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Saini P, Hunt A, Blaney P, Murray A. Recognising and Responding to Suicide-Risk Factors in Primary Care: A Scoping Review. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00783-1. [PMID: 38801507 DOI: 10.1007/s10935-024-00783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
The cost of one suicide is estimated to be £1.67 million (2 million euros) to the UK economy. Most people who die by suicide have seen a primary care practitioner (PCP) in the year prior to death. PCPs could aim to intervene before suicidal behaviours arise by addressing suicide-risk factors noted in primary care consultations, thereby preventing suicide and promoting health and wellbeing. This study aimed to conduct a rapid, systematic scoping review to explore how PCPs can effectively recognise and respond to suicide-risk factors. MedLine, CINAHL, PsycINFO, Web of Science and Cochrane Library databases were searched for three key concepts: suicide prevention, mental health and primary care. Two reviewers screened titles, abstracts and full papers independently against the eligibility criteria. Data synthesis was achieved by extracting and analysing study characteristics and findings. Forty-two studies met the eligibility criteria and were cited in this scoping review. Studies were published between 1990 and 2020 and were of good methodological quality. Six themes regarding suicide risk assessment in primary care were identified: Primary care consultations prior to suicide; Reasons for non-disclosure of suicidal behaviour; Screening for suicide risk; Training for primary care staff; Use of language by primary care staff; and, Difference in referral pathways from general practitioners or primary care practitioners. This review focused on better recognition and response to specific suicide-risk factors more widely such as poor mental health, substance misuse and long-term physical health conditions. Primary care is well placed to address the range of suicide-risk factors including biological, physical-health, psychological and socio-economic factors and therefore these findings could inform the development of person-centred approaches to be used in primary care.
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Affiliation(s)
- Pooja Saini
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK.
| | - Anna Hunt
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Peter Blaney
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Annie Murray
- Department of Health and Social Care, Office for Health Improvement and Disparities, Piccadilly Place 3, Manchester, M1 3BN, UK
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Nobile B, Gourguechon-Buot E, Gorwood P, Olié E, Courtet P. Association of clinical characteristics, depression remission and suicide risk with discrepancies between self- and clinician-rated suicidal ideation: Two large naturalistic cohorts of outpatients with depression. Psychiatry Res 2024; 335:115833. [PMID: 38471242 DOI: 10.1016/j.psychres.2024.115833] [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: 12/01/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
Clinician- and self-rating of suicidal ideation (SI) are often discrepant. The aim of this study was to determine: 1) Association between discrepant self- and clinician-rated SI with clinical characteristics, depression remission and SA (SA) risk; 2) which SI assessment (self or clinician) predicted depression remission and risk of SA. LUEUR and GENESE are two large, prospective, naturalistic cohorts of French adult outpatients with unipolar depression treated and followed for 6 weeks. SI presence was assessed and defined with a score to the suicidal item of the Montgomery-Åsberg Depression Rating Scale ≥3. Discordant SI was defined as SI detection by only one of the two evaluators (patient or clinician). In both cohorts, 49.3 % (GENESE) and 34 % (LUEUR) patients had discordant SI. Clinical characteristics were more severe, and risk of SA was higher in patients with current SI (concordant and discordant) than in patients without SI and in the concordant than in the discordant group. Prediction of the risk of SA and of depression non-remission was comparable by the two ratings. Patients with SI (concordant and discordant) have more severe clinical characteristics and patients with concordant SI are the most at risk of SA during the follow-up. It is crucial to assess SI and to improve how it is evaluated.
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Affiliation(s)
- Bénédicte Nobile
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Hôpital La Colombière, University of Montpellier, CNRS, INSERM, 39, Avenue Charles Flahault, BP 34493, Montpellier 34093 CEDEX 5, France.
| | - Elia Gourguechon-Buot
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Hôpital La Colombière, University of Montpellier, CNRS, INSERM, 39, Avenue Charles Flahault, BP 34493, Montpellier 34093 CEDEX 5, France
| | - Philip Gorwood
- Inserm UMRS1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Hôpital La Colombière, University of Montpellier, CNRS, INSERM, 39, Avenue Charles Flahault, BP 34493, Montpellier 34093 CEDEX 5, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Hôpital La Colombière, University of Montpellier, CNRS, INSERM, 39, Avenue Charles Flahault, BP 34493, Montpellier 34093 CEDEX 5, France
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Sattler A, Dunn J, Albarran M, Berger C, Calugar A, Carper J, Chirravuri L, Jawad N, Zein M, McGovern M. Asynchronous Versus Synchronous Screening for Depression and Suicidality in a Primary Health Care System: Quality Improvement Study. JMIR Ment Health 2024; 11:e50192. [PMID: 38712997 PMCID: PMC11082433 DOI: 10.2196/50192] [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: 06/22/2023] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 05/08/2024] Open
Abstract
Background Despite being a debilitating, costly, and potentially life-threatening condition, depression is often underdiagnosed and undertreated. Previsit Patient Health Questionnaire-9 (PHQ-9) may help primary care health systems identify symptoms of severe depression and prevent suicide through early intervention. Little is known about the impact of previsit web-based PHQ-9 on patient care and safety. Objective We aimed to investigate differences among patient characteristics and provider clinical responses for patients who complete a web-based (asynchronous) versus in-clinic (synchronous) PHQ-9. Methods This quality improvement study was conducted at 33 clinic sites across 2 health systems in Northern California from November 1, 2020, to May 31, 2021, and evaluated 1683 (0.9% of total PHQs completed) records of patients endorsing thoughts that they would be better off dead or of self-harm (question 9 in the PHQ-9) following the implementation of a depression screening program that included automated electronic previsit PHQ-9 distribution. Patient demographics and providers' clinical response (suicide risk assessment, triage nurse connection, medication management, electronic consultation with psychiatrist, and referral to social worker or psychiatrist) were compared for patients with asynchronous versus synchronous PHQ-9 completion. Results Of the 1683 patients (female: n=1071, 63.7%; non-Hispanic: n=1293, 76.8%; White: n=831, 49.4%), Hispanic and Latino patients were 40% less likely to complete a PHQ-9 asynchronously (odds ratio [OR] 0.6, 95% CI 0.45-0.8; P<.001). Patients with Medicare insurance were 36% (OR 0.64, 95% CI 0.51-0.79) less likely to complete a PHQ-9 asynchronously than patients with private insurance. Those with moderate to severe depression were 1.61 times more likely (95% CI 1.21-2.15; P=.001) to complete a PHQ-9 asynchronously than those with no or mild symptoms. Patients who completed a PHQ-9 asynchronously were twice as likely to complete a Columbia-Suicide Severity Rating Scale (OR 2.41, 95% CI 1.89-3.06; P<.001) and 77% less likely to receive a referral to psychiatry (OR 0.23, 95% CI 0.16-0.34; P<.001). Those who endorsed question 9 "more than half the days" (OR 1.62, 95% CI 1.06-2.48) and "nearly every day" (OR 2.38, 95% CI 1.38-4.12) were more likely to receive a referral to psychiatry than those who endorsed question 9 "several days" (P=.002). Conclusions Shifting depression screening from in-clinic to previsit led to a dramatic increase in PHQ-9 completion without sacrificing patient safety. Asynchronous PHQ-9 can decrease workload on frontline clinical team members, increase patient self-reporting, and elicit more intentional clinical responses from providers. Observed disparities will inform future improvement efforts.
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Affiliation(s)
- Amelia Sattler
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Julia Dunn
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Marleni Albarran
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Charlotte Berger
- Technology and Digital Solutions, Stanford Health Care, Palo Alto, CA, United States
| | - Ana Calugar
- Department of Quality, Stanford Health Care, Stanford, CA, United States
| | - John Carper
- University Healthcare Alliance, Stanford, CA, United States
| | | | - Nadine Jawad
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Mira Zein
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Mark McGovern
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
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Jeong H, Yim HW, Lee SY, Park M, Ko W. The effectiveness of a suicide prevention program in primary care clinics supported by community public health resources: A difference-in-differences analysis. Psychiatry Res 2024; 334:115803. [PMID: 38412714 DOI: 10.1016/j.psychres.2024.115803] [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: 07/31/2023] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 02/29/2024]
Abstract
The importance of appropriate and intensive follow-up management for individuals identified with suicide risk through screening is highlighted. The Link between Primary Care Clinic and Public Health Resources Intervention(LinkPC-PH), a suicide prevention program in primary care clinics supported by community public health resources, was implemented at the district level in 2017. The purpose of the present study is to evaluate the effectiveness of the LinkPC-PH intervention by comparing suicide rates before(2014-2016) and after(2017-2019) implementation of the intervention using a difference-in-differences design. The LinkPC-PH comprises several dimensions of intervention including screening, risk assessment of suicidality, and referral in primary care clinics and crisis contact within 24 hours, case management, and safety planning led by public health professionals. After adjustment for district-level confounders, an intervention-implemented district had 2.87 fewer suicide deaths per 100,000 people in a population sample at post-intervention than would have been expected from the same trend in suicide rates as non-implemented intervention districts. In other words, the suicide rate in the intervention area decreased by 25% following the intervention. These results empirically substantiate suicide prevention programs in primary care clinics by community public health resources for reduced suicide rates to support effective community-based suicide prevention interventions.
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Affiliation(s)
- Hyunsuk Jeong
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Rep. of Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Rep. of Korea.
| | - Seung-Yup Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Rep of Korea
| | - Misun Park
- Department of Biostatistics, Clinical Research Coordinating Center, The Catholic University of Korea, Seoul, Rep of Korea
| | - Woolim Ko
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Rep. of Korea
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Harris BR. Helplines for Mental Health Support: Perspectives of New York State College Students and Implications for Promotion and Implementation of 988. Community Ment Health J 2024; 60:191-199. [PMID: 37351714 DOI: 10.1007/s10597-023-01157-3] [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: 01/22/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
Mental health and suicide are serious concerns in the U.S. Though many adults report struggling with their mental health, a significant proportion do not receive care for various reasons including stigma, limited availability, long wait times, inability to pay, and a lack of culturally appropriate options. Helplines can be used to fill gaps in care and, though currently underutilized, are a significant focus of the federal government in the implementation of 988. To better understand the factors that facilitate and impede the utilization of helplines, we conducted 14 focus groups with 95 college students attending a public university and two private colleges in upstate New York between April 2019 and October 2020. Participants included undergraduates, graduate students, LGBTQIA + students, student-athletes, and international students. Participants shared several reasons for using helplines including convenience, comfort, immediate support, and privacy and anonymity. On the other hand, participants expressed hesitation as they expected ingenuine interactions with operators and a lack of continuity, they feared police involvement, and they felt that helplines are not for them, as they are marketed for those in a mental health or suicide crisis and their issues are not that severe. LGBTQIA + participants provided additional reasons as to why they use and do not use LGBTQIA+-specific helplines. Together, our findings suggest the need for improved education, marketing, and training around helplines and may be used to inform the implementation and promotion of 988 in its early stages.
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Affiliation(s)
- Brett R Harris
- Public Health Research Department, NORC at the University of Chicago, 4350 East-West Highway, 8th Floor, 20814, Bethesda, MD, USA.
- Department of Health Policy, Management and Behavior, University at Albany School of Public Health, One University Place, 12144, Rensselaer, NY, USA.
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Becker-Haimes EM, Brady M, Jamison J, Jager-Hyman S, Reilly ME, Patel E, Brown GK, Mandell DS, Oquendo MA. An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER). Implement Sci Commun 2023; 4:148. [PMID: 38001478 PMCID: PMC10675939 DOI: 10.1186/s43058-023-00530-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Clinicians often report that their own anxiety and low self-efficacy inhibit their use of evidence-based suicide prevention practices, including gold-standard screening and brief interventions. Exposure therapy to reduce clinician maladaptive anxiety and bolster self-efficacy use is a compelling but untested approach to improving the implementation of suicide prevention evidence-based practices (EBPs). This project brings together an interdisciplinary team to leverage decades of research on behavior change from exposure theory to design and pilot test an exposure-based implementation strategy (EBIS) to target clinician anxiety to improve suicide prevention EBP implementation. METHODS We will develop, iteratively refine, and pilot test an EBIS paired with implementation as usual (IAU; didactic training and consultation) in preparation for a larger study of the effect of this strategy on reducing clinician anxiety, improving self-efficacy, and increasing use of the Columbia Suicide Severity Rating Scale and the Safety Planning Intervention in outpatient mental health settings. Aim 1 of this study is to use participatory design methods to develop and refine the EBIS in collaboration with a stakeholder advisory board. Aim 2 is to iteratively refine the EBIS with up to 15 clinicians in a pilot field test using rapid cycle prototyping. Aim 3 is to test the refined EBIS in a pilot implementation trial. Forty community mental health clinicians will be randomized 1:1 to receive either IAU or IAU + EBIS for 12 weeks. Our primary outcomes are EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention statistics. Secondary outcomes are the engagement of target implementation mechanisms (clinician anxiety and self-efficacy related to implementation) and preliminary effectiveness of EBIS on implementation outcomes (adoption and fidelity) assessed via mixed methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews). DISCUSSION Outcomes from this study will yield insight into the feasibility and utility of directly targeting clinician anxiety and self-efficacy as mechanistic processes informing the implementation of suicide prevention EBPs. Results will inform a fully powered hybrid effectiveness-implementation trial to test EBIS' effect on implementation and patient outcomes. TRIAL REGISTRATION Clinical Trials Registration Number: NCT05172609 . Registered on 12/29/2021.
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Affiliation(s)
- Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA.
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA.
| | - Megan Brady
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Jesslyn Jamison
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Megan E Reilly
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Esha Patel
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Gregory K Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3 Rd floor, Philadelphia, PA, 19104, USA
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Mehrabi A, Naghavi A, Afsharzada ME, Friedrich S, Forkmann T, Glaesmer H, Teismann T. Validation of the Farsi version of the Suicide Ideation and Behavior Scale. Front Psychiatry 2023; 14:1201193. [PMID: 37736059 PMCID: PMC10509848 DOI: 10.3389/fpsyt.2023.1201193] [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: 04/06/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Objective Suicide ideation and suicide attempts are prevalent in Farsi speaking populations. The present study aimed at validating the Farsi version of the Suicide Ideation and Behavior Scale (SIBS). Methods Reliability and validity of the Farsi version of the SIBS were established in a highly burdened Afghan student sample (N = 279). Internal consistency, convergent and discriminant validity were investigated, and confirmatory factor analysis was conducted. Results The Farsi version of the SIBS was shown to have a unidimensional structure with excellent internal consistency, as well as good convergent and divergent validity. Discussion The results suggest that the SIBS is a brief, reliable, and valid measure of current suicidal ideation and behavior that can be used in Farsi speaking populations.
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Affiliation(s)
- Ali Mehrabi
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | - Azam Naghavi
- Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | | | - Sören Friedrich
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Duisburg, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Tobias Teismann
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
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Hallford D, Rusanov D, Winestone B, Kaplan R, Fuller-Tyszkiewicz M, Melvin G. Disclosure of suicidal ideation and behaviours: A systematic review and meta-analysis of prevalence. Clin Psychol Rev 2023; 101:102272. [PMID: 37001469 DOI: 10.1016/j.cpr.2023.102272] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/30/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Abstract
Disclosure of suicidal ideation and behaviours, defined as thoughts, plans, or attempts, to other people provides opportunity for intervention and prevention. This study is the first to meta-analyze all available studies to estimate the prevalence of disclosure, to whom people disclose, and examine factors that influence disclosure. Databases were searched for studies reporting samples of people who had experienced suicidal ideation or behaviours (including those who had died by suicide) and whether they had disclosed this. Almost 100 studies (k = 94, N participants = 1,044,629) were included in the overall prevalance analysis. The results showed less than half of people disclosed suicidal ideation or behaviour: 45.9% (95%CI 41.9-49.9%, PI 12.3-81.8%; k = 94). High heterogeneity, common to prevalence studies, was found (Q[93] = 130,584, p < .001; I2 = 99.9%). No publication bias was detected. Removing outliers did not change the prevalence estimate, but provided tighter prediction intervals: 45.6% (95%CI 43.4-47.9%, PI 35.8-55.7%; k = 33). Disclosure was related to higher prevalence of psychiatric disorders, female gender, and a longer timeframe of suicidal ideation or behaviour. Prevalence of disclosure was lower among people who died by suicide, relative to community samples, and lower when reported verbally rather than written online. Disclosure, and proportions of disclosures, to family members, was numerically higher than to friends or professionals, but could not be directly compared. In conclusion, between 50 and 60% of people do not disclose their suicidal ideation and behaviours to other people, and therefore remain unidentified and potentially untreated.
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Elzinga E, Zomers M, van der Burg K, van Veen S, Schweren L, van Thiel G, van Wijngaarden E. Lifelong versus not lifelong death wishes in older adults without severe illness: a cross-sectional survey. BMC Geriatr 2022; 22:885. [PMID: 36411442 PMCID: PMC9680128 DOI: 10.1186/s12877-022-03592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Some older adults with a persistent death wish without being severely ill report having had a death wish their whole lives (lifelong persistent death wish; L-PDW). Differentiating them from older adults without severe illness who developed a death wish later in life (persistent death wish, not lifelong; NL-PDW) can be relevant for the provision of adequate help and support. This study aims to gain insight into the characteristics, experiences, and needs of older adults with a L-PDW versus older adults with a NL-PDW and into the nature of their death wishes. METHODS In the Netherlands, in April 2019, a cross-sectional survey study was conducted among a large representative sample of 32,477 citizens aged 55 years and older. Respondents with a L-PDW (N = 50) were compared with respondents with a NL-PDW (N = 217) using descriptive statistics, Kruskal-Wallis tests, and Fisher's exact tests. RESULTS Respondents with a L-PDW were relatively younger and less often had (step)children. They less often looked back on a good and satisfying life with many good memories and more often reported trauma. Older adults with a NL-PDW more often reported loss and bereavement. Overall, the groups showed a lot of similarities. Both groups reported a death wish diverse in nature, numerous health problems, and a variety of needs for help and support. CONCLUSIONS Some of the differences we found between the groups might be particularly relevant for the provision of adequate help and support to older adults with a L-PDW (i.e., their past and trauma) and to older adults with a NL-PDW (i.e., their loss and bereavement). The heterogeneity of both groups and the diverse nature of their death wish indicate that careful assessment of the death wish, its background, and underlying needs is required to provide personalized help and support to older adults with a death wish.
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Affiliation(s)
- Elke Elzinga
- Research Department, 113 Suicide prevention, Paasheuvelweg 25, 1105 BP Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Margot Zomers
- grid.7692.a0000000090126352Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX Utrecht, the Netherlands
| | - Kiki van der Burg
- grid.7692.a0000000090126352Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Sisco van Veen
- Research Department, 113 Suicide prevention, Paasheuvelweg 25, 1105 BP Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Department of Psychiatry & Department of Ethics, Law and Humanities, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Lizanne Schweren
- Research Department, 113 Suicide prevention, Paasheuvelweg 25, 1105 BP Amsterdam, the Netherlands
| | - Ghislaine van Thiel
- grid.7692.a0000000090126352Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX Utrecht, the Netherlands
| | - Els van Wijngaarden
- grid.10417.330000 0004 0444 9382Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
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Ethical and methodological challenges slowing progress in primary care-based suicide prevention: Illustrations from a randomized controlled trial and guidance for future research. J Psychiatr Res 2022; 154:242-251. [PMID: 35961180 PMCID: PMC10124132 DOI: 10.1016/j.jpsychires.2022.07.038] [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: 12/30/2021] [Revised: 06/26/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Despite the pressing need for primary care-based suicide prevention initiatives and growing acknowledgement of recruitment difficulties and Institutional Review Board (IRB) challenges in suicide research, we are aware of no illustrative examples describing how IRB decisions in the design of a primary care trial can compound recruitment challenges. METHODS The CDC-funded trial (NCT02986113) of Men and Providers Preventing Suicide aimed to examine the effects of a tailored computer program encourage men with suicidal thoughts (n = 304, ages 35-64) to discuss suicide with a primary care clinician and accept treatment. Before a visit, participants viewed MAPS or a non-tailored control video. Post-visit, both arms were offered telephone collaborative care, as mandated by the institutional review board (IRB). We previously showed that exposure to MAPs led to improvements in communication about suicide in a primary care visit. In this paper, we report data on the study's primary outcome, suicide preparatory behaviors. RESULTS After screening nearly 4100 men, 48 enrolled. Recruitment challenges, which were exacerabted by an IRB mandate narrowing post-intervention patient management differences between trial arms, limited detection of the effects of MAPS on suicide preparatory behaviors. CONCLUSIONS While primary care settings are key sites for suicide prevention trials, issues such as recruitment difficulties and overly restrictive IRB requirements may limit their utility. Methodological innovation to improve recruitment and ethical guidance to inform IRB decision-making are needed.
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Stacy M, Dwyer E, Kremer M, Schulkin J. Obstetrician/Gynecologists' Knowledge, Attitudes, and Practice Regarding Suicide Screening Among Women. J Womens Health (Larchmt) 2022; 31:1481-1489. [PMID: 35984865 DOI: 10.1089/jwh.2021.0646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Suicide is a public health issue, and there are differences between men and women in terms of suicide ideation, behavior, and completion. Obstetrician/gynecologists (OB/GYNs) are uniquely positioned to assess women's suicide risk. Methods: A 53-question survey was distributed to the Pregnancy-Related Care Research Network, assessing practice, attitudes, and knowledge regarding suicide risk assessment and management, and personal experience with suicide. Wilcoxon signed-rank tests with paired samples were used to compare the frequency of screening and interventions for different groups of women, and practices of those with and without suicide experience. Significance was set at p < 0.05. Results: Response rate was 31.9%. Respondents were largely White females. OB/GYNs reported more frequently screening for suicide ideation/intent/behavior among pregnant and postpartum patients than nonpregnant/nonpostpartum patients of childbearing age. The most common assessment tool was the Edinburgh Postnatal Depression Scale; half ask about past suicide ideation/behavior or current thoughts/plans. The most common intervention for at-risk patients was a mental health referral; all interventions were reported more frequently for pregnant patients. Common barriers to screening were inadequate mental health services, time constraints, and inadequate training. Most agreed suicide screening is within their purview, and were knowledgeable about the topic, although gaps were identified. Few reported adequate training in suicide risk assessment, and believed continuing education would be beneficial. A majority endorsed experience with suicide and some practice differences emerged. Conclusions: OB/GYNs view suicide risk assessment in their scope. Some knowledge gaps were identified, and respondents believe additional training would be beneficial.
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Affiliation(s)
- Meaghan Stacy
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Erin Dwyer
- Department of Obstetrics and Gynecology, University of Washington Medicine, Seattle, Washington, USA
| | - Mallory Kremer
- Department of Obstetrics and Gynecology, University of Washington Medicine, Seattle, Washington, USA
| | - Jay Schulkin
- Department of Obstetrics and Gynecology, University of Washington Medicine, Seattle, Washington, USA
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12
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Bentley KH, Zuromski KL, Fortgang RG, Madsen EM, Kessler D, Lee H, Nock MK, Reis BY, Castro VM, Smoller JW. Implementing Machine Learning Models for Suicide Risk Prediction in Clinical Practice: Focus Group Study With Hospital Providers. JMIR Form Res 2022; 6:e30946. [PMID: 35275075 PMCID: PMC8956996 DOI: 10.2196/30946] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background Interest in developing machine learning models that use electronic health record data to predict patients’ risk of suicidal behavior has recently proliferated. However, whether and how such models might be implemented and useful in clinical practice remain unknown. To ultimately make automated suicide risk–prediction models useful in practice, and thus better prevent patient suicides, it is critical to partner with key stakeholders, including the frontline providers who will be using such tools, at each stage of the implementation process. Objective The aim of this focus group study is to inform ongoing and future efforts to deploy suicide risk–prediction models in clinical practice. The specific goals are to better understand hospital providers’ current practices for assessing and managing suicide risk; determine providers’ perspectives on using automated suicide risk–prediction models in practice; and identify barriers, facilitators, recommendations, and factors to consider. Methods We conducted 10 two-hour focus groups with a total of 40 providers from psychiatry, internal medicine and primary care, emergency medicine, and obstetrics and gynecology departments within an urban academic medical center. Audio recordings of open-ended group discussions were transcribed and coded for relevant and recurrent themes by 2 independent study staff members. All coded text was reviewed and discrepancies were resolved in consensus meetings with doctoral-level staff. Results Although most providers reported using standardized suicide risk assessment tools in their clinical practices, existing tools were commonly described as unhelpful and providers indicated dissatisfaction with current suicide risk assessment methods. Overall, providers’ general attitudes toward the practical use of automated suicide risk–prediction models and corresponding clinical decision support tools were positive. Providers were especially interested in the potential to identify high-risk patients who might be missed by traditional screening methods. Some expressed skepticism about the potential usefulness of these models in routine care; specific barriers included concerns about liability, alert fatigue, and increased demand on the health care system. Key facilitators included presenting specific patient-level features contributing to risk scores, emphasizing changes in risk over time, and developing systematic clinical workflows and provider training. Participants also recommended considering risk-prediction windows, timing of alerts, who will have access to model predictions, and variability across treatment settings. Conclusions Providers were dissatisfied with current suicide risk assessment methods and were open to the use of a machine learning–based risk-prediction system to inform clinical decision-making. They also raised multiple concerns about potential barriers to the usefulness of this approach and suggested several possible facilitators. Future efforts in this area will benefit from incorporating systematic qualitative feedback from providers, patients, administrators, and payers on the use of these new approaches in routine care, especially given the complex, sensitive, and unfortunately still stigmatized nature of suicide risk.
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Affiliation(s)
- Kate H Bentley
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychology, Harvard University, Cambridge, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Kelly L Zuromski
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Rebecca G Fortgang
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Emily M Madsen
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Daniel Kessler
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Hyunjoon Lee
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Ben Y Reis
- Harvard Medical School, Boston, MA, United States.,Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
| | - Victor M Castro
- Research Information Science and Computing, Mass General Brigham, Somerville, MA, United States
| | - Jordan W Smoller
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
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13
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The Role of General Practitioners in Suicide Prevention—What You Said and Did then Actually Saved My Life. REPORTS 2021. [DOI: 10.3390/reports4030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: General practitioners (GPs) have an important role in the prevention of suicidal behavior. The purpose of this study was to explore their views and experiences in identifying and assessing suicidal ideation. Methods: Ten GPs were recruited through convenience sampling based on accessibility, interest and willingness to participate. In-depth interviews were carried out, and the results were transcribed verbatim. Aspects of experiences with suicidal patients emerged through the thematic analysis process. Results: The GPs described the varied clinical picture when patients presented in their office. How they identified depressive symptoms apart from originally somatic complaints included forming a trusting relationship and addressing suicide ideation. They described customized interventions as well as obstacles and factors that facilitated communication, including time, their own personal traits, patient’s disclosure and organizational barriers. Conclusions: The levels of the suicidal process among patients in general practice vary greatly. GPs adjust their appraisals to profoundly understand and intervene to prevent a crisis of escalation into subsequent suicidal behavior.
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14
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Walsh CG, Johnson KB, Ripperger M, Sperry S, Harris J, Clark N, Fielstein E, Novak L, Robinson K, Stead WW. Prospective Validation of an Electronic Health Record-Based, Real-Time Suicide Risk Model. JAMA Netw Open 2021; 4:e211428. [PMID: 33710291 PMCID: PMC7955273 DOI: 10.1001/jamanetworkopen.2021.1428] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Numerous prognostic models of suicide risk have been published, but few have been implemented outside of integrated managed care systems. OBJECTIVE To evaluate performance of a suicide attempt risk prediction model implemented in a vendor-supplied electronic health record to predict subsequent (1) suicidal ideation and (2) suicide attempt. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study evaluated implementation of a suicide attempt prediction model in live clinical systems without alerting. The cohort comprised patients seen for any reason in adult inpatient, emergency department, and ambulatory surgery settings at an academic medical center in the mid-South from June 2019 to April 2020. MAIN OUTCOMES AND MEASURES Primary measures assessed external, prospective, and concurrent validity. Manual medical record validation of coded suicide attempts confirmed incident behaviors with intent to die. Subgroup analyses were performed based on demographic characteristics, relevant clinical context/setting, and presence or absence of universal screening. Performance was evaluated using discrimination (number needed to screen, C statistics, positive/negative predictive values) and calibration (Spiegelhalter z statistic). Recalibration was performed with logistic calibration. RESULTS The system generated 115 905 predictions for 77 973 patients (42 490 [54%] men, 35 404 [45%] women, 60 586 [78%] White, 12 620 [16%] Black). Numbers needed to screen in highest risk quantiles were 23 and 271 for suicidal ideation and attempt, respectively. Performance was maintained across demographic subgroups. Numbers needed to screen for suicide attempt by sex were 256 for men and 323 for women; and by race: 373, 176, and 407 for White, Black, and non-White/non-Black patients, respectively. Model C statistics were, across the health system: 0.836 (95% CI, 0.836-0.837); adult hospital: 0.77 (95% CI, 0.77-0.772); emergency department: 0.778 (95% CI, 0.777-0.778); psychiatry inpatient settings: 0.634 (95% CI, 0.633-0.636). Predictions were initially miscalibrated (Spiegelhalter z = -3.1; P = .001) with improvement after recalibration (Spiegelhalter z = 1.1; P = .26). CONCLUSIONS AND RELEVANCE In this study, this real-time predictive model of suicide attempt risk showed reasonable numbers needed to screen in nonpsychiatric specialty settings in a large clinical system. Assuming that research-valid models will translate without performing this type of analysis risks inaccuracy in clinical practice, misclassification of risk, wasted effort, and missed opportunity to correct and prevent such problems. The next step is careful pairing with low-cost, low-harm preventive strategies in a pragmatic trial of effectiveness in preventing future suicidality.
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Affiliation(s)
- Colin G. Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin B. Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Ripperger
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah Sperry
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joyce Harris
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nathaniel Clark
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elliot Fielstein
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laurie Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katelyn Robinson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William W. Stead
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Høyen KS, Solem S, Cohen LJ, Prestmo A, Hjemdal O, Vaaler AE, Galynker I, Torgersen T. Non-disclosure of suicidal ideation in psychiatric inpatients: Rates and correlates. DEATH STUDIES 2021; 46:1823-1831. [PMID: 33586630 DOI: 10.1080/07481187.2021.1879317] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The study explored how common non-disclosure of suicidal ideation is in a sample of adult psychiatric inpatients (N = 171) plus associated patient characteristics. A large percentage (51.5%) withheld some information on suicidal ideation during admission. In multivariable analyses, correlates of non-disclosure included a diagnosis of emotionally unstable personality disorder, low satisfaction with stay, and symptoms of the suicide crisis syndrome. In univariate analyses, therapists' emotional response to the patient was also a correlate. Findings indicate that among acute psychiatric inpatients, non-disclosure of suicidal ideation is quite common, requiring awareness from clinicians relying on this parameter in suicide risk assessments.
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Affiliation(s)
- Karina Sagmo Høyen
- Department of Østmarka, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lisa Janet Cohen
- Carl Icahn School of Medicine, Mount Sinai/Mount Sinai Beth Israel, New York, New York, USA
| | - Astrid Prestmo
- Department of Østmarka, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Einar Vaaler
- Department of Østmarka, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Igor Galynker
- Carl Icahn School of Medicine, Mount Sinai/Mount Sinai Beth Israel, New York, New York, USA
| | - Terje Torgersen
- Department of Østmarka, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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16
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Yoon S, Park K, Choi KH. The ultra brief checklist for suicidality. J Affect Disord 2020; 276:279-286. [PMID: 32697710 DOI: 10.1016/j.jad.2020.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/31/2020] [Accepted: 07/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurately identifying patients at an elevated risk of suicide in minimal time is an important mental health issue. Therefore, we developed the Ultra Brief Checklist for Suicidality (UBCS) and reported its psychometric properties. METHODS We studied 544 participants who had completed the UBCS, other self-report measures, and structured clinical interviews by trained interviewers. We explored the psychometric properties of the UBCS's paper-based and online versions by identifying optimal cutoff points, sensitivity, specificity, etc. of all participants. RESULTS The mean score of the UBCS (paper-pencil version) in the no-suicide-risk group was 0.23 (SD = 0.73), while in the Risk-Positive (RP) and the High-Risk (HR) groups it was 3.54 (SD = 3.22) and 6.31 (SD = 3.97), respectively. Optimal cutoff points for the RP and HR groups were 1 (AUC = 0.914) and 3 (AUC = 0.928), respectively. LIMITATIONS The current findings apply only to adults, not to children or adolescents. The original MINI was used as the assessment instrument's reference standard rather than MINI 7.0.2 of DSM-5. Predictive validity was not addressed as this was not a longitudinal cohort study. CONCLUSIONS The UBCS was rigorously tested and validated. More than half the participants completed the UBCS within a minute. It possesses adequate psychometric properties and can be easily administered with minimal clinician time and effort, via paper or Internet. We believe it can contribute to suicide risk identification and timely interventions.
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Affiliation(s)
- Seowon Yoon
- Department of Psychology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea
| | - Kiho Park
- Department of Psychology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea; KU Mind Health Institute, Korea University, Seoul, Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea; KU Mind Health Institute, Korea University, Seoul, Korea.
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17
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Jerant A, Duberstein P, Kravitz RL, Stone DM, Cipri C, Franks P. Tailored Activation of Middle-Aged Men to Promote Discussion of Recent Active Suicide Thoughts: a Randomized Controlled Trial. J Gen Intern Med 2020; 35:2050-2058. [PMID: 32185660 PMCID: PMC7351903 DOI: 10.1007/s11606-020-05769-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Middle-aged men are at high risk of suicide. While about half of those who kill themselves visit a primary care clinician (PCC) shortly before death, in current practice, few spontaneously disclose their thoughts of suicide during the visits, and PCCs seldom inquire about such thoughts. In a randomized controlled trial, we examined the effect of a tailored interactive computer program designed to encourage middle-aged men's discussion of suicide with PCCs. METHODS We recruited men 35-74 years old reporting recent (within 4 weeks) active suicide thoughts from the panels of 42 PCCs (the unit of randomization) in eight offices within a single California health system. In the office before a visit, men viewed the intervention corresponding to their PCC's random group assignment: Men and Providers Preventing Suicide (MAPS) (20 PCCs), providing tailored multimedia promoting discussion of suicide thoughts, or control (22 PCCs), composed of a sleep hygiene video plus brief non-tailored text encouraging discussion of suicide thoughts. Logistic regressions, adjusting for patient nesting within physicians, examined MAPS' effect on patient-reported suicide discussion in the subsequent office visit. RESULTS Sixteen of the randomized PCCs had no patients enroll in the trial. From the panels of the remaining 26 PCCs (12 MAPS, 14 control), 48 men (MAPS 21, control 27) were enrolled (a mean of 1.8 (range 1-5) per PCC), with a mean age of 55.9 years (SD 11.4). Suicide discussion was more likely among MAPS patients (15/21 [65%]) than controls (8/27 [35%]). Logistic regression showed men viewing MAPS were more likely than controls to discuss suicide with their PCC (OR 5.91, 95% CI 1.59-21.94; P = 0.008; nesting-adjusted predicted effect 71% vs. 30%). CONCLUSIONS In addressing barriers to discussing suicide, the tailored MAPS program activated middle-aged men with active suicide thoughts to engage with PCCs around this customarily taboo topic.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California Davis (UCD) School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817 USA
| | - Paul Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854 USA
| | - Richard L. Kravitz
- Division of General Medicine, Department of Internal Medicine, UCD School of Medicine, 4150 V Street, Suite 2400, PSSB, Sacramento, CA 95817 USA
| | - Deborah M. Stone
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341 USA
| | - Camille Cipri
- Center for Healthcare Policy and Research, UCD, 2103 Stockton Blvd, Sacramento, CA 95817 USA
| | - Peter Franks
- Department of Family and Community Medicine, University of California Davis (UCD) School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817 USA
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18
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Abstract
Inaccurate disclosure of information is a significant limitation when relying on self-report for suicide risk screening. However, allowing for an explicit nondisclosure response option in screening items (e.g., “prefer not to disclose”) may ultimately improve follow-up assessment validity. This study investigated explicit nondisclosure in suicide risk screening among military service members and veterans ( n = 135), men older than 50 years, ( n = 187), and LGBTQ (lesbian, gay, bisexual, transgender, or queer) young adults ( n = 140); all higher risk and lower help-seeking populations. Results indicated that allowing for explicit nondisclosure minimally affected screening sensitivity and specificity. However, its selection was prevalent among higher risk participants, and was associated with experience of past unhelpful reactions and “avoidance of stigmatized consequences.” Allowing for nondisclosure creates potential psychometric and classification advantages, and may be a safe and effective way to encourage discussion of barriers, build trust, maximize patient autonomy, and ultimately facilitate accurate risk disclosure to improve assessment validity.
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Affiliation(s)
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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19
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Elzinga E, Gilissen R, Donker GA, Beekman ATF, de Beurs DP. Discussing suicidality with depressed patients: an observational study in Dutch sentinel general practices. BMJ Open 2019; 9:e027624. [PMID: 31023763 PMCID: PMC6501984 DOI: 10.1136/bmjopen-2018-027624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/06/2019] [Accepted: 02/22/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This paper aims to describe the degree to which general practitioners (GPs) explore suicidal behaviour among depressed patients in the Netherlands. DESIGN An observational study of consultations between GPs and depressed patients. SETTING 39 sentinel GP practices within the Netherlands in 2017. PARTICIPANTS Patients with a registration of depression. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measure is suicide exploration by the GP. Secondary outcome measures at patient level, assessed by surveying GPs, include prevalence and severity of suicidal thoughts. Secondary outcome measures at GP level include follow-up actions of GP and reasons not to explore suicidality. RESULTS A total of 1034 questionnaires were included in the analyses. GPs assessed and explored suicidality in 44% of patients with depression (66% in patients with a new episode of depression). GPs explored suicidal feelings more often in patients with a new episode of depression (OR 4.027, p<0.001, 95% CI 2.924 to 5.588), male patients (OR 1.709, p<0.001, 95% CI 1.256 to 2.330) or younger patients (OR 1.017, p<0.001, 95% CI 1.009 to 1.026). Multilevel analysis showed that 22% of the variation in suicide exploration is due to differences in GP practice. Thirty-eight per cent of the patients who were asked by their GP, reported (severe) suicidal ideation. Most GPs (68%) did not explore suicidal feelings because they thought the patient would not be suicidal. CONCLUSION GPs explored suicidal thoughts in less than half of all depressed patients and in two-thirds of patients with a new episode of depression. Suicide prevention training is recommended to enhance suicide exploration.
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Affiliation(s)
- Elke Elzinga
- 113 Suicide Prevention, Amsterdam, The Netherlands
| | | | - Gé A Donker
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Aartjan T F Beekman
- Psychiatry, Amsterdam Public Health (research institute), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Derek P de Beurs
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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20
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Jerant A, Duberstein P, Cipri C, Bullard B, Stone D, Paterniti D. Stakeholder views regarding a planned primary care office-based interactive multimedia suicide prevention tool. PATIENT EDUCATION AND COUNSELING 2019; 102:332-339. [PMID: 30220599 PMCID: PMC6886248 DOI: 10.1016/j.pec.2018.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/11/2018] [Accepted: 09/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Nearly half of all men who die by suicide visit a primary care clinician (PCC) in the month before death, yet few disclose suicide thoughts. We solicited stakeholders' views to guide development of a tailored multimedia program to activate middle-aged men experiencing suicide thoughts to engage with PCCs. METHODS We conducted semi-structured interviews with 44 adults self-identifying as: suicide attempt survivor; family member/loved one of person(s) who attempted or died by suicide; PCC; non-PCC office staff; health administrator; and/or prevention advocate. We coded recorded interview transcripts and identified relevant themes using grounded theory. RESULTS Two thematic groupings emerged, informing program design: structure and delivery (including belief the program could be effective and desire for use of plain language and media over text); and informational and motivational content (including concerns about PCC preparedness; fear that disclosing suicide thoughts would necessitate hospitalization; and influence of male identity and masculinity, respectively, in care-seeking for and interpreting suicide thoughts). CONCLUSION Stakeholder input informed the design of a primary care tailored multimedia suicide prevention tool. PRACTICE IMPLICATIONS In revealing a previously unreported barrier to disclosing suicide thoughts to PCCs (fear of hospitalization), and underscoring known barriers, the findings may suggest additional suicide prevention approaches.
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Affiliation(s)
- Anthony Jerant
- Department of Family & Community Medicine, University of California Davis School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA, 95817, USA.
| | - Paul Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Camille Cipri
- Center for Healthcare Policy and Research, University of California, Davis, 2103 Stockton Blvd, Sacramento, CA, USA
| | - Bethany Bullard
- Department of Sociology, Sonoma State University, 1801 East Cotati Ave, Rohnert Park, California, USA
| | - Deborah Stone
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, 4770 Buford Highway NE, Atlanta, GA, USA
| | - Debora Paterniti
- Department of Sociology, Sonoma State University, 1801 East Cotati Ave, Rohnert Park, California, USA; Department of Internal Medicine, University of California, Davis, School of Medicine, 4150 V St, Suite 3100, Sacramento, CA, USA
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21
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Abstract
Researchers are increasingly interested in how clinicians should screen for suicide ideation in care settings and the merits of doing so. A common finding is that screening does no harm, and may do good, insofar as once the subject of suicide is broached clinicians can conduct a suicide risk assessment to determine the course of safe care. To date, little has been published about just how clinicians should ask "the ask" about suicidal ideation. The aim of this article is to suggest that the difficulty clinicians seem to have in initiating a verbal probe for suicidal ideation has less to do with patient characteristics than it does with clinician anticipatory anxiety about learning that a patient is positive for suicidal ideation. Face-negotiation theory and politeness theory are offered as possible explanations for why a simple direct question is so difficult to ask. Future research directions are suggested and an absence of data from public health gatekeeper training is offered as argument for clinicians to be more direct in their probes for suicidal ideation.
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Affiliation(s)
- Paul Quinnett
- QPR Institute, Spokane, WA, USA.,University of Washington School of Medicine, Department of Psychiatry and Behavioral Health, Seattle, WA, USA
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22
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Teismann T, Lukaschek K, Hiller TS, Breitbart J, Brettschneider C, Schumacher U, Margraf J, Gensichen J. Suicidal ideation in primary care patients suffering from panic disorder with or without agoraphobia. BMC Psychiatry 2018; 18:305. [PMID: 30249220 PMCID: PMC6154913 DOI: 10.1186/s12888-018-1894-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/17/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Suicidal ideation is common in patients suffering from panic disorder. The present study investigated rates of suicidal ideation and risk factors for suicidal ideation in a sample of primary care patients suffering from panic disorder with or without agoraphobia. METHODS A total of N = 296 patients [n = 215 (72.6%) women; age: M = 43.99, SD = 13.44] were investigated. Anxiety severity, anxiety symptoms, avoidance behavior, comorbid depression diagnosis, severity of depression, age, sex, employment status, living situation and frequency of visits at the general practitioner were considered as risk factors of suicidal ideation. RESULTS Suicidal ideation was experienced by 25% of the respondents. In a logistic regression analysis, depression diagnosis and depression severity emerged as significant risk factors for suicidal ideation. Anxiety measures were not associated with suicidal ideation. CONCLUSION Suicidal ideation is common in primary care patients suffering from panic disorder with or without agoraphobia. Individuals with greater burden of mental illness in terms of mood disorder comorbidity and depressive symptomatology are especially likely to suffer from suicidal ideation.
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Affiliation(s)
- Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Massenbergstraße 11, 44787, Bochum, Germany.
| | - Karoline Lukaschek
- 0000 0004 0477 2585grid.411095.8Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians- University Munich, Pettenkoferstr. 10, D-80336 Munich, Germany ,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany
| | - Thomas S. Hiller
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-Universität, Bachstr. 18, D-07743 Jena, Germany
| | - Jörg Breitbart
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-Universität, Bachstr. 18, D-07743 Jena, Germany
| | - Christian Brettschneider
- 0000 0001 2180 3484grid.13648.38Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
| | - Ulrike Schumacher
- 0000 0000 8517 6224grid.275559.9Centre for Clinical Studies, Jena University Hospital, Salvador-Allende-Platz 27, D-07747 Jena, Germany
| | - Jürgen Margraf
- 0000 0004 0490 981Xgrid.5570.7Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Massenbergstraße 11, 44787 Bochum, Germany
| | - Jochen Gensichen
- 0000 0004 0477 2585grid.411095.8Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians- University Munich, Pettenkoferstr. 10, D-80336 Munich, Germany ,Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-Universität, Bachstr. 18, D-07743 Jena, Germany
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Vannoy S, Park M, Maroney MR, Unützer J, Apesoa-Varano EC, Hinton L. The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care. CRISIS 2018; 39:397-405. [PMID: 29618265 DOI: 10.1027/0227-5910/a000511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. AIMS This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. METHOD Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. RESULTS Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" CONCLUSION Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.
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Affiliation(s)
- Steven Vannoy
- 1 Department of Counseling and School Psychology, University of Massachusetts Boston, MA, USA
| | - Mijung Park
- 2 Family Health Care Nursing, University of California San Francisco, CA, USA
| | - Meredith R Maroney
- 1 Department of Counseling and School Psychology, University of Massachusetts Boston, MA, USA
| | - Jürgen Unützer
- 3 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - Ladson Hinton
- 4 Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
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Murphy AL, O’Reilly C, Martin-Misener R, Ataya R, Gardner D. Community pharmacists' attitudes on suicide: A preliminary analysis with implications for medical assistance in dying. Can Pharm J (Ott) 2018; 151:17-23. [PMID: 29317932 PMCID: PMC5755823 DOI: 10.1177/1715163517744225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Claire O’Reilly
- the College of Pharmacy (Murphy, Ataya), School of Nursing (Martin-Misener) and Department of Psychiatry (Gardner, Murphy), Dalhousie University, Halifax, Nova Scotia
- the Faculty of Pharmacy (O’Reilly), The University of Sydney, Sydney, Australia
| | - Ruth Martin-Misener
- the College of Pharmacy (Murphy, Ataya), School of Nursing (Martin-Misener) and Department of Psychiatry (Gardner, Murphy), Dalhousie University, Halifax, Nova Scotia
- the Faculty of Pharmacy (O’Reilly), The University of Sydney, Sydney, Australia
| | - Randa Ataya
- the College of Pharmacy (Murphy, Ataya), School of Nursing (Martin-Misener) and Department of Psychiatry (Gardner, Murphy), Dalhousie University, Halifax, Nova Scotia
- the Faculty of Pharmacy (O’Reilly), The University of Sydney, Sydney, Australia
| | - David Gardner
- the College of Pharmacy (Murphy, Ataya), School of Nursing (Martin-Misener) and Department of Psychiatry (Gardner, Murphy), Dalhousie University, Halifax, Nova Scotia
- the Faculty of Pharmacy (O’Reilly), The University of Sydney, Sydney, Australia
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Murphy AL, Hillier K, Ataya R, Thabet P, Whelan AM, O'Reilly C, Gardner D. A scoping review of community pharmacists and patients at risk of suicide. Can Pharm J (Ott) 2017; 150:366-379. [PMID: 29123596 DOI: 10.1177/1715163517733482] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Medications are commonly used in suicide attempts. Pharmacists are inextricably linked to medications and may have roles in helping those at risk of suicide. We conducted a scoping review to characterize the existing literature and make recommendations about future research. Methods We used a 6-step approach based on an existing scoping review methodological framework, including identifying the research question; identifying relevant studies and other literature; study and literature selection; data charting; collating, summarizing and reporting results; and dissemination of results. We searched electronic databases, various grey literature sources and mobile app stores. Results Thirty-five articles were included following screening of 1013 database citations. Of 1085 results from grey literature searches, we included 12. Most publications were opinion pieces (n = 22), followed by survey studies (n = 9), primarily assessing pharmacists' knowledge and attitudes. Themes included education and training to impact knowledge and attitudes, gatekeeping of medication supply, collaboration and integration, and role perception. Public perspectives on pharmacists' roles were limited. Conclusions Research regarding pharmacists' roles in the care of people at risk for suicide is limited. The areas that have dominated the literature include legal liability, especially with respect to gatekeeping medications, ethical decision making and education and training. Research is needed to determine what methods, outcomes and measures are required to best serve in building the evidence base for policy and practice decisions in this area.
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Affiliation(s)
- Andrea Lynn Murphy
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - Katelyn Hillier
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - Randa Ataya
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - Pierre Thabet
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - Anne Marie Whelan
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - Claire O'Reilly
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
| | - David Gardner
- College of Pharmacy (Murphy, Hillier, Ataya, Thabet, Whelan), University of Sydney, Sydney, New South Wales, Australia
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Indu PS, Anilkumar TV, Pisharody R, Russell PSS, Raju D, Sarma PS, Remadevi S, Amma KRLI, Sheelamoni A, Andrade C. Prevalence of depression and past suicide attempt in primary care. Asian J Psychiatr 2017; 27:48-52. [PMID: 28558895 DOI: 10.1016/j.ajp.2017.02.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 02/10/2017] [Accepted: 02/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is known that persons who die by suicide commonly visit a primary care physician (PCP) shortly before the fatal act.There is little information on history of suicide attempt in depressed patients who consult PCPs for non-mental health indications.This information is important because past history of suicide attempt is a known predictor of future suicide risk. OBJECTIVE To estimate the prevalence of depression among outpatients in primary care and to determine the prevalence and determinants of past suicide attempt among them. METHOD This cross-sectional study was conducted in six primary care settings, both public and private, in Kerala, India. A psychiatrist evaluated adult outpatients (n=827), diagnosed depression using ICD-10 Diagnostic Criteria for Research, and elicited history of suicide attempt. RESULTS Overall depression prevalence was 27.2% and was higher in women. Past suicide attempt was identified in 6.9% (95% CI, 5.17-8.63%) of all outpatients; higher in women (9.2%) than men (3.6%). Among the depressed, 21.3% had previously attempted suicide; while this figure was 1.5% in the non-depressed. The prevalence of current depression was 81% (severe depression, 61%) in patients reporting past suicide attempts. In univariate analyses, female gender, perceived financial stress, and being depressed were significantly associated with past suicide attempts. In multivariate analysis, current depression was the largest predictor of past suicide attempt (adjusted odds ratio, 14.3; 95% CI, 6.60-31.07). CONCLUSION Depression and suicide attempt are both common in primary care. Depression is the single most important predictor of suicide attempt.
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Affiliation(s)
- Pillaveetil Sathyadas Indu
- Department of Community Medicine, Government Medical College, Trivandrum, Kerala, India; Clinical Epidemiology Resource & Training Centre, Government Medical College, Trivandrum, Kerala, India.
| | - Thekkethayyil Viswanathan Anilkumar
- Department of Psychiatry, Government Medical College, Trivandrum, Kerala, India; Clinical Epidemiology Resource & Training Centre, Government Medical College, Trivandrum, Kerala, India
| | - Ramdas Pisharody
- Clinical Epidemiology Resource & Training Centre, Government Medical College, Trivandrum, Kerala, India
| | | | - Damodaran Raju
- Department of Psychiatry, Government Medical College, Trivandrum, Kerala, India
| | - P Sankara Sarma
- Department of Biostatistics, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Saradamma Remadevi
- Department of Community Medicine, Government Medical College, Trivandrum, Kerala, India; Clinical Epidemiology Resource & Training Centre, Government Medical College, Trivandrum, Kerala, India
| | - K R Leela Itty Amma
- Department of Community Medicine, Government Medical College, Trivandrum, Kerala, India
| | - A Sheelamoni
- Clinical Epidemiology Resource & Training Centre, Government Medical College, Trivandrum, Kerala, India
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India
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de Lima MM, Tobias-Machado M. Suicide in patients with genitourinary malignancies. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28134462 DOI: 10.1111/ecc.12635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 09/20/2016] [Accepted: 11/20/2016] [Indexed: 12/21/2022]
Abstract
Genitourinary cancers are significant causes of morbidity and mortality around the world. The present review summarises the current literature on suicide and its risk factors among patients with genitourinary cancers. The review was based on relevant articles published in MEDLINE, ProQuest, PsycINFO, Science Direct and Scopus databases. Patients with prostate cancer represented the most important risk group for suicide, among patients with urogenital cancers. Other risk factors are male gender, older age, white race, advanced disease, living alone and co-existing psychological comorbidities. Findings from the review call for a greater caregiver awareness on psychosocial morbidity and suicidality among genitourinary cancer patients pre- and post-treatment and their early identification, adoption of risk-reduction strategies and prompt referral for expert mental health care.
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Affiliation(s)
- M M de Lima
- Department of Urology, Coronel Mota Hospital, Roraima, Brazil
| | - M Tobias-Machado
- Section of Urologic Oncology, Department of Urology, ABC Medical School, São Paulo, UK
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Abstract
Primary care providers (PCPs) play a crucial role caring for patients with depression, managing antidepressant therapy, and assessing patients for suicide risk. Ten percent of the more than 20 million primary care visits for depression each year involve mental health issues, and account for 62% of the antidepressants prescribed in the United States. Psychiatric disorders appear to be underrecognized and undertreated in primary care. Suicidal ideation is present in a significant percentage of depressed primary care patients but rarely discussed. This article describes the warning signs and risk factors associated with suicide and recommends screening tools that can help PCPs identify patients at risk.
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Husky MM, Zablith I, Alvarez Fernandez V, Kovess-Masfety V. Factors associated with suicidal ideation disclosure: Results from a large population-based study. J Affect Disord 2016; 205:36-43. [PMID: 27400193 DOI: 10.1016/j.jad.2016.06.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is crucial for clinicians and researchers to understand the factors associated with the disclosure of suicidal ideation. Describing the characteristics of those who do not disclose their suicidal ideation or who disclose their ideation only to close others, to health professionals or to both may help researchers and clinicians in their preventive efforts to treat persons at risk for suicidal behavior. METHODS The sample was drawn from a large cross-sectional survey (n=22,138) on mental health in France. The analyses were based on the 4,156 persons (17.1%) who endorsed lifetime suicidal ideation with or without a history of suicide attempt and who indicated whether and to whom they disclosed their ideation. Socio-demographics, current mental disorders, and social connectedness were assessed. RESULTS Half of those with suicidal ideation had not shared their ideation with anyone, 6.3% did so with health professionals only, 20% with friends or family only, and 20% with both healthcare professionals and close others. Male gender, older age, lower education level and poor social connectedness were associated with greater odds of non-disclosure. Adjusting for socio-demographics and social connectedness, suicidal behavior and mental disorders were overall associated an increased likelihood of sharing suicidal ideation with health professionals. LIMITATIONS Cross-sectional survey assessing lifetime suicidal ideation and disclosure. CONCLUSIONS The findings provide important insight into the individual and social factors to take into account in suicidal ideation disclosure.
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Affiliation(s)
- Mathilde M Husky
- Institut Universitaire de France, Université de Bordeaux, INSERM U1219, Bordeaux, France; Institut de Psychologie, EA4057 Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Ingrid Zablith
- Etablissement Public Départemental Blanche de Fontarce, Chateauroux, France
| | | | - Viviane Kovess-Masfety
- Institut de Psychologie, EA4057 Université Paris Descartes, Sorbonne Paris Cité, Paris, France; EHESP French School of Public Health, Paris, France
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Yi SW, Hong JS. Depressive symptoms and other risk factors predicting suicide in middle-aged men: a prospective cohort study among Korean Vietnam War veterans. PeerJ 2015; 3:e1071. [PMID: 26157634 PMCID: PMC4493683 DOI: 10.7717/peerj.1071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/12/2015] [Indexed: 12/17/2022] Open
Abstract
Background. Few studies have prospectively examined whether depressive symptoms and other risk factors are associated with a higher risk of suicide death in individuals other than high-risk populations such as psychiatric patients and individuals with self-harm histories. The purpose of the study is to prospectively examine whether depressive symptoms assessed by the Beck Depression Inventory (BDI) are associated with greater risk of suicide death and whether depressive symptoms and other risk factors are independent predictors of suicide in general-risk populations. Another aim is to evaluate the sensitivity of the BDI for predicting suicide death. Methods. 10,238 Korean Vietnam War veterans (mean age: 56.3 years) who participated in two surveys in 2001 were followed up for suicide mortality over 7.5 years. Results. 41 men died by suicide. Severely depressed participants had a higher adjusted hazard ratio (aHR = 3.4; 95% CI [1.5–7.7]) of suicide than non-to-moderately depressed ones. Higher suicide risk was associated with more severe depressive symptoms (p for trend = 0.009). After adjustment for depressive symptoms and other factors, very poor health, low education, and past drinking were associated with higher suicide risk, while good health, body mass index, and marital status were not associated with suicide. The sensitivity at the cut-off score of 31 for detecting suicide was higher during the earlier 3.5 years of the follow-up (75%; 95% CI [50–90]) than during the latter 4 years (60%; 95% CI [41–76]). Conclusions. Depressive symptoms are a strong independent predictor and very poor health, low education, and drinking status may be independent predictors of future suicide. The BDI may have acceptable diagnostic properties as a risk assessment tool for identifying people with depression and suicidal potential among middle-aged men.
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Affiliation(s)
- Sang-Wook Yi
- Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine , Gangneung , Republic of Korea ; Institute for Clinical and Translational Research, Catholic Kwandong University , Gangneung , Republic of Korea
| | - Jae-Seok Hong
- Department of Healthcare Management, Cheongju University College of Health Sciences , Cheongju , Republic of Korea
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Younes N, Melchior M, Turbelin C, Blanchon T, Hanslik T, Chee CC. Attempted and completed suicide in primary care: not what we expected? J Affect Disord 2015; 170:150-4. [PMID: 25240842 DOI: 10.1016/j.jad.2014.08.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND General Practitioners (GPs) play a central role in suicide prevention. This study aims to compare the characteristics of individuals who attempt suicide to those who complete suicide in a same primary care setting. METHODS We compared the characteristics and GP's management of all patients with attempted (N=498, SA) or completed suicide (N=141, SC) reported to the GPs'French Sentinelles surveillance system (2009-2013). RESULTS Compared to patients who attempted suicide, those who completed suicide were more likely to be male, older and to have used a more lethal method; for men they were less likely to have a history of previous suicide attempt and prior contacts with their GP. In terms of GPs' management, we found no differences between the SA and SC groups in the identification of psychological difficulties and in the care, but GPs were more likely to provide psychological support to the SA group. During the last consultation, the SC group expressed suicidal ideas more frequently than the SA group (26.7% vs. 14.8%, p<0.01), only for women. LIMITATIONS The network may have missed cases and selected more serious SA. CONCLUSIONS Individuals who commit suicide differ from those who attempt suicide in terms of demographic characteristics and by sex, of history of suicide attempt, previous contact and expressed suicidal ideas. We show that GPs do not act more intensively with patients who will commit suicide, as if they do not foresee them. Current prevention programs particularly in primary care should be tailored.
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Affiliation(s)
- N Younes
- EA 40-47 Université Versailles Saint-Quentin-en-Yvelines, F-78047 Guyancourt, France; Academic Unit of Psychiatry, Versailles Hospital, 177 Rue de Versailles, F-78157 Le Chesnay, France.
| | - M Melchior
- INSERM, UMR_S 1136, Pierre Louis Institute for Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louise Institute of Epidemiology and Public Health, F-75013 Paris, France
| | - C Turbelin
- INSERM, U707, F-75012, Paris, France; UPMC University Paris 06, UMR-S U707, F-75012, Paris, France
| | - T Blanchon
- INSERM, U707, F-75012, Paris, France; UPMC University Paris 06, UMR-S U707, F-75012, Paris, France
| | - T Hanslik
- INSERM, U707, F-75012, Paris, France; UPMC University Paris 06, UMR-S U707, F-75012, Paris, France; Université Versailles Saint Quentin en Yvelines, F-78000, Versailles, France
| | - C Chan Chee
- French Institute for Public Health Surveillance, Saint Maurice, France
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Zhou ES, Hu JC, Kantoff PW, Recklitis CJ. Identifying suicidal symptoms in prostate cancer survivors using brief self-report. J Cancer Surviv 2014; 9:59-67. [PMID: 25135206 DOI: 10.1007/s11764-014-0385-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/17/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Prostate cancer (PC) survivors are at elevated risk for completed suicide even many years post-treatment. Despite this risk, practical and efficient methods for assessing these symptoms have not been established. We sought to determine if suicidal symptoms could be effectively and efficiently identified in a cohort of PC survivors, and whether these men were receptive to emotional health interventions. METHODS Six hundred fifty-six PC survivors, an average of 5 years post-diagnosis, completed eight self-report items about suicidal symptoms and behavior in the past 7 days, and 12 months, as well as medical utilization and interest in emotional health support. RESULTS Between 3.6 and 17.9% of PC survivors endorsed a single suicidal ideation item, and denied all other ideation. All survivors who endorsed serious suicidal ideation/behavior also endorsed either passive or active ideation. 58.3% of survivors denied any suicidal symptoms within the past week, but endorsed it within the past year. Most survivors had medical provider contact within the past year and were open to receiving information about emotional health interventions. CONCLUSIONS Suicidal ideation in PC survivors cannot be accurately evaluated using only a one-item screen, or by inquiring within a single time frame. IMPLICATIONS FOR CANCER SURVIVORS In both research and clinical settings, the evaluation for suicidal ideation in PC survivors should utilize multiple questions, across several time periods. It is possible to skip queries about serious ideation/behavior if passive or active ideation is denied. Once identified, medical providers should refer these men to psychosocial providers who can offer emotional support.
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Affiliation(s)
- Eric S Zhou
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
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Silverman MM, Berman AL. Suicide risk assessment and risk formulation part I: a focus on suicide ideation in assessing suicide risk. Suicide Life Threat Behav 2014; 44:420-31. [PMID: 25250407 DOI: 10.1111/sltb.12065] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The main procedure used by clinicians to determine whether an individual may be at risk of suicidal behaviors is the suicide risk assessment (SRA). The purpose of the SRA is to identify risk and protective factors that then provide the data for the formulation of suicide risk. The suicide risk formulation (SRF) assigns a level of suicide risk that ideally leads to triage and treatment deemed appropriate for that level of risk. Some of the problems with the SRA are explored here, with an emphasis on addressing the over reliance on communicated suicide ideation, and recommendations are made for improvements. Part II of this article (Berman & Silverman, 2013, also appears in this issue of STLB) examines the process of an SRF and, similarly, makes recommendations to improve clinical practice toward the desired end of saving lives.
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Affiliation(s)
- Morton M. Silverman
- Department of Psychiatry; The University of Colorado Denver School of Medicine; Aurora CO USA
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The effect of targeted and tailored patient depression engagement interventions on patient-physician discussion of suicidal thoughts: a randomized control trial. J Gen Intern Med 2014; 29:1148-54. [PMID: 24710994 PMCID: PMC4099444 DOI: 10.1007/s11606-014-2843-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 01/02/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite improvements in the diagnosis and treatment of depression, primary care provider (PCP) discussion regarding suicidal thoughts among patients with depressive symptoms remains low. OBJECTIVE To determine whether a targeted depression public service announcement (PSA) video or an individually tailored interactive multimedia computer program (IMCP) leads to increased primary care provider (PCP) discussion of suicidal thoughts in patients with elevated risk for clinical depression when compared to an attention control. DESIGN Randomized control trial at five different healthcare systems in Northern California; two academic, two Veterans Affairs (VA), and one group-model health maintenance organization (HMO). PARTICIPANTS Eight-hundred sixty-seven participants, with mean age 51.7; 43.9% women, 43.4% from a racial/ethnic minority group. INTERVENTION The PSA was targeted to gender and socio-economic status, and designed to encourage patients to seek depression care or request information regarding depression. The IMCP was an individually tailored interactive health message designed to activate patients to discuss possible depressive symptoms. The attention control was a sleep hygiene video. MAIN MEASURES Clinician reported discussion of suicidal thoughts. Analyses were stratified by depressive symptom level (Patient Health Questionnaire [PHQ-9] score < 9 [mild or lower] versus ≥ 10 [at least moderate]). KEY RESULTS Among patients with a PHQ-9 score ≥ 10, PCP discussion of suicidal thoughts was significantly higher in the IMCP group than in the control group (adjusted odds ratio = 2.33, 95% confidence interval = 1.5, 5.10, p = 0.03). There were no significant effects of either intervention on PCP discussion of suicidal thoughts among patients with a PHQ-9 score < 9. CONCLUSIONS Exposure of patients with at least moderate depressive symptoms to an individually tailored intervention designed to increase patient engagement in depression care led to increased PCP discussion of suicidal thoughts.
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Alosaimi FD, Al-Sultan OA, Alghamdi QA, Almohaimeed IK, Alqannas SI. Gender-specific differences in depression and anxiety symptoms and help-seeking behavior among gastroenterology patients in Riyadh, Saudi Arabia. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2014; 19:203-9. [PMID: 24983282 PMCID: PMC4727654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the gender-specific difference in the prevalence of depression and anxiety and the help-seeking behavior among gastroenterology outpatients. METHODS A cross-sectional study was carried out in gastroenterology clinics in 4 hospitals in Riyadh, Saudi Arabia between February and September 2013. A self-administrated questionnaire was developed and administered to patients. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) questionnaires were used to identify depression and anxiety. RESULTS A total of 438 patients completed the study questionnaire; 135 (31%) females, and 303 (69%) males. Compared with males, females had more depression symptoms (44% versus 32%, p=0.012), anxiety symptoms (34% versus 24%, p=0.036), anxiety-associated difficulty (65% versus 52%, p=0.012), but similar suicidal thoughts (14% versus 11%, p=0.347). Females had similar gastrointestinal complaints but longer duration of symptoms. In both females and males, the most common first interventions were using medications (63% versus 69%), and undergoing endoscopy (19% versus 15%), while very few patients initially used herbs or Islamic incantation `Roquia` (7% versus 8%). Compared with males, females were more likely to subsequently seek help at private clinics (23% versus 14%, p=0.014), or with a Quran therapist (11% versus 5%, p=0.012). CONCLUSION There are clear gender-specific differences in depression and anxiety symptoms and associated perceived difficulty, but modest differences in help-seeking behavior. Female patients at the gastroenterology clinic may deserve more psychological attention to diagnose depression and anxiety and to alleviate their impact.
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Affiliation(s)
- Fahad D. Alosaimi
- From the Department of Psychiatry, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia,Address correspondence and reprint request to: Dr. Fahad D. Alosaimi, Psychiatrist & Psychosomatic Medicine Consultant, Psychiatry Department #55, King Khalid University Hospital, King Saud University, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia. Tel. +966 (11) 4671226. Fax. +966 (11) 4672571. E-mail:
| | - Omar A. Al-Sultan
- From the Department of Psychiatry, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Qusay A. Alghamdi
- From the Department of Psychiatry, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim K. Almohaimeed
- From the Department of Psychiatry, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sulaiman I. Alqannas
- From the Department of Psychiatry, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Cukrowicz KC, Duberstein PR, Vannoy SD, Lin EH, Unützer J. What factors determine disclosure of suicide ideation in adults 60 and older to a treatment provider? Suicide Life Threat Behav 2014; 44:331-7. [PMID: 24494695 DOI: 10.1111/sltb.12075] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 08/30/2013] [Indexed: 11/27/2022]
Abstract
Correlates of patient disclosure of suicide ideation to a primary care or mental health provider were identified. Secondary analyses of IMPACT trial data were conducted. Of the 107 patients 60 years of age or older who endorsed thoughts of ending their life at least "a little bit" during the past month, 53 indicated they had disclosed these thoughts to a mental health or primary care provider during this period. Multiple logistic regression was used to identify predictors of disclosure to a provider. Significant predictors included poorer quality of life and prior mental health specialty treatment. Among participants endorsing thoughts of suicide, the likelihood of disclosing these thoughts to a provider was 2.96 times higher if they had a prior history of mental health specialty treatment and 1.56 times higher for every one-unit decrease in quality of life. Variation in disclosure of thoughts of suicide to a mental health or primary care provider depends, in part, on patient characteristics. Although the provision of evidence-based suicide risk assessment and guidelines could minimize unwanted variation and enhance disclosure, efforts to routinize the process of suicide risk assessment should also consider effective ways to lessen potential unintended consequences.
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Chesin M, Stanley B. Risk assessment and psychosocial interventions for suicidal patients. Bipolar Disord 2013; 15:584-93. [PMID: 23782460 PMCID: PMC3835446 DOI: 10.1111/bdi.12092] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/28/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Suicide is a leading cause of death in the USA. Although factors elevating long-term risk for suicide are known and include bipolar disorder, signs of imminent suicide risk are difficult to study and not well specified. Acute risk determinations must be made to determine the appropriate level of care to safeguard patients. To increase safety among at-risk patients in the short term and to decrease risk over time, psychosocial interventions to prevent suicide have been developed and tested in acute care and outpatient settings. METHODS A narrative review of studies of imminent risk factors for suicide, suicide risk decision-making, and psychosocial suicide prevention interventions was conducted. RESULTS Although some long-term risk factors of suicide have been established, accurate identification of individuals at imminent risk for suicide is difficult. Therefore, prevention efforts targeting individuals at high suicide behavior risk discharging from acute care settings tend to be generic and focus on psychoeducation and supportive follow-up contact. Data regarding the effectiveness of brief interventions (i.e., those not requiring more than one individualized treatment session) are mixed, showing better outcomes in the shorter term and when the incidence of suicidal behavior or ideation is the outcome. With respect to longer-term suicide prevention interventions (i.e., those with a minimum of ten sessions), Dialectical Behavior Therapy has the largest evidence base. CONCLUSIONS To improve suicide prevention efforts, more rigorous study of imminent risk factors and psychosocial interventions is needed. Adaptations specific to individuals with bipolar disorder are possible and needed.
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Affiliation(s)
- Megan Chesin
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
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Characteristics, management, and depression outcomes of primary care patients who endorse thoughts of death or suicide on the PHQ-9. J Gen Intern Med 2013; 28:363-9. [PMID: 22936288 PMCID: PMC3579977 DOI: 10.1007/s11606-012-2194-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/05/2012] [Accepted: 07/31/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND With increasing emphasis on integrating behavioral health services, primary care providers play an important role in managing patients with suicidal thoughts. OBJECTIVE To evaluate whether Patient Health Questionnaire-9 (PHQ-9) Item 9 scores are associated with patient characteristics, management, and depression outcomes in a primary care-based mental health program. DESIGN Observational analysis of data collected from a patient registry. PARTICIPANTS Eleven thousand fifteen adults enrolled in the Mental Health Integration Program (MHIP). INTERVENTIONS MHIP provides integrated mental health services for safety-net populations in over 100 community health centers across Washington State. Key elements of the team-based model include: a disease registry; integrated care management; and organized psychiatric case review. MAIN MEASURES The independent variable, suicidal ideation (SI), was assessed by PHQ-9 Item 9. Depression severity was assessed with the PHQ-8. Outcomes included four indicators of depression treatment process (care manager contact, psychiatric case review, psychotropic medications, and specialty mental health referral), and two indicators of depression outcomes (50 % reduction in PHQ-9 score and PHQ-9 score < 10). KEY RESULTS SI was common (45.2 %) at baseline, with significantly higher rates among men and patients with greater psychopathology. Few patients with SI (5.4 %) lacked substantial current depressive symptoms. After adjusting for age, gender, and severity of psychopathology, patients with SI received follow-up earlier (care manager contact HR = 1.05, p < 0.001; psychiatric review HR = 1.02, p < 0.05), and were more likely to receive psychotropic medications (OR = 1.11, p = 0.001) and specialty referral (OR = 1.23, p < 0.001), yet were less likely to achieve a PHQ-9 score < 10 (HR = 0.87, p < 0.001). CONCLUSIONS Suicidal thoughts are common among safety-net patients referred by primary care providers for behavioral health care. Scores on Item 9 of the PHQ-9 are easily obtainable in primary care, may help providers initiate conversations about suicidality, and serve as useful markers of psychiatric complexity and treatment-resistance. Patients with positive scores should receive timely and comprehensive psychiatric evaluation and follow-up.
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Smith EG, Kim HM, Ganoczy D, Stano C, Pfeiffer PN, Valenstein M. Suicide risk assessment received prior to suicide death by Veterans Health Administration patients with a history of depression. J Clin Psychiatry 2013; 74:226-32. [PMID: 23561227 PMCID: PMC4055158 DOI: 10.4088/jcp.12m07853] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine the quality of suicide risk assessment provided to veterans with a history of depression who died by suicide between 1999 and 2004. METHOD We conducted a case-control study of suicide risk assessment information recorded in 488 medical charts of veterans previously diagnosed with major depression, depression not otherwise specified, dysthymia, or other, less common ICD-9-CM depression codes. Patients dying by suicide from April 1999 through September 2004 or comparison patients (n = 244 pairs) were matched for age, sex, entry year, and region. RESULTS Seventy-four percent of patients with a history of depression received a documented assessment of suicidal ideation within the past year, and 59% received more than 1 assessment. However, 70% of those who died of suicide did not have a documented assessment for suicidal ideation at their final Veterans Health Administration (VHA) visit, even if that visit occurred within 0 through 7 days prior to suicide death. Most patients dying by suicide denied suicidal ideation when assessed (85%; 95% CI, 75%-92%), even just 0 through 7 days prior to suicide death (73%; 95% CI, 39%-94%). Suicidal ideation was assessed more frequently during outpatient final visits with mental health providers (60%) than during outpatient final visits with primary care (13%) or other non-mental health providers (10%, P < .0001). CONCLUSIONS Most VHA patients with a history of depression received some suicide risk assessment within the past year, but suicide risk assessments were infrequently administered at the final visit of patients who eventually died by suicide. Among patients who had assessments, denial of suicidal ideation appeared to be of limited value. Practice changes are needed to improve suicide risk assessment among patients with histories of depression, including the development of assessment and prevention strategies that are less dependent on the presence or disclosure of suicidal ideation at scheduled medical visits.
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