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Balit J, Erlangsen A, Docherty A, Turecki G, Orri M. Association of chronic pain with suicide attempt and death by suicide: a two-sample Mendelian randomization. Mol Psychiatry 2024; 29:2043-2049. [PMID: 38366113 DOI: 10.1038/s41380-024-02465-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
Prior studies have suggested an association between chronic pain and suicidal behavior. However, evidence supporting the causal nature of this association, and the role played by depression, remain difficult to establish due to confounding. We investigated associations of chronic pain with suicide attempt and death by suicide as well as the mediating role of depression in this association using a genetically informed method strengthening causal inference. We conducted a two-sample Mendelian randomization. Independent SNPs (N = 97) from the multisite chronic pain GWAS (NGWAS = 387,649) were used as instrumental variables to test associations of chronic pain with suicide attempt (measured from hospital records; NGWAS = 50,264) and death by suicide (measured from official death causes; NGWAS = 18,085). Indirect associations of chronic pain with suicide attempt and death by suicide via major depressive disorder (NGWAS = 173,005) were estimated. Primary analyses were supported by a range of sensitivity and outlier analyses. We found evidence supporting the contribution of chronic pain to increasing the risk of suicide attempt (OR = 1.67, CI = 1.21-2.35) and death by suicide (OR = 2.00, CI = 1.10-3.62). Associations were consistent across sensitivity analysis methods, and no evidence for outliers driving these associations was found. Through mediation analyses, we found that major depressive disorder explained a substantial proportion of the association between chronic pain and suicide attempt (proportion mediated = 39%; ORindirect association = 1.32, CI = 1.09-1.61) and death by suicide (proportion mediated = 34%; ORindirect association = 1.40, CI = 1.13-1.73). Our findings suggest that both pain management interventions and prevention of depression are likely to be effective strategies to reduce suicide risk in individuals with chronic pain.
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Affiliation(s)
- Jude Balit
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Anna Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Department of Epidemiology, Biostatics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada.
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.
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Zainal NH. Is combined antidepressant medication (ADM) and psychotherapy better than either monotherapy at preventing suicide attempts and other psychiatric serious adverse events for depressed patients? A rare events meta-analysis. Psychol Med 2024; 54:457-472. [PMID: 37964436 DOI: 10.1017/s0033291723003306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Antidepressant medication (ADM)-only, psychotherapy-only, and their combination are the first-line treatment options for major depressive disorder (MDD). Previous meta-analyses of randomized controlled trials (RCTs) established that psychotherapy and combined treatment were superior to ADM-only for MDD treatment remission or response. The current meta-analysis extended previous ones by determining the comparative efficacy of ADM-only, psychotherapy-only, and combined treatment on suicide attempts and other serious psychiatric adverse events (i.e. psychiatric emergency department [ED] visit, psychiatric hospitalization, and/or suicide death; SAEs). Peto odds ratios (ORs) and their 95% confidence intervals were computed from the present random-effects meta-analysis. Thirty-four relevant RCTs were included. Psychotherapy-only was stronger than combined treatment (1.9% v. 3.7%; OR 1.96 [1.20-3.20], p = 0.012) and ADM-only (3.0% v. 5.6%; OR 0.45 [0.30-0.67], p = 0.001) in decreasing the likelihood of SAEs in the primary and trim-and-fill sensitivity analyses. Combined treatment was better than ADM-only in reducing the probability of SAEs (6.0% v. 8.7%; OR 0.74 [0.56-0.96], p = 0.029), but this comparative efficacy finding was non-significant in the sensitivity analyses. Subgroup analyses revealed the advantage of psychotherapy-only over combined treatment and ADM-only for reducing SAE risk among children and adolescents and the benefit of combined treatment over ADM-only among adults. Overall, psychotherapy and combined treatment outperformed ADM-only in reducing the likelihood of SAEs, perhaps by conferring strategies to enhance reasons for living. Plausibly, psychotherapy should be prioritized for high-risk youths and combined treatment for high-risk adults with MDD.
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Affiliation(s)
- Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Psychology, National University of Singapore, Singapore
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Alotaibi R, Halbesma N, Wild SH, Jackson CA. Severe depression and all-cause and cause-specific mortality in Scotland: 20 year national cohort study. BJPsych Open 2024; 10:e28. [PMID: 38205603 PMCID: PMC10790224 DOI: 10.1192/bjo.2023.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Understanding cause of death in people with depression could inform approaches to reducing premature mortality. AIM To describe all-cause and cause-specific mortality for people with severe depression in Scotland, by sex, relative to the general population. METHOD We performed a retrospective cohort study, using psychiatric hospital admission data linked to death data, to identify adults (≥18 years old) with severe depression and ascertain cause-specific deaths, during 2000-2019. We estimated relative all-cause and cause-specific mortality for people with severe depression using standardised mortality ratios (SMRs), stratified by sex using the whole Scottish population as the standard. RESULTS Of 28 808 people with severe depression, 7903 (27.4%) died during a median follow-up of 8.7 years. All-cause relative mortality was over three times higher than expected (SMR, both sexes combined: 3.26, 95% CI 3.19-3.34). Circulatory disease was the leading cause of death, and, among natural causes of death, excess relative mortality was highest for circulatory diseases (SMR 2.51, 2.40-2.66), respiratory diseases (SMR 3.79, 3.56-4.01) and 'other' causes (SMR 4.10, 3.89-4.30). Among circulatory disease subtypes, excess death was highest for cerebrovascular disease. Both males and females with severe depression had higher all-cause and cause-specific mortality than the general population. Suicide had the highest SMR among both males (SMR 12.44, 95% CI 11.33-13.54) and females (22.86, 95% CI 20.35-25.36). CONCLUSION People with severe depression have markedly higher all-cause mortality than the general population in Scotland, with relative mortality varying by cause of death. Effective interventions are needed to reduce premature mortality for people with severe depression.
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Affiliation(s)
- Raied Alotaibi
- Usher Institute, University of Edinburgh, Edinburgh, UK; and Prince Sultan College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | | | - Sarah H. Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Arnon S, Shahar G, Brunstein Klomek A. Continuity of care in suicide prevention: current status and future directions. Front Public Health 2024; 11:1266717. [PMID: 38259744 PMCID: PMC10800998 DOI: 10.3389/fpubh.2023.1266717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Continuity of Care (CoC) is central to suicide prevention. The present study aims to review contemporary definitions, operationalization in research, and key components of CoC in the prevention of suicide. Methods The present study is a narrative review. A thorough search of available literature on CoC and suicidality was conducted. Studies published between 1995 and 2021 were reviewed and selected based on relevance to CoC and suicidality. Selected research was subsequently summarized to outline definitions of CoC, its operationalization in research, and key components for suicide prevention. Results The definition, measurement, and operationalization of CoC in suicide prevention varies tremendously, derailing clinical practice. Key elements of CoC identified across the literature include (1) CoC across multiple levels of care, (2) the role of primary care providers and case managers in CoC of suicidal patients, (3) the importance of follow up contact with suicidal patients post-treatment, and (4) the role of national and institutional guidelines for CoC of suicidal patients. Limitations: There is a dearth of randomized controlled trials and insufficient evidence on specific populations. Conclusion CoC refers to a wide, complex concept that must be broken down into specific categories that can provide more nuanced guidance of research and clinical implications.
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Affiliation(s)
- Shay Arnon
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Golan Shahar
- Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Azizi H, Fakhari A, Farahbakhsh M, Davtalab Esmaeili E, Chattu VK, Ali Asghari N, Nazemipour M, Mansournia MA. Prevention of Re-attempt Suicide Through Brief Contact Interventions: A Systematic Review, Meta-analysis, and Meta-regression of Randomized Controlled Trials. JOURNAL OF PREVENTION (2022) 2023; 44:777-794. [PMID: 37707696 DOI: 10.1007/s10935-023-00747-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/15/2023]
Abstract
Brief contact intervention (BCI) is a low-cost intervention to prevent re-attempt suicide. This meta-analysis and meta-regression study aimed to evaluate the effect of BCI on re-attempt prevention following suicide attempts (SAs). We systematically searched using defined keywords in MEDLINE, Embase, and Scopus up to April, 2023. All randomized controlled trials (RCTs) were eligible for inclusion after quality assessment. Random-effects model and subgroup analysis were used to estimate pooled risk difference (RD) and risk ratio (RR) between BCI and re-attempt prevention with 95% confidence intervals (CIs). Meta-regression analysis was carried out to explore the potential sources of heterogeneity. The pooled estimates were (RD = 4%; 95% CI 2-6%); and (RR = 0.62; 95% CI 0.48-0.77). Subgroup analysis demonstrated that more than 12 months intervention (RR = 0.46; 95% CI 0.10-0.82) versus 12 months or less (RR = 0.67; 95% CI 0.54-0.80) increased the effectiveness of BCI on re-attempt suicide reduction. Meta-regression analysis explored that BCI time (more than 12 months), BCI type, age, and female sex were the potential sources of the heterogeneity. The meta-analysis indicated that BCI could be a valuable strategy to prevent suicide re-attempts. BCI could be utilized within suicide prevention strategies as a surveillance component of mental health since BCI requires low-cost and low-educated healthcare providers.
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Affiliation(s)
- Hosein Azizi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Fakhari
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Vijay Kumar Chattu
- Department of OS & OT, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1V7, Canada
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 600077, India
| | - Nasrin Ali Asghari
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Nazemipour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, P.O. Box 14155-6446, Tehran, Iran.
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Cox RC, Brown SL, Chalmers BN, Scott LN. Examining sleep disturbance components as near-term predictors of suicide ideation in daily life. Psychiatry Res 2023; 326:115323. [PMID: 37392522 PMCID: PMC10527974 DOI: 10.1016/j.psychres.2023.115323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
Suicide ideation emerges and fluctuates over short timeframes (minutes, hours, days); however, near-term predictors of such fluctuations have not been well-elucidated. Sleep disturbance is a distal suicide risk factor, but less work has examined whether daily sleep disturbance predicts near-term changes in suicide ideation. We examined subjective sleep disturbance components as predictors of passive and active suicide ideation at the within-person (i.e., day-to-day changes within individuals relative to their own mean) and between-persons (individual differences relative to the sample mean) levels. A transdiagnostic sample of 102 at-risk young adults ages 18-35 completed a 21-day ecological momentary assessment protocol, during which they reported on sleep and passive and active suicide ideation. At the within-persons level, nightmares, sleep quality, and wake after sleep onset predicted passive suicide ideation, and sleep quality and wake after sleep onset predicted active suicide ideation. At the between-persons level, nightmares, sleep onset latency, and sleep quality were associated with passive suicide ideation, and sleep onset latency was associated with active suicide ideation. In contrast, suicide ideation did not predict subsequent sleep at the within-person level. Specific sleep disturbance components are near-term predictors of intraindividual increases in suicide ideation and may hold promise for suicide prevention and intervention.
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Affiliation(s)
- Rebecca C Cox
- Department of Integrative Physiology, University of Colorado Boulder, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Sarah L Brown
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Brittany N Chalmers
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Lori N Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
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Yao Z, McCall WV. Designing Clinical Trials to Assess the Impact of Pharmacological Treatment for Suicidal Ideation/Behavior: Issues and Potential Solutions. Pharmaceut Med 2023; 37:221-232. [PMID: 37046135 PMCID: PMC10097518 DOI: 10.1007/s40290-023-00467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 04/14/2023]
Abstract
Suicide is a serious and growing public health concern yet randomized controlled trials (RCTs) that inform pharmacologic treatment remain limited. We emphasize the overall need for such trials and review the literature to highlight examples of trials that have aimed to study patients at elevated risk of suicide. We discuss key examples of existing psychotropic medication trials as well as psychotherapy intervention studies that can yield important design insights. Medications that have been studied in individuals at risk for suicide include lithium, clozapine, zolpidem, prazosin, ketamine, esketamine, and aripiprazole. While important design challenges should be considered-RCTs to study suicide are feasible and much needed. Issues such as overall trial design, patient-selection criteria, and the scales/tools used to assess suicidality are discussed.
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Affiliation(s)
- Zhixing Yao
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA.
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Abstract
Bipolar disorders (BDs) are recurrent and sometimes chronic disorders of mood that affect around 2% of the world's population and encompass a spectrum between severe elevated and excitable mood states (mania) to the dysphoria, low energy, and despondency of depressive episodes. The illness commonly starts in young adults and is a leading cause of disability and premature mortality. The clinical manifestations of bipolar disorder can be markedly varied between and within individuals across their lifespan. Early diagnosis is challenging and misdiagnoses are frequent, potentially resulting in missed early intervention and increasing the risk of iatrogenic harm. Over 15 approved treatments exist for the various phases of bipolar disorder, but outcomes are often suboptimal owing to insufficient efficacy, side effects, or lack of availability. Lithium, the first approved treatment for bipolar disorder, continues to be the most effective drug overall, although full remission is only seen in a subset of patients. Newer atypical antipsychotics are increasingly being found to be effective in the treatment of bipolar depression; however, their long term tolerability and safety are uncertain. For many with bipolar disorder, combination therapy and adjunctive psychotherapy might be necessary to treat symptoms across different phases of illness. Several classes of medications exist for treating bipolar disorder but predicting which medication is likely to be most effective or tolerable is not yet possible. As pathophysiological insights into the causes of bipolar disorders are revealed, a new era of targeted treatments aimed at causal mechanisms, be they pharmacological or psychosocial, will hopefully be developed. For the time being, however, clinical judgment, shared decision making, and empirical follow-up remain essential elements of clinical care. This review provides an overview of the clinical features, diagnostic subtypes, and major treatment modalities available to treat people with bipolar disorder, highlighting recent advances and ongoing therapeutic challenges.
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Affiliation(s)
- Fernando S Goes
- Precision Medicine Center of Excellence in Mood Disorders, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Wilkinson ST, Trujillo Diaz D, Rupp ZW, Kidambi A, Ramirez KL, Flores JM, Avila-Quintero VJ, Rhee TG, Olfson M, Bloch MH. Pharmacological and Somatic Treatment Effects on Suicide in Adults: A Systematic Review and Meta-Analysis. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:197-208. [PMID: 37201149 PMCID: PMC10172559 DOI: 10.1176/appi.focus.23021006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk. Methods A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations. Results In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. Conclusion Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.Reprinted from Depress Anxiety 2022; 39:100-112, with permission from John Wiley and Sons. Copyright © 2022.
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Affiliation(s)
- Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Daniel Trujillo Diaz
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Zachary W Rupp
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Anubhav Kidambi
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Karina L Ramirez
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - José M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Victor J Avila-Quintero
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - T Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Mark Olfson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Michael H Bloch
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
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Risk of suicide attempt repetition after an index attempt: A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 81:51-56. [PMID: 36805332 DOI: 10.1016/j.genhosppsych.2023.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To estimate the risk of suicide attempt repetition among individuals with an index attempt. It also aims to study the role of risk factors and prevention programme in repetition. METHODS This systematic review and meta-analysis was conducted in keeping with the PRISMA 2020 guidelines. Studies on attempt repetition (both cohort studies and intervention studies) were searched from inception to 2022. RESULTS A total of 110 studies comprising 248,829 attempters was reviewed. The overall repetition rate was 0.20 (0.17, 0.22). Repetition risk linearly increased over time. A higher risk of attempt repetition was associated with female sex and index attempts in which self-cutting methods were used. Moreover, a mental disorder diagnosis was associated with an increasing repetition risk (OR = 2.02, p < .01). The delivery of a preventive programme reduced the repetition risk, OR = 0.76, p < .05; however, this effect was significant for psychotherapy interventions, OR = 0.38, p < .01. CONCLUSION One in five suicide attempters will engage in a new suicide attempt. An elevated repetition risk is associated with being female, more severe index methods and psychiatric disorder diagnosis. Preventive programmes, particularly psychotherapy, may contribute to reducing repetition risk and eventually save lives.
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Bakian AV, Chen D, Zhang C, Hanson HA, Docherty AR, Keeshin B, Gray D, Smith KR, VanDerslice JA, Yu DZ, Zhang Y, Coon H. A population-wide analysis of the familial risk of suicide in Utah, USA. Psychol Med 2023; 53:1448-1457. [PMID: 37010215 PMCID: PMC10009406 DOI: 10.1017/s0033291721003020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/25/2021] [Accepted: 07/09/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The degree to which suicide risk aggregates in US families is unknown. The authors aimed to determine the familial risk of suicide in Utah, and tested whether familial risk varies based on the characteristics of the suicides and their relatives. METHODS A population-based sample of 12 160 suicides from 1904 to 2014 were identified from the Utah Population Database and matched 1:5 to controls based on sex and age using at-risk sampling. All first through third- and fifth-degree relatives of suicide probands and controls were identified (N = 13 480 122). The familial risk of suicide was estimated based on hazard ratios (HR) from an unsupervised Cox regression model in a unified framework. Moderation by sex of the proband or relative and age of the proband at time of suicide (<25 v. ⩾25 years) was examined. RESULTS Significantly elevated HRs were observed in first- (HR 3.45; 95% CI 3.12-3.82) through fifth-degree relatives (HR 1.07; 95% CI 1.02-1.12) of suicide probands. Among first-degree relatives of female suicide probands, the HR of suicide was 6.99 (95% CI 3.99-12.25) in mothers, 6.39 in sisters (95% CI 3.78-10.82), and 5.65 (95% CI 3.38-9.44) in daughters. The HR in first-degree relatives of suicide probands under 25 years at death was 4.29 (95% CI 3.49-5.26). CONCLUSIONS Elevated familial suicide risk in relatives of female and younger suicide probands suggests that there are unique risk groups to which prevention efforts should be directed - namely suicidal young adults and women with a strong family history of suicide.
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Affiliation(s)
- Amanda V. Bakian
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Danli Chen
- Study Design & Biostatics Center, Utah Clinical & Translational Science Institute, Salt Lake City, Utah, USA
| | - Chong Zhang
- Study Design & Biostatics Center, Utah Clinical & Translational Science Institute, Salt Lake City, Utah, USA
| | - Heidi A. Hanson
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
- Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Scientific Computing Institute, University of Utah, Salt Lake City, UT, USA
| | - Anna R. Docherty
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brooks Keeshin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Douglas Gray
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ken R. Smith
- Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Scientific Computing Institute, University of Utah, Salt Lake City, UT, USA
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, USA
| | - James A. VanDerslice
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - David Z. Yu
- Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Yue Zhang
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hilary Coon
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
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Azizi H, Esmaeili ED, Khodamoradi F, Sarbazi E. Effective suicide prevention strategies in primary healthcare settings: a systematic review. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00271-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
There is a fundamental need for health systems, health managers, and policymakers to identify effective components of suicide prevention strategies (SPS) and programs in primary healthcare (PHC) settings. Accordingly, this systematic review aimed to identify and summarize effective and significant evidence on suicide prevention in PHC setting. We systematically searched the published literature in English from PubMed, Web of Science, Scopus, CINAHL, PsychoINFO, and Embase up to 31 July 2022. The study searched all records reporting effective and significant strategies and programs on suicide prevention in PHC settings. A content analysis approach was carried out to extract major components of suicide prevention strategies in PHC settings.
Results
A total of 10 records (8 original articles and 2 reports) with 1,199,986 samples were included. In all the included articles, SPS decreased suicide rates. The majority of studies were conducted among the general population. The content analysis approach emerged five major components to SPS in PHC setting: (1) training and educating healthcare providers, (2) screening and suicide risk assessment, (3) managing depression symptoms and mental disorders, (4) managing suicide attempters and at-risk cases, and (5) prevention strategies at the general population.
Conclusions
This review provided reliable evidence for health systems to develop SPS in PHC and practitioners who are eager to provide brief and effective contact interventions for suicide risk to well-serve their patients.
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Riblet NB, Shiner B, Young-Xu Y, Watts BV. Lithium in the prevention of suicide in adults: systematic review and meta-analysis of clinical trials. BJPsych Open 2022; 8:e199. [PMID: 36384820 PMCID: PMC9707499 DOI: 10.1192/bjo.2022.605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Controversy exists regarding the efficacy of lithium for suicide prevention. Except for a recent trial that enrolled over 500 patients, available trials of lithium for suicide prevention have involved small samples. It is challenging to measure suicide in a single randomised controlled trial (RCT). Adding a single large study to existing meta-analyses may provide insights into lithium's anti-suicidal effects. We performed a meta-analysis of RCTs comparing lithium with a control condition for suicide prevention. MEDLINE and other databases were searched up to 30 November 2021. Efficacy was assessed by calculating the summary Peto odds ratio (OR) and incidence rate ratio (IRR) with 95% confidence intervals. Among seven RCTs, the odds of suicide were lower among patients receiving lithium versus control (OR = 0.30, 95% CI 0.09-1.02; IRR = 0.22, 95% CI 0.05-1.05), although the findings were still not statistically significant. The role of lithium in suicide prevention remains uncertain.
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Affiliation(s)
- Natalie B Riblet
- Veterans Affairs Medical Center, White River Junction, Vermont, USA; and Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Brian Shiner
- Veterans Affairs Medical Center, White River Junction, Vermont, USA; Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA; and National Center for PTSD, White River Junction, Vermont, USA
| | - Yinong Young-Xu
- Veterans Affairs Medical Center, White River Junction, Vermont, USA; and Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Bradley V Watts
- Veterans Affairs Medical Center, White River Junction, Vermont, USA; Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA; and Veterans Rural Health Resource Center, Veterans Affairs Medical Center, White River Junction, Vermont, USA
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14
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Riblet NB, Varela M, Ashby W, Zubkoff L, Shiner B, Pogue J, Stevens SP, Wasserman D, Watts BV. Spreading a Strategy to Prevent Suicide After Psychiatric Hospitalization: Results of a Quality Improvement Spread Initiative. Jt Comm J Qual Patient Saf 2022; 48:503-512. [PMID: 35382976 PMCID: PMC9445104 DOI: 10.1016/j.jcjq.2022.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Suicide after psychiatric hospitalization is a major concern. Poor treatment engagement may contribute to risk. The World Health Organization Brief Intervention and Contact (BIC) Program is an evidence-based practice shown to prevent suicide after psychiatric discharge in international trials. There have been no efforts to implement BIC into routine practice in US populations. METHODS The authors conducted a 12-month quality improvement (QI) collaborative at six US Department of Veterans Affairs (VA) medical centers serving a large rural population. Sites had low to moderate performance on a VA quality measure of mental health postdischarge care; a measure assessing the proportion of discharged patients who achieve the required number of visits ≤ 30 days. Sites received programmatic support to implement BIC locally. Implementation was assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. RESULTS Overall, teams had high participation in programmatic activities and enrolled 85% of eligible patients that they approached. Among 70 enrolled patients, 81.4% achieved the VA quality measure of mental health postdischarge care, suggesting good treatment engagement. On average, patients rated BIC as excellent. Team members agreed that BIC was easy to use, implementable, possible, and doable. Factors facilitating implementation included standardized operating procedures to standardize processes. Barriers included insufficient staffing and loss to follow-up. Most sites plan to continue to enroll patients and to expand BIC to other areas. CONCLUSION A QI collaborative can facilitate implementation of BIC in six VA facilities that provide inpatient psychiatric treatment. BIC may appeal to patients and providers and may improve treatment engagement.
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15
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Barrigon ML, Porras-Segovia A, Courtet P, Lopez-Castroman J, Berrouiguet S, Pérez-Rodríguez MM, Artes A, Baca-Garcia E. Smartphone-based Ecological Momentary Intervention for secondary prevention of suicidal thoughts and behaviour: protocol for the SmartCrisis V.2.0 randomised clinical trial. BMJ Open 2022; 12:e051807. [PMID: 36127081 PMCID: PMC9490606 DOI: 10.1136/bmjopen-2021-051807] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Suicide is one of the leading public health issues worldwide. Mobile health can help us to combat suicide through monitoring and treatment. The SmartCrisis V.2.0 randomised clinical trial aims to evaluate the effectiveness of a smartphone-based Ecological Momentary Intervention to prevent suicidal thoughts and behaviour. METHODS AND ANALYSIS The SmartCrisis V.2.0 study is a randomised clinical trial with two parallel groups, conducted among patients with a history of suicidal behaviour treated at five sites in France and Spain. The intervention group will be monitored using Ecological Momentary Assessment (EMA) and will receive an Ecological Momentary Intervention called 'SmartSafe' in addition to their treatment as usual (TAU). TAU will consist of mental health follow-up of the patient (scheduled appointments with a psychiatrist) in an outpatient Suicide Prevention programme, with predetermined clinical appointments according to the Brief Intervention Contact recommendations (1, 2, 4, 7 and 11 weeks and 4, 6, 9 and 12 months). The control group would receive TAU and be monitored using EMA. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the University Hospital Fundación Jiménez Díaz. It is expected that, in the near future, our mobile health intervention and monitoring system can be implemented in routine clinical practice. Results will be disseminated through peer-reviewed journals and psychiatric congresses. Reference number EC005-21_FJD. Participants gave informed consent to participate in the study before taking part. TRIAL REGISTRATION NUMBER NCT04775160.
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Affiliation(s)
- Maria Luisa Barrigon
- Grupo de Investigación en Psiquiatría Translacional, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Universidad Autonoma de Madrid, Madrid, Spain
| | - Alejandro Porras-Segovia
- Grupo de Investigación en Psiquiatría Translacional, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Montpellier, France
| | | | | | | | - Antonio Artes
- Departamento de Teoría de Señal, Universidad Carlos III de Madrid, Getafe, Spain
| | - Enrique Baca-Garcia
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Universidad Autonoma de Madrid, Madrid, Spain
- Department of Adult Psychiatry, Nîmes University Hospital, Nimes, France
- Universidad Catolica del Maule, Talca, Chile
- CIBERSAM (Centro de Investigacion en Salud Mental), Carlos III Institute of Health, Madrid, Spain
- Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain
- Department of Psychiatry, General Hospital of Villalba, Madrid, Spain
- Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain
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16
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Effects of lithium on suicide and suicidal behaviour: a systematic review and meta-analysis of randomised trials. Epidemiol Psychiatr Sci 2022; 31:e65. [PMID: 36111461 PMCID: PMC9533115 DOI: 10.1017/s204579602200049x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS Lithium has long been believed to reduce the risk of suicide and suicidal behaviour in people with mood disorders. Previous meta-analyses appeared to support this belief, but excluded relevant data due to the difficulty of conducting meta-analysis of rare events. The current study is an updated systematic review and meta-analysis that includes all eligible data, and evaluates suicide, non-fatal suicidal behaviour (including suicidal ideation) and suicide attempts. METHODS We searched PubMed, PsycINFO and Embase and some trial registers. We included all randomised trials comparing lithium and placebo or treatment as usual in mood disorders published after 2000, to ensure suicide was reliably reported. Trial quality was assessed using the Cochrane Risk of Bias tool. Pooled data were analysed using Fisher's Exact test. In addition, meta-analysis was conducted using various methods, prioritizing the Exact method. All trials were included in the analysis of suicide initially, regardless of whether they reported on suicide or not. We conducted a sensitivity analysis with trials that specifically reported on suicides and one that included trials published before 2000. Pre-specified subgroup analyses were performed involving suicide prevention trials, trials excluding people already taking lithium, trials involving people with bipolar disorder exclusively and those involving people with mixed affective diagnoses. Non-fatal suicidal behaviour and suicide attempts were analysed using the same methods, but only trials that reported these outcomes were included. PROSPERO registration: CRD42021265809. RESULTS Twelve eligible studies involving 2578 participants were included. The pooled suicide rate was 0.2% for people randomised to lithium and 0.4% with placebo or treatment as usual, which was not a statistically significant difference; odds ratio (OR) = 0.41 (95% confidence interval 0.03-2.49), p = 0.45. Meta-analysis using the Exact method produced an OR of 0.42 (95% confidence interval 0.01-4.5). The result was not substantially different when restricted to 11 trials that explicitly reported suicides and remained statistically non-significant when including 15 trials published before 2000 (mostly in the 1970s). There were no significant differences in any subgroup analysis. There was no difference in rates of all non-fatal suicidal behaviour in seven trials that reported this outcome, or in five trials that reported suicide attempts specifically. Meta-analyses using other methods also revealed no statistically significant differences. CONCLUSIONS Evidence from randomised trials is inconclusive and does not support the idea that lithium prevents suicide or suicidal behaviour.
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17
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Sufrate-Sorzano T, Pérez J, Juárez-Vela R, Garrote-Cámara M, de Viñaspre RR, Molina-Luque F, Santolalla-Arnedo I. Umbrella review of nursing interventions NIC for the treatment and prevention of suicidal behavior. Int J Nurs Knowl 2022. [PMID: 35997164 DOI: 10.1111/2047-3095.12392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this umbrella review was to determine the most effective nursing interventions for the prevention and management of suicidal behavior. In order to do so, the review identifies interventions from the Nursing Interventions Classifications taxonomy with evidence to this end. METHODS A systematic search was conducted for systematic reviews included in the PubMed, CINAHL, Cochrane, Scopus, Web of Knowledge, and Joanna Briggs Institute databases between January 1, 2011 and May 1, 2020. FINDINGS The review is made up of 21 systematic reviews. In order to carefully analyze the interventions described, these were coded into categories, grouping the interventions into those based on psychological therapy, interventions related to pharmacotherapy, interventions related to the professional relationship between health professional and patient, and interventions aimed at the general public. CONCLUSIONS Nursing interventions for suicide risk management are prevalent in the scientific literature and are shown to be effective for patients with suicidal ideation or suicide attempts. Prevention and treatment of suicidal behavior require the provision of coping tools, behavioral interventions that directly address suicidal thoughts and behaviors, and support through therapeutic partnerships, among others. IMPLICATIONS FOR NURSING PRACTICE This paper synthesizes the most current evidence on the most effective Nursing Interventions Classifications interventions for the treatment and prevention of suicidal behavior. It provides nursing practitioners with a comprehensive review of the therapeutic interventions with the best evidence and is useful for the development of clinical guidelines and protocols, as well as for the development of health policies and plans.
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Affiliation(s)
- Teresa Sufrate-Sorzano
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR) Logroño, Logroño, Spain.,Department of Nursing, GRUPAC, University of La Rioja, Logroño, La Rioja, Spain
| | - Jesús Pérez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Raúl Juárez-Vela
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR) Logroño, Logroño, Spain.,Department of Nursing, GRUPAC, University of La Rioja, Logroño, La Rioja, Spain
| | - MaríaElena Garrote-Cámara
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR) Logroño, Logroño, Spain
| | - Regina Ruiz de Viñaspre
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR) Logroño, Logroño, Spain
| | - Fidel Molina-Luque
- Faculty of Education, Psychology and Social Work, University of Lleida, Lleida, Spain.,Group for the Study of Society, Health, Education and Culture (GESEC). University of Lleida, Lleida, Spain.,Research Institute in Social and Territorial Development (INDEST), University of Lleida, Lleida, Spain
| | - Iván Santolalla-Arnedo
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR) Logroño, Logroño, Spain.,Department of Nursing, GRUPAC, University of La Rioja, Logroño, La Rioja, Spain
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18
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Chee KY, Muhdi N, Ali NH, Amir N, Bernardo C, Chan LF, Ho R, Ittasakul P, Kwansanit P, Mariano MP, Mok YM, Tran DT, Trinh TBH. A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age. BMC Psychiatry 2022; 22:489. [PMID: 35864465 PMCID: PMC9306096 DOI: 10.1186/s12888-022-04140-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The high prevalence of suicidal behavior among individuals with major depressive disorder (MDD) in Southeast Asia (SEA) underscores the need for optimized management to address depressive symptoms, reduce suicide risk and prevent suicide in these individuals. Given the lack of clear guideline recommendations for assessing and managing these patients, regional consensus-based recommendations which take into account diverse local contexts across SEA may provide useful guidance for clinical practice. METHODS A narrative literature review and pre-meeting survey were conducted prior to the consensus meeting of an SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with MDD with suicidal behavior. Utilizing the RAND/UCLA Appropriateness Method, the expert panel developed consensus-based recommendations on the assessment and treatment of adult patients with MDD with suicidal behavior under 65 years. RESULTS Screening of adult patients under 65 years with MDD for suicide risk using both a validated assessment tool and clinical interview is recommended. An improved suicide risk stratification - incorporating both severity and temporality, or using a prevention-focused risk formulation - should be considered. For a patient with an MDD episode with low risk of suicide, use of antidepressant monotherapy, and psychotherapy in combination with pharmacological treatment are both recommended approaches. For a patient with an MDD episode with high risk of suicide, or imminent risk of suicide requiring rapid clinical response, or for a patient who had received adequate AD but still reported suicidal behavior, recommended treatment strategies include antidepressant augmentation, combination use of psychotherapy or electroconvulsive therapy with pharmacological treatment, and inpatient care. Suicide-specific psychosocial interventions are important for suicide prevention and should also be part of the management of patients with MDD with suicidal behavior. CONCLUSIONS There are still unmet needs in the assessment of suicide risk and availability of treatment options that can deliver rapid response in patients with MDD with suicidal behavior. These consensus recommendations on the management of adult patients with MDD with suicidal behavior under 65 years may serve as a useful guidance in diverse clinical practices across the SEA region. Clinical judgment based on careful consideration of individual circumstances of each patient remains key to determining the most appropriate treatment option.
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Affiliation(s)
- Kok Yoon Chee
- NEURON, Department of Psychiatry & Mental Health, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
| | - Nalini Muhdi
- Department of Psychiatry, Dr Soetomo General Hospital; Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Nor Hayati Ali
- Department of Psychiatry & Mental Health, Selayang Hospital, Selayang, Selangor, Malaysia
| | - Nurmiati Amir
- Department of Psychiatry, Ciptomangunkusumo Hospital; Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Carmina Bernardo
- Mood and Anxiety Resource and Referral Center, Professional Services, Department of Neuroscience, Makati Medical Center, Makati City, Philippines
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Roger Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Melissa Paulita Mariano
- Department of Psychiatry, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Yee Ming Mok
- Institute of Mental Health, Singapore, Singapore
| | - Duy Tam Tran
- Ho Chi Minh Psychiatric Hospital, Ho Chi Minh, Vietnam
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19
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Katz IR, Ferguson RE, Liang MH. Suicide Risk and Lithium-Reply. JAMA Psychiatry 2022; 79:513-514. [PMID: 35262638 DOI: 10.1001/jamapsychiatry.2022.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ira R Katz
- Department of Psychiatry, Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan E Ferguson
- Boston Cooperative Studies Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Matthew H Liang
- Boston Cooperative Studies Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts.,Section of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Section of Rheumatology, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts
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20
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Lengvenyte A, Strumila R, Olié E, Courtet P. Ketamine and esketamine for crisis management in patients with depression: Why, whom, and how? Eur Neuropsychopharmacol 2022; 57:88-104. [PMID: 35219097 DOI: 10.1016/j.euroneuro.2022.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/13/2022]
Abstract
Currently, only a limited number of interventions can rapidly relieve depressive symptomatology in patients with major depressive disorder or bipolar disorder experiencing extreme distress. Such crises, especially when suicide attempt or ideation is involved, are a major risk factor of suicide. Ketamine, a N-methyl-d-aspartate glutamate receptor antagonist, and its enantiomer esketamine rapidly reduce depressive symptoms in depressed patients with current suicidal ideation. Recently, esketamine has been approved for use in patients with depression at risk of suicide and for psychiatric emergency by major medical agencies in the United States and Europe, whereas ketamine is increasingly used off-label. However, there is currently limited guidance on why, when, and how to use these drugs in patients with depression to treat a crisis. In this review article, we provide a succinct overview of the cellular and molecular mechanisms of action of ketamine and esketamine, and of the functional brain changes following their administration. We also summarize the major clinical studies on ketamine and esketamine efficacy in patients experiencing a crisis (generally, suicidal ideation), and propose a profile of patients who can benefit most from such drugs, on the basis of neurobiological and clinical observations. Finally, we describe the administration mode, the efficacy and tolerability profiles, the side effect management, possible concomitant treatments and the issue of deprescribing.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Psychiatric Clinic, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Robertas Strumila
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Psychiatric Clinic, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
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21
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Riblet NB, Kenneally L, Stevens S, Watts BV, Gui J, Forehand J, Cornelius S, Rousseau GS, Schwartz JC, Shiner B. A virtual, pilot randomized trial of a brief intervention to prevent suicide in an integrated healthcare setting. Gen Hosp Psychiatry 2022; 75:68-74. [PMID: 35202942 PMCID: PMC8955571 DOI: 10.1016/j.genhosppsych.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients who die by suicide are often seen in primary care settings in the weeks leading to their death. There has been little study of brief interventions to prevent suicide in these settings. METHOD We conducted a virtual, pilot, randomized controlled trial of a brief suicide prevention strategy called Veterans Affairs Brief Intervention and Contact Program (VA BIC) in patients who presented to a primary care mental health walk-in clinic for a new mental health intake appointment and were at risk for suicide. Our primary aim was to assess feasibility. We measured our ability to recruit 20 patients. We measured the proportion of enrolled patients who completed all study assessments. We assessed adherence among patients assigned to VA BIC. RESULTS Twenty patients were enrolled and 95% (N = 19) completed all study assessments. Among the 10 patients assigned to VA BIC, 90% (N = 9) of patients completed all required intervention visits, and 100% (N = 10) completed ≥70% of the required interventions visits. CONCLUSION It is feasible to conduct a virtual trial of VA BIC in an integrated care setting. Future research should clarify the role of VA BIC as a suicide prevention strategy in integrated care settings using an adequately powered design. CLINICAL TRIAL REGISTRATION NCT04054947.
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Affiliation(s)
- Natalie B Riblet
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry and Dartmouth Institute, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America.
| | - Lauren Kenneally
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America
| | - Susan Stevens
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America
| | - Bradley V Watts
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America; Veterans Rural Health Resource Center, White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America
| | - Jiang Gui
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Biomedical Data Science, Dartmouth Institute, Community and Family Medicine, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America
| | - Jenna Forehand
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America
| | - Sarah Cornelius
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America
| | - Glenna S Rousseau
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America
| | - Jonathan C Schwartz
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America
| | - Brian Shiner
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry and Dartmouth Institute, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, United States of America; National Center for PTSD, Mental Health Service, Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, United States of America
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22
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Wilkinson ST, Trujillo Diaz D, Rupp ZW, Kidambi A, Ramirez KL, Flores JM, Avila-Quintero VJ, Rhee TG, Olfson M, Bloch MH. Pharmacological and somatic treatment effects on suicide in adults: A systematic review and meta-analysis. Depress Anxiety 2022; 39:100-112. [PMID: 34762330 DOI: 10.1002/da.23222] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk. METHODS A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations. RESULTS In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. CONCLUSION Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.
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Affiliation(s)
- Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Zachary W Rupp
- Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA
| | - Anubhav Kidambi
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Karina L Ramirez
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - José M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - T Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Michael H Bloch
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA.,Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
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23
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The national suicide prevention strategy in India: context and considerations for urgent action. Lancet Psychiatry 2022; 9:160-168. [PMID: 34895477 DOI: 10.1016/s2215-0366(21)00152-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 01/03/2023]
Abstract
India reports the highest number of suicide deaths in the world. At this time when the Indian Government is formulating a national suicide prevention strategy, we have reviewed the current status of suicides in India, focusing on epidemiology, risk factors, and existing suicide prevention strategies to identify key challenges and priorities for suicide prevention. The suicide rate among Indian girls and women continues to be twice the global rate. Suicide accounts for most deaths in the 15-39 years age group compared with other causes of death. Hanging is the most common method of suicide, followed by pesticides poisoning, medicine overdose, and self-immolation. In addition to depression and alcohol use disorders as risk factors, several social and cultural factors appear to increase risk of suicide. The absence of a national suicide prevention strategy, inappropriate media reporting, legal conflicts in the interpretation of suicide being punishable, and inadequate multisectoral engagement are major barriers to effective suicide prevention. A scaffolding approach is useful to reduce suicide rates, as interventions provided at the right time, intensity, and duration can help navigate situations in which a person might be susceptible to and at risk of suicide. In addition to outlining research and data priorities, we provide recommendations that emphasise multilevel action priorities for suicide prevention across various sectors. We call for urgent action in India by integrating suicide prevention measures at every level of public health, with special focus on the finalisation and implementation of the national suicide prevention strategy.
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24
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Vanzela AS, Silva AC, Borges TL, Castilho ECD, Miasso AI, Zanetti ACG, Alonso JB, Vedana KGG. Predictors of drug-drug interactions of medications prescribed to patients admitted due to suicidal behavior. Heliyon 2022; 8:e08850. [PMID: 35198752 PMCID: PMC8844659 DOI: 10.1016/j.heliyon.2022.e08850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 09/30/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Drug-drug interactions among people with suicidal behavior is a challenging topic, considering the harm it poses for patients already vulnerable and the lack of literature on the thematic. This aspect must not be neglected in research and clinical practice, and thus requires thorough investigation. OBJECTIVE to investigate predictors of drug-drug interaction of prescribed drugs and the prescription of two or more drugs for people admitted due to suicidal behavior in a psychiatric emergency department (short-stay hospital ward). METHOD A cross-sectional study with retrospective approach, carried out in a Brazilian psychiatric emergency unit in 2015. Data about first and last medical prescriptions were collected from 127 patients' files. Descriptive statistics and the Zero Adjusted Logarithmic Distribution (ZALG) model were adopted, with the significance level α = 0.05. RESULTS Potential drug-drug interactions were found in most of the first and last prescriptions. The sample majority were female, with previous suicide attempts, being discharged from the hospital with three drugs (or more) prescribed, and without referral to any health service. Age and comorbidities were predictors of more drug prescriptions and the amount of prescribed drugs was the most important predictor of drug-drug interactions (quantity and severity). CONCLUSIONS the variables associated with drug-drug interactions and prescription of two or more drugs among people with suicidal behavior needs to be investigated in different contexts and addressed in interventions with the aim to promote patient safety.
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Affiliation(s)
- Amanda Sarah Vanzela
- Master's Student in Psychiatric Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | - Aline Conceição Silva
- Doctoral Student in Psychiatric Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
- PhD in Psychiatric Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | - Tatiana Longo Borges
- PhD in Psychiatric Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | | | - Adriana Inocenti Miasso
- Associate Professor, Department of Psychiatric Nursing and Human Sciences, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Associate Professor, Department of Psychiatric Nursing and Human Sciences, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | - Jonas Bodini Alonso
- Statistician, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
| | - Kelly Graziani Giacchero Vedana
- Associate Professor, Department of Psychiatric Nursing and Human Sciences, University of São Paulo, Ribeirão Preto College of Nursing, Brazil
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25
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Kim H, Kim Y, Shin MH, Park YJ, Park HE, Fava M, Mischoulon D, Park MJ, Kim EJ, Jeon HJ. Early psychiatric referral after attempted suicide helps prevent suicide reattempts: A longitudinal national cohort study in South Korea. Front Psychiatry 2022; 13:607892. [PMID: 36147991 PMCID: PMC9486390 DOI: 10.3389/fpsyt.2022.607892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 08/10/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Although people who attempted suicide tend to repeat suicide attempts, there is a lack of evidence on the association between psychiatric service factors and suicide reattempt among them. METHODS We used a nationwide, population-based medical record database of South Korea to investigate the use of psychiatric services before and after the index suicide attempt and the association between psychiatric service factors after the index suicide attempt with the risk of suicide reattempt. RESULTS Among 5,874 people who had attempted suicide, the all-cause mortality within 3 months after the suicide attempt was 11.6%. Among all subjects who attempted suicide, 30.6% of them had used psychiatric services within 6 months before the suicide attempt; 43.7% of them had used psychiatric services within 3 months after the suicide attempt. Among individuals who had visited clinics following attempted suicide, the cumulative incidence of suicide reattempt over a mean follow-up period of 5.1 years was 3.4%. About half of suicide reattempts occurred within 1 year after the index suicide attempt. Referral to psychiatric services within 7 days was associated with a decreased risk of suicide reattempt (adjusted hazard ratio, 0.51; 95% confidence intervals, 0.29-0.89). CONCLUSION An early psychiatric referral within 1 week after a suicide attempt was associated with a decreased risk of suicide reattempt.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, South Korea
| | - Yuwon Kim
- Department of Data Science, Evidnet, Seongnam, South Korea
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoo-Jung Park
- Pfizer Pharmaceuticals Korea Ltd., Seoul, South Korea
| | | | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mi Jin Park
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Eun Ji Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
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26
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Bahlmann L, Lübbert MBJS, Sobanski T, Kastner UW, Walter M, Smesny S, Wagner G. Relapse Prevention Intervention after Suicidal Event (RISE): Feasibility study of a psychotherapeutic short-term program for inpatients after a recent suicide attempt. Front Psychiatry 2022; 13:937527. [PMID: 35935432 PMCID: PMC9353323 DOI: 10.3389/fpsyt.2022.937527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Recent research suggests that treating only mental disorders may not be sufficient to reduce the risk for future suicidal behavior in patients with a suicide attempt(s). It is therefore necessary to pay special therapeutic attention to past suicidal acts. Thus, the newly developed RISE (Relapse Prevention Intervention after Suicidal Event) program was built on the most effective components of existing psychotherapeutic and psychosocial interventions according to our current meta-analysis. The RISE program consists of five individual sessions designed for the acute psychiatric inpatient setting. The main goals of the treatment are to decrease future suicidal events and to improve patients' ability to cope with future suicidal crises. In the present study, feasibility and acceptance of the RISE program were investigated as well as its clinical effects on suicidal ideations, mental pain, self-efficacy and depressive symptoms. We recruited a sample of 27 inpatients of the Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany. The final sample consisted of 20 patients hospitalized for a recent suicide attempt, including 60 percent of multiple attempters. The data collection included a structured interview and a comprehensive battery of questionnaires to evaluate the feasibility and acceptance of the RISE program as well as associated changes in clinical symptoms. A follow-up examination was carried out after 6 months. Considering the low dropout rate and the overall positive evaluation, the RISE program was highly accepted in a sample of severely impaired patients. The present study also demonstrated that the levels of suicidal ideations, mental pain, depressive symptoms, and hopelessness decreased significantly after RISE. Since all of these clinical parameters are associated with the risk of future suicidal behavior, a potential suicide-preventive effect of the intervention can be inferred from the present findings. The positive results of the follow-up assessment after 6 months point in the same direction. In addition, RISE treatment increased self-efficacy in patients, which is an important contributor for better coping with future suicidal crises. Thus, present study demonstrate that RISE is a suitable therapy program for the treatment of patients at high risk for suicidal behavior in an acute inpatient setting.
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Affiliation(s)
- Lydia Bahlmann
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Marlehn B J S Lübbert
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Thomas Sobanski
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Thüringen-Kliniken, Saalfeld, Germany
| | - Ulrich W Kastner
- Department of Psychiatry and Psychotherapy, Helios Fachkliniken Hildburghausen, Hildburghausen, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Stefan Smesny
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
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27
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Britton PC, Berrouiguet S, Riblet NB, Zhong BL. Editorial: Brief interventions in suicide prevention across the continuum of care. Front Psychiatry 2022; 13:976855. [PMID: 35958652 PMCID: PMC9363012 DOI: 10.3389/fpsyt.2022.976855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Peter C Britton
- Veterans Integrated Services Network (VISN) 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, United States.,Department of Psychiatry, University of Rochester Medical School, Rochester, NY, United States
| | | | - Natalie B Riblet
- Veterans Affairs Medical Center, White River Junction, VT, United States.,Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, NH, United States
| | - Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
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28
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Katz IR, Rogers MP, Lew R, Thwin SS, Doros G, Ahearn E, Ostacher MJ, DeLisi LE, Smith EG, Ringer RJ, Ferguson R, Hoffman B, Kaufman JS, Paik JM, Conrad CH, Holmberg EF, Boney TY, Huang GD, Liang MH. Lithium Treatment in the Prevention of Repeat Suicide-Related Outcomes in Veterans With Major Depression or Bipolar Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:24-32. [PMID: 34787653 PMCID: PMC8600458 DOI: 10.1001/jamapsychiatry.2021.3170] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Suicide and suicide attempts are persistent and increasing public health problems. Observational studies and meta-analyses of randomized clinical trials have suggested that lithium may prevent suicide in patients with bipolar disorder or depression. OBJECTIVE To assess whether lithium augmentation of usual care reduces the rate of repeated episodes of suicide-related events (repeated suicide attempts, interrupted attempts, hospitalizations to prevent suicide, and deaths from suicide) in participants with bipolar disorder or depression who have survived a recent event. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled randomized clinical trial assessed lithium vs placebo augmentation of usual care in veterans with bipolar disorder or depression who had survived a recent suicide-related event. Veterans at 29 VA medical centers who had an episode of suicidal behavior or an inpatient admission to prevent suicide within 6 months were screened between July 1, 2015, and March 31, 2019. INTERVENTIONS Participants were randomized to receive extended-release lithium carbonate beginning at 600 mg/d or placebo. MAIN OUTCOMES AND MEASURES Time to the first repeated suicide-related event, including suicide attempts, interrupted attempts, hospitalizations specifically to prevent suicide, and deaths from suicide. RESULTS The trial was stopped for futility after 519 veterans (mean [SD] age, 42.8 [12.4] years; 437 [84.2%] male) were randomized: 255 to lithium and 264 to placebo. Mean lithium concentrations at 3 months were 0.54 mEq/L for patients with bipolar disorder and 0.46 mEq/L for patients with major depressive disorder. No overall difference in repeated suicide-related events between treatments was found (hazard ratio, 1.10; 95% CI, 0.77-1.55). No unanticipated safety concerns were observed. A total of 127 participants (24.5%) had suicide-related outcomes: 65 in the lithium group and 62 in the placebo group. One death occurred in the lithium group and 3 in the placebo group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, the addition of lithium to usual Veterans Affairs mental health care did not reduce the incidence of suicide-related events in veterans with major depression or bipolar disorders who experienced a recent suicide event. Therefore, simply adding lithium to existing medication regimens is unlikely to be effective for preventing a broad range of suicide-related events in patients who are actively being treated for mood disorders and substantial comorbidities. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01928446.
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Affiliation(s)
- Ira R. Katz
- Department of Psychiatry, Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, Pennsylvania,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Malcolm P. Rogers
- Department of Psychiatry, VA Maine Healthcare System, Togus,Department of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts
| | - Robert Lew
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Soe Soe Thwin
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts,Department of Sexual and Reproductive Health and Rights, World Health Organization, Geneva, Switzerland
| | - Gheorghe Doros
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Eileen Ahearn
- Department of Psychiatry, William S. Middleton VA Medical Center, Madison, Wisconsin,Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Michael J. Ostacher
- Department of Psychiatry, VA Palo Alto Healthcare System, Palo Alto, California,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Lynn E. DeLisi
- Department of Psychiatry, Cambridge Health Alliance, Cambridge Hospital, Cambridge, Massachusetts
| | - Eric G. Smith
- Department of Psychiatry, VA Bedford Healthcare System, Bedford, Massachusetts,Department of Psychiatry, University of Massachusetts Medical School, Worcester
| | - Robert J. Ringer
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Ryan Ferguson
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | | | - James S. Kaufman
- Department of Nephrology, VA New York Harbor Healthcare System, New York,Renal Division, New York University School of Medicine, New York
| | - Julie M. Paik
- New England Geriatric Research Education and Clinical Center and Renal Section, VA Boston Healthcare System, Boston, Massachusetts
| | - Chester H. Conrad
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts,Department of Cardiology, VA Boston Healthcare System, Boston, Massachusetts
| | - Erika F. Holmberg
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Tamara Y. Boney
- Department of Psychiatry, Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, Pennsylvania
| | - Grant D. Huang
- Cooperative Studies Program, Office of Research and Development Department of Veterans Affairs, Washington, DC
| | - Matthew H. Liang
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts,Department of Medicine, Section of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts,Department of Medicine, Section of Rheumatology, VA Boston Healthcare System, Boston, Massachusetts
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29
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Letourneur F, Collonge L, Makdassi A, Gérard P, Boittiaux G, Chastang F. Suicide attempts and COVID-19 related confinement measures in France: Happy ending or dangerous liaisons? INTERNATIONAL JOURNAL OF MENTAL HEALTH 2021. [DOI: 10.1080/00207411.2021.2015230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Louise Collonge
- University of Caen Normandy & Caen University Hospital, Caen, France
| | | | - Pierre Gérard
- University of Caen Normandy & Caen University Hospital, Caen, France
| | | | - Françoise Chastang
- Caen University Hospital, Caen, France
- CESP, INSERM, University of Paris-Saclay, Gif-sur-Yvette, France
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30
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Hou X, Wang J, Guo J, Zhang X, Liu J, Qi L, Zhou L. Methods and efficacy of social support interventions in preventing suicide: a systematic review and meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2021; 25:29-35. [PMID: 34911688 PMCID: PMC8788249 DOI: 10.1136/ebmental-2021-300318] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/25/2021] [Indexed: 01/01/2023]
Abstract
QUESTION Suicide is a global public and mental health problem. The effectiveness of social support interventions has not been widely demonstrated in the prevention of suicide. We aimed to describe the methods of social support interventions in preventing suicide and examine the efficacy of them. STUDY SELECTION AND ANALYSIS We searched literature databases and conducted clinical trials. The inclusion criteria for the summary of intervention methods were as follows: (1) studies aimed at preventing suicide through method(s) that directly provide social support; (2) use of one or more method(s) to directly provide social support. The additional inclusion criteria for meta-analysis on the efficacy of these interventions included: (1) suicide, suicide attempt or social support-related outcome was measured; (2) randomised controlled trial design and (3) using social support intervention as the main/only method. FINDINGS In total, 22 656 records and 185 clinical trials were identified. We reviewed 77 studies in terms of intervention methods, settings, support providers and support recipients. There was a total of 18 799 person-years among the ten studies measuring suicide. The number of suicides was significantly reduced in the intervention group (risk ratio (RR)=0.48, 95% CI 0.27 to 0.85). In 14 studies with a total of 14 469 person-years, there was no significant reduction of suicide attempts in the overall pooled RR of 0.88 (95% CI 0.73 to 1.07). CONCLUSIONS Social support interventions were recommended as a suicide prevention strategy for those with elevated suicide risk.
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Affiliation(s)
- Xiaofei Hou
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jiali Wang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jing Guo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xinxu Zhang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jiahai Liu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Linmao Qi
- School of Mental Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liang Zhou
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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31
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[Psychotherapy after a suicide attempt-current evidence and evaluation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 65:40-46. [PMID: 34878566 PMCID: PMC8732955 DOI: 10.1007/s00103-021-03466-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
Suizidversuche gelten als einer der wichtigsten Risikofaktoren für Suizide. Vor diesem Hintergrund wurden in den letzten Jahren diverse Psychotherapieangebote für Personen nach einem Suizidversuch entwickelt und untersucht. Im Rahmen dieses Artikels wird der aktuelle Stand der Effektivitätsforschung zusammengefasst, es werden Beispiele für erfolgreiche suizidfokussierte Psychotherapieprogramme gegeben und der gegenwärtige Forschungs- und Wissensstand wird kritisch reflektiert. Die Ergebnisse von 2 aktuellen Cochrane-Reviews zur Psychotherapie nach selbstverletzendem Verhalten im Kindes‑, Jugend- und Erwachsenenalter sowie Befunde aus 14 weiteren Metaanalysen zur psychologischen Suizidprävention, die in den vergangenen 5 Jahren publiziert wurden, werden überblicksartig dargestellt. Die kognitive Verhaltenstherapie (KVT) und die dialektisch-behaviorale Therapie (DBT) haben sich als effektiv erwiesen. Insgesamt sind die gemittelten Effektstärken jedoch von geringer Größe und diverse methodische Probleme verunmöglichen weitreichende Schlussfolgerungen. Grundsätzlich kommt der suizidspezifischen Psychotherapie in der individuumszentrierten Suizidprävention besondere Bedeutung zu; die empirische Fundierung und Dissemination entsprechender Programme sind jedoch noch unzureichend.
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Liu H, Chen G, Li J, Hao C, Zhang B, Bai Y, Song L, Chen C, Xie H, Liu T, Caine ED, Hou F. Sequential multiple assignment randomised trial of a brief contact intervention for suicide risk management among discharged psychiatric patients: an implementation study protocol. BMJ Open 2021; 11:e054131. [PMID: 34836907 PMCID: PMC8628333 DOI: 10.1136/bmjopen-2021-054131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The postdischarge suicide risk among psychiatric patients is significantly higher than it is among patients with other diseases and general population. The brief contact interventions (BCIs) are recommended to decrease suicide risk in areas with limited mental health service resources like China. This study aims to develop a postdischarge suicide intervention strategy based on BCIs and evaluate its implementability under the implementation outcome framework. METHODS AND ANALYSIS This study will invite psychiatric patients and family members, clinical and community mental health service providers as the community team to develop a postdischarge suicide intervention strategy. The study will recruit 312 patients with psychotic symptoms and 312 patients with major depressive disorder discharged from Shenzhen Kangning Hospital (SKH) in a Sequential Multiple Assignment Randomised Trial. Participants will be initially randomised into two intervention groups to receive BCIs monthly and weekly, and they will be rerandomised into three intervention groups to receive BCIs monthly, biweekly and weekly at 3 months after discharge according to the change of their suicide risk. Follow-ups are scheduled at 1, 3, 6 and 12 months after discharge. With the intention-to-treat approach, generalised estimating equation and survival analysis will be applied. This study will also collect qualitative and quantitative information on implementation and service outcomes from the community team. ETHICS/DISSEMINATION This study has received ethical approval from the Ethics Committee Review Board of SKH. All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations. A project report will be submitted to the National Natural Science Foundation of China as the concluding report of this funded project, and to the mental health authorities in the Shenzhen to refine and apply evidence-based and pragmatic interventions into health systems for postdischarge suicide prevention. TRIAL REGISTRATION NUMBER NCT04907669.
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Affiliation(s)
- Huiming Liu
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Guanjie Chen
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Jinghua Li
- Sun Yat-sen Global Health Institute, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Chun Hao
- Sun Yat-sen Global Health Institute, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Bin Zhang
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Yuanhan Bai
- Department of Bipolar Disorders, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Liangchen Song
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Chang Chen
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Haiyan Xie
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Tiebang Liu
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Eric D Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Fengsu Hou
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
- Sun Yat-sen Global Health Institute, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
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Sobanski T, Josfeld S, Peikert G, Wagner G. Psychotherapeutic interventions for the prevention of suicide re-attempts: a systematic review. Psychol Med 2021; 51:2525-2540. [PMID: 34608856 DOI: 10.1017/s0033291721003081] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A history of suicide attempt (SA) is a strong predictor of future suicide re-attempts or suicide. The aim of this systematic review is to evaluate the efficacy of psychotherapeutic interventions specifically designed for the prevention of suicide re-attempts. A systematic search from 1980 to June 2020 was performed via the databases PubMed and Google Scholar. Only randomized controlled trials were included which clearly differentiated suicidal self-harm from non-suicidal self-injury in terms of intent to die. Moreover, psychotherapeutic interventions had to be focused on suicidal behaviour and the numbers of suicide re-attempts had to be used as outcome variables. By this procedure, 18 studies were identified. Statistical comparison of all studies revealed that psychotherapeutic interventions in general were significantly more efficacious than control conditions in reducing the risk of future suicidal behaviour nearly by a third. Separate analyses revealed that cognitive-behavioural therapy as well as two different psychodynamic approaches were significantly more efficacious than control conditions. Dialectical behaviour therapy and elementary problem-solving therapy were not superior to control conditions in reducing the number of SAs. However, methodological reasons may explain to some extent these negative results. Considering the great significance of suicidal behaviour, there is unquestionably an urgent need for further development of psychotherapeutic techniques for the prevention of suicide re-attempts. Based on the encouraging results of this systematic review, it can be assumed that laying the focus on suicidal episodes might be the key intervention for preventing suicide re-attempts and suicides.
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Affiliation(s)
- Thomas Sobanski
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Thüringen-Kliniken GmbH, Rainweg 68, 07318Saalfeld, Germany
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743Jena, Germany
| | - Sebastian Josfeld
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743Jena, Germany
| | - Gregor Peikert
- Network for Suicide Prevention in Thuringia (NeST), Jena, Germany
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743Jena, Germany
- Network for Suicide Prevention in Thuringia (NeST), Jena, Germany
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Paris J. Can we predict or prevent suicide?: An update. Prev Med 2021; 152:106353. [PMID: 34538362 DOI: 10.1016/j.ypmed.2020.106353] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022]
Abstract
This article updates a 2006 review of empirical data concerning whether clinicians can predict whether patients will die by suicide, or whether fatality can be prevented. Based on further empirical data, a negative conclusion remains justified. There is good evidence that treatment programs, using psychotherapy and medication, can reduce suicide attempts. But people who die by suicide are a distinct population from attempters, and those at high risk do not necessarily present for treatment. Research on suicide prevention has not shown that fatalities among patients can be predicted, or that clinical interventions can reduce the risk. The strongest evidence for prevention derives from reducing access to means. Population-based strategies are more effective than high-risk strategies focusing on patients with suicidal ideas or attempts.
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Affiliation(s)
- Joel Paris
- Professor Emeritus, Department of Psychiatry, McGill University;Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital;4333 Chemin de la Cote Ste. Catherine; Montreal, Québec H3T1E4, Canada.
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Hochschild A, Grunebaum MF, Mann JJ. The rapid anti-suicidal ideation effect of ketamine: A systematic review. Prev Med 2021; 152:106524. [PMID: 34538369 DOI: 10.1016/j.ypmed.2021.106524] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 11/19/2022]
Abstract
In many countries suicide rates have been trending upwards for close to twenty years-presenting a public health crisis. Most suicide attempts and deaths are associated with psychiatric illness, usually a depressive disorder. Subanesthetic ketamine is the only FDA-approved antidepressant that works in hours not weeks-thus potentially transforming treatment of suicidal patients. We reviewed all randomized controlled trials of the effect of ketamine on suicidal ideation to determine if ketamine rapidly reduces suicidal ideation [SI] in depressed patients and how long the benefit persists after one dose and if the route of administration or dose affects the outcome. A systematic review was conducted as per PRISMA [preferred reporting items for systematic reviews and meta-analyses] criteria. PubMed search inclusive of "ketamine" and "suicide" yielded 358 results. Papers (N = 354) were then read by at least two authors, identifying 12 meeting eligibility requirements and eleven RCTs examining whether ketamine treatment ameliorated SI. Four of five RCTs examined racemic ketamine (0.5 mg/kg) given intravenously and found an advantage for ketamine over control for rapid reduction in SI in acutely depressed patients. Two studies examined intranasal esketamine in depressed suicidal patients and found no advantage over saline. One study examined outcome six weeks after a single intravenous dose of ketamine and found benefit for SI sustained relative to 24 h post-dose. Further research is warranted into: optimal dosing strategy, including number and frequency; and long-term efficacy and safety. Ultimately, it remains to be shown that ketamine's benefit for SI translates into prevention of suicidal behavior.
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Affiliation(s)
- Annabella Hochschild
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Michael F Grunebaum
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States of America
| | - J John Mann
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States of America.
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Riblet NB, Stevens SP, Watts BV, Gui J, Forehand J, Cornelius S, Powell R, Lewicki K, Wasserman D, Shiner B. A Pilot Randomized Trial of a Brief Intervention to Prevent Suicide After Inpatient Psychiatric Discharge. Psychiatr Serv 2021; 72:1320-1323. [PMID: 33979200 DOI: 10.1176/appi.ps.202000537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Risk for suicide is high after psychiatric hospitalization. The World Health Organization's Brief Intervention and Contact (BIC) program has shown efficacy in preventing suicide. A version adapted for the U.S. Department of Veterans Affairs (VA) was studied to determine preliminary effects. METHODS Patients receiving psychiatric hospitalization because of acute risk for self-harm were randomly assigned to the VA BIC or standard care alone. Effect sizes (Hedges' g) for suicidal ideation (primary outcome), social connectedness (measured as thwarted belongingness and perceived burdensomeness), hopelessness, and engagement were calculated at 1 and 3 months. RESULTS Patients were randomly assigned to the VA BIC (N=10) or standard care (N=9). The VA BIC had a medium or large effect on most measures at 1 month (suicidal ideation, g=0.45). Effects diminished at 3 months, except for thwarted belongingness (g=0.81). CONCLUSIONS The VA BIC had meaningful effects on suicide-related outcomes. The largest effect was seen in the first month.
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Affiliation(s)
- Natalie B Riblet
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Susan P Stevens
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Bradley V Watts
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Jiang Gui
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Jenna Forehand
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Sarah Cornelius
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Robert Powell
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Karen Lewicki
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Danuta Wasserman
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
| | - Brian Shiner
- U.S. Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont (Riblet, Stevens, Watts, Forehand, Cornelius, Powell, Lewicki, Shiner); Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Riblet, Stevens, Watts, Gui, Powell, Lewicki, Shiner); VA Office of Systems Redesign and Improvement, White River Junction, Vermont (Watts); National Centre for Suicide Research and Prevention of Mental Ill-Health, and World Health Organization Collaborating Centre for Research, Methods, Development and Training in Suicide Prevention, Karolinska Institutet, Stockholm (Wasserman).Send correspondence to Dr. Riblet
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Vloet TD, Fekete S, Gerlach M, Romanos M. [The Pharmacological Management of Emergencies in Child and Adolescent Psychiatry]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2021; 50:262-274. [PMID: 34668770 DOI: 10.1024/1422-4917/a000833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Pharmacological Management of Emergencies in Child and Adolescent Psychiatry Abstract. Emergencies in child and adolescent psychiatry are highly prevalent and often pose significant challenges to physicians, since substantial danger to the patient or others must be avoided through the application of largely moderate interventions. Besides using de-escalating strategies and exploiting psychotherapeutic options, the physician frequently employs psychopharmacological interventions. because of a lack of systematically assessed data, however, in emergencies in child and adolescent psychiatry most administrations of psychotropic drugs occur "off label." This review deduces practice-relevant recommendations for the pharmacological management of occurring child and adolescent emergencies such as acute suicidality, acute psychotic episodes, delirium, disorders of consciousness, acute intoxication, and alcohol withdrawal syndrome. We discuss the issue of quality and safety in pharmacological emergency strategies.
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Affiliation(s)
- Timo D Vloet
- Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg
| | - Stefanie Fekete
- Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg
| | - Manfred Gerlach
- Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg
| | - Marcel Romanos
- Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg
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Sufrate-Sorzano T, Juárez-Vela R, Ramírez-Torres CA, Rivera-Sanz F, Garrote-Camara ME, Roland PP, Gea-Sánchez M, Del Pozo-Herce P, Gea-Caballero V, Angulo-Nalda B, Santolalla-Arnedo I. Nursing interventions of choice for the prevention and treatment of suicidal behaviour: The umbrella review protocol. Nurs Open 2021; 9:845-850. [PMID: 34547187 PMCID: PMC8685777 DOI: 10.1002/nop2.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/01/2021] [Indexed: 11/08/2022] Open
Abstract
AIM To determine which interventions, from a nursing perspective, can be considered as the interventions of choice for the prevention and treatment of suicidal behaviour. In this way, the umbrella review attempts to identify nursing interventions from the Nursing Interventions Classification (NIC) taxonomy with evidence for this purpose. DESIGN Descriptive study protocol. METHODS This umbrella review will consist of an extensive, systematic search of published systematic reviews and meta-analyses of studies examining interventions of choice for the prevention and treatment of suicidal behaviour. A systematic search of papers indexed in PubMed, CINAHL, Cochrane Database of Systematic Reviews, Scopus, ISI Web of Knowledge and the Joanna Briggs Institute databases will be carried out; the results will be evaluated for inclusion by two independent reviewers. In addition, the bibliographic references of the included reviews will be searched. The assessment of the methodological quality of the included systematic reviews and meta-analyses, and data extraction, will be performed by two independent reviewers. Conflicts between reviewers will be resolved by an independent third reviewer. Research Ethics Committee approval is not required for this umbrella review. RESULTS We will determine which of the interventions identified as being of choice in the review are included in the Nursing Interventions Classification (NIC); they may be an effective therapeutic tool for nurses in the prevention and treatment of suicidal behaviour.
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Affiliation(s)
- Teresa Sufrate-Sorzano
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain.,Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
| | - Raúl Juárez-Vela
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain.,Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain.,Research of PBM Group, Research Institute IDI-PAZ, Madrid, Spain
| | - Carmen Amaia Ramírez-Torres
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain
| | - Félix Rivera-Sanz
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain.,Rioja Health Service, Primary Care, Logroño, Spain
| | - María Elena Garrote-Camara
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain.,Rioja Health Service, Mental Health Center of Albelda de Iregua, Logroño, Spain
| | - Pastells-Peiró Roland
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Healthcare Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain.,Group for the Study of Society Health Education and Culture (GESEC), Lleida, Spain
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Healthcare Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain.,Group for the Study of Society Health Education and Culture (GESEC), Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Lleida, Spain
| | - Pablo Del Pozo-Herce
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain.,Hospital Universitario Fundación Jiménez Díaz, Psychiatry Department, Madrid, 28040, Madrid
| | - Vicente Gea-Caballero
- Research of PBM Group, Research Institute IDI-PAZ, Madrid, Spain.,Faculty of Health Sciences, International University of Valencia, Valencia, Spain
| | | | - Iván Santolalla-Arnedo
- Research Unit on Health System Sustainability (GISSOS), Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain.,Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
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Haroz EE, Grubin F, Goklish N, Pioche S, Cwik M, Barlow A, Waugh E, Usher J, Lenert MC, Walsh CG. Designing a Clinical Decision Support Tool That Leverages Machine Learning for Suicide Risk Prediction: Development Study in Partnership With Native American Care Providers. JMIR Public Health Surveill 2021; 7:e24377. [PMID: 34473065 PMCID: PMC8446841 DOI: 10.2196/24377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Machine learning algorithms for suicide risk prediction have been developed with notable improvements in accuracy. Implementing these algorithms to enhance clinical care and reduce suicide has not been well studied. Objective This study aims to design a clinical decision support tool and appropriate care pathways for community-based suicide surveillance and case management systems operating on Native American reservations. Methods Participants included Native American case managers and supervisors (N=9) who worked on suicide surveillance and case management programs on 2 Native American reservations. We used in-depth interviews to understand how case managers think about and respond to suicide risk. The results from interviews informed a draft clinical decision support tool, which was then reviewed with supervisors and combined with appropriate care pathways. Results Case managers reported acceptance of risk flags based on a predictive algorithm in their surveillance system tools, particularly if the information was available in a timely manner and used in conjunction with their clinical judgment. Implementation of risk flags needed to be programmed on a dichotomous basis, so the algorithm could produce output indicating high versus low risk. To dichotomize the continuous predicted probabilities, we developed a cutoff point that favored specificity, with the understanding that case managers’ clinical judgment would help increase sensitivity. Conclusions Suicide risk prediction algorithms show promise, but implementation to guide clinical care remains relatively elusive. Our study demonstrates the utility of working with partners to develop and guide the operationalization of risk prediction algorithms to enhance clinical care in a community setting.
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Affiliation(s)
- Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Fiona Grubin
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Novalene Goklish
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shardai Pioche
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mary Cwik
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Allison Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emma Waugh
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason Usher
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew C Lenert
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, United States
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Baldaçara L, Grudtner RR, da S. Leite V, Porto DM, Robis KP, Fidalgo TM, Rocha GA, Diaz AP, Meleiro A, Correa H, Tung TC, Malloy-Diniz L, Quevedo J, da Silva AG. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2021; 43:538-549. [PMID: 33331533 PMCID: PMC8555636 DOI: 10.1590/1516-4446-2020-1108] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/10/2020] [Indexed: 12/20/2022]
Abstract
This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517.
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal do Tocantins (UFT), Palmas, TO, Brazil
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
| | - Roberta R. Grudtner
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Hospital Psiquiátrico São Pedro, Secretaria Estadual da Saúde do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Verônica da S. Leite
- Universidade Federal do Tocantins (UFT), Palmas, TO, Brazil
- Secretaria de Saúde do Município de Palmas, Palmas, TO, Brazil
| | - Deisy M. Porto
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Associação Catarinense de Psiquiatria, Florianópolis, SC, Brazil
| | - Kelly P. Robis
- Departamento de Psiquiatria, Pontifícia Universidade Católica de Minas Gerais (PUC Minas), Belo Horizonte, MG, Brazil
- Departamento de Psiquiatria, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Thiago M. Fidalgo
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Gislene A. Rocha
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Hospital Universitário Clemente de Faria, Montes Claros, MG, Brazil
| | - Alexandre P. Diaz
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | | | - Humberto Correa
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Departamento de Psiquiatria, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Teng C. Tung
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Leandro Malloy-Diniz
- Departamento de Psiquiatria, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
- Associação Brasileira de Impulsividade e Patologia Dual, Brasília, DF, Brazil
| | - João Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Antônio G. da Silva
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Asociación Psiquiátrica de América Latina (APAL)
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Shiner B, Gottlieb DJ, Levis M, Peltzman T, Riblet NB, Cornelius SL, Russ CJ, Watts BV. National cross-sectional cohort study of the relationship between quality of mental healthcare and death by suicide. BMJ Qual Saf 2021; 31:434-440. [DOI: 10.1136/bmjqs-2020-012944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/04/2021] [Indexed: 01/26/2023]
Abstract
BackgroundPatient safety-based interventions aimed at lethal means restriction are effective at reducing death by suicide in inpatient mental health settings but are more challenging in the outpatient arena. As an alternative approach, we examined the association between quality of mental healthcare and suicide in a national healthcare system.MethodsWe calculated regional suicide rates for Department of Veterans Affairs (VA) Healthcare users from 2013 to 2017. To control for underlying variation in suicide risk in each of our 115 mental health referral regions (MHRRs), we calculated standardised rate ratios (SRRs) for VA users compared with the general population. We calculated quality metrics for outpatient mental healthcare in each MHRR using individual metrics as well as an Overall Quality Index. We assessed the correlation between quality metrics and suicide rates.ResultsAmong the 115 VA MHRRs, the age-adjusted, sex-adjusted and race-adjusted annual suicide rates varied from 6.8 to 92.9 per 100 000 VA users, and the SRRs varied between 0.7 and 5.7. Mean regional-level adherence to each of our quality metrics ranged from a low of 7.7% for subspecialty care access to a high of 58.9% for care transitions. While there was substantial regional variation in quality, there was no correlation between an overall index of mental healthcare quality and SRR.ConclusionThere was no correlation between overall quality of outpatient mental healthcare and rates of suicide in a national healthcare system. Although it is possible that quality was not high enough anywhere to prevent suicide at the population level or that we were unable to adequately measure quality, this examination of core mental health services in a well-resourced system raises doubts that a quality-based approach alone can lower population-level suicide rates.
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Ross EL, Zuromski KL, Reis BY, Nock MK, Kessler RC, Smoller JW. Accuracy Requirements for Cost-effective Suicide Risk Prediction Among Primary Care Patients in the US. JAMA Psychiatry 2021; 78:642-650. [PMID: 33729432 PMCID: PMC7970389 DOI: 10.1001/jamapsychiatry.2021.0089] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/17/2021] [Indexed: 12/30/2022]
Abstract
Importance Several statistical models for predicting suicide risk have been developed, but how accurate such models must be to warrant implementation in clinical practice is not known. Objective To identify threshold values of sensitivity, specificity, and positive predictive value that a suicide risk prediction method must attain to cost-effectively target a suicide risk reduction intervention to high-risk individuals. Design, Setting, and Participants This economic evaluation incorporated published data on suicide epidemiology, the health care and societal costs of suicide, and the costs and efficacy of suicide risk reduction interventions into a novel decision analytic model. The model projected suicide-related health economic outcomes over a lifetime horizon among a population of US adults with a primary care physician. Data analysis was performed from September 19, 2019, to July 5, 2020. Interventions Two possible interventions were delivered to individuals at high predicted risk: active contact and follow-up (ACF; relative risk of suicide attempt, 0.83; annual health care cost, $96) and cognitive behavioral therapy (CBT; relative risk of suicide attempt, 0.47; annual health care cost, $1088). Main Outcomes and Measures Fatal and nonfatal suicide attempts, quality-adjusted life-years (QALYs), health care sector costs and societal costs (in 2016 US dollars), and incremental cost-effectiveness ratios (ICERs) (with ICERs ≤$150 000 per QALY designated cost-effective). Results With a specificity of 95% and a sensitivity of 25%, primary care-based suicide risk prediction could reduce suicide death rates by 0.5 per 100 000 person-years (if used to target ACF) or 1.6 per 100 000 person-years (if used to target CBT) from a baseline of 15.3 per 100 000 person-years. To be cost-effective from a health care sector perspective at a specificity of 95%, a risk prediction method would need to have a sensitivity of 17.0% or greater (95% CI, 7.4%-37.3%) if used to target ACF and 35.7% or greater (95% CI, 23.1%-60.3%) if used to target CBT. To achieve cost-effectiveness, ACF required positive predictive values of 0.8% for predicting suicide attempt and 0.07% for predicting suicide death; CBT required values of 1.7% for suicide attempt and 0.2% for suicide death. Conclusions and Relevance These findings suggest that with sufficient accuracy, statistical suicide risk prediction models can provide good health economic value in the US. Several existing suicide risk prediction models exceed the accuracy thresholds identified in this analysis and thus may warrant pilot implementation in US health care systems.
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Affiliation(s)
- Eric L. Ross
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Kelly L. Zuromski
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Ben Y. Reis
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2021; 4:CD013668. [PMID: 33884617 PMCID: PMC8094743 DOI: 10.1002/14651858.cd013668.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for SH in adults. This review therefore updates a previous Cochrane Review (last published in 2016) on the role of psychosocial interventions in the treatment of SH in adults. OBJECTIVES To assess the effects of psychosocial interventions for self-harm (SH) compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing interventions of specific psychosocial treatments versus treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, or a combination of these, in the treatment of adults with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratio (ORs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMDs) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 76 trials with a total of 21,414 participants. Participants in these trials were predominately female (61.9%) with a mean age of 31.8 years (standard deviation [SD] 11.7 years). On the basis of data from four trials, individual cognitive behavioural therapy (CBT)-based psychotherapy may reduce repetition of SH as compared to TAU or another comparator by the end of the intervention (OR 0.35, 95% CI 0.12 to 1.02; N = 238; k = 4; GRADE: low certainty evidence), although there was imprecision in the effect estimate. At longer follow-up time points (e.g., 6- and 12-months) there was some evidence that individual CBT-based psychotherapy may reduce SH repetition. Whilst there may be a slightly lower rate of SH repetition for dialectical behaviour therapy (DBT) (66.0%) as compared to TAU or alternative psychotherapy (68.2%), the evidence remains uncertain as to whether DBT reduces absolute repetition of SH by the post-intervention assessment. On the basis of data from a single trial, mentalisation-based therapy (MBT) reduces repetition of SH and frequency of SH by the post-intervention assessment (OR 0.35, 95% CI 0.17 to 0.73; N = 134; k = 1; GRADE: high-certainty evidence). A group-based emotion-regulation psychotherapy may also reduce repetition of SH by the post-intervention assessment based on evidence from two trials by the same author group (OR 0.34, 95% CI 0.13 to 0.88; N = 83; k = 2; moderate-certainty evidence). There is probably little to no effect for different variants of DBT on absolute repetition of SH, including DBT group-based skills training, DBT individual skills training, or an experimental form of DBT in which participants were given significantly longer cognitive exposure to stressful events. The evidence remains uncertain as to whether provision of information and support, based on the Suicide Trends in At-Risk Territories (START) and the SUicide-PREvention Multisite Intervention Study on Suicidal behaviors (SUPRE-MISS) models, have any effect on repetition of SH by the post-intervention assessment. There was no evidence of a difference for psychodynamic psychotherapy, case management, general practitioner (GP) management, remote contact interventions, and other multimodal interventions, or a variety of brief emergency department-based interventions. AUTHORS' CONCLUSIONS Overall, there were significant methodological limitations across the trials included in this review. Given the moderate or very low quality of the available evidence, there is only uncertain evidence regarding a number of psychosocial interventions for adults who engage in SH. Psychosocial therapy based on CBT approaches may result in fewer individuals repeating SH at longer follow-up time points, although no such effect was found at the post-intervention assessment and the quality of evidence, according to the GRADE criteria, was low. Given findings in single trials, or trials by the same author group, both MBT and group-based emotion regulation therapy should be further developed and evaluated in adults. DBT may also lead to a reduction in frequency of SH. Other interventions were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to the use of these interventions is inconclusive at present.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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De Rozario MR, Van Velzen LS, Davies P, Rice SM, Davey CG, Robinson J, Alvarez-Jimenez M, Allott K, McKechnie B, Felmingham KL, Schmaal L. Mental images of suicide: Theoretical framework and preliminary findings in depressed youth attending outpatient care. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:100114. [PMID: 36567757 PMCID: PMC9785063 DOI: 10.1016/j.jadr.2021.100114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- MR De Rozario
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia,Corresponding author at: Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, Melbourne, VIC 3052, Australia. (M. De Rozario)
| | - LS Van Velzen
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - P Davies
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - SM Rice
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - CG Davey
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - J Robinson
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - M Alvarez-Jimenez
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - K Allott
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | - KL Felmingham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - L Schmaal
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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da Silva APC, Henriques MR, Rothes IA, Zortea T, Santos JC, Cuijpers P. Effects of psychosocial interventions among people cared for in emergency departments after a suicide attempt: a systematic review protocol. Syst Rev 2021; 10:68. [PMID: 33766137 PMCID: PMC7992994 DOI: 10.1186/s13643-021-01609-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The care of the emergency department (ED) for a person after a suicide attempt can act as a protector against future suicidal behavior. For this reason, it is essential that the ED ensure an assistance that involves effective interventions in preventing suicidal behaviors. Among suicidal behaviors, it is known that suicide attempt is one of the most lethal risk factors for consummated suicide. In addition, the risk for further attempts is greater in the period from the immediate post-discharge up to 12 months after the last attempt. This makes the ED a key link in the suicide prevention chain. The purpose of this review is to investigate the effects of psychosocial interventions on suicide prevention, when applied in the ED after a suicide attempt. METHODS This systematic review protocol was built and registered with the collaboration of a multidisciplinary scientific team. The review will include randomized clinical studies, quasi-experimental trials, and comparative observational studies, all conducted with people (11 years old or more) who have received a psychosocial suicide prevention intervention initiated in the ED after a suicide attempt. The research will be conducted across databases such as Cochrane Library, PubMed, EMBASE, PsycINFO, and DARE. The repetition of a suicide attempt and death by suicide as primary outcomes will be analyzed. The eligibility of the studies and data extraction will be carried out by matched and blind researchers. The risk of bias will be addressed using appropriate instruments. The analyses and synthesis of the results will be both qualitative and quantitative. DISCUSSION From a public health point of view, suicide is in itself a public health problem and requires appropriate interventions at different levels of care in order to be prevented. Taking into account that a high percentage of people who died by suicide sought the ED for suicide attempt in the year before their death, the ED is a clinical context with a privileged potential to implement these interventions. Presently, several clinical studies seek to validate interventions to be adopted regarding the prevention of suicidal behavior. Current evidence indicates that different interventions must be strategically combined to reduce suicide attempts and their mortality. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42019131040.
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Affiliation(s)
- Ana Paula Coutinho da Silva
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal FPCEUP/Center for Psychology at University of Porto CPUP, Rua Alfredo Allen, 4200-392 Porto, Portugal
- Department of Clinical Nursing, Health Sciences Center, Federal University of Paraíba, Cidade Universitária, João Pessoa/PB, CEP: 58051-900 Brazil
| | - Margarida Rangel Henriques
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal FPCEUP/Center for Psychology at University of Porto CPUP, Rua Alfredo Allen, 4200-392 Porto, Portugal
| | - Inês Areal Rothes
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal FPCEUP/Center for Psychology at University of Porto CPUP, Rua Alfredo Allen, 4200-392 Porto, Portugal
| | - Tiago Zortea
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, Scotland G12 0XH UK
| | - José Carlos Santos
- Nursing School of Coimbra, Avenida Bissaya Barreto s/n, 3004-011 Coimbra, Portugal
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
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Abstract
This chapter presents a narrative synthesis of the evidence relating to the effectiveness of 13 different approaches (interventions) that have been incorporated into national suicide prevention programs. These approaches are presented in an analytic framework that distinguishes between national and community-based multilevel programs, prevention, and treatment/maintenance. The primary source of evidence are six reviews of reviews published since 2005, supplemented by a small number of systematic reviews and primary studies. We report strongly supportive evidence concerning the effectiveness of structural interventions (restrictions on access to bridges, tall buildings, and railways) and restriction on access to pharmacological agents. Weakly supportive evidence of effectiveness is available for community-based multilevel programs; restrictions on access to firearms and ligature points in institutional settings; settings-based programs (in schools, communities, workplaces, prisons, and the armed forces); education and training targeted at primary care physicians; lithium; cognitive behavioral therapy and dialectical behavioral therapy; and brief contact. There is insufficient or conflicting evidence concerning the effectiveness of the remaining approaches. We conclude that the evidence base for effective suicide prevention is far from convincing. Major improvement in the extent and quality of collaboration between researchers, policymakers, and practitioners and a considerable increase in funding for evaluation studies in suicide prevention are required if the current knowledge gap about effective interventions is to be bridged.
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Janackovski A, Deane FP, Hains A. Psychotherapy and youth suicide prevention: An interpretative phenomenological analysis of specialist clinicians' experiences. Clin Psychol Psychother 2020; 28:828-843. [PMID: 33283882 DOI: 10.1002/cpp.2536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022]
Abstract
The study explored psychologists' experiences in delivering short-term psychotherapy for suicidal adolescents and sought to clarify how these experiences fit with empirically supported interventions and the interpersonal psychological theory of suicide. Semistructured interviews were conducted with 12 psychologists' who provided short-term psychotherapy in a suicide prevention programme for youth (12- to 25-year-olds). Interview transcripts were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: (i) understand the experience and context of the suicidality and the importance of a formulation-based approach to engagement and individualized treatment planning; (ii) involve broad support systems, and in particular families, to help the young person reduce feelings of burdensomeness and increase safety, connectedness and belonging; and (iii) improve affect regulation and reflective functioning, important not only for the young person but also for the support system to maximize the positive impact of supports via emotional coregulation and effective problem-solving. Interventions and approaches as well as the potential underlying processes of change being targeted are discussed in light of these findings. As an example, the development of a suicide safety plan was an intervention that traversed these themes. When used as a process tool, it helped foster a collaborative, formulation, dimensional and biopsychosocial approach to treat psychopathology and suicidality and extended beyond the therapist-client dyad. Moreover, treatment needs to be extended beyond the therapist-client dyad to allow therapists to facilitate a systemic treatment response, as this was seen as a major component of interventions for suicidal youth.
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Affiliation(s)
- Atanas Janackovski
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Frank P Deane
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Institute for Mental Health, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Alex Hains
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Illawarra Shoalhaven Suicide Prevention Collaborative, Wollongong, New South Wales, Australia
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Hu MX, Palantza C, Setkowski K, Gilissen R, Karyotaki E, Cuijpers P, Riper H, de Beurs D, Nuij C, Christensen H, Calear A, Werner-Seidler A, Hoogendoorn A, van Balkom A, Eikelenboom M, Smit J, van Ballegooijen W. Comprehensive database and individual patient data meta-analysis of randomised controlled trials on psychotherapies reducing suicidal thoughts and behaviour: study protocol. BMJ Open 2020; 10:e037566. [PMID: 33277275 PMCID: PMC7722389 DOI: 10.1136/bmjopen-2020-037566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Psychotherapy may reduce suicidal thoughts and behaviour, but its effectiveness is not well examined. Furthermore, conventional meta-analyses are unable to test possible effects of moderators affecting this relationship. This protocol outlines the building of a comprehensive database of the literature in this research field. In addition, we will conduct an individual patient data meta-analysis (IPD-MA) to establish the effectiveness of psychotherapy in reducing suicidality, and to examine which factors moderate the efficacy of these interventions. METHODS AND ANALYSIS To build a comprehensive database, randomised controlled trials examining the effect of any psychotherapy targeting any psychiatric disorder on suicidal thoughts or behaviour will be identified by running a systematic search in PubMed, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Central Register of Controlled Trials from data inception to 12 August 2019. For the IPD-MA, we will focus on adult outpatients with suicidal ideation or behaviour. In addition, as a comparison group we will focus on a control group (waiting-list, care as usual or placebo). A 1-stage IPD-MA will be used to determine the effectiveness of psychotherapy on suicidal ideation, suicide attempts and/or suicide deaths, and to investigate potential patient-related and intervention-related moderators. Subgroup and sensitivity analyses will be conducted to test the robustness of the findings. Additionally, a conventional MA will be conducted to determine the differences between studies that provided IPD and those that did not. IPD-MA may determine the effectiveness of psychotherapy in reducing suicidality and provide insights into the moderating factors influencing the efficacy of psychotherapy. Answering these questions will inform mental healthcare practitioners about optimal treatments for different groups of individuals with suicidal ideation and/or behaviour and consequently help to reduce suicide risk. ETHICS AND DISSEMINATION An ethical approval is not required for this study. The results will be published in a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42020140573.
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Affiliation(s)
- Mandy Xian Hu
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- 113 Zelfmoordpreventie, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands
| | - Christina Palantza
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Heleen Riper
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Derek de Beurs
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chani Nuij
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydneyali, New South Wales, Australia
| | - Alison Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Sydneyali, New South Wales, Australia
| | | | - Anton van Balkom
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands
| | - Merijn Eikelenboom
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands
| | - Jan Smit
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- 113 Zelfmoordpreventie, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center and GGZinGeest, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Recent trends in the rural–urban suicide disparity among veterans using VA health care. J Behav Med 2020; 44:492-506. [DOI: 10.1007/s10865-020-00176-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023]
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