370566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction The Profamille V3.2 multi-family psycho-educational program directed at caregivers of relatives with schizophrenia or schizophrenia related disorder has been shown to decrease the annual prevalence of suicide attempts. It has been reported that psychoeducation of families can sometimes improve compliance with treatment. This study investigates whether the Profamille program improves compliance and thus reduces the risk of suicide among patients. Method This is a retrospective study of 179 groups of family caregivers, encompassing 1946 participants enrolled in Module 1 of the Profamille program and followed up one year after completion of the module. Evaluations were conducted using questionnaires filled out by family caregivers at three distinct times: prior to beginning the program, upon its completion, and again one year following its conclusion. The annual prevalence of suicide attempts was measured both before the program began and one year after its conclusion, while compliance to treatment was evaluated at the start and end of the program. Result After the Profamille program, the annual prevalence of suicide attempts fell by a factor of 2 (p-value = 0.00002) and patient compliance improved (p-value <0.000001). This reduction in suicide attempts was observed independently of improved compliance. Compliance seems to have an additional effect, but only after participation in the program. Conclusion The Profamille program reduces patients' risk of suicide even when patients are not taking the treatment. When family psychoeducation is not proposed in schizophrenia or schizophrenia related disorder, this can represent a loss of chance for patients.
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Affiliation(s)
- Yann Hode
- Association Psychoeducation PROFAMILLE, Chatenois, France
| | | | - Wydad Hikmat
- Psychiatric Hospital of Kelaa Sraghna, Ministry of Health, Morocco, Kelâa des Sraghna, Morocco
| | - Nathalie Guillard-Bouhet
- CREATIV Centre de REhabilitation et d'Activités Thérapeutiques Intersectoriel de la Vienne, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Jérome Attal
- La Colombière, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Marie-Cecile Bralet
- CRISALID-HDF (Department Support of cognitive remediation and psychosocial rehabilitation- South Hauts de France area), Etablissement Public de Santé Mentale Oise, Clermont de l Oise, France
- INSERM Unit Research 1247 GRAP, Picardie Jules Vernes University, Amiens, France
- GDR 3557 Research network, Addiction and Psychiatry, Paris, France
- Centre Hospitalier Isarien, Clermont de l’Oise, France
| | | | - Isabelle Chereau Boudet
- Centre Expert Schizophrenie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont Ferrand, France
| | - Olivier Canceil
- Fondation Santé des Etudiants de France, Paris, France
- Sante Mentale France, Paris, France
| | | | - Céline Roussel
- Centre Hospitalier Annecy Genevois (CH Annecy), Metz-Tessy, France
| | - Stéphanie Lemestré
- Association de psychoéducation des Familles Profamille Liège Belgique, Liège, Belgium
| | - Dominique Willard
- Pôle PEPIT (Pôle Hospitalo-Universitaire d’Evaluation Prévention et Innovation Thérapeutique), Groupe Hospitalier Universitaire Paris psychiatrie et neurosciences, Paris, France
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Ton AT, Carter SP, Leitner R, Zoellner LA, Mizik N, Reger MA. Peer-Written Caring Letters for Veterans after a Suicidal Crisis. Arch Suicide Res 2024; 28:585-599. [PMID: 37095634 DOI: 10.1080/13811118.2023.2199799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE In the evidence-based suicide prevention intervention, Caring Letters, healthcare providers send brief, caring messages to patients following psychiatric inpatient care, a time of elevated suicide risk. However, recent studies with military populations have found mixed results. An adaptation of Caring Letters employed a peer framework in which veterans from the community wrote brief caring messages to veterans discharging from psychiatric inpatient treatment after a suicidal crisis. METHODS The present study utilized content analysis to assess 90 caring messages generated by 15 peer veterans recruited from veteran service organizations (e.g., American Legion). RESULTS Three themes emerged: (1) Shared Military Service, (2) Care, and (3) Overcoming Adversity. Peer-generated content varied in how the coded themes were expressed in the messages. CONCLUSION These veteran-to-veteran caring messages may bolster belongingness, social support, and destigmatize mental health struggles, and have the potential to augment existing Caring Letters effects and interventions.
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Hu FH, Xu J, Jia YJ, Ge MW, Zhang WQ, Tang W, Zhao DY, Hu SQ, Du W, Shen WQ, Xu H, Zhang WB, Chen HL. Non-pharmacological interventions for preventing suicide attempts: A systematic review and network meta-analysis. Asian J Psychiatr 2024; 93:103913. [PMID: 38219553 DOI: 10.1016/j.ajp.2024.103913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
Suicide attempts can cause serious physical harm or death. It would be crucial to gain a better understanding of the comparative efficacy of non-pharmacological interventions. We aimed to identify which non-pharmacological interventions are more effective in preventing suicide attempts. PubMed, Web of Science, and EMBASE databases were searched systematically from their inception until 3 April 2023. To be eligible for inclusion, randomized controlled trials (RCTs) had to meet the following criteria: Participants were individuals who had suicidal ideation or a history of severe self-harm or attempted suicide. A network meta-analysis was performed using a random effects model to estimate the treatment effect of various non-pharmacological interventions. (PROSPERO registration number: CRD42023411393). We obtained data from 54 studies involving 17,630 participants. Our primary analysis found that Cognitive therapy (CT) (OR=0.19, 95%CI =0.04-0.81), Dialectical Behavior Therapy (DBT) (OR=0.37, 95%CI =0.13-0.97), Cognitive-behavioral therapy (CBT) (OR=0.42, 95%CI =0.17-0.99), and Brief intervention and contact (BIC) (OR=0.65, 95%CI=0.44-0.94) were superior to TAU (within the longest available follow-up time) in preventing suicide attempts, while other intervention methods do not show significant advantages over TAU. Secondary analysis showed that the two intervention measures (CT and BIC) were effective when follow-up time did not exceed 6 months, but there was no effective intervention measure with longer follow-up times. CT, DBT, CBT, and BIC have a better effect in preventing suicide attempts than other non-pharmacological interventions. Additional research is necessary to validate which interventions, as well as which combinations of interventions, are the most effective.
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Affiliation(s)
- Fei-Hong Hu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Jie Xu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Yi-Jie Jia
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Dan-Yan Zhao
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Shi-Qi Hu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wei Du
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wang-Qin Shen
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Hong Xu
- Nantong Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Wei-Bing Zhang
- Nantong Center for Disease Control and Prevention, Nantong, Jiangsu, PR China.
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, PR China.
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5
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Landes SJ, Abraham TH, Woods JA, Curtis ND, Lauver M, Manchester C, Garrido MM, Porter S, Hughes G, Reger MA. Qualitative Evaluation of a Caring Letters Suicide Prevention Intervention for the Veterans Crisis Line. Psychiatr Serv 2023; 74:1234-1239. [PMID: 37221888 DOI: 10.1176/appi.ps.20220632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Suicide is a leading cause of death in the United States. This has prompted the U.S. surgeon general to issue a report describing actionable items to reduce suicide rates, including a recommendation to increase the use of the caring letters intervention. This intervention involves mailing brief, nondemanding messages of care. As part of the Department of Veterans Affairs' (VA's) efforts to reduce suicide rates among veterans, a caring letters project was developed for veterans who contact the Veterans Crisis Line (VCL). This article describes the results of qualitative interviews conducted to better understand the experiences of veterans who received caring letters. METHODS Beginning in 2020, all identifiable veterans who used Veterans Health Administration services and contacted the VCL received nine letters over 1 year, along with a list of mental health resources. Semistructured interviews (N=23) were conducted, and content analysis was used to identify veterans' perspectives and suggestions for improving the intervention. RESULTS Sixteen men and seven women participated (mean age=53 years). Feedback varied, with most participants reporting that receiving caring letters had a positive impact and others noting aspects that could be improved to enhance the intervention's caring intent. Some also reported that the letters helped them engage with community resources and made them more likely to seek VA care. CONCLUSIONS The caring letters intervention, received after contact with the VCL, was well received by participants. They described feeling appreciated, cared for, encouraged, and connected. The results of this study will inform future evaluation examining veteran outcomes.
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Affiliation(s)
- Sara J Landes
- Behavioral Health Quality Enhancement Research Initiative (QUERI) (Landes, Woods, Curtis) and Center for Mental Health Outcomes and Research (Abraham, Woods), Central Arkansas Veterans Healthcare System, North Little Rock; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Abraham); Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, D.C. (Lauver, Hughes); VA Puget Sound Health Care System, Seattle (Manchester, Porter, Reger); Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston (Garrido); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Traci H Abraham
- Behavioral Health Quality Enhancement Research Initiative (QUERI) (Landes, Woods, Curtis) and Center for Mental Health Outcomes and Research (Abraham, Woods), Central Arkansas Veterans Healthcare System, North Little Rock; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Abraham); Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, D.C. (Lauver, Hughes); VA Puget Sound Health Care System, Seattle (Manchester, Porter, Reger); Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston (Garrido); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Jack A Woods
- Behavioral Health Quality Enhancement Research Initiative (QUERI) (Landes, Woods, Curtis) and Center for Mental Health Outcomes and Research (Abraham, Woods), Central Arkansas Veterans Healthcare System, North Little Rock; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Abraham); Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, D.C. (Lauver, Hughes); VA Puget Sound Health Care System, Seattle (Manchester, Porter, Reger); Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston (Garrido); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Nyssa D Curtis
- Behavioral Health Quality Enhancement Research Initiative (QUERI) (Landes, Woods, Curtis) and Center for Mental Health Outcomes and Research (Abraham, Woods), Central Arkansas Veterans Healthcare System, North Little Rock; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Abraham); Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, D.C. (Lauver, Hughes); VA Puget Sound Health Care System, Seattle (Manchester, Porter, Reger); Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston (Garrido); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - MaryGrace Lauver
- Behavioral Health Quality Enhancement Research Initiative (QUERI) (Landes, Woods, Curtis) and Center for Mental Health Outcomes and Research (Abraham, Woods), Central Arkansas Veterans Healthcare System, North Little Rock; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Abraham); Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, D.C. (Lauver, Hughes); VA Puget Sound Health Care System, Seattle (Manchester, Porter, Reger); Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston (Garrido); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Caitlin Manchester
- Behavioral Health Quality Enhancement Research Initiative (QUERI) (Landes, Woods, Curtis) and Center for Mental Health Outcomes and Research (Abraham, Woods), Central Arkansas Veterans Healthcare System, North Little Rock; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Abraham); Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, D.C. (Lauver, Hughes); VA Puget Sound Health Care System, Seattle (Manchester, Porter, Reger); Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston (Garrido); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Melissa M Garrido
- Behavioral Health Quality Enhancement Research Initiative (QUERI) (Landes, Woods, Curtis) and Center for Mental Health Outcomes and Research (Abraham, Woods), Central Arkansas Veterans Healthcare System, North Little Rock; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Abraham); Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, D.C. (Lauver, Hughes); VA Puget Sound Health Care System, Seattle (Manchester, Porter, Reger); Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston (Garrido); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Shelan Porter
- Behavioral Health Quality Enhancement Research Initiative (QUERI) (Landes, Woods, Curtis) and Center for Mental Health Outcomes and Research (Abraham, Woods), Central Arkansas Veterans Healthcare System, North Little Rock; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Abraham); Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, D.C. (Lauver, Hughes); VA Puget Sound Health Care System, Seattle (Manchester, Porter, Reger); Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston (Garrido); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Gregory Hughes
- Behavioral Health Quality Enhancement Research Initiative (QUERI) (Landes, Woods, Curtis) and Center for Mental Health Outcomes and Research (Abraham, Woods), Central Arkansas Veterans Healthcare System, North Little Rock; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Abraham); Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, D.C. (Lauver, Hughes); VA Puget Sound Health Care System, Seattle (Manchester, Porter, Reger); Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston (Garrido); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Mark A Reger
- Behavioral Health Quality Enhancement Research Initiative (QUERI) (Landes, Woods, Curtis) and Center for Mental Health Outcomes and Research (Abraham, Woods), Central Arkansas Veterans Healthcare System, North Little Rock; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Abraham); Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, D.C. (Lauver, Hughes); VA Puget Sound Health Care System, Seattle (Manchester, Porter, Reger); Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston (Garrido); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
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Soderlund PD, Cheung EH, Cadiz MP, Siddiq H, Yerstein M, Lee S, Wells K, Heilemann MV. Bridging the gap: a qualitative study of providers' perceptions of a partnered crisis follow-up program for suicidal patients post-emergency department discharge. BMC Psychiatry 2023; 23:854. [PMID: 37978360 PMCID: PMC10655296 DOI: 10.1186/s12888-023-05106-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/11/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Effective interventions are needed to address suicide risk following discharge from the hospital emergency department or inpatient setting. Studies that examine follow-up contact methods show promise, but little is known about how follow-up programs are implemented in the real world and who is benefitting. The purpose of this formative evaluation and analysis was to gain insight about the usefulness and value of a partnered suicide prevention follow-up program (academic medical center emergency department partnered with a regional suicide prevention center) from the standpoint of psychiatry resident physicians providing direct care and suicide prevention center crisis counselors making follow-up outreach telephone calls to patients. METHODS A qualitative thematic analysis was conducted with focus group data from a convenience sample of psychiatry residents who performed consultations in the emergency department setting and counselors at the suicide prevention center crisis follow-up program. Focus group sessions, using semi-structured question guides, were completed at each participant group's workplace. Grounded theory techniques were used to guide coding and analytic theme development. RESULTS Analyses resulted in four overarching themes: valuing the program's utility and benefit to patients, desiring to understand what happens from emergency department discharge to program follow-up, having uncertainty about which patients would benefit from the program, and brainstorming to improve the referral process. Psychiatry residents appreciated the option of an "active" referral service (one that attempts to actively engage a patient after discharge through outreach), while suicide prevention crisis counselors valued their ability to offer a free and immediate service that had potential for fostering meaningful relationships. Both participant groups desired a better understanding of their partner's program operations, a uniform and smooth referral process, and awareness of who may or may not benefit from program services. CONCLUSION Results revealed the need for improved communication and implementation, such as expanded inter-agency contacts, consistent provider training, more documentation of the requirements and rules, a consistent message about program logistics for patients, and coordination between the program elements.
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Affiliation(s)
- Patricia D Soderlund
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, 624 East 1St St, Duluth, MN, 20155805, USA.
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, National Clinician Scholars Program, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA.
| | - Erick H Cheung
- David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Madonna P Cadiz
- Luskin School of Public Affairs, University of California Los Angeles, 337 Charles E Young Dr E, Los Angeles, CA, 90095, USA
| | - Hafifa Siddiq
- Charles R. Drew University College of Nursing, 1731 E. 120th St., Los Angeles, CA, 90059, USA
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
| | - Maria Yerstein
- Boston University School of Medicine, St. Elizabeth's Medical Center, 736 Cambridge St, Brighton, MA, 02135, USA
| | - Sae Lee
- Didi Hirsch Mental Health Services, 4760 S. Sepulveda Blvd, Culver City, CA. 90230, USA
| | - Kenneth Wells
- David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
- Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Suite 17.369B, Los Angeles, CA, 90024, USA
- David Geffen School of Medicine, National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
- Department of Mental Health, Veterans Affairs Greater Los Angeles HealthCare System, 11301 Wilshire Boulevard, Los Angeles, CA, 90073, USA
| | - MarySue V Heilemann
- School of Nursing, Factor Building, University of California Los Angeles, Box 6919, Los Angeles, CA, 90095, USA
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, National Clinician Scholars Program, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
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7
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Arias SA, Sperber K, Jones R, Taxman FS, Miller TR, Zylberfuden S, Weinstock LM, Brown GK, Ahmedani B, Johnson JE. Managed care updates of subscriber jail release to prompt community suicide prevention: clinical trial protocol. BMC Health Serv Res 2023; 23:1265. [PMID: 37974126 PMCID: PMC10655488 DOI: 10.1186/s12913-023-10249-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Recent jail detention is a marker for trait and state suicide risk in community-based populations. However, healthcare providers are typically unaware that their client was in jail and few post-release suicide prevention efforts exist. This protocol paper describes an effectiveness-implementation trial evaluating community suicide prevention practices triggered by advances in informatics that alert CareSource, a large managed care organization (MCO), when a subscriber is released from jail. METHODS This randomized controlled trial investigates two evidence-based suicide prevention practices triggered by CareSource's jail detention/release notifications, in a partial factorial design. The first phase randomizes ~ 43,000 CareSource subscribers who pass through any Ohio jail to receive Caring Contact letters sent by CareSource or to Usual Care after jail release. The second phase (running simultaneously) involves a subset of ~ 6,000 of the 43,000 subscribers passing through jail who have been seen in one of 12 contracted behavioral health agencies in the 6 months prior to incarceration in a stepped-wedge design. Agencies will receive: (a) notifications of the client's jail detention/release, (b) instructions for re-engaging these clients, and (c) training in suicide risk assessment and the Safety Planning Intervention for use at re-engagement. We will track suicide-related and service linkage outcomes 6 months following jail release using claims data. CONCLUSIONS This design allows us to rigorously test two intervention main effects and their interaction. It also provides valuable information on the effects of system-level change and the scalability of interventions using big data from a MCO to flag jail release and suicide risk. TRIAL REGISTRATION The trial is registered at clinicaltrials.gov (NCT05579600). Registered 27 June, 2023.
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Affiliation(s)
- Sarah A Arias
- Butler Hospital, Providence, RI, USA.
- Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, USA.
| | | | - Richard Jones
- Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, USA
| | - Faye S Taxman
- Center for Advancing Correctional Excellence!, George Mason University, Arlington, VA, USA
| | - Ted R Miller
- Pacific Institute for Research & Evaluation, Beltsville, MI, USA
- Curtin University School of Public Health, Perth, Australia
| | | | - Lauren M Weinstock
- Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, USA
| | - Gregory K Brown
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Ahmedani
- Department of Psychiatry, Henry Ford Health System, Detroit, MI, USA
| | - Jennifer E Johnson
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint, MI, USA
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Arias SA, Sperber K, Jones R, Taxman FS, Miller TR, Zylberfuden S, Weinstock LM, Brown GK, Ahmedani B, Johnson JE. Managed Care Updates of Subscriber Jail Release to Prompt Community Suicide Prevention: Clinical Trial Protocol. RESEARCH SQUARE 2023:rs.3.rs-3350204. [PMID: 37841869 PMCID: PMC10571633 DOI: 10.21203/rs.3.rs-3350204/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Recent jail detention is a marker for trait and state suicide risk in community-based populations. However, healthcare providers are typically unaware that their client was in jail and few post-release suicide prevention efforts exist. This protocol paper describes an effectiveness-implementation trial evaluating community suicide prevention practices triggered by advances in informatics that alert CareSource, a large managed care organization (MCO), when a subscriber is released from jail. Methods This randomized controlled trial investigates two evidence-based suicide prevention practices triggered by CareSource's jail detention/release notifications, in a partial factorial design. The first phase randomizes ~43,000 CareSource subscribers who pass through any Ohio jail to receive Caring Contact letters sent by CareSource or to Usual Care after jail release. The second phase (running simultaneously) involves a subset of ~6,000 of the 43,000 subscribers passing through jail who have been seen in one of 12 contracted behavioral health agencies in the 6 months prior to incarceration in a stepped-wedge design. Agencies will receive: (a) notifications of the client's jail detention/release, (b) instructions for re-engaging these clients, and (c) training in suicide risk assessment and the Safety Planning Intervention for use at re-engagement. We will track suicide-related and service linkage outcomes 6 months following jail release using claims data. Conclusions This design allows us to rigorously test two intervention main effects and their interaction. It also provides valuable information on the effects of system-level change and the scalability of interventions using big data from a MCO to flag jail release and suicide risk. Trial Registration The trial is registered at clinicaltrials.gov (NCT05579600). Registered 27 June, 2023, https://beta.clinicaltrials.gov/study/NCT05579600?cond=Suicide&term=Managed%20Care&rank=1.
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9
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Radin AK, Shaw J, Brown SP, Flint H, Fouts T, McCue E, Skeie A, Peña C, Youell J, Ratzliff A, Powers DM, Biss M, Lemon H, Sandoval D, Hartmann J, Hammar E, Doty-Jones A, Wilson J, Austin G, Chan KCG, Zheng Z, Fruhbauerova M, Ross M, Stright M, Pullen S, Edwards C, Walton M, Kerbrat A, Comtois KA. Comparative effectiveness of safety planning intervention with instrumental support calls (ISC) versus safety planning intervention with two-way text message caring contacts (CC) in adolescents and adults screening positive for suicide risk in emergency departments and primary care clinics: Protocol for a pragmatic randomized controlled trial. Contemp Clin Trials 2023; 131:107268. [PMID: 37321352 PMCID: PMC10530453 DOI: 10.1016/j.cct.2023.107268] [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: 03/31/2023] [Revised: 05/24/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Suicide is a leading cause of death in adolescents and adults in the US. Follow-up support delivered when patients return home after an emergency department (ED) or primary care encounter can significantly reduce suicidal ideation and attempts. Two follow-up models to augment usual care including the Safety Planning Intervention have high efficacy: Instrumental Support Calls (ISC) and Caring Contacts (CC) two-way text messages, but they have never been compared to assess which works best. This protocol for the Suicide Prevention Among Recipients of Care (SPARC) Trial aims to determine which model is most effective for adolescents and adults with suicide risk. METHODS The SPARC Trial is a pragmatic randomized controlled trial comparing the effectiveness of ISC versus CC. The sample includes 720 adolescents (12-17 years) and 790 adults (18+ years) who screen positive for suicide risk during an ED or primary care encounter. All participants receive usual care and are randomized 1:1 to ISC or CC. The state suicide hotline delivers both follow-up interventions. The trial is single-masked, with participants unaware of the alternative treatment, and is stratified by adolescents/adults. The primary outcome is suicidal ideation and behavior, measured using the Columbia Suicide Severity Rating Scale (C-SSRS) screener at 6 months. Secondary outcomes include C-SSRS at 12 months, and loneliness, return to crisis care for suicidality, and utilization of outpatient mental health services at 6 and 12 months. DISCUSSION Directly comparing ISC and CC will determine which follow-up intervention is most effective for suicide prevention in adolescents and adults.
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Affiliation(s)
- Anna K Radin
- St. Luke's Health System, Applied Research Division, Boise, ID, United States.
| | - Jenny Shaw
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Siobhan P Brown
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Hilary Flint
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Tara Fouts
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Elizabeth McCue
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Anton Skeie
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Cecelia Peña
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Jonathan Youell
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Anna Ratzliff
- University of Washington, Department of Psychiatry and Behavioral Sciences,, Seattle, WA, United States
| | - Diane M Powers
- University of Washington, Department of Psychiatry and Behavioral Sciences,, Seattle, WA, United States
| | - Matthew Biss
- Idaho Crisis and Suicide Hotline, Boise, ID, United States; SPARC Lived Experience Advisory Board, ID, United States
| | - Hannah Lemon
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | | | | | | | - Amelia Doty-Jones
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Jacob Wilson
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States; Cornerstone Whole Healthcare Organization, Inc., McCall, ID, United States
| | - George Austin
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | - Kwun C G Chan
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Zihan Zheng
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Martina Fruhbauerova
- University of Washington, Department of Psychiatry and Behavioral Sciences,, Seattle, WA, United States
| | - Michelle Ross
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Megan Stright
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Samuel Pullen
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States; Novant Health, Psychiatry and Mental Health Institute, Winston-Salem, NC, United States; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, United States
| | - Christopher Edwards
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States; National Staffing Solutions (Contracted Provider for Optum Serve), Twin Falls, ID, United States
| | - Michael Walton
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Amanda Kerbrat
- University of Washington, Department of Psychiatry and Behavioral Sciences,, Seattle, WA, United States
| | - Katherine Anne Comtois
- University of Washington, Department of Psychiatry and Behavioral Sciences,, Seattle, WA, United States
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Bogic M, Hebert LE, Evanson A, Wright BD, Petras A, Jansen K, Shaw J, Comtois KA, Nelson L. "Keep up the messages, sometimes it was a lifesaver": Effects of cultural adaptation on a suicide prevention clinical trial in American Indian/Alaska Native communities. Behav Res Ther 2023; 166:104333. [PMID: 37224700 PMCID: PMC10354378 DOI: 10.1016/j.brat.2023.104333] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023]
Abstract
Suicide disproportionately affects many American Indian/Alaska Native (AI/AN) communities. Caring Contacts is one of the few suicide prevention interventions with demonstrated success in diverse populations, but its acceptability and effectiveness have not been evaluated in AI/AN communities. Using community-based participatory research (Phase 1), we conducted focus groups and semi-structured interviews with AI/AN adults, healthcare providers, and leaders in four communities to improve study design and maximize intervention acceptability and effectiveness for implementation in a randomized controlled trial (Phase 2). This paper describes how adaptations made during Phase 1 affected the acceptability, fit, and responsiveness of the study features to the communities' needs. Acceptability of the study procedures and materials in this community appears to be high, with 92% of participants indicating the initial assessment interview was a positive experience. Broadening eligibility criteria with regard to age and possession of a cellular device resulted in the recruitment of an additional 48% and 46% of participants, respectively. Inclusion of locally-informed methods of self-harm allowed us to capture a wider range of suicidal behavior than would have otherwise been identified. Clinical trials would benefit from community-engaged, cultural adaptation studies with populations in which the interventions would eventually be applied.
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Affiliation(s)
- Marija Bogic
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
| | - Luciana E Hebert
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
| | - Anna Evanson
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
| | - Barbara D Wright
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
| | - Anthippy Petras
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
| | - Kelley Jansen
- Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK, 99577, USA.
| | - Jennifer Shaw
- Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK, 99577, USA.
| | - Katherine Anne Comtois
- University of Washington, Box 359911, Harborview Medical Center, Seattle, WA, 98195, USA.
| | - Lonnie Nelson
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
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11
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Radin AK, Shaw J, Brown SP, Torres J, Harper M, Flint H, Fouts T, McCue E, Skeie A, Peña C, Youell J, Doty-Jones A, Wilson J, Flinn L, Austin G, Chan KCG, Zheng Z, Fruhbauerova M, Walton M, Kerbrat A, Comtois KA. Comparative effectiveness of two versions of a caring contacts intervention in healthcare providers, staff, and patients for reducing loneliness and mental distress: A randomized controlled trial. J Affect Disord 2023; 331:442-451. [PMID: 36963515 PMCID: PMC10304492 DOI: 10.1016/j.jad.2023.03.029] [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: 09/19/2022] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Caring Contacts can effectively reduce suicide ideation, attempts, and death. In published clinical trials, Caring Contacts were sent by someone who knew the recipient. At scale, Caring Contacts programs rarely introduce the recipient and sender. It is not known whether receiving Caring Contacts from someone unknown is as effective as messages from someone the recipient has met. METHODS Pragmatic randomized controlled trial comparing Caring Contacts with (CC+) versus without an introductory phone call (CC). Recruitment occurred January-July 2021, with outcomes assessed at 6 months. Participants were primary care patients or healthcare providers/staff reporting adverse mental health outcomes on a qualifying survey. Participants were sent 11 standardized caring text messages over 6 months; when participants replied, they received personalized unscripted responses. CC+ calls were semi-structured. The primary outcome was loneliness (NIH Toolkit). RESULTS Participants included 331 patients (mean [SD] age: 45.5 [16.4], 78.9 % female) and 335 healthcare providers/staff (mean [SD] age: 40.9 [11.8], 86.6 % female). There were no significant differences in loneliness at 6 months by treatment arm in either stratum. In patients, mean (SD) loneliness was 61.9 (10.7) in CC, and 60.8 (10.3) in CC+, adjusted mean difference of -1.0 (95 % CI: -3.0, 1.0); p-value = 0.31. In providers/staff, mean (SD) loneliness was 61.2 (11) in CC, and 61.3 (11.1) in CC+, adjusted mean difference of 0.2 (95 % CI: -1.8, 2.2); p-value = 0.83. LIMITATIONS Study population was 93 % white which may limit generalizability. CONCLUSIONS Including an initial phone call added operational complexity without significantly improving the effectiveness of a Caring Contacts program.
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Affiliation(s)
- Anna K Radin
- St. Luke's Health System, Applied Research Division, Boise, ID, United States.
| | - Jenny Shaw
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Siobhan P Brown
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Jessica Torres
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | - Maggie Harper
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | - Hilary Flint
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Tara Fouts
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Elizabeth McCue
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Anton Skeie
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Cecelia Peña
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Jonathan Youell
- St. Luke's Health System, Applied Research Division, Boise, ID, United States
| | - Amelia Doty-Jones
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Jacob Wilson
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Lee Flinn
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | - George Austin
- Idaho Crisis and Suicide Hotline, Boise, ID, United States
| | - Kwun C G Chan
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Zihan Zheng
- University of Washington, Department of Biostatistics, Seattle, WA, United States
| | - Martina Fruhbauerova
- University of Washington, Department of Psychiatry and Behavioral Sciences, Center for Suicide Prevention & Recovery, Seattle, WA, United States
| | - Michael Walton
- St. Luke's Health System, Behavioral Health Service Line, Boise, ID, United States
| | - Amanda Kerbrat
- University of Washington, Department of Psychiatry and Behavioral Sciences, Center for Suicide Prevention & Recovery, Seattle, WA, United States
| | - Katherine Anne Comtois
- University of Washington, Department of Psychiatry and Behavioral Sciences, Center for Suicide Prevention & Recovery, Seattle, WA, United States
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12
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DeVylder JE, Ryan TC, Cwik M, Wilson ME, Jay S, Nestadt PS, Goldstein M, Wilcox HC. Assessment of Selective and Universal Screening for Suicide Risk in a Pediatric Emergency Department. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:217-224. [PMID: 37201139 PMCID: PMC10172558 DOI: 10.1176/appi.focus.23021007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Importance According to National Patient Safety Goal 15.01.01, all individuals being treated or evaluated for behavioral health conditions as their primary reason for care in hospitals and behavioral health care organizations accredited by The Joint Commission should be screened for suicide risk using a validated tool. Existing suicide risk screens have minimal or no high-quality evidence of association with future suicide-related outcomes. Objective To test the association between results of the Ask Suicide-Screening Questions (ASQ) instrument in a pediatric emergency department (ED), implemented through selective and universal screening approaches, and subsequent suicide-related outcomes. Design Setting and Participants In this retrospective cohort study at an urban pediatric ED in the United States, the ASQ was administered to youths aged 8 to 18 years with behavioral and psychiatric presenting problems from March 18, 2013, to December 31, 2016 (selective condition), and then to youths aged 10 to 18 years with medical presenting problems (in addition to those aged 8-18 years with behavioral and psychiatric presenting problems) from January 1, 2017, to December 31, 2018 (universal condition). Exposure Positive ASQ screen at baseline ED visit. Main Outcomes and Measures The main outcomes were subsequent ED visits with suicide-related presenting problems (ie, ideation or attempts) based on electronic health records and death by suicide identified through state medical examiner records. Association with suicide-related outcomes was calculated over the entire study period using survival analyses and at 3-month follow-up for both conditions using relative risk. Results The complete sample was 15003 youths (7044 47.0%] male; 10209 [68.0%] black; mean [SD] age, 14.5 [3.1] years at baseline). The follow-up for the selective condition was a mean (SD) of 1133.7 (433.3) days; for the universal condition, it was 366.2 (209.2) days. In the selective condition, there were 275 suicide-related ED visits and 3 deaths by suicide. In the universal condition, there were 118 suicide-related ED visits and no deaths during the follow-up period. Adjusting for demographic characteristics and baseline presenting problem, positive ASQ screens were associated with greater risk of suicide-related outcomes among both the universal sample (hazard ratio, 6.8 [95% CI, 4.2-11.1]) and the selective sample (hazard ratio, 4.8 [95% CI, 3.5-6.5]). Conclusions and Relevance Positive results of both selective and universal screening for suicide risk in pediatric EDs appear to be associated with subsequent suicidal behavior. Screening may be a particularly effective way to detect suicide risk among those who did not present with ideation or attempt. Future studies should examine the impact of screening in combination with other policies and procedures aimed at reducing suicide risk.Appeared originally in JAMA Netw Open 2019; 2:e1914070.
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Affiliation(s)
- Jordan E DeVylder
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Taylor C Ryan
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Mary Cwik
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Mary Ellen Wilson
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Samantha Jay
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Paul S Nestadt
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Mitchell Goldstein
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Holly C Wilcox
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
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Holman S, Steinberg R, Sinyor M, Lane H, Starritt K, Kennedy SH, Niederkrotenthaler T, Zaretsky A, Castel S, Schaffer A. Caring Contacts to Reduce Psychiatric Morbidity Following Hospitalization During the COVID-19 Pandemic: A Pilot Randomized Controlled Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:152-162. [PMID: 35996823 PMCID: PMC9412148 DOI: 10.1177/07067437221121111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Caring Contacts are an emerging intervention that aims to reduce distress and suicide risk after acute psychiatric care. This trial aimed to determine whether, during a pandemic, there was any evidence that the mental health benefits and reduction in suicidal ideation (SI) associated with delivering Caring Contacts to recently discharged psychiatric patients were greater than a control communication. The secondary objective was to identify whether the predicted benefits were greater among people living alone or those diagnosed with depression. METHOD A single-site pilot randomized clinical trial (n = 100), with patients recruited from the adult Inpatient Psychiatry Unit at Sunnybrook Health Sciences Centre, Toronto, Canada between August 2020 and May 2021. Participants were randomized (1:1) to the Caring Contact or control group. Participants received three Caring Contact or control communications via email or mail (on days 4, 21, and 56 post-discharge). Mental health symptoms were assessed using the self-report Hopkins Symptom Checklist-25 (HSCL-25) scores at discharge (baseline) and when participants received each communication. Analysis of variance was used for the primary comparisons and exploratory analyses for subgroups. RESULTS Both groups experienced a significant worsening of mental health symptoms at all time points post-discharge relative to baseline. There were no significant differences between groups at any time point, however, on day 4 there was a 24.2% and 72.6% attenuated worsening in the Caring Contact group compared to the control group for total symptom severity and SI, respectively. There was no significant interaction effect for the depression subgroup or those living alone. CONCLUSIONS While this pilot study was not powered to identify significant differences between groups, results are indicative of feasibility and acceptability of the intervention and provide some indication that Caring Contacts may have benefited patients in the days following discharge, supporting the need for larger-scale trials. The study was registered with clinicaltrials.gov (study ID NCT04456062).
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Affiliation(s)
- Sarah Holman
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rosalie Steinberg
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada
| | - Mark Sinyor
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada
| | - Hillary Lane
- Department of Psychiatry Patient and Family Advisory Council, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kaleigh Starritt
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,10071Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Ari Zaretsky
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada
| | - Saulo Castel
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada
| | - Ayal Schaffer
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada
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14
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Rusé J, Clenet A, Vaiva G, Debien C, Arbus C, Salles J. The association between reattempted suicide and incoming calls to the brief contact intervention service, VigilanS: a study of the clinical profile of callers. BMC Psychiatry 2023; 23:21. [PMID: 36624409 PMCID: PMC9829445 DOI: 10.1186/s12888-022-04503-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Suicide is a major health problem globally. As attempted suicide is a major risk factor for suicide, specific prevention strategies have been designed for use thereafter. An example is the brief contact intervention (BCI). In this regard, France employs a composite BCI, VigilanS, which utilizes three types of contact: phone calls, postcards and a 'who to contact in a crisis' card. Previous studies have found that this system is effective at preventing suicide. Nevertheless, VigilanS was not effective in the same way for all the patients included. This observation raises the question of specific adaptation during follow-up for populations that were less receptive to the service. In consideration of this issue, we identified one study which found that incoming calls to the service were linked with a higher risk of suicide reattempts. However, this study did not document the profiles of the patients who made these calls. Better understanding of why this population is more at risk is important in terms of identifying factors that could be targeted to improve follow-up. This research therefore aims to bring together such data. METHODS We performed a retrospective analysis of 579 patients referred to VigilanS by Toulouse University Hospital (France). We examined the sociodemographics, clinical characteristics, and follow-ups in place and compared the patients who made incoming calls to the service versus those who did not. Subsequently, we conducted a regression analysis using the significantly associated element of patients calling VigilanS. Then, in order to better understand this association, we analyzed the factors, including such calls, that were linked to the risk of suicide reattempts. RESULTS We found that 22% of the patients in our sample called the VigilanS service. These individuals: were older, at 41.4 years versus 37.9 years for the non-callers; were more likely to have a borderline personality disorder (BPD) diagnosis (28.9% versus 19.3%); and had a history of suicide attempts (71.9% versus 54.6%). Our analysis confirmed that incoming calls to VigilanS (OR = 2.9) were associated with reattempted suicide, as were BPD (OR = 1.8) and a history of suicide attempts (OR = 1.7). CONCLUSION There was a high risk that the patients calling VigilanS would make another suicide attempt. However, this association was present regardless of the clinical profile. We postulate that this link between incoming calls and reattempted suicide may arise because this form of contact is, in fact, a way in which patients signal that a further attempt will be made.
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Affiliation(s)
- Jeanne Rusé
- grid.411175.70000 0001 1457 2980Department of Psychiatry, University Hospital of Toulouse, CHU Toulouse, Toulouse, France
| | - Adeline Clenet
- grid.411175.70000 0001 1457 2980Department of Psychiatry, University Hospital of Toulouse, CHU Toulouse, Toulouse, France
| | - Guillaume Vaiva
- Centre National de Ressources et de Résilience Lille-Paris, Lille, France ,grid.410463.40000 0004 0471 8845Department of Psychiatry, Centre Hospitalier Universitaire de Lille, Inserm, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
| | - Christophe Debien
- Centre National de Ressources et de Résilience Lille-Paris, Lille, France ,grid.410463.40000 0004 0471 8845Department of Psychiatry, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Christophe Arbus
- grid.411175.70000 0001 1457 2980University Hospital of Toulouse, CHU Toulouse, Department of Psychiatry, Toulouse NeuroImaging Center, ToNIC, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Juliette Salles
- University Hospital of Toulouse, CHU Toulouse, Department of Psychiatry, Infinity (Toulouse Institute for Infectious and Inflammatory Diseases), INSERM UMR1291, CNRS UMR5051, Université Toulouse III, Toulouse, France.
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15
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Jansen KJ, Shaw JL, Comtois KA, Elliott-Groves E, Slaney T, Avey JP, Nelson L. Culturally Adapting Caring Contacts for Suicide Prevention in Four Alaska Native and American Indian Communities. Arch Suicide Res 2023; 27:89-106. [PMID: 34492210 PMCID: PMC8898990 DOI: 10.1080/13811118.2021.1967820] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM Despite substantial tribal, state, and federal effort, American Indian and Alaska Native (AI/AN) suicide rates have changed little in the last 30 years, prompting attention to new and innovative approaches to this persistent health disparity. Suicide prevention interventions with demonstrated success in other populations may be useful in AI/AN communities. Caring Contacts is a suicide prevention intervention that has been adapted and shown to reduce suicide ideation, attempts, and deaths in other populations. CONCLUSION Overall, AI/AN study participants in four diverse AI/AN communities endorsed the use of Caring Contacts for suicide prevention in their communities. Intervention adaptations for use in these communities centered primarily on message frequency and timing as well as expanding access to Caring Contacts. The results of this study may be applicable to other populations that experience suicide-related health disparities. METHODS We used a community-based participatory research approach to gather qualitative data from community members, healthcare providers, and leaders in four AI/AN communities. These data were analyzed thematically and used to adapt Caring Contacts for use in a subsequent clinical trial with AI/AN people at high risk for suicide. RESULTS A total of 189 community members and other health system stakeholders in four tribal communities participated in focus groups and interviews. Caring Contacts was perceived in all communities to be acceptable. Feedback for intervention adaptations focused on the themes of trial eligibility criteria; instruments; message frequency, timing, and content; and cultural considerations.
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16
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Tay JL, Li Z. Brief contact interventions to reduce suicide among discharged patients with mental health disorders-A meta-analysis of RCTs. Suicide Life Threat Behav 2022; 52:1074-1095. [PMID: 35899821 DOI: 10.1111/sltb.12903] [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: 09/24/2020] [Revised: 03/22/2022] [Accepted: 07/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Worldwide, about 1 million died from suicide in 2000. People with mental health disorders are at greater risk of suicide, and they are especially susceptible during 1-week period after discharge from the hospital. OBJECTIVE This meta-analysis paper aims to evaluate the effectiveness of brief contact interventions in preventing (1) suicidal deaths, (2) suicidal attempts, and (3) suicidal ideations among mental health patients discharged from the hospital. METHODS Search for published and unpublished articles were conducted using 10 databases: CINAHL, Cochrane Central Register of Controlled Trials, Embase, Scopus, Pubmed, PsycINFO, Web of Science, Randomised Control Trial Registry Website, ClinicalTrials.gov, and Proquest Dissertation and Theses Global, using the keywords "suicide" AND "discharged," AND "patients." All articles printed in English and published from the year 1995 to August 2019 were included. RESULTS A total of 23 articles were included in the meta-analysis. Contact interventions significantly reduced suicidal attempts within (1) 12-14 months and (2) suicide ideations within 12 months. There were no significant findings on suicidal deaths. DISCUSSION A new finding of this meta-analysis is that combining several brief contact interventions could potentially reduce suicidal attempts and ideations. This is important in preserving the lives of discharged patients.
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Affiliation(s)
- Jing Ling Tay
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Ziqiang Li
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
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17
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Schmeckenbecher J, Rattner K, Cramer RJ, Plener PL, Baran A, Kapusta ND. Effectiveness of distance-based suicide interventions: multi-level meta-analysis and systematic review. BJPsych Open 2022; 8:e140. [PMID: 35861112 PMCID: PMC9345623 DOI: 10.1192/bjo.2022.526] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of distance-based interventions (DBIs) to reduce suicidal ideation and behaviours are an increasingly relevant form of intervention. DBIs are more affordable, scalable and available than traditional face-to-face interventions, helping to narrow the gap between needed and provided care. AIMS To evaluate the overall effectiveness of DBIs against suicidal ideation and behaviours. METHOD We systematically searched Web of Science, Scopus and PubMed for all DBIs primarily aimed at reducing suicidal ideation and behaviours. Data were analysed with a robust variance estimation corrected, multi-level meta-analysis. RESULTS We found 38 studies, reporting 110 outcomes. Effectiveness in reducing suicidal ideation was low (standardised mean difference -0.174, 95% CI -0.238 to -0.110). DBIs were significantly less effective against suicidal behaviours than against suicidal ideation, although still effective (standardised mean difference -0.059, 95% CI -0.087 to -0.032). Human involvement had no significant effect on effectiveness. CONCLUSIONS Despite low effectiveness, DBIs might play a role in large-scale prevention efforts against suicidal ideation within a stepped care approach. Further, DBIs may be helpful in expanding mental health services in low- and middle-income countries with otherwise limited access to mental healthcare. Although the evidence for DBIs efficacy is well grounded, the technical and scientific evaluation of DBIs regarding their set up, functionality and components needs to be addressed in future studies.
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Affiliation(s)
- Jim Schmeckenbecher
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Austria
| | - Katrin Rattner
- Clinic for Psychiatry and Psychotherapy, kbo-Inn-Salzach-Klinikum, Freilassing, Germany
| | - Robert J Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, North Carolina, USA
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria; and Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Germany
| | - Anna Baran
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Sweden; and Department of Psychiatry, Blekinge Hospital, Sweden
| | - Nestor D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Austria
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18
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McGill K, Whyte IM, Sawyer L, Adams D, Delamothe K, Lewin TJ, Robinson J, Kay-Lambkin FJ, Carter GL. Effectiveness of the Hunter Way Back Support Service: An historical controlled trial of a brief non-clinical after-care program for hospital-treated deliberate self-poisoning. Suicide Life Threat Behav 2022; 52:500-514. [PMID: 35122297 DOI: 10.1111/sltb.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/27/2021] [Accepted: 11/12/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Active contact and follow-up interventions have been shown to be effective in reducing repetition of hospital-treated self-harm. The Way Back Support Service (WBSS) is a new service funded by the Australian government to provide three months of non-clinical after-care following a hospital-treated suicide attempt. The aim of this study was to investigate the effectiveness of WBSS in reducing deliberate self-poisoning (DSP) and psychiatric hospital admissions over a 12-month follow-up period for a population of DSP patients within the Hunter (Australia) region. METHODS A non-randomized, historical controlled (two periods) trial design with intention-to-treat analyses. Outcome data were drawn from hospital records. RESULTS There were a total of 2770 participants across study periods. There were no significant differences between cohorts for proportion with any, or number of, re-admissions for DSP in the follow-up period. For psychiatric admissions, the intervention cohort had a non-significantly greater proportion with any psychiatric admission and significantly more admissions compared to one of the control cohorts. CONCLUSION The WBSS model of care should be modified to strengthen treatment engagement and retention and to include established, clinical, evidence-based treatments shown to reduce DSP repetition. Any modified WBSS model should be subject to further evaluation.
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Affiliation(s)
- Katie McGill
- MH-READ, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Ian M Whyte
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Lisa Sawyer
- Hunter Primary Care, Newcastle, New South Wales, Australia
| | - Danielle Adams
- Hunter Primary Care, Newcastle, New South Wales, Australia
| | | | - Terry J Lewin
- MH-READ, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jo Robinson
- Orygen, Parkvillle, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkvillle, Victoria, Australia
| | - Frances J Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gregory L Carter
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Calvary Mater Newcastle, Newcastle, New South Wales, Australia
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19
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Pouquet M, Niare D, Guerrisi C, Blanchon T, Hanslik T, Younes N. [Suicide prevention: How to act?]. Rev Med Interne 2022; 43:375-380. [PMID: 35606205 DOI: 10.1016/j.revmed.2022.03.342] [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: 08/03/2021] [Revised: 03/04/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022]
Abstract
Although being complex, suicide is a phenomenon considered as preventable, and its prevention has been made as a public health priority. Some interventions to prevent suicide have been evaluated, such as the education of the healthcare workers, especially in the suicidal assessment (suicidal risk and suicidal emergency/dangerousness), the diagnosis and management of common mental disorders, the care provided after a suicide attempt, the restriction access to common means of suicide, the use of websites to educate the public, or the appropriate reports of suicide in media. Other interventions, even not rigorously evaluated, are implemented in France as in many parts of the world. It is the case of interventions among identified high-risk groups. To be efficient, prevention programs should simultaneously include different strategies targeting several known risk factors for suicide. Clinicians play a crucial role in the suicide prevention strategies.
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Affiliation(s)
- M Pouquet
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France.
| | - D Niare
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France
| | - C Guerrisi
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France
| | - T Blanchon
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France
| | - T Hanslik
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France; Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, AP-HP, 92100 Boulogne-Billancourt, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 78280 Versailles, France
| | - N Younes
- UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 78280 Versailles, France; Université Versailles-Saint-Quentin, université Paris Saclay, CESP, Team DevPsy, 94807 Villejuif, France; Centre hospitalier Versailles, service hospitalo-universitaire de psychiatrie de l'adulte et d'addictologie, 78157 Le Chesnay, France; Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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20
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Spottswood M, Lim CT, Davydow D, Huang H. Improving Suicide Prevention in Primary Care for Differing Levels of Behavioral Health Integration: A Review. Front Med (Lausanne) 2022; 9:892205. [PMID: 35712115 PMCID: PMC9196265 DOI: 10.3389/fmed.2022.892205] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
Importance Suicide prevention implementation in primary care is needed due to the increasing rate of suicide in the past few decades, particularly for young and marginalized people. Primary care is the most likely point of contact for suicidal patients in the healthcare system. Attention to the level of medical integration with behavioral health is vital to suicide prevention and is applied throughout this review. Methods A narrative review was performed. Observations Many interventions help improve suicide prevention care. PCP education, screening, safety planning/lethal means reduction, care transitions, psychotherapy, and medication management are all evidence-based strategies. Additionally, the pragmatic topics of financing suicide prevention, supporting providers, enacting suicide postvention, and preparing for future directions in the field at each level of primary care/behavioral health integration are discussed. Conclusions and Relevance The findings are clinically relevant for practices interested in implementing evidence-based suicide prevention strategies by attending to the behavioral health/medical interface. Leveraging the patient/provider relationship to allow for optimal suicide prevention care requires clinics to structure provider time to allow for emotionally present care. Defining clear roles for staff and giving attention to provider well being are also critical factors to supporting primary care-based suicide prevention efforts.
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Affiliation(s)
- Margaret Spottswood
- Department of Psychiatry, University of Vermont Medical Center, University of Vermont, Burlington, VT, United States
- Department of Psychiatry, Community Health Centers of Burlington, Burlington, VT, United States
| | - Christopher T. Lim
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Dimitry Davydow
- Executive Leadership, Comprehensive Life Resources, Tacoma, WA, United States
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
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Reger MA, Lauver MG, Manchester C, Abraham TH, Landes SJ, Garrido MM, Griffin C, Woods JA, Strombotne KL, Hughes G. Development of the Veterans Crisis Line Caring Letters Suicide Prevention Intervention. Health Serv Res 2022; 57 Suppl 1:42-52. [DOI: 10.1111/1475-6773.13985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/22/2022] [Accepted: 03/28/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Mark A. Reger
- VA Puget Sound Health Care System Seattle WA USA
- Department of Psychiatry and Behavioral Sciences University of Washington Seattle WA USA
| | - Mary Grace Lauver
- Department of Veterans Affairs, Veterans Crisis Line Office of Mental Health and Suicide Prevention, VA Central Office Washington DC USA
| | | | - Traci H. Abraham
- Center for Mental Health Outcomes and Research Central Arkansas Veterans Healthcare System North Little Rock AR USA
- South Central Mental Illness Research Education and Clinical Center (MIRECC) Central Arkansas Veterans Healthcare System North Little Rock AR USA
| | - Sara J. Landes
- South Central Mental Illness Research Education and Clinical Center (MIRECC) Central Arkansas Veterans Healthcare System North Little Rock AR USA
- Behavioral Health QUERI Central Arkansas Veterans Healthcare System North Little Rock AR USA
- Department of Psychiatry University of Arkansas for Medical Sciences Little Rock AR USA
| | - Melissa M. Garrido
- VA Boston Healthcare System Boston MA USA
- Boston University School of Public Health Boston MA USA
| | - Cameron Griffin
- Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation Center Office of Mental Health and Suicide Prevention Ann Arbor Michigan USA
| | - Jack A. Woods
- Center for Mental Health Outcomes and Research Central Arkansas Veterans Healthcare System North Little Rock AR USA
| | - Kiersten L. Strombotne
- VA Boston Healthcare System Boston MA USA
- Boston University School of Public Health Boston MA USA
| | - Gregory Hughes
- Department of Veterans Affairs, Veterans Crisis Line Office of Mental Health and Suicide Prevention, VA Central Office Washington DC USA
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22
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Fossi LD, Debien C, Demarty AL, Vaiva G, Messiah A. Loss to follow-up in a population-wide brief contact intervention to prevent suicide attempts - The VigilanS program, France. PLoS One 2022; 17:e0263379. [PMID: 35231052 PMCID: PMC8887722 DOI: 10.1371/journal.pone.0263379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Brief Contact Interventions (BCIs) after a suicide attempt (SA) are an important element of prevention against SA and suicide. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls and sending postcards, according to a predefined algorithm. However, a major obstacle to such real-life intervention is the loss of contact during follow-up. Here, we analyze the occurrence of loss of follow-up (LFU) and compare characteristics of patients LFU with follow-up completers. METHODS The study concerned patients included in VigilanS over the period from 1st January 2015 to 31 December 2018, with an end of follow-up on 1st July 2019. We performed a series of descriptive analysis and logistic regressions. The outcome was the loss to follow-up, relative to the 6th month call marking the end of the follow-up; the predictive variables were the characteristics of the patient at entry and during follow-up. Age and sex were considered as adjustment variables. RESULTS 11879 inclusions occurred during the study period, corresponding to 10666 different patients. The mean age was 40.6 ± 15 years. More than a third were non-first suicide attempters (46.6%) and the most frequent means of suicide was by voluntary drug intoxication (83.2%). 8335 patients were LFU. After simple and multiple regression, a significant relationship with loss to follow-up was identified among non-first suicide attempters, alcohol consumers, patients having no companion on arrival at the emergency room, patients who didn't make or receive any calls. An increased stay in hospital after a SA was a protective factor against loss of follow-up. CONCLUSION A majority of patients were lost to follow-up by the expected surveillance time of 6 months. Characteristics of lost patients will help focusing efforts to improve retention in the VigilanS program and might give insights for BCI implemented elsewhere.
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Affiliation(s)
- Larissa Djembi Fossi
- INSERM, MOODS Research unit “Depression, Anxiety, Psychotraumatism and Suicide”, Centre de recherche en Epidémiologie et santé des populations (CESP), Université Paris-Saclay, Hôpital Paul-Brousse, Villejuif, France
- INSERM, Sorbonne University, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Social Epidemiology Team, Paris, France
| | - Christophe Debien
- Department of Psychiatry, University Hospital of Lille, Lille, France
- Univ. Lille, Inserm, CHU Lille, U1172—LilNCog (JPARC)—Lille Neurosciences & Cognition, Lille, France
- Centre National de Ressources et Résilience Pour Les Psychotraumas (Cn2r Lille Paris), Department of Psychiatry, University Hospital of Lille, Lille, France
| | | | - Guillaume Vaiva
- Department of Psychiatry, University Hospital of Lille, Lille, France
- Univ. Lille, Inserm, CHU Lille, U1172—LilNCog (JPARC)—Lille Neurosciences & Cognition, Lille, France
- Centre National de Ressources et Résilience Pour Les Psychotraumas (Cn2r Lille Paris), Department of Psychiatry, University Hospital of Lille, Lille, France
| | - Antoine Messiah
- INSERM, MOODS Research unit “Depression, Anxiety, Psychotraumatism and Suicide”, Centre de recherche en Epidémiologie et santé des populations (CESP), Université Paris-Saclay, Hôpital Paul-Brousse, Villejuif, France
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23
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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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24
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Ehret BC, Treichler EBH, Ehret PJ, Chalker SA, Depp CA, Perivoliotis D. Designed and created for a veteran by a veteran: A pilot study of caring cards for suicide prevention. Suicide Life Threat Behav 2021; 51:872-881. [PMID: 33998035 DOI: 10.1111/sltb.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/14/2020] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This pilot study investigates feasibility and acceptability of Caring Cards, a suicide prevention intervention inspired by Caring Contacts and the Recovery Model, where Veteran peers create cards that are sent to Veterans recently discharged from a VA psychiatric hospitalization for suicide risk. METHODS Caring Cards consists of: (1) a weekly outpatient group where Veterans (card makers) create cards, and (2) sending cards to recently discharged Veterans (card recipients). Feasibility for card makers was measured by attendance; acceptability (satisfaction) was examined. Card recipients were sent one caring card, one week post-discharge. Feasibility for recipients was measured by the percentage of Veterans that met eligibility and follow-up response rate; acceptability (satisfaction) was examined. RESULTS Caring Cards is feasible and acceptable. The outpatient group had a higher attendance rate (81%) compared with other clinic groups. The percentage of eligible card recipients was 61%. Of these, 69% were reached for follow-up and 50% provided follow-up responses. Card makers and recipients both expressed positive experiences with Caring Cards. CONCLUSION Caring Cards is a low-intensity, feasible, and acceptable intervention with potential benefits for both Veteran card makers and recipients. Additional research is needed to determine the efficacy of Caring Cards as a suicide prevention intervention.
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Affiliation(s)
- Blaire C Ehret
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Emily B H Treichler
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Los Angeles, VA, USA
| | - Phillip J Ehret
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, CA, USA
| | - Samantha A Chalker
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, CA, USA
| | - Colin A Depp
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Dimitri Perivoliotis
- Department of Veterans Affairs, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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25
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Lee H, Lim J, Lee SM, Kim SN, Lee H, Lee KU, Lee BC, Lee HY, Paik JW. Hospital-Based Case Management for Suicide High-Risk Group Using Delphi Survey. Psychiatry Investig 2021; 18:986-996. [PMID: 34619817 PMCID: PMC8542750 DOI: 10.30773/pi.2021.0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE As of 2019, suicide is serious problem in Korea, with the highest suicide rate among OECD countries. To reduce suicide rates Emergency Department Based Post-Suicide Attempt Case Management carried out with government funding in South Korea, but it is insufficient to address the issue. Aim of this study is to prevent suicide attempts through continuous provision of mental health services even after discharge from acute care. METHODS We selected 15 mental health specialists who are multidisciplinary experts in Suicide Prevention. Two-round Delphi survey was conducted on them to reach an agreement for hospital-based case management. RESULTS The first Delphi survey consisted of 8 areas and 39 questions. Among them, 30 questions draw agreement above the reference value. The second Delphi survey, consisted of 37 questions, resulted in 32 above-standard questions. CONCLUSION Consensus was reached in most category of the Hospital Based Case Management for Suicide High-Risk Group. Core of the developed plan was to provide services to patients who visited the hospital, pursue the stability and universalization of services through a medical insurance fee system. In the future, hospital-based case management service will be implemented as a new model contributing to the reduction of suicide rates in Korea.
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Affiliation(s)
- Hwan Lee
- Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jeungsuk Lim
- Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Soung Nam Kim
- Dongdaemun-Gu, Primary Mental Health Welfare Center, Seoul, Republic of Korea
| | - Haewoo Lee
- Department of Psychiatry, Seoul Medical Center, Seoul, Republic of Korea
| | - Kyoung-Uk Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Boung Chul Lee
- Department of Psychiatry, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Hwa-Young Lee
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Jong-Woo Paik
- Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Inui-Yukawa M, Miyaoka H, Yamamoto K, Kamijo Y, Takai M, Yonemoto N, Kawanishi C, Otsuka K, Tachikawa H, Hirayasu Y. Effectiveness of assertive case management for patients with suicidal intent. Psychiatry Res 2021; 304:114125. [PMID: 34332432 DOI: 10.1016/j.psychres.2021.114125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
The aim of this study was to examine the effectiveness of assertive case management intervention in preventing suicidal behaviour in self-poisoning patients. We conducted a secondary analysis of data from the ACTION-J study. Participants were self-poisoning patients with clear suicide intent admitted to emergency departments and with a primary psychiatric diagnosis (as per DSM-IV-TR axis 1). Patients were randomly assigned either to assertive case management or enhanced usual care. The primary outcome measure was the incidence of a first recurrent suicide attempt within 6 months. This study is registered at ClinicalTrials.gov (NCT00736918) and UMIN-CTR (C000000444). There were 297 self-poisoning patients in the intervention group and 295 in the control group. The primary outcome was significantly lower in the intervention group than in the control group. The incidence of a first recurrent suicide attempt within 1 and 3 months was also significantly lower in the intervention group, as was the number of overall self-harm episodes over the entire study period. Furthermore, the number of non-suicidal self-harm episodes and suicide attempts was significantly lower in the intervention group. Assertive case management is effective when promptly introduced in a hospital setting as an intervention following a suicide attempt, particularly for self-poisoning patients.
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Affiliation(s)
- Masami Inui-Yukawa
- Department of Psychiatry, Kitasato University, School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Hitoshi Miyaoka
- Department of Psychiatry, Kitasato University, School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Kenji Yamamoto
- Department of Psychiatry, Tokai University, School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Yoshito Kamijo
- Department of Emergency Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Michiko Takai
- Department of Emergency Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashimachi, Kodaira, Tokyo 187-8553 187-8551, Japan.; Department of Public Health, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Chiaki Kawanishi
- Department of Neuropsychiatry, Sapporo Medical University Graduate School of Medicine, S-1, W-17, Chuo-ku, Sapporo 060-8556, Japan
| | - Kotaro Otsuka
- Department of Neuropsychiatry, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan
| | - Hirokazu Tachikawa
- Department of Disaster and Community Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yoshio Hirayasu
- Hirayasu Hospital, 346 Kyouzuka, Urasoe, Okinawa 901-2553, Japan
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Simões RMP, Dos Santos JCP, Martinho MJCM. Adolescents with suicidal behaviours: A qualitative study about the assessment of Inpatient Service and Transition to Community. J Psychiatr Ment Health Nurs 2021; 28:622-631. [PMID: 33113225 DOI: 10.1111/jpm.12707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/25/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Only a small number of adolescents with suicidal behaviour receives any follow-up treatment. The implementation of recurrent behaviour prevention strategies is crucial in the period following suicide attempts and should take into account adolescents' opinions to be effective and congruent. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper shows that the 33 adolescent participants in the study identified the following protective factors of recurrent suicidal behaviour: family, friends and other trusted persons, as well as the self and newly learned strategies. The adolescents described their family as a constant presence and reported wishing that their parents maintain their current family support. Psychological support, health professionals and occupational activities are what the adolescents value most about hospitalization, and some criticisms are related to the environment, activities and health professionals. The adolescents also emphasize the need to maintain contact with the nurses after hospital discharge and make suggestions for service improvement related to the environment and the interventions implemented. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Knowing the protective factors of recurrent suicidal behaviours, perception of the impact of the intervention, the expectation of future support and healthcare follow-up is crucial for adapting suicide prevention strategies to be put in place by health services for better quality care delivery. The results obtained allow us to define as specific implications the implementation of psychoeducational intervention directed at the adolescent's family with suicidal behaviour during hospitalization and the definition of strategies for maintaining contact and follow-up with the adolescent after discharge. This study emphasizes the need to reinforce training in suicidology for all health professionals for the improvement of clinical practice. ABSTRACT INTRODUCTION: The prevention of recurrent suicidal behaviours in adolescents should consider their perceptions, needs and expectations. AIM/QUESTION To identify the protective factors of recurrent suicidal behaviours in adolescents; To describe the family and the expectations for future involvement; To know the most important aspects of hospitalization and discuss expectations of nursing care follow-up after hospital discharge. METHOD A descriptive, qualitative and exploratory study was carried out in a sample of 33 adolescents with suicidal behaviours. Data were collected through semi-structured interviews, and the data processing used the content analysis technique. RESULTS Findings arising from data allowed identifying the protective factors: family, friends and other trusted persons. During the hospitalization, the adolescents reinforce the knowledge about themselves and the newly learnt coping strategies. Psychological support and health professionals are what they value most about hospitalization and emphasize the need to maintain contact with the nurses after discharge. DISCUSSION Knowing the needs and expectations of adolescents with suicidal behaviour will make nursing psychotherapeutic interventions more effective and congruent in this vulnerable group. IMPLICATIONS FOR PRACTICE Ensuring psychoeducational intervention to the families of adolescents with suicidal behaviour and continuity of care after discharge, and reinforcing the training in suicidology for all health professionals.
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Djembi Fossi L, Debien C, Demarty AL, Vaiva G, Messiah A. SUICIDE REATTEMPT IN A POPULATION-WIDE BRIEF CONTACT INTERVENTION TO PREVENT SUICIDE ATTEMPTS - THE VIGILANS PROGRAM, FRANCE. Eur Psychiatry 2021; 64:e57. [PMID: 34266505 PMCID: PMC8516749 DOI: 10.1192/j.eurpsy.2021.2221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Among the postcrisis suicide prevention programmes, brief contact interventions (BCIs) have been proven to be efficient. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls, and sending postcards, according to a predefined algorithm. However, a major problem in suicide prevention is the suicide reattempt, which can lead to final suicide. Here, we analyze the suicide reattempt in VigilanS. Methods The study concerned patients included in VigilanS over the period from January 1, 2015 to December 31, 2018, with an end of follow-up on July 1, 2019. We performed a series of descriptive analyses, survival curves, and regressions. The outcome was the suicide reattempt, and the predictive variables were the characteristics of the patient at entry and during follow-up in VigilanS. Age and sex were considered as adjustment variables. Results A total of 11,879 inclusions occurred during the study period, corresponding to 10,666 different patients, among which 905 reattempted suicide. More than half were primary suicide attempters (53.4%). A significant relationship with suicide reattempt was identified for the following characteristics: being a non-primary suicide attempter, having attempted suicide by voluntary drug intoxication and phlebotomy, alcohol consumption among primary suicide attempters, and having no companion at the emergency room visit among non-primary suicide attempters. Hanging (as suicide method), having made no call to VigilanS were protective factors. Conclusion This study provides us with a valuable insight into the profiles of patients repeating a suicide attempts, which is important for suicide prevention in general.
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Affiliation(s)
- Larissa Djembi Fossi
- INSERM, MOODS Research unit "Depression, Anxiety, Psychotraumatism and Suicide", Centre de recherche en Epidémiologie et santé des populations (CESP), Université Paris-Saclay, Hôpital Paul-Brousse, Villejuif, France.,INSERM, Sorbonne University, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Social Epidemiology Team, Paris, France
| | - Christophe Debien
- Department of Psychiatry, University Hospital of Lille.,Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neurosciences & Cognition, F-59000Lille, France.,Centre National de Ressources et Résilience pour les psychotraumas (Cn2r Lille Paris), Lille, France Department of Psychiatry, University Hospital of Lille
| | | | - Guillaume Vaiva
- Department of Psychiatry, University Hospital of Lille.,Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neurosciences & Cognition, F-59000Lille, France.,Centre National de Ressources et Résilience pour les psychotraumas (Cn2r Lille Paris), Lille, France Department of Psychiatry, University Hospital of Lille
| | - Antoine Messiah
- INSERM, MOODS Research unit "Depression, Anxiety, Psychotraumatism and Suicide", Centre de recherche en Epidémiologie et santé des populations (CESP), Université Paris-Saclay, Hôpital Paul-Brousse, Villejuif, France
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2021; 4:CD013668. [PMID: 33884617 PMCID: PMC8094743 DOI: 10.1002/14651858.cd013668.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for SH in adults. This review therefore updates a previous Cochrane Review (last published in 2016) on the role of psychosocial interventions in the treatment of SH in adults. OBJECTIVES To assess the effects of psychosocial interventions for self-harm (SH) compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing interventions of specific psychosocial treatments versus treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, or a combination of these, in the treatment of adults with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratio (ORs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMDs) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 76 trials with a total of 21,414 participants. Participants in these trials were predominately female (61.9%) with a mean age of 31.8 years (standard deviation [SD] 11.7 years). On the basis of data from four trials, individual cognitive behavioural therapy (CBT)-based psychotherapy may reduce repetition of SH as compared to TAU or another comparator by the end of the intervention (OR 0.35, 95% CI 0.12 to 1.02; N = 238; k = 4; GRADE: low certainty evidence), although there was imprecision in the effect estimate. At longer follow-up time points (e.g., 6- and 12-months) there was some evidence that individual CBT-based psychotherapy may reduce SH repetition. Whilst there may be a slightly lower rate of SH repetition for dialectical behaviour therapy (DBT) (66.0%) as compared to TAU or alternative psychotherapy (68.2%), the evidence remains uncertain as to whether DBT reduces absolute repetition of SH by the post-intervention assessment. On the basis of data from a single trial, mentalisation-based therapy (MBT) reduces repetition of SH and frequency of SH by the post-intervention assessment (OR 0.35, 95% CI 0.17 to 0.73; N = 134; k = 1; GRADE: high-certainty evidence). A group-based emotion-regulation psychotherapy may also reduce repetition of SH by the post-intervention assessment based on evidence from two trials by the same author group (OR 0.34, 95% CI 0.13 to 0.88; N = 83; k = 2; moderate-certainty evidence). There is probably little to no effect for different variants of DBT on absolute repetition of SH, including DBT group-based skills training, DBT individual skills training, or an experimental form of DBT in which participants were given significantly longer cognitive exposure to stressful events. The evidence remains uncertain as to whether provision of information and support, based on the Suicide Trends in At-Risk Territories (START) and the SUicide-PREvention Multisite Intervention Study on Suicidal behaviors (SUPRE-MISS) models, have any effect on repetition of SH by the post-intervention assessment. There was no evidence of a difference for psychodynamic psychotherapy, case management, general practitioner (GP) management, remote contact interventions, and other multimodal interventions, or a variety of brief emergency department-based interventions. AUTHORS' CONCLUSIONS Overall, there were significant methodological limitations across the trials included in this review. Given the moderate or very low quality of the available evidence, there is only uncertain evidence regarding a number of psychosocial interventions for adults who engage in SH. Psychosocial therapy based on CBT approaches may result in fewer individuals repeating SH at longer follow-up time points, although no such effect was found at the post-intervention assessment and the quality of evidence, according to the GRADE criteria, was low. Given findings in single trials, or trials by the same author group, both MBT and group-based emotion regulation therapy should be further developed and evaluated in adults. DBT may also lead to a reduction in frequency of SH. Other interventions were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to the use of these interventions is inconclusive at present.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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30
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Abstract
Created in 2015 in the Nord-Pas-de-Calais region by Professor Guillaume Vaiva, the VigilanS system for maintaining a post-hospital link with suicidal patients is the result of a long process of maturation. Its effectiveness in reducing recidivism and suicidal mortality has led the Ministry of Health and Solidarity to request its extension to the entire country by 2022. Supported by a new type of caregiving, it can only be legitimate if it is integrated into the various measures of the global and multimodal suicide prevention policy.
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Affiliation(s)
- Christophe Debien
- Centre hospitalier régional universitaire de Lille, rue André-Verhaeghe, 59000 Lille, France.
| | - Jardon Vincent
- Centre hospitalier régional universitaire de Lille, rue André-Verhaeghe, 59000 Lille, France
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31
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da Silva APC, Henriques MR, Rothes IA, Zortea T, Santos JC, Cuijpers P. Effects of psychosocial interventions among people cared for in emergency departments after a suicide attempt: a systematic review protocol. Syst Rev 2021; 10:68. [PMID: 33766137 PMCID: PMC7992994 DOI: 10.1186/s13643-021-01609-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The care of the emergency department (ED) for a person after a suicide attempt can act as a protector against future suicidal behavior. For this reason, it is essential that the ED ensure an assistance that involves effective interventions in preventing suicidal behaviors. Among suicidal behaviors, it is known that suicide attempt is one of the most lethal risk factors for consummated suicide. In addition, the risk for further attempts is greater in the period from the immediate post-discharge up to 12 months after the last attempt. This makes the ED a key link in the suicide prevention chain. The purpose of this review is to investigate the effects of psychosocial interventions on suicide prevention, when applied in the ED after a suicide attempt. METHODS This systematic review protocol was built and registered with the collaboration of a multidisciplinary scientific team. The review will include randomized clinical studies, quasi-experimental trials, and comparative observational studies, all conducted with people (11 years old or more) who have received a psychosocial suicide prevention intervention initiated in the ED after a suicide attempt. The research will be conducted across databases such as Cochrane Library, PubMed, EMBASE, PsycINFO, and DARE. The repetition of a suicide attempt and death by suicide as primary outcomes will be analyzed. The eligibility of the studies and data extraction will be carried out by matched and blind researchers. The risk of bias will be addressed using appropriate instruments. The analyses and synthesis of the results will be both qualitative and quantitative. DISCUSSION From a public health point of view, suicide is in itself a public health problem and requires appropriate interventions at different levels of care in order to be prevented. Taking into account that a high percentage of people who died by suicide sought the ED for suicide attempt in the year before their death, the ED is a clinical context with a privileged potential to implement these interventions. Presently, several clinical studies seek to validate interventions to be adopted regarding the prevention of suicidal behavior. Current evidence indicates that different interventions must be strategically combined to reduce suicide attempts and their mortality. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42019131040.
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Affiliation(s)
- Ana Paula Coutinho da Silva
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal FPCEUP/Center for Psychology at University of Porto CPUP, Rua Alfredo Allen, 4200-392 Porto, Portugal
- Department of Clinical Nursing, Health Sciences Center, Federal University of Paraíba, Cidade Universitária, João Pessoa/PB, CEP: 58051-900 Brazil
| | - Margarida Rangel Henriques
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal FPCEUP/Center for Psychology at University of Porto CPUP, Rua Alfredo Allen, 4200-392 Porto, Portugal
| | - Inês Areal Rothes
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal FPCEUP/Center for Psychology at University of Porto CPUP, Rua Alfredo Allen, 4200-392 Porto, Portugal
| | - Tiago Zortea
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, Scotland G12 0XH UK
| | - José Carlos Santos
- Nursing School of Coimbra, Avenida Bissaya Barreto s/n, 3004-011 Coimbra, Portugal
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
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32
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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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33
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Landes SJ, Jegley SM, Kirchner JE, Areno JP, Pitcock JA, Abraham TH, McBain SA, Singh RS, Bollinger MJ, Painter J, Woods JA, Curtis ND, Jones DE, Matarazzo BB, Reger MA, Comtois KA. Adapting Caring Contacts for Veterans in a Department of Veterans Affairs Emergency Department: Results From a Type 2 Hybrid Effectiveness-Implementation Pilot Study. Front Psychiatry 2021; 12:746805. [PMID: 34721114 PMCID: PMC8548725 DOI: 10.3389/fpsyt.2021.746805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/13/2021] [Indexed: 12/02/2022] Open
Abstract
Transitions in care, such as discharge from an emergency department (ED), are periods of increased risk for suicide and effective interventions that target these periods are needed. Caring Contacts is an evidence-based suicide prevention intervention that targets transitions, yet it has not been widely implemented. This pilot study adapted Caring Contacts for a Department of Veterans Affairs (VA) ED setting and population, created an implementation toolkit, and piloted implementation and evaluation of effectiveness. To inform adaptation, qualitative interviews were conducted with stakeholders. Data were used by an advisory board comprised of stakeholders, experts, and veterans to make adaptations and develop an implementation planning guide to delineate steps needed to implement. Key decisions about how to adapt Caring Contacts included recipients, author, content, and the schedule for sending. Pilot implementation occurred at one VA ED. Caring Contacts involved sending patients at risk of suicide brief, non-demanding expressions of care. Program evaluation of the pilot used a type 2 hybrid effectiveness-implementation design to both pilot an implementation strategy and evaluate effectiveness of Caring Contacts. Evaluation included qualitative interviews with veteran patients during implementation. VA electronic health records were used to evaluate VA service utilization in the 6-month periods immediately before and after veterans were delivered their first Caring Contact. Hundred and seventy-five veterans were mailed Caring Contacts and the facility continued adoption after the pilot. Participants were positive about the intervention and reported feeling cared about and connected to VA as a result of receiving Caring Contacts. This project developed an implementation planning process that successfully implemented Caring Contacts at one site. This can be used to further implement Caring Contacts at additional VA or community EDs.
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Affiliation(s)
- Sara J Landes
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Susan M Jegley
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - JoAnn E Kirchner
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - John P Areno
- South Central VA Health Care Network, Ridgeland, MS, United States
| | - Jeffery A Pitcock
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Traci H Abraham
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Sacha A McBain
- South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - R Sonia Singh
- South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mary J Bollinger
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Jacob Painter
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Jack A Woods
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Nyssa D Curtis
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Donald E Jones
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Bridget B Matarazzo
- Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States.,Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, CO, United States
| | - Mark A Reger
- VA Puget Sound Health Care System, Tacoma, WA, United States
| | - Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
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Richards JE, Simon GE, Boggs JM, Beidas R, Yarborough BJH, Coleman KJ, Sterling SA, Beck A, Flores JP, Bruschke C, Grumet JG, Stewart CC, Schoenbaum M, Westphal J, Ahmedani BK. An implementation evaluation of "Zero Suicide" using normalization process theory to support high-quality care for patients at risk of suicide. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34447940 PMCID: PMC8384258 DOI: 10.1177/26334895211011769] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Suicide rates continue to rise across the United States, galvanizing the need for increased suicide prevention and intervention efforts. The Zero Suicide (ZS) model was developed in response to this need and highlights four key clinical functions of high-quality health care for patients at risk of suicide. The goal of this quality improvement study was to understand how six large health care systems operationalized practices to support these functions-identification, engagement, treatment and care transitions. Methods Using a key informant interview guide and data collection template, researchers who were embedded in each health care system cataloged and summarized current and future practices supporting ZS, including, (1) the function addressed; (2) a description of practice intent and mechanism of intervention; (3) the target patient population and service setting; (4) when/how the practice was (or will be) implemented; and (5) whether/how the practice was documented and/or measured. Normalization process theory (NPT), an implementation evaluation framework, was applied to help understand how ZS had been operationalized in routine clinical practices and, specifically, what ZS practices were described by key informants (coherence), the current state of norms/conventions supporting these practices (cognitive participation), how health care teams performed these practices (collective action), and whether/how practices were measured when they occurred (reflexive monitoring). Results The most well-defined and consistently measured ZS practices (current and future) focused on the identification of patients at high risk of suicide. Stakeholders also described numerous engagement and treatment practices, and some practices intended to support care transitions. However, few engagement and transition practices were systematically measured, and few treatment practices were designed specifically for patients at risk of suicide. Conclusions The findings from this study will support large-scale evaluation of the effectiveness of ZS implementation and inform recommendations for implementation of high-quality suicide-related care in health care systems nationwide.
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Affiliation(s)
- Julie E Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Rinad Beidas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | | | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Jean P Flores
- Care Management Institute, Kaiser Permanente, Oakland, CA, USA
| | | | | | | | - Michael Schoenbaum
- Division of Services and Intervention Research, National Institute of Mental Health, Rockville, MD, USA
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
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Simões RMP, Dos Santos JCP, Martinho MJCM. Characterization of adopted suicidal behavior and its main influencing factors: A qualitative study with adolescents. Arch Psychiatr Nurs 2020; 34:405-411. [PMID: 33032766 DOI: 10.1016/j.apnu.2020.07.014] [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: 01/28/2020] [Revised: 05/12/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION A better understanding of the meanings that adolescents associate with suicide, contributes to the development of psychotherapeutic intervention programs to be implemented by nurse specialists in mental health and psychiatric nursing. Therefore, adolescents need to characterize their adopted suicidal behaviors and identify the personal characteristics that contribute to this same behavior. METHODOLOGY A descriptive, exploratory, and qualitative study was conducted with 33 adolescents with suicidal behavior, hospitalized in a child psychiatry unit. Data were collected through a structured interview, and data treatment used the content analysis technique. RESULTS Suicidal behaviors are characterized according to causality, meaning, and intent. Causality is mostly related to psychological factors (sadness, desperation, mental suffering, internal pain, emptiness, and rejection). As to the meaning, suicidal behavior is understood as an escape but also as a personal choice, sometimes regarded as rational. In what concerns intent, the intent to die is the most frequently reported. The most-reported personal characteristics which contributed to the suicidal behavior are feelings of exclusion, rejection, and humiliation, and also introversion. CONCLUSIONS The results point to the need to reflect on the perceptions of adolescents with suicidal behavior. The current intervention strategies should be adjusted especially through the identification of the signs associated with mental distress in adolescents and the training of gatekeepers, contributing to productive and congruent suicide prevention in this vulnerable group.
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Johnson JE, Jones R, Miller T, Miller I, Stanley B, Brown G, Arias SA, Cerbo L, Rexroth J, Fitting H, Russell D, Kubiak S, Stein M, Matkovic C, Yen S, Gaudiano B, Weinstock LM. Study Protocol: A randomized controlled trial of suicide risk reduction in the year following jail release (the SPIRIT Trial). Contemp Clin Trials 2020; 94:106003. [DOI: 10.1016/j.cct.2020.106003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/14/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
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Abstract
The risk of suicide is significant during the transition of care; the highest in the first few weeks after discharge from a healthcare facility. This systematic review summarizes the evidence for interventions providing care during this high-risk period. In January 2019, PubMed and Scopus were systematically searched using the search terms: Suicide AND (Hospital OR Emergency department) AND Discharge. Articles relevant to interventions targeting suicidal behaviors during the transition of care were selected after the title and abstract screening followed by full-text screening. This review article included 40 articles; with a total patient population of 24,568. The interventions included telephone contacts, letters, green cards, postcards, structured visits, and community outreach programs. An improvement in the engagement of patients in outpatient services was observed but the evidence for suicidal behaviors was conflicting. The reviewed interventions were efficacious in linking patients to outpatient services, reducing feelings of social isolation and helping patients in navigating the available community resources. For patients with repetitive suicidal behaviors, psychosocial interventions such as dialectical behavioral therapy can be helpful. Patients should be followed by targeted interventions based on risk categorization of the patients by using evidence-based tools.
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Kim MH, Lee J, Noh H, Hong JP, Kim H, Cha YS, Ahn JS, Chang SJ, Min S. Effectiveness of a Flexible and Continuous Case Management Program for Suicide Attempters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072599. [PMID: 32290297 PMCID: PMC7178043 DOI: 10.3390/ijerph17072599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to investigate the effect of continuous case management with a flexible approach on the prevention of suicide by suicide reattempt in a real clinical setting. The subjects in this study were 526 suicide attempters who visited emergency rooms in a teaching hospital in South Korea. Subjects were provided a continuous case management program with a flexible approach according to the severity of their suicide risk and needs. During the entire observation period (from 182 days to 855 days, mean = 572 ± 254), 18 patients (3.7%) died by suicide reattempt: Eight patients (2.27%) in the case management group and 10 patients (7.35%) in the no-case management group. The Cox regression analysis showed that the case management group had a 75% lower risk of death from suicide attempts than the no-case management group (HR = 0.34, 95% CI = 0.13–0.87). This result was shown to be more robust after adjusting for confounding factors such as gender, age, psychiatric treatment, suicide attempts, and family history of suicide (adjusted HR = 0.27, 95% CI = 0.09–0.83). This study was conducted in a single teaching hospital and not a randomized controlled one. A flexible and continuous case management program for suicide attempters is effective for preventing death by suicide reattempts.
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Affiliation(s)
- Min-Hyuk Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (M.-H.K.); (J.L.); (J.-S.A.)
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (M.-H.K.); (J.L.); (J.-S.A.)
| | | | - Jin-Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Hyun Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (H.K.); (Y.S.C.)
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (H.K.); (Y.S.C.)
| | - Joung-Sook Ahn
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (M.-H.K.); (J.L.); (J.-S.A.)
| | - Sei-Jin Chang
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Seongho Min
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (M.-H.K.); (J.L.); (J.-S.A.)
- Correspondence: ; Tel.: +82-33-741-1260; Fax: +82-33-741-0532
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Wilson MP, Moutier C, Wolf L, Nordstrom K, Schulz T, Betz ME. ED recommendations for suicide prevention in adults: The ICAR2E mnemonic and a systematic review of the literature. Am J Emerg Med 2020; 38:571-581. [DOI: 10.1016/j.ajem.2019.06.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/28/2023] Open
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Dimeff LA, Jobes DA, Chalker SA, Piehl BM, Duvivier LL, Lok BC, Zalake MS, Chung J, Koerner K. A novel engagement of suicidality in the emergency department: Virtual Collaborative Assessment and Management of Suicidality. Gen Hosp Psychiatry 2020; 63:119-126. [PMID: 29934033 DOI: 10.1016/j.genhosppsych.2018.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/17/2018] [Accepted: 05/17/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE A novel avatar system (Virtual Collaborative Assessment and Management of Suicidality System; V-CAMS) for suicidal patients and medical personnel in emergency departments (EDs) was developed and evaluated. V-CAMS facilitates the delivery of CAMS and other evidence-based interventions to reduce unnecessary hospitalization, readmissions, and suicide following an ED visit. METHOD Using iterative user-centered design with 24 suicidal patients, an avatar prototype, "Dr. Dave" (based on Dr. Jobes) was created, along with other patient-facing tools; provider-facing tools, including a clinical decision support tool were also designed and tested to aid discharge disposition. RESULTS Feasibility tests supported proof of concept. Suicidal patients affirmed the system's overall merit, positive Perception of Care, and acceptability; medical providers (n = 21) viewed the system as an efficient, effective, and safe method of improving care for suicidal ED patients and reducing unnecessary hospitalization. CONCLUSIONS Technology tools including a patient-facing avatar and e-caring contacts, along with provider-facing tools may offer a powerful method of facilitating best-practice suicide prevention interventions and point-of-care tools for suicidal patients seeking ED services and their medical providers. Future directions include full development of V-CAMS and integration into a health electronic medical record and a rigorous randomized controlled trial to study its effectiveness.
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Affiliation(s)
- Linda A Dimeff
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA.
| | - David A Jobes
- The Catholic University of America, O'Boyle Hall, Room 314, 620 Michigan Ave NE, Washington, DC 20064, USA.
| | - Samantha A Chalker
- The Catholic University of America, O'Boyle Hall, Room 314, 620 Michigan Ave NE, Washington, DC 20064, USA.
| | - Brian M Piehl
- The Catholic University of America, O'Boyle Hall, Room 314, 620 Michigan Ave NE, Washington, DC 20064, USA.
| | - Leticia Lobo Duvivier
- Central Arkansas Veterans Healthcare System, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146, USA
| | - Benjamin C Lok
- University of Florida, Department of Computer and Information Sciences and Engineering, CSE Room E544, P.O. Box 116120, Gainesville, FL 32611-6120, USA.
| | - Mohan S Zalake
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA
| | - Julie Chung
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA.
| | - Kelly Koerner
- Evidence-Based Practice Institute, LLC, 3303 South Irving Street, Seattle, WA 98144, USA.
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Luxton DD, Smolenski DJ, Reger MA, Relova RMV, Skopp NA. Caring E-mails for Military and Veteran Suicide Prevention: A Randomized Controlled Trial. Suicide Life Threat Behav 2020; 50:300-314. [PMID: 31562660 DOI: 10.1111/sltb.12589] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/11/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this multisite study was to conduct a randomized controlled trial of an e-mail version of the caring letters (CL) suicide prevention intervention to determine whether the intervention is efficacious in preventing suicide behaviors among U.S. service members and veterans. METHOD Psychiatric inpatients (N = 1,318) were recruited from four military medical centers and two VA hospitals and randomized to receive either 13 caring e-mails over two years or usual care. RESULTS There were 10 deaths from any cause in the CL group (three suicides) and 14 in the usual care group (seven suicides) during the individual two-year follow-up intervals. There was no statistically significant difference in the rate of all-cause hospital readmission between the study groups (RR = 1.13; 95% CI = 0.94, 1.36). There were no differences observed between groups on self-reported psychiatric hospital readmissions, self-reported suicide attempts, or other measures associated with risk for suicide. CONCLUSIONS No firm conclusions about the efficacy of the intervention can be made because the study was inadequately powered. There were no adverse events associated with the intervention, and implementation of the procedures was feasible in the military and veteran hospital settings. These results provide important methodological considerations for caring contact trials in military populations.
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Affiliation(s)
- David D Luxton
- National Center for Telehealth & Technology, Joint Base Lewis-McChord, Tacoma, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Derek J Smolenski
- Defense Health Agency, Psychological Health Center of Excellence, Tacoma, WA, USA
| | - Mark A Reger
- National Center for Telehealth & Technology, Joint Base Lewis-McChord, Tacoma, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Rona Margaret V Relova
- VA Palo Alto Health Care System, Palo Alto, CA, USA.,Stanford University, Palo Alto, CA, USA
| | - Nancy A Skopp
- Defense Health Agency, Psychological Health Center of Excellence, Tacoma, WA, USA
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Fossi Djembi L, Vaiva G, Debien C, Duhem S, Demarty AL, Koudou YA, Messiah A. Changes in the number of suicide re-attempts in a French region since the inception of VigilanS, a regionwide program combining brief contact interventions (BCI). BMC Psychiatry 2020; 20:26. [PMID: 31992251 PMCID: PMC6986096 DOI: 10.1186/s12888-020-2443-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/13/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Brief Contact Interventions (BCIs) after a suicide attempt (SA) are an important element of prevention against SA and suicide. They are easier to generalize to an entire population than other forms of intervention. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls and mailings, according to a predefined algorithm. It was implemented gradually in the Nord-Pas-de-Calais (NPC), France, between 2015 and 2018. Here, we evaluate the effectiveness of VigilanS, in terms of SA reduction, using annual data collected by participating centers. Hypothesis tested: the higher the VigilanS implementation in a center (measured by penetrance), the greater the decrease in the number of SA observed in this center. METHODS The study period was from 2014 to 2018, across all of NPC centers. We performed a series of linear regressions, each center representing a statistical unit. The outcome was the change in the number of SA, relative to the initial number, and the predictive variable was VigilanS' penetrance: number of patients included in VigilanS over the total number of SA. Search for influential points (points beyond threshold values of 3 influence criteria) and weighted least squares estimations were performed. RESULTS Twenty-one centers were running VigilanS in 2018, with an average penetrance of 32%. A significant relationship was identified, showing a sharp decrease in SA as a function of penetrance (slope = - 1.13; p = 3*10- 5). The model suggested that a 25% of penetrance would yield a SA decrease of 41%. CONCLUSION VigilanS has the potential to reduce SA. Subgroup analyzes are needed to further evaluate its effectiveness. Subgroup analyses remain to be done, in order to evaluate the specific variations of SA by group.
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Affiliation(s)
- Larissa Fossi Djembi
- INSERM Research unit U-1178 "Mental Health and Public Health", Centre de recherche en Epidémiologie et santé des populations (CESP), INSERM, Université Paris-Sud, Université Paris-Saclay, Hôpital Paul-Brousse, Villejuif, France.
| | - Guillaume Vaiva
- 0000 0001 0206 8146grid.413133.7INSERM Research unit U-1178 “Mental Health and Public Health”, Centre de recherche en Epidémiologie et santé des populations (CESP), INSERM, Université Paris-Sud, Université Paris-Saclay, Hôpital Paul-Brousse, Villejuif, France ,0000 0001 2242 6780grid.503422.2SCALab Laboratory, CNRS, UMR 9193, Université de Lille, Lille, France ,0000 0004 0471 8845grid.410463.4Department of Adult Psychiatry, Hôpital Fontan, CHRU de Lille, Lille, France
| | - Christophe Debien
- 0000 0001 2242 6780grid.503422.2SCALab Laboratory, CNRS, UMR 9193, Université de Lille, Lille, France ,0000 0004 0471 8845grid.410463.4Department of Adult Psychiatry, Hôpital Fontan, CHRU de Lille, Lille, France
| | - Stéphane Duhem
- 0000 0004 0471 8845grid.410463.4Department of Adult Psychiatry, Hôpital Fontan, CHRU de Lille, Lille, France ,0000 0001 2242 6780grid.503422.2INSERM, Clinical Investigation Center (CIC) 1403, CHRU de Lille, Université de Lille, Lille, France
| | - Anne-Laure Demarty
- 0000 0004 0471 8845grid.410463.4Department of Adult Psychiatry, Hôpital Fontan, CHRU de Lille, Lille, France ,0000 0001 2242 6780grid.503422.2INSERM, Clinical Investigation Center (CIC) 1403, CHRU de Lille, Université de Lille, Lille, France
| | - Yves-Akoli Koudou
- 0000 0001 0206 8146grid.413133.7UMRS 1018 Centre de recherche en Epidémiologie et santé des populations (CESP) “Epidemiology of Cancer, Genes and Environment”, Hôpital Paul-Brousse, Villejuif, France
| | - Antoine Messiah
- 0000 0001 0206 8146grid.413133.7INSERM Research unit U-1178 “Mental Health and Public Health”, Centre de recherche en Epidémiologie et santé des populations (CESP), INSERM, Université Paris-Sud, Université Paris-Saclay, Hôpital Paul-Brousse, Villejuif, France
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Witt K, Townsend E, Arensman E, Gunnell D, Hazell P, Taylor Salisbury T, Van Heeringen K, Hawton K. Psychosocial Interventions for People Who Self-Harm: Methodological Issues Involved in Trials to Evaluate Effectiveness. Arch Suicide Res 2020; 24:S32-S93. [PMID: 30955501 DOI: 10.1080/13811118.2019.1592043] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We have assessed the methodological quality of randomized controlled trials (RCTs) of interventions to prevent self-harm repetition and suicide. Trials were identified in two systematic reviews of RCTs of psychosocial treatments following a recent (within six months) episode of self-harm indexed in any of five electronic databases (CCDANCTR-Studies and References, CENTRAL, Medline, Embase, and PsycINFO) between 1 January, 1998 and 29 April, 2015. A total of 66 trials were included, 55 in adults and 11 in children and adolescents. While evidence for efficacy of some approaches has grown, there were few trials from low-to-middle income countries, little information on interventions for males, information on the control condition was often limited, data on suicides were often not reported, and, while trials have increased in size in recent years, most have included too few participants to detect clinically significant results. There are major limitations in many trials of interventions for individuals who self-harm. Improved methodology, especially with regard to study size, provision of details of control therapy, and evaluation of key outcomes, would enhance the evidence base for clinicians and service users.
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Pantoja T, Grimshaw JM, Colomer N, Castañon C, Leniz Martelli J. Manually-generated reminders delivered on paper: effects on professional practice and patient outcomes. Cochrane Database Syst Rev 2019; 12:CD001174. [PMID: 31858588 PMCID: PMC6923326 DOI: 10.1002/14651858.cd001174.pub4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Health professionals sometimes do not use the best evidence to treat their patients, in part due to unconscious acts of omission and information overload. Reminders help clinicians overcome these problems by prompting them to recall information that they already know, or by presenting information in a different and more accessible format. Manually-generated reminders delivered on paper are defined as information given to the health professional with each patient or encounter, provided on paper, in which no computer is involved in the production or delivery of the reminder. Manually-generated reminders delivered on paper are relatively cheap interventions, and are especially relevant in settings where electronic clinical records are not widely available and affordable. This review is one of three Cochrane Reviews focused on the effectiveness of reminders in health care. OBJECTIVES 1. To determine the effectiveness of manually-generated reminders delivered on paper in changing professional practice and improving patient outcomes. 2. To explore whether a number of potential effect modifiers influence the effectiveness of manually-generated reminders delivered on paper. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and two trials registers on 5 December 2018. We searched grey literature, screened individual journals, conference proceedings and relevant systematic reviews, and reviewed reference lists and cited references of included studies. SELECTION CRITERIA We included randomised and non-randomised trials assessing the impact of manually-generated reminders delivered on paper as a single intervention (compared with usual care) or added to one or more co-interventions as a multicomponent intervention (compared with the co-intervention(s) without the reminder component) on professional practice or patients' outcomes. We also included randomised and non-randomised trials comparing manually-generated reminders with other quality improvement (QI) interventions. DATA COLLECTION AND ANALYSIS Two review authors screened studies for eligibility and abstracted data independently. We extracted the primary outcome as defined by the authors or calculated the median effect size across all reported outcomes in each study. We then calculated the median percentage improvement and interquartile range across the included studies that reported improvement related outcomes, and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We identified 63 studies (41 cluster-randomised trials, 18 individual randomised trials, and four non-randomised trials) that met all inclusion criteria. Fifty-seven studies reported usable data (64 comparisons). The studies were mainly located in North America (42 studies) and the UK (eight studies). Fifty-four studies took place in outpatient/ambulatory settings. The clinical areas most commonly targeted were cardiovascular disease management (11 studies), cancer screening (10 studies) and preventive care (10 studies), and most studies had physicians as their target population (57 studies). General management of a clinical condition (17 studies), test-ordering (14 studies) and prescription (10 studies) were the behaviours more commonly targeted by the intervention. Forty-eight studies reported changes in professional practice measured as dichotomous process adherence outcomes (e.g. compliance with guidelines recommendations), 16 reported those changes measured as continuous process-of-care outcomes (e.g. number of days with catheters), eight reported dichotomous patient outcomes (e.g. mortality rates) and five reported continuous patient outcomes (e.g. mean systolic blood pressure). Manually-generated reminders delivered on paper probably improve professional practice measured as dichotomous process adherence outcomes) compared with usual care (median improvement 8.45% (IQR 2.54% to 20.58%); 39 comparisons, 40,346 participants; moderate certainty of evidence) and may make little or no difference to continuous process-of-care outcomes (8 comparisons, 3263 participants; low certainty of evidence). Adding manually-generated paper reminders to one or more QI co-interventions may slightly improve professional practice measured as dichotomous process adherence outcomes (median improvement 4.24% (IQR -1.09% to 5.50%); 12 comparisons, 25,359 participants; low certainty of evidence) and probably slightly improve professional practice measured as continuous outcomes (median improvement 0.28 (IQR 0.04 to 0.51); 2 comparisons, 12,372 participants; moderate certainty of evidence). Compared with other QI interventions, manually-generated reminders may slightly decrease professional practice measured as process adherence outcomes (median decrease 7.9% (IQR -0.7% to 11%); 14 comparisons, 21,274 participants; low certainty of evidence). We are uncertain whether manually-generated reminders delivered on paper, compared with usual care or with other QI intervention, lead to better or worse patient outcomes (dichotomous or continuous), as the certainty of the evidence is very low (10 studies, 13 comparisons). Reminders added to other QI interventions may make little or no difference to patient outcomes (dichotomous or continuous) compared with the QI alone (2 studies, 2 comparisons). Regarding resource use, studies reported additional costs per additional point of effectiveness gained, but because of the different currencies and years used the relevance of those figures is uncertain. None of the included studies reported outcomes related to harms or adverse effects. AUTHORS' CONCLUSIONS Manually-generated reminders delivered on paper as a single intervention probably lead to small to moderate increases in outcomes related to adherence to clinical recommendations, and they could be used as a single QI intervention. It is uncertain whether reminders should be added to other QI intervention already in place in the health system, although the effects may be positive. If other QI interventions, such as patient or computerised reminders, are available, they should be preferred over manually-generated reminders, but under close evaluation in order to decrease uncertainty about their potential effect.
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Affiliation(s)
- Tomas Pantoja
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Jeremy M Grimshaw
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramThe Ottawa Hospital ‐ General Campus501 Smyth Road, Box 711OttawaONCanadaK1H 8L6
| | - Nathalie Colomer
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Carla Castañon
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Javiera Leniz Martelli
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
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Bliokas VV, Hains AR, Allan JA, Lago L, Sng R. Community-based aftercare following an emergency department presentation for attempted suicide or high risk for suicide: study protocol for a non-randomised controlled trial. BMC Public Health 2019; 19:1380. [PMID: 31655571 PMCID: PMC6815378 DOI: 10.1186/s12889-019-7751-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/04/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Suicide is a major public health issue worldwide. Those who have made a recent suicide attempt are at high risk for dying by suicide in the future, particularly during the period immediately following departure from a hospital emergency department. As such the transition from hospital-based care to the community is an important area of focus in the attempt to reduce suicide rates. There is a need for evaluation studies to test the effectiveness of interventions directed to this stage (termed 'aftercare' interventions). METHODS A controlled non-randomised two group (intervention vs treatment-as-usual control) design, using an intention-to-treat model, will evaluate the effectiveness of a suicide prevention aftercare intervention providing follow-up after presentations to a hospital emergency department as a result of a suicide attempt or high risk for suicide. The intervention is a community-based service, utilising two meetings with a mental health clinician and follow-up contacts by peer workers via a combination of face-to-face and telephone for four weeks, with the option of extension to 12 weeks. Seventy-five participants of the intervention service will be recruited to the study and compared to 1265 treatment-as-usual controls. The primary hypotheses are that over 12 months, those who participate in the aftercare follow-up intervention are less likely than controls to present to a hospital emergency department for a repeat suicide attempt or because of high risk for suicide, will have fewer re-presentations during this period and will have lower all-cause mortality. As a secondary aim, the impact of the intervention on suicide risk factors for those who participate in the service will be evaluated using pre- and post-intervention repeated measures of depression, anxiety, stress, hopelessness, belongingness, burdensomeness, and psychological distress. Enrolments into the study commenced on 1 November 2017 and are anticipated to cease in November 2019. DISCUSSION The study aims to contribute to the understanding of effective interventions for individuals who have presented to a hospital emergency department as a result of a suicide attempt or at high risk for suicide and provide evidence in relation to interventions that incorporate peer-workers. TRIAL REGISTRATION ACTRN12618001701213 . Registered on 16 October 2018. Retrospectively registered.
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Affiliation(s)
- Vida V Bliokas
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, Northfields Avenue, Wollongong, NSW, 2522, Australia.
| | - Alex R Hains
- Illawarra Health and Medical Research Institute, Northfields Avenue, Wollongong, NSW, 2522, Australia.,Illawarra Shoalhaven Suicide Prevention Collaborative, The Central, Innovation Campus, Wollongong, NSW, 2500, Australia.,Coordinare, Primary Health Network South Eastern NSW, The Central, Innovation Campus, Squires Way, Wollongong, NSW, 2500, Australia
| | - Jonathan A Allan
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Luise Lago
- Centre for Health Research Illawarra Shoalhaven Population, University of Wollongong, Building 234, Innovation Campus, Wollongong, NSW, 2500, Australia
| | - Rebecca Sng
- Grand Pacific Health, 336 Keira Street, Wollongong, NSW, 2500, Australia
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Landes SJ, Kirchner JE, Areno JP, Reger MA, Abraham TH, Pitcock JA, Bollinger MJ, Comtois KA. Adapting and implementing Caring Contacts in a Department of Veterans Affairs emergency department: a pilot study protocol. Pilot Feasibility Stud 2019; 5:115. [PMID: 31624637 PMCID: PMC6785900 DOI: 10.1186/s40814-019-0503-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Suicide among veterans is a problem nationally, and suicide prevention remains a high priority for the Department of Veterans Affairs (VA). Focusing suicide prevention initiatives in the emergency department setting provides reach to veterans who may not be seen in mental health and targets a critical risk period, transitions in care following discharge. Caring Contacts is a simple and efficacious suicide prevention approach that could be used to target this risk period. The purpose of this study is to (1) adapt Caring Contacts for use in a VA emergency department, (2) conduct a pilot program at a single VA emergency department, and (3) create an implementation toolkit to facilitate spread of Caring Contacts to other VA facilities. Methods This project includes planning activities and a pilot at a VA emergency department. Planning activities will include determining available data sources, determining logistics for identifying and sending Caring Contacts, and creating an implementation toolkit. We will conduct qualitative interviews with emergency department staff and other key stakeholders to gather data on what is needed to adapt and implement Caring Contacts in a VA emergency department setting and possible barriers to and facilitators of implementation. An advisory board of key stakeholders in the facility will be created. Qualitative findings from interviews will be presented to the advisory board for discussion, and the board will use these data to inform decision making regarding implementation of the pilot. Once the pilot is underway, the advisory board will convene again to discuss ongoing progress and determine if any changes are needed to the implementation of the Caring Contacts intervention. Discussion Findings from the current project will inform future scale-up and spread of this innovation to other VA medical center emergency departments across the network and other networks. The current pilot will adapt Caring Contacts, create an implementation toolkit and implementation guide, evaluate the feasibility of gathering outcome measures, and provide information about what is needed to implement this evidence-based suicide prevention intervention in a VA emergency department.
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Affiliation(s)
- Sara J Landes
- 1QUERI for Team-Based Behavioral Healthcare, Central Arkansas Veterans Healthcare System, North Little Rock, AR USA.,South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas VA Health Care System, North Little Rock, AR USA.,3Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - JoAnn E Kirchner
- 1QUERI for Team-Based Behavioral Healthcare, Central Arkansas Veterans Healthcare System, North Little Rock, AR USA.,3Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - John P Areno
- 4South Central VA Health Care Network, Ridgeland, MS USA
| | - Mark A Reger
- 4South Central VA Health Care Network, Ridgeland, MS USA.,5VA Puget Sound Health Care System, Tacoma, WA USA
| | - Traci H Abraham
- South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas VA Health Care System, North Little Rock, AR USA.,3Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA.,6Center for Mental Healthcare & Outcomes Research (CeMHOR), Central Arkansas Veterans Healthcare System, North Little Rock, AR USA
| | - Jeffery A Pitcock
- 1QUERI for Team-Based Behavioral Healthcare, Central Arkansas Veterans Healthcare System, North Little Rock, AR USA
| | - Mary J Bollinger
- 3Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA.,6Center for Mental Healthcare & Outcomes Research (CeMHOR), Central Arkansas Veterans Healthcare System, North Little Rock, AR USA
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DeVylder JE, Ryan TC, Cwik M, Wilson ME, Jay S, Nestadt PS, Goldstein M, Wilcox HC. Assessment of Selective and Universal Screening for Suicide Risk in a Pediatric Emergency Department. JAMA Netw Open 2019; 2:e1914070. [PMID: 31651971 PMCID: PMC6822088 DOI: 10.1001/jamanetworkopen.2019.14070] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/08/2019] [Indexed: 12/03/2022] Open
Abstract
Importance According to National Patient Safety Goal 15.01.01, all individuals being treated or evaluated for behavioral health conditions as their primary reason for care in hospitals and behavioral health care organizations accredited by The Joint Commission should be screened for suicide risk using a validated tool. Existing suicide risk screens have minimal or no high-quality evidence of association with future suicide-related outcomes. Objective To test the association between results of the Ask Suicide-Screening Questions (ASQ) instrument in a pediatric emergency department (ED), implemented through selective and universal screening approaches, and subsequent suicide-related outcomes. Design, Setting, and Participants In this retrospective cohort study at an urban pediatric ED in the United States, the ASQ was administered to youths aged 8 to 18 years with behavioral and psychiatric presenting problems from March 18, 2013, to December 31, 2016 (selective condition), and then to youths aged 10 to 18 years with medical presenting problems (in addition to those aged 8-18 years with behavioral and psychiatric presenting problems) from January 1, 2017, to December 31, 2018 (universal condition). Exposure Positive ASQ screen at baseline ED visit. Main Outcomes and Measures The main outcomes were subsequent ED visits with suicide-related presenting problems (ie, ideation or attempts) based on electronic health records and death by suicide identified through state medical examiner records. Association with suicide-related outcomes was calculated over the entire study period using survival analyses and at 3-month follow-up for both conditions using relative risk. Results The complete sample was 15 003 youths (7044 [47.0%] male; 10 209 [68.0%] black; mean [SD] age, 14.5 [3.1] years at baseline). The follow-up for the selective condition was a mean (SD) of 1133.7 (433.3) days; for the universal condition, it was 366.2 (209.2) days. In the selective condition, there were 275 suicide-related ED visits and 3 deaths by suicide. In the universal condition, there were 118 suicide-related ED visits and no deaths during the follow-up period. Adjusting for demographic characteristics and baseline presenting problem, positive ASQ screens were associated with greater risk of suicide-related outcomes among both the universal sample (hazard ratio, 6.8 [95% CI, 4.2-11.1]) and the selective sample (hazard ratio, 4.8 [95% CI, 3.5-6.5]). Conclusions and Relevance Positive results of both selective and universal screening for suicide risk in pediatric EDs appear to be associated with subsequent suicidal behavior. Screening may be a particularly effective way to detect suicide risk among those who did not present with ideation or attempt. Future studies should examine the impact of screening in combination with other policies and procedures aimed at reducing suicide risk.
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Affiliation(s)
- Jordan E. DeVylder
- Graduate School of Social Service, Fordham University, New York, New York
| | - Taylor C. Ryan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mary Ellen Wilson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Samantha Jay
- Department of Psychology, University of Maryland Baltimore County, Baltimore
| | - Paul S. Nestadt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mitchell Goldstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Holly C. Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
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Reger MA, Gebhardt HM, Lee JM, Ammerman BA, Tucker RP, Matarazzo BB, Wood AE, Ruskin DA. Veteran Preferences for the Caring Contacts Suicide Prevention Intervention. Suicide Life Threat Behav 2019; 49:1439-1451. [PMID: 30451311 DOI: 10.1111/sltb.12528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/12/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The Caring Contacts intervention has been implemented with a variety of methodologies. The purpose of this study was to examine high-risk inpatient preferences for the Caring Contacts intervention. METHOD Veteran psychiatric inpatients (N = 154) completed an anonymous patient preferences survey to obtain feedback on Caring Contact methods such as message wording, preferred correspondent, frequency of contact, duration of the intervention, imagery, and mailing modality. RESULTS Eighty-five percent of veterans Agreed or Strongly Agreed that they would like to receive Caring Contacts from at least one of the correspondent options, with inpatient or outpatient mental health counselor, or primary care physician most preferred. Example messages based on prior studies were overwhelmingly rated as caring and helpful; 84% believed that Caring Contacts could help suicidal individuals. Letters or postcards sent through postal mail were preferred over e-mail or text messages. Participants most commonly thought Caring Contacts should be sent monthly for a period of a year. CONCLUSIONS The results of this study suggest that most high-risk veterans would perceive Caring Contacts as helpful and caring. The results provide several practical, helpful tips for programs seeking to establish a Caring Contacts program.
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Affiliation(s)
- Mark A Reger
- VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - Jacob M Lee
- VA Puget Sound Health Care System, Seattle, WA, USA
| | | | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Bridget B Matarazzo
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Denver, CO, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amanda E Wood
- VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - David A Ruskin
- VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Short NA, Stentz L, Raines AM, Boffa JW, Schmidt NB. Intervening on Thwarted Belongingness and Perceived Burdensomeness to Reduce Suicidality Among Veterans: Subanalyses From a Randomized Controlled Trial. Behav Ther 2019; 50:886-897. [PMID: 31422845 PMCID: PMC6703169 DOI: 10.1016/j.beth.2019.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 01/27/2023]
Abstract
Suicide is a growing public health crisis among military veterans. Despite recent attention to this area, there are few empirically supported preventative interventions for suicidality among veterans. In the context of an empirically supported theoretical framework, the Interpersonal Theory of Suicide, the current study targeted suicide risk factors (i.e., perceived burdensomeness and thwarted belongingness) among a sample of 46 veterans selected from a larger clinical trial. Participants were randomized to receive either a newly developed computerized intervention aimed at decreasing perceived burdensomeness and thwarted belongingness, or participate in a repeated contact control condition. Results indicated a direct effect of the intervention on both perceived burdensomeness and thwarted belongingness. Temporal mediation analyses also revealed an indirect effect of condition on suicidality at Month 1 follow-up via reductions in perceived burdensomeness. The current results are the first to indicate that factors from the interpersonal theory of suicide can be reduced among veterans, and to demonstrate that these reductions in perceived burdensomeness lead to reductions in suicidality. Because of the brevity and computer delivery system, this intervention could be widely and rapidly disseminated among military veterans to reduce the public health burden of suicide in this population.
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50
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Charron E, Francis EC, Heavner-Sullivan SF, Truong KD. Disparities in Access to Mental Health Services Among Patients Hospitalized for Deliberate Drug Overdose. Psychiatr Serv 2019; 70:758-764. [PMID: 31084295 DOI: 10.1176/appi.ps.201800496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined patient and hospitalization characteristics associated with receiving a mental health assessment and disposition to an inpatient psychiatric facility among patients hospitalized for deliberate drug overdose. METHODS This retrospective analysis of 2012-2013 South Carolina all-payer data included adults ages 18-64 with at least one inpatient admission for a primary diagnosis of deliberate illicit or pharmaceutical drug overdose (N=2,686). Outcomes were receipt of a mental health assessment and disposition to an inpatient psychiatric facility. Multivariable logistic regression models were used to estimate the effects of patient and hospitalization characteristics on study outcomes. RESULTS Non-Hispanic blacks and people of other races-ethnicities were less likely than non-Hispanic whites to receive a mental health assessment (non-Hispanic blacks, adjusted odds ratio [AOR]=0.52, 95% CI=0.34-0.81; other races-ethnicities, AOR=0.24, 95% CI=0.12-0.49). Non-Hispanic blacks were also less likely than non-Hispanic whites to be discharged to an inpatient psychiatric facility than to home (AOR=0.60, 95% CI=0.47-0.77). Compared with persons without insurance, those with insurance, except those with Medicaid, were more likely to be discharged to an inpatient psychiatric facility than to home (Medicare, AOR=3.06, 95% CI=2.36-3.96; private, AOR=2.78, 95% CI=2.23-3.47; other, AOR=7.58, 95% CI=4.21-13.6). CONCLUSIONS Non-Hispanic white race-ethnicity and having insurance were predictive of receipt of a mental health assessment and disposition to an inpatient psychiatric facility among patients hospitalized for deliberate drug overdose. Study findings can inform clinical strategies and interventions aimed at reducing mental health care disparities among populations who are vulnerable to overdose or suicide.
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Affiliation(s)
- Elizabeth Charron
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
| | - Ellen C Francis
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
| | | | - Khoa D Truong
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
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