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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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Osborne D, De Boer K, Meyer D, Nedeljkovic M. Raising Suicide in Medical Appointments-Barriers and Facilitators Experienced by Young Adults and GPs: A Mixed-Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:822. [PMID: 36613144 PMCID: PMC9820164 DOI: 10.3390/ijerph20010822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
The aim of this review was to understand the barriers and facilitators facing GPs and young adults in raising and addressing suicide in medical appointments. A mixed-methods systematic review was conducted of qualitative and quantitative studies. The focus was papers that explored barriers and facilitators experienced by young adults aged 18 to 26, and GPs working in primary care environments. Nine studies met the inclusion criteria. Four studies provided information on young adults' views, four on GPs, and one considered both GP and young adults' viewpoints. Nine barrier and seven facilitator themes were identified. Unique to this review was the recognition that young adults want GPs to initiate the conversation about suicide. They see this as a GP's responsibility. This review further confirmed that GPs lack the confidence and skills to assess suicide risk in young adults. Both findings combined could explain previous results for reduced identification of suicide risk in this cohort. GP training needs considerable focus on addressing skill deficiencies and improving GP confidence to assess suicide risk. However, introducing suicide risk screening in primary care for young adults should be a priority as this will overcome the need for young adults to voluntarily disclose thoughts of suicide.
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Pouquet M, Launay T, Rivière M, Chan-Chee C, Urbain F, Coulombel N, Bardoulat I, Pons R, Guerrisi C, Blanchon T, Hanslik T, Younes N. Trends and characteristics of attempted and completed suicides reported to general practitioners before vs during the COVID-19 pandemic in France: Data from a nationwide monitoring system, 2010-2022. PLoS One 2022; 17:e0278266. [PMID: 36520827 PMCID: PMC9754243 DOI: 10.1371/journal.pone.0278266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Most studies published to date have investigated the impact of the COVID-19 pandemic on suicidal acts using hospital data. Trends from primary care in a country such as France are crucial, as individuals may not consult hospital services after suicide attempts (SAs) but rather see their general practitioner (GP). OBJECTIVES We aimed to evaluate whether the incidence and characteristics of SAs and completed suicides (CSs) reported to French GPs were different during the COVID-19 pandemic than those of before. METHODS AND FINDINGS We conducted a retrospective observational study using data from a nationwide monitoring system, the French Sentinel Network (FSN). All SAs and CSs reported by GPs to the FSN from January 1, 2010, to March 10, 2022 were included. The annual incidence rates (IRs) and the characteristics of SAs and CSs during the pandemic (March 11, 2020, to March 10, 2022) were compared to those of before. In total, 687 SAs and 169 CSs were included. The IRs remained stable for SAs and CSs before and during the pandemic (overlap in confidence intervals). The mean IRs were 52 (95%CI = 44; 57) per 100,000 inhabitants for SAs during the pandemic versus 47 [36; 57] during the pre-pandemic period (p = 0.49), and 5 (95%CI = 2; 9) for CSs versus 11 [6; 16] (p = 0.30). During the pandemic, SA were slightly different from those before in terms of age and occupational status (young/students and older/retirees over-represented), history of consultation and expression of suicidal ideas to GP (more frequent), and CS in terms of occupational status (students over-represented) (p<0.05). CONCLUSION The COVID-19 pandemic had no major effect on the overall incidence of SAs and CSs reported to French GPs. However, more suicidal acts were reported among younger and older individuals. Suicidal patients and GPs have adapted by improving the expression of suicidal ideas.
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Affiliation(s)
- Marie Pouquet
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- * E-mail:
| | - Titouan Launay
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Mathieu Rivière
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | | | - Frédéric Urbain
- Unité de Formation et de Recherche des Sciences de la Santé Simone-Veil, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | | | | | - Romain Pons
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Caroline Guerrisi
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Thierry Blanchon
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Thomas Hanslik
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Unité de Formation et de Recherche des Sciences de la Santé Simone-Veil, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
- Service de Médecine Interne, Hôpital Ambroise-Paré, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Nadia Younes
- Unité de Formation et de Recherche des Sciences de la Santé Simone-Veil, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
- Université Versailles Saint Quentin, Université Paris Saclay, Team DevPsy, Villejuif, France
- Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l’Adulte et d’Addictologie, Le Chesnay, France
- Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Michaud PA, Michaud L, Mazur A, Hadjipanayis A, Kapp C, Ambresin AE. The Impact of COVID on Adolescent Mental Health, Self-Harm and Suicide: How Can Primary Care Provider Respond? A Position Paper of the European Academy of Pediatrics. Front Pediatr 2022; 10:800000. [PMID: 35402345 PMCID: PMC8984250 DOI: 10.3389/fped.2022.800000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Adolescents aged 10 to 19 live a period of their life marked by opportunities and vulnerabilities during which the issue of mental health is of prime importance. Since several decades, and especially since the start of the COVID pandemic, mental health problems and disorders among adolescents have increased around the world. Depression, self-harm and suicidal behavior are common during this period of life, and pediatricians can play a pivotal role in identifying affected or vulnerable youngsters. This article describes risk factors for self-harm and suicidal behavior and reviews how primary care pediatricians and health professionals can respond to such situations. This scoping review is based on existing evidences as well as the authors clinical experience. It suggests concrete actions that can be taken to secure the life of at risk teenagers, and discusses how to organize the transfer to mental health professionals when needed.
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Affiliation(s)
| | - Laurent Michaud
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Artur Mazur
- Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | | | - Carole Kapp
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Shellman AB, Meinert AC, Curtis DF. Physician Utilization of a Universal Psychosocial Screening Protocol in Pediatric Primary Care. Clin Pediatr (Phila) 2019; 58:957-969. [PMID: 31030553 DOI: 10.1177/0009922819845878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study evaluated physicians' utilization of a universal psychosocial screening protocol within a pediatric primary care setting. Pediatricians (n = 20) adopted a multitiered screening algorithm using the Pediatric Symptom Checklist-17 (PSC-17) within well-child checkups (WCC) for children, ages 7 and 11 years. Descriptive analyses were performed to evaluate the initial 3 years of physician screening protocol implementation to: (1) determine frequency and proportion of use and (2) examine patient outcomes associated with accessing behavioral health care. Physicians frequently initiated the protocol, administering the PSC-17 within 3678 WCC encounters, with frequency progressively increasing over the 3-year period. Results highlighted elements of screener utilization, cost-effectiveness, screening algorithm fidelity, and prevalence of psychosocial concerns identified. Secondary implementation challenges were observed after initial screening, specific to implementation of prescribed follow-up procedures. Primary care behavioral health collaborations appear helpful for improving universal screening utilization and cost-effectiveness, and for ensuring children with psychosocial problems are identified early and directed to follow-up care as needed.
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Affiliation(s)
- Alison B Shellman
- 1 The University of Texas Health Science Center at Houston, TX, USA.,2 Texas Children's Hospital, Houston, TX, USA
| | | | - David F Curtis
- 2 Texas Children's Hospital, Houston, TX, USA.,4 The University of Texas at Austin, TX, USA
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Lee J, Bang YS, Min S, Ahn JS, Kim H, Cha YS, Park IS, Kim MH. Characteristics of adolescents who visit the emergency department following suicide attempts: comparison study between adolescents and adults. BMC Psychiatry 2019; 19:231. [PMID: 31349782 PMCID: PMC6660711 DOI: 10.1186/s12888-019-2213-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/15/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify the demographic and clinical characteristics of suicide attempts in adolescents who visit the emergency department compared to those of adults. METHODS This study included 149 children under the age of 18, and 1427 people in the age of 19-65 who came to the emergency department with suicide attempt from 2009 to 2015. We compare sociodemographic, clinical, and suicide attempt-related characteristics through Chi-square test and logistic regression analysis to evaluate the difference between two groups. RESULTS In adolescents, suicide attempters had more number of previous suicide attempt history than adults. Adolescents used more non-lethal method such as poisoning of over the counter drugs and had about 5 times higher odds ratio in suicide attempts with analgesics. The motivation of suicide attempt among adolescents was more related with interpersonal problems but less with financial or illness-related problems. The intention of suicide attempt in adolescents was less serious and lethal compared to adults. CONCLUSION Suicide attempts among adolescents had showed different from adults in method, motivation and intention. Considering the characteristics of suicide attempt among adolescent, it is necessary to keep close attention to adolescent's suicide attempters and develop the customized intervention program to prevent the suicide attempt in this groups.
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Affiliation(s)
- Jinhee Lee
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Yeon Sik Bang
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Seongho Min
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Joung-Sook Ahn
- 0000 0004 0470 5454grid.15444.30Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426 Republic of Korea
| | - Hyun Kim
- 0000 0004 0470 5454grid.15444.30Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong-Sung Cha
- 0000 0004 0470 5454grid.15444.30Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - In-Suk Park
- Yonsei Soul Psychiatric Clinic, Wonju, South Korea
| | - Min-Hyuk Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426, Republic of Korea.
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Horrocks M, Michail M, Aubeeluck A, Wright N, Morriss R. An Electronic Clinical Decision Support System for the Assessment and Management of Suicidality in Primary Care: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2018; 7:e11135. [PMID: 30530459 PMCID: PMC6303673 DOI: 10.2196/11135] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022] Open
Abstract
Background Suicide is a global public health concern, but it is preventable. Increased contact with primary care before the suicide or attempted suicide raises opportunities for intervention and prevention. However, suicide assessment and management are areas that many general practitioners (GPs) find particularly challenging. Previous research has indicated significant variability in how GPs understand, operationalize, and assess suicide risk, which subsequently has an impact on clinical decision making. Clinical decision support systems (CDSS) have been widely implemented across different health care settings, including primary care to support practitioners in clinical decision making. A CDSS may reduce inconsistencies in the identification, assessment, and management of suicide risk by GPs by guiding them through the consultation and generating a risk assessment plan that can be shared with a service user or with specialized mental health services. Objective Our aim is to co-develop and test with end users (eg, GPs, primary care attendees, mental health professionals) an electronic clinical decision support system (e-CDSS) to support GPs in the identification, assessment, and management of suicidality in primary care. Methods Ours is an ongoing embedded mixed-methods study with four phases: (1) qualitative interviews with GPs to explore their views on the content, format, and use of the e-CDSS, as well as consultation with two service-user advisory groups (people aged ≤25 and people aged ≥25) to inform the content of the e-CDSS including phrasing of items and clarity; (2) participatory co-production workshops with GPs, service users, and clinical experts in suicidality to determine the content and format of the e-CDDS; gain consensus of the relevance of items; establish content validity and identify pathways to implementation, using the Consolidated Framework for Implementation Research; (3) building the e-CDSS so that it guides the GP through a consultation; and (4) usability testing of the e-CDSS with GPs and service users in one primary care practice involving a nonlive and a live stage. Results The study was funded for four years, to take place between 2015 and 2019, and is currently completing phase 4 data collection. The first results are expected to be submitted for publication in June 2019. The findings will enable us to evaluate the feasibility, acceptability, and usability of a suicide-specific, electronic, guided decision support system in primary care. Conclusions This study will be the first to explore the feasibility, acceptability, and usability of an electronic, guided decision support system for use in primary care consultations for the improved assessment and management of suicidality. International Registered Report Identifier (IRRID) RR1-10.2196/11135
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Affiliation(s)
- Matthew Horrocks
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Aimee Aubeeluck
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nicola Wright
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Richard Morriss
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Tudrej BV, Heintz AL, Rehman MB, Marcelli D, Ingrand P, Binder P. Even if they are not aware of it, general practitioners improve well-being in their adolescent patients. Eur J Gen Pract 2017; 23:182-189. [PMID: 28714758 PMCID: PMC5774284 DOI: 10.1080/13814788.2017.1346077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Most adolescents consult their general practitioner (GP) for common reasons, somatic or administrative but many of them have hidden feelings of distress. Objectives: To assess the immediate impact of ‘ordinary’ consultations on feelings of distress among adolescents and to compare adolescents experiencing difficulties (D) to those with no difficulties (N). To analyse how accurately GPs assess the impact of their consultation on adolescents’ feelings. Methods: GPs were randomly selected from two non-contiguous French administrative areas between April and June 2006. Fifty-three GPs gave two questionnaires to the first 10 to 15 adolescents aged 12 to 20 seen in consultation. One questionnaire was issued before the consultation and the other one afterwards. Adolescents had to position themselves about different aspects of well-being and say where they would seek help if they had problems. A GP questionnaire assessed how well they estimated their impact on the adolescent’s feeling of well-being. Results: Six hundred and sixty-five adolescents were assessed. They reported feeling better about their health, being able to talk, having someone to talk to or to confide in and on feeling understood. The D group (n = 147) felt significantly better compared to the N group (n = 518). GPs tended to underestimate this improvement, especially regarding adolescents in the D group feeling better about their health. Conclusions: Consulting a GP generates increased well-being among adolescents, especially for those experiencing difficulties. GPs tend to underestimate the positive impact they may have. Further studies are needed to explore if this benefit is permanent over time.
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Affiliation(s)
- Benoit V Tudrej
- a Department of General Practice , Université de Poitiers UFR Medecine et Pharmacie , Poitiers , France.,b Medical Ethics and Legal Medicine Laboratory , Université Paris Descartes Paris , Île-de-France , France
| | - Anne-Laure Heintz
- a Department of General Practice , Université de Poitiers UFR Medecine et Pharmacie , Poitiers , France.,c ADOC Group (Adolescents and Risk Behaviours), Association , Lussant , France
| | - Michaela B Rehman
- d Department of Cardiology , Centre Hospitalier Universitaire de Poitiers , Poitiers , France
| | - Daniel Marcelli
- e University Clinic of Child and Adolescent Psychiatry , CHU Poitiers and Centre Hospitalier Henri Laborit, Faculty of Medicine , Poitiers , France
| | - Pierre Ingrand
- f Department of Epidemiology & Biostatistics , INSERM CIC-1402, Faculty of Medicine , Poitiers , France
| | - Philippe Binder
- a Department of General Practice , Université de Poitiers UFR Medecine et Pharmacie , Poitiers , France.,c ADOC Group (Adolescents and Risk Behaviours), Association , Lussant , France
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Michail M, Tait L. Exploring general practitioners' views and experiences on suicide risk assessment and management of young people in primary care: a qualitative study in the UK. BMJ Open 2016; 6:e009654. [PMID: 26758263 PMCID: PMC4716217 DOI: 10.1136/bmjopen-2015-009654] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore general practitioner (GP) views and experiences of assessing, communicating with and managing suicidal young people with the aim of co-producing an educational intervention on youth suicide prevention tailored to GPs' perceived needs. DESIGN Qualitative focus group study using framework analysis. SETTING 5 inner city general practices in Nottingham. PARTICIPANTS 28 GPs took part (9 males) with mean age of 37 years. The median number of years of professional experience was 13. Participants were recruited through convenience sampling based on accessibility, interest in the study and willingness to participate. RESULTS 3 themes emerged from the data in relation to GP's attitudes and beliefs towards suicide; the challenges GPs experience when it comes to the assessment and management of suicide risk in young people; and optimal ways of addressing some of these challenges through the provision of specialist education and training targeting GPs' knowledge and clinical skills in this field. CONCLUSIONS The findings revealed wide variations in the understanding and operationalisation of risk among GPs, which has subsequent implications to how GPs perceive risk should be assessed. GP education on suicide risk assessment and management in youth should promote a holistic understanding and assessment of risk and its individual, social and contextual influences.
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Affiliation(s)
- Maria Michail
- School of Health Sciences, Jubilee Campus, University of Nottingham, Nottingham, UK
| | - Lynda Tait
- School of Health Sciences, Jubilee Campus, University of Nottingham, Nottingham, UK
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10
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Dalglish SL, Melchior M, Younes N, Surkan PJ. Work characteristics and suicidal ideation in young adults in France. Soc Psychiatry Psychiatr Epidemiol 2015; 50:613-20. [PMID: 25308058 DOI: 10.1007/s00127-014-0969-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Job insecurity, unemployment, and job strain can predict psychological distress and suicide risk. Young people, who are particularly at risk of suicide, may be especially vulnerable to the deterioration of labor market conditions as a result of the current economic crisis in Europe. We aimed to examine the effects of work and employment characteristics on suicidal ideation in a contemporary sample of young adults. METHODS Using data from a sample of French young adults surveyed in 2011 (TEMPO study, N = 1,214, 18-37 years old) and their parents who took part in a longitudinal cohort study, we used multiple logistic regression to examine the relationship between job insecurity, lifetime and recent unemployment and suicidal ideation in the past 12 months. Our analyses were adjusted for factors associated with suicidal risk including age, sex, educational attainment, living with a partner, insufficient social support, alcohol abuse, depression and parental history of depression. RESULTS Five percent of the sample reported suicidal ideation in the preceding 12 months. Controlling for all covariates, the likelihood of suicidal ideation was associated with job insecurity (OR 2.24, 95% CI 1.08-4.63), lifetime unemployment (OR 2.25, 95% CI 1.17-4.29), and recent unemployment (OR 2.10, 95% CI 1.04-4.25). After stratifying by educational attainment, the association between suicidal ideation and job insecurity was particularly notable for participants with low educational attainment (OR 9.28, 95% CI 1.19-72.33). CONCLUSION Young adults who have unstable and unfavorable employment characteristics are disproportionately likely to be suicidal, which should be monitored, particularly in times of economic downturn.
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Affiliation(s)
- Sarah L Dalglish
- Johns Hopkins School of Public Health, Social and Behavioral Interventions Program, Department of International Health, Baltimore, MD, USA
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11
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de Beurs DP, Fokkema M, de Groot MH, de Keijser J, Kerkhof AJFM. Longitudinal measurement invariance of the Beck Scale for Suicide Ideation. Psychiatry Res 2015; 225:368-73. [PMID: 25571773 DOI: 10.1016/j.psychres.2014.11.075] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 09/18/2014] [Accepted: 11/24/2014] [Indexed: 12/11/2022]
Abstract
In mental health care, both clinical and scientific decisions are based on within-subject comparisons of test scores on the same self-report questionnaire at different points in time. To establish the validity of test score comparisons over time, longitudinal measurement invariance should be established. The current study tested whether the 19 item Beck Scale for Suicide Ideation (BSS) is measurement invariant (MI) over time. As the first five items of the scale are often used to screen for the presence of suicidal thoughts, we also tested a model consisting of only the first five items. Psychiatric in- and out-patients (n=475) completed the questionnaire upon admission and after 3 months. By means of confirmatory factor analysis (CFA) we tested whether the parameters of a single factor model were equal over time. All fit indices indicated that both the 19-item questionnaire and the five-item screener were measurement invariant over time. This means that changes in test-scores over time can be attributed to true changes in the construct of interest. These findings legitimate the use of the 19 item scale and the five-item screener in longitudinal assessments.
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Affiliation(s)
- Derek P de Beurs
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | - Marjolein Fokkema
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | - Marieke H de Groot
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | - Jos de Keijser
- GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands.
| | - Ad J F M Kerkhof
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
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Rice SM, Simmons MB, Bailey AP, Parker AG, Hetrick SE, Davey CG, Phelan M, Blaikie S, Edwards J. Development of practice principles for the management of ongoing suicidal ideation in young people diagnosed with major depressive disorder. SAGE Open Med 2014; 2:2050312114559574. [PMID: 26770751 PMCID: PMC4607237 DOI: 10.1177/2050312114559574] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/21/2014] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES There is a lack of clear guidance regarding the management of ongoing suicidality in young people experiencing major depressive disorder. This study utilised an expert consensus approach in identifying practice principles to complement relevant clinical guidelines for the treatment of major depressive disorder in young people. The study also sought to outline a broad treatment framework for clinical intervention with young people experiencing ongoing suicidal ideation. METHODS In-depth focus groups were undertaken with a specialist multidisciplinary clinical team (the Youth Mood Clinic at Orygen Youth Health Clinical Program, Melbourne) working with young people aged 15-25 years experiencing ongoing suicidal ideation. Each focus group was audio recorded and transcribed verbatim using orthographic conventions. Principles of grounded theory and thematic analysis were used to analyse and code the resultant data. RESULTS The identified codes were subsequently synthesised into eight practice principles reflecting engagement and consistency of care, ongoing risk assessment and documentation, individualised crisis planning, engaging systems of support, engendering hopefulness, development of adaptive coping, management of acute risk, and consultation and supervision. CONCLUSIONS The identified practice principles provide a broad management framework, and may assist to improve treatment consistency and clinical management of young people experiencing ongoing suicidal ideation. The practice principles may be of use to health professionals working within a team-based setting involved in the provision of care, even if peripherally, to young people with ongoing suicidal ideation. Findings address the lack of treatment consistency and shared terminology and may provide containment and guidance to multidisciplinary clinicians working with this at-risk group.
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Affiliation(s)
- Simon M Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre of Excellence in Youth Mental Health, headspace – National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Magenta B Simmons
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre of Excellence in Youth Mental Health, headspace – National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Alan P Bailey
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre of Excellence in Youth Mental Health, headspace – National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Alexandra G Parker
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre of Excellence in Youth Mental Health, headspace – National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre of Excellence in Youth Mental Health, headspace – National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Orygen Youth Health Clinical Program, Melbourne, VIC, Australia
| | - Mark Phelan
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Orygen Youth Health Clinical Program, Melbourne, VIC, Australia
| | - Simon Blaikie
- Orygen Youth Health Clinical Program, Melbourne, VIC, Australia
| | - Jane Edwards
- Orygen Youth Health Clinical Program, Melbourne, VIC, Australia
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De Beurs DP, de Vries AL, de Groot MH, de Keijser J, Kerkhof AJ. Applying computer adaptive testing to optimize online assessment of suicidal behavior: a simulation study. J Med Internet Res 2014; 16:e207. [PMID: 25213259 PMCID: PMC4180339 DOI: 10.2196/jmir.3511] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/25/2014] [Indexed: 12/25/2022] Open
Abstract
Background The Internet is used increasingly for both suicide research and prevention. To optimize online assessment of suicidal patients, there is a need for short, good-quality tools to assess elevated risk of future suicidal behavior. Computer adaptive testing (CAT) can be used to reduce response burden and improve accuracy, and make the available pencil-and-paper tools more appropriate for online administration. Objective The aim was to test whether an item response–based computer adaptive simulation can be used to reduce the length of the Beck Scale for Suicide Ideation (BSS). Methods The data used for our simulation was obtained from a large multicenter trial from The Netherlands: the Professionals in Training to STOP suicide (PITSTOP suicide) study. We applied a principal components analysis (PCA), confirmatory factor analysis (CFA), a graded response model (GRM), and simulated a CAT. Results The scores of 505 patients were analyzed. Psychometric analyses showed the questionnaire to be unidimensional with good internal consistency. The computer adaptive simulation showed that for the estimation of elevation of risk of future suicidal behavior 4 items (instead of the full 19) were sufficient, on average. Conclusions This study demonstrated that CAT can be applied successfully to reduce the length of the Dutch version of the BSS. We argue that the use of CAT can improve the accuracy and the response burden when assessing the risk of future suicidal behavior online. Because CAT can be daunting for clinicians and applied scientists, we offer a concrete example of our computer adaptive simulation of the Dutch version of the BSS at the end of the paper.
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Affiliation(s)
- Derek Paul De Beurs
- Faculty of Psychology and Education, Department of Clinical Psychology, VU University Amsterdam, Amsterdam, Netherlands.
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14
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Leahy D, Schaffalitzky E, Armstrong C, Bury G, Cussen-Murphy P, Davis R, Dooley B, Gavin B, Keane R, Keenan E, Latham L, Meagher D, McGorry P, McNicholas F, O'Connor R, O'Dea E, O'Keane V, O'Toole TP, Reilly E, Ryan P, Sanci L, Smyth BP, Cullen W. Primary care and youth mental health in Ireland: qualitative study in deprived urban areas. BMC FAMILY PRACTICE 2013; 14:194. [PMID: 24341616 PMCID: PMC3880165 DOI: 10.1186/1471-2296-14-194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 12/09/2013] [Indexed: 11/22/2022]
Abstract
Background Mental disorders account for six of the 20 leading causes of disability worldwide with a very high prevalence of psychiatric morbidity in youth aged 15–24 years. However, healthcare professionals are faced with many challenges in the identification and treatment of mental and substance use disorders in young people (e.g. young people’s unwillingness to seek help from healthcare professionals, lack of training, limited resources etc.) The challenge of youth mental health for primary care is especially evident in urban deprived areas, where rates of and risk factors for mental health problems are especially common. There is an emerging consensus that primary care is well placed to address mental and substance use disorders in young people especially in deprived urban areas. This study aims to describe healthcare professionals’ experience and attitudes towards screening and early intervention for mental and substance use disorders among young people (16–25 years) in primary care in deprived urban settings in Ireland. Methods The chosen method for this qualitative study was inductive thematic analysis which involved semi-structured interviews with 37 healthcare professionals from primary care, secondary care and community agencies at two deprived urban centres. Results We identified three themes in respect of interventions to increase screening and treatment: (1) Identification is optimised by a range of strategies, including raising awareness, training, more systematic and formalised assessment, and youth-friendly practices (e.g. communication skills, ensuring confidentiality); (2) Treatment is enhanced by closer inter-agency collaboration and training for all healthcare professionals working in primary care; (3) Ongoing engagement is enhanced by motivational work with young people, setting achievable treatment goals, supporting transition between child and adult mental health services and recognising primary care’s longitudinal nature as a key asset in promoting treatment engagement. Conclusions Especially in deprived areas, primary care is central to early intervention for youth mental health. Identification, treatment and continuing engagement are likely to be enhanced by a range of strategies with young people, healthcare professionals and systems. Further research on youth mental health and primary care, including qualitative accounts of young people’s experience and developing complex interventions that promote early intervention are priorities. (350 words)
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Affiliation(s)
- Dorothy Leahy
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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