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Bullington C, Kroenke K. P4 suicidality screener: Literature synthesis and results from two randomized trials. Gen Hosp Psychiatry 2023; 85:177-184. [PMID: 37948795 DOI: 10.1016/j.genhosppsych.2023.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/05/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To synthesize the literature on use of the P4 suicidality screener since its introduction in 2010 and to summarize results from 2 randomized clinical trials. METHOD A PubMed search was conducted from 2010 to 2023 to retrieve studies reporting on use of the P4. Also, data was extracted from the CAMMPS and SCOPE trials in which the P4 was periodically administered over 12 months when the 9th item of the PHQ-9 was endorsed. RESULTS A total of 21 research studies using the P4 were found, of which 12 provided some data on P4 findings. Additionally, another 7 protocol papers reported intended use of the P4 as a study measure. In our 2 trials, the 9th item was endorsed 259 (12.5%) times in 2068 administrations of the PHQ-9. Higher risk suicidal ideation was identified in 4.1% (12/294) of CAMMPS participants and 2.8% (7/250) of SCOPE participants. No suicide attempts occurred over the 12 months in either trial. CONCLUSIONS The P4 has had moderate use as a brief suicidality screener and is an efficient way to identify the small proportion of depressed patients with higher risk suicidality. Studies comparing the P4 with other common suicidality screeners would further inform use.
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Affiliation(s)
- Craig Bullington
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kurt Kroenke
- Regenstrief Institute, Inc, Indianapolis, IN, USA.
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2
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Augsburger M, Kaal E, Ülesoo T, Wenger A, Blankers M, Haug S, Ebert DD, Riper H, Keough M, Noormets H, Schaub MP, Kilp K. Effects of a minimal-guided on-line intervention for alcohol misuse in Estonia: a randomized controlled trial. Addiction 2022; 117:108-117. [PMID: 34184795 PMCID: PMC9292731 DOI: 10.1111/add.15633] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/09/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Estonia has one of the highest alcohol-attributable mortality rates within the European Union. The aim of this study was to estimate the efficacy of an on-line self-help intervention to reduce problem drinking at the population level. DESIGN On-line open randomized controlled trial with an 8-week intervention and an active control group (intervention n = 303, control n = 286). Assessments took place at baseline and at 6 months follow-up. SETTING On- and offline channels were used for population-based recruitment within a nation-wide prevention campaign in Estonia. PARTICIPANTS Inclusion criteria were age ≥ 18 years, heavy drinking [Alcohol Use Disorders Identification (AUDIT) test score ≥ 8], literacy in Estonian and at least weekly access to the internet; n = 589 participants were randomized (50% male, 1% other; mean age 37.86 years; 45% with higher level of education). INTERVENTION AND COMPARATOR The intervention consisted of 10 modules based on principles of cognitive-behavioral therapy and motivational interviewing. The active control group received access to a website with a self-test including personalized normative feedback and information for standard alcohol treatment. MEASUREMENTS The primary outcome was AUDIT scores at 6 months follow-up adjusted for baseline scores. FINDINGS Intention-to-treat analyses were applied. Missing data were addressed by using baseline observation carried forward (BOCF) and multiple imputation by chained equations (MI); 175 completed follow-up in the intervention group and 209 in the control group. AUDIT score at follow-up was significantly smaller in the intervention [BOCF mean = 13.91, standard deviation (SD) = 7.61, MI mean = 11.03, SD = 6.55] than control group (BOCF mean = 15.30, SD = 7.31; MI mean = 14.30, SD = 7.21), with a group difference of -1.38 [95% confidence interval (CI) = -2.58, -0.18], P = 0.02 for BOCF and -3.26 (95% CI = -2.01, -4.51), P < 0.001 for MI. CONCLUSIONS A randomized controlled trial has found that an on-line self-help intervention with minimal guidance was effective at reducing problem drinking in Estonia.
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Affiliation(s)
- Mareike Augsburger
- University of Zurich; Swiss Research Institute for Public Health and Addiction ISGFZurichSwitzerland
| | - Esta Kaal
- National Institute for Health Development; Centre for Health MarketingTallinnEstonia,Tallinn UniversityTallinnEstonia
| | - Triin Ülesoo
- National Institute for Health Development; Centre for Health MarketingTallinnEstonia
| | - Andreas Wenger
- University of Zurich; Swiss Research Institute for Public Health and Addiction ISGFZurichSwitzerland
| | - Matthijs Blankers
- Department of ResearchArkin Mental Health CareAmsterdamthe Netherlands,Academic Medical Centre, Department of PsychiatryUniversity of AmsterdamAmsterdamthe Netherlands
| | - Severin Haug
- University of Zurich; Swiss Research Institute for Public Health and Addiction ISGFZurichSwitzerland
| | - David D. Ebert
- Department of Clinical, Neuro and Developmental PsychologyVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental PsychologyVrije Universiteit AmsterdamAmsterdamthe Netherlands,GGZ inGeest, Research and InnovationAmsterdamthe Netherlands
| | - Matthew Keough
- Department of PsychologyYork UniversityTorontoOntarioCanada
| | - Helen Noormets
- National Institute for Health Development; Centre for Health MarketingTallinnEstonia
| | - Michael P. Schaub
- University of Zurich; Swiss Research Institute for Public Health and Addiction ISGFZurichSwitzerland
| | - Karin Kilp
- National Institute for Health Development; Centre for Health MarketingTallinnEstonia
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Bendau A, Viohl L, Petzold MB, Helbig J, Reiche S, Marek R, Romanello A, Moon DU, Gross RE, Masah DJ, Gutwinski S, Mick I, Montag C, Evens R, Majić T, Betzler F. No party, no drugs? Use of stimulants, dissociative drugs, and GHB/GBL during the early COVID-19 pandemic1. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103582. [PMID: 35093679 PMCID: PMC8730379 DOI: 10.1016/j.drugpo.2022.103582] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Antonia Bendau
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany
| | - Leonard Viohl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany
| | - Moritz Bruno Petzold
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany
| | - Jonas Helbig
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany
| | - Simon Reiche
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany; Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany
| | - Roman Marek
- Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany; Akademie der Wissenschaften Berlin-Brandenburg, Germany
| | - Amy Romanello
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany; Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany; Humboldt-Universität zu Berlin, Berlin School of Mind and Brain, Germany
| | - Daa Un Moon
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany
| | - Rosa Elisa Gross
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany
| | - Dario Jalilzadeh Masah
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany
| | - Stefan Gutwinski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany; Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany
| | - Inge Mick
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany
| | - Christiane Montag
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany
| | - Ricarda Evens
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany; Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany
| | - Tomislav Majić
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany; Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany
| | - Felix Betzler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany.
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Spanhel K, Balci S, Feldhahn F, Bengel J, Baumeister H, Sander LB. Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review. NPJ Digit Med 2021; 4:128. [PMID: 34433875 PMCID: PMC8387403 DOI: 10.1038/s41746-021-00498-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Providing accessible and effective healthcare solutions for people living in low- and middle-income countries, migrants, and indigenous people is central to reduce the global mental health treatment gap. Internet- and mobile-based interventions (IMI) are considered scalable psychological interventions to reduce the burden of mental disorders and are culturally adapted for implementation in these target groups. In October 2020, the databases PsycInfo, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for studies that culturally adapted IMI for mental disorders. Among 9438 screened records, we identified 55 eligible articles. We extracted 17 content, methodological, and procedural components of culturally adapting IMI, aiming to consider specific situations and perspectives of the target populations. Adherence and effectiveness of the adapted IMI seemed similar to the original IMI; yet, no included study conducted a direct comparison. The presented taxonomy of cultural adaptation of IMI for mental disorders provides a basis for future studies investigating the relevance and necessity of their cultural adaptation.PROSPERO registration number: CRD42019142320.
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Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
| | - Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Felicitas Feldhahn
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
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Baumgartner C, Schaub MP, Wenger A, Malischnig D, Augsburger M, Lehr D, Blankers M, Ebert DD, Haug S. "Take Care of You" - Efficacy of integrated, minimal-guidance, internet-based self-help for reducing co-occurring alcohol misuse and depression symptoms in adults: Results of a three-arm randomized controlled trial. Drug Alcohol Depend 2021; 225:108806. [PMID: 34171823 DOI: 10.1016/j.drugalcdep.2021.108806] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and harmful alcohol use are two of the top five leading causes of years of life lost to disability in high-income countries. Integrated treatment targeting both at the same time is often considered more complicated and difficult and, therefore, more expensive. Consequently, integrated internet-based interventions could be a valuable addition to traditional care. METHODS A three-arm randomized controlled trial was conducted comparing the effectiveness of (1) an integrated, minimal-guidance, adherence-focused self-help intervention designed to reduce both alcohol use and depression symptoms (AFGE-AD); (2) a similar intervention designed to reduce alcohol use only (AFGE-AO), and (3) internet access as usual (IAU) as a control condition, in at least moderately depressed alcohol misusers from February 2016-March 2020. We recruited 689 alcohol misusers (51.6 % males, mean age = 42.8 years) with at least moderate depression symptoms not otherwise in treatment from the general population. Six months after baseline, 288 subjects (41.8 %) were reachable for the final assessment. RESULTS All interventions yielded reduced alcohol-use after six months (AFGE-AD: -16.6; AFGE-AO: -19.8; IAU: -13.2). Those who undertook active-interventions reported significantly fewer standard drinks than controls (AFGE-AD: p = .048, d=0.10; AFGE-AO: p = .004, d=0.20). The two active-intervention groups also reported significantly less severe depression symptoms than controls (AFGE-AD: p = .006, d=0.41; AFGE-AO: p = .008, d=0.43). Testing revealed noninferiority between the two interventions. CONCLUSIONS This study documented sustained effectiveness of the first integrated, fully internet-based self-help intervention developed for the reduction of both alcohol use and depression symptoms in at least moderately depressed adult alcohol misusers recruited from the general population.
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Affiliation(s)
- Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland.
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Doris Malischnig
- Institute for Addiction Prevention, Addiction and Drug Coordination Vienna, Vienna, Austria
| | - Mareike Augsburger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Dirk Lehr
- Division of Online Health Training, Leuphana University Lueneburg, Germany
| | - Matthijs Blankers
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - David D Ebert
- Department for Sport and Health Sciences, Chair for Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
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Schaub MP. How to achieve greater comparability-suggested ways to improve the determination of treatment gap and treatment lag. DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-07-2020-0049] [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]
Abstract
Purpose
The aim of this paper is to reveal these problems and to derive recommendations for improvement. In the field of alcohol use disorders (AUDs), two common complaints are the large treatment gap that exists because only a small percentage of people with an AUD are in treatment; and the prolonged lag that typically exists between the emergence of problematic symptoms and actual on set of treatment. However, there also are no clear definitions for these terms – “treatment gap” and “treatment lag” – and, therefore, no consensus regarding how to quantify them. For this reason, it is difficult to compare the results of studies assessing either of these measures.
Design/methodology/approach
A non-systematic literature search and logical-analytical investigation was performed of immanent problems related to definitions and measurements aiming to enhance understanding in this area and derive suggestions for improvement.
Findings
The following four fundamental questions were identified: How does one operationalise the need to change substance use behaviours? Which interventions can justifiably be called treatment? Is treatment always necessary? and How regularly do patients need to be in contact with a treatment system to be considered “in treatment”? Potential approaches to answering these questions are discussed and recommendations made for future studies to determine how the treatment gap and treatment lag should be derived.
Originality/value
The derived recommendations should make the calculation of treatment gap and treatment lag more transparent and comparable between studies. They also may serve as checklists for future studies on the treatment gap and lag in the AUD field.
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