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Boggs JM, Yarborough BJH, Clarke G, Aguirre-Miyamoto EM, Barton LJ, Beck A, Bruschke C, Buttlaire S, Coleman KJ, Flores JP, Penfold R, Powers JD, Richards JA, Richardson L, Runkle A, Ryan JM, Simon GE, Sterling S, Stewart C, Stumbo S, Quintana LM, Yeh HH, Ahmedani BK. Development and Validation of Electronic Health Record Measures of Safety Planning Practices as Part of Zero Suicide Implementation. Arch Suicide Res 2024:1-14. [PMID: 39193908 DOI: 10.1080/13811118.2024.2394676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
OBJECTIVE Safety planning for suicide prevention is an important quality metric for Zero Suicide implementation. We describe the development, validation, and application of electronic health record (EHR) programs to measure uptake of safety planning practices across six integrated healthcare systems as part of a Zero Suicide evaluation study. METHODS Safety planning was documented in narrative notes and structured EHR templates using the Stanley Brown Safety Planning Intervention (SBSPI) in response to a high-risk cutoff score on the Columbia Suicide Severity Rating Scale (CSSRS). Natural Language Processing (NLP) metrics were developed and validated using chart review to characterize practices documented in narrative notes. We applied NLP to measure frequency of documentation in the narrative text and standard programming methods to examine structured SBSPI templates from 2010-2022. RESULTS Chart reviews found three safety planning practices documented in narrative notes that were delivered to at least half of patients at risk: professional contacts, lethal means counseling for firearms, and lethal means counseling for medication access/storage. NLP methods were developed to identify these practices in clinical text with high levels of accuracy (Sensitivity, Specificity, & PPV ≥ 82%). Among visits with a high-risk CSSRS, 40% (Range 2-73% by health system) had an SBSPI template within 1 year of implementation. CONCLUSIONS This is one of the first reports describing development of measures that leverage electronic health records to track use of suicide prevention safety plans. There are opportunities to use the methods developed here in future evaluations of safety planning.
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DiVietro S, Hunter AA, Schwab-Reese L, Green C, Aseltine R. Disparities Among Pediatric Firearm Suicides in the United States: An Analysis of the National Violent Death Reporting System, 2014 to 2018. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:3308-3319. [PMID: 38366858 DOI: 10.1177/08862605241229719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Suicide is a leading cause of death in the United States (U.S.), with firearms being the predominant method. This study examines the racial disparity and disproportionality of pediatric firearm suicide from 2014 to 2018 in 17 U.S. states. We used the National Violent Death Reporting System to quantify the burden of pediatric firearm suicide by race/ethnicity and gender and assessed themes among decedents aged 10 to 17 years. Racial disparity and disproportionality were measured using the Disparity Index and Disproportionality Representation Index, respectively. Decedents were primarily non-Hispanic White (NHW, 77.5%) and male (84.0%). NHW children died at a rate that was 1.3 times greater than expected based on their proportion in the general population and were 2.6 times more likely to die by firearm suicide than non-Hispanic Black (NHB) children. NHB children were less likely to disclose suicide intention, suggesting that this group may require more active screening intervention. Qualitative analysis revealed unsafe firearm storage as a common theme among these deaths. Differences in age with respect to social media use and precipitating factors such as bullying and arguments with parents were also identified as contributing factors. Results of this study support the expansion of interventions such as lethal means restriction counseling and implementation of safer firearm storage laws.
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Affiliation(s)
- Susan DiVietro
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA
- University of Connecticut, Farmington, CT, USA
| | - Amy A Hunter
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA
- University of Connecticut, Farmington, CT, USA
| | | | - Christa Green
- Medical University of South Carolina, Charleston, SC, USA
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Boggs JM, Richards J, Simon G, Aguirre-Miyamoto EM, Barton LJ, Beck A, Beidas RS, Bruschke C, Buckingham ET, Buttlaire S, Clarke G, Coleman K, Flores JP, Frank C, Penfold RB, Richardson L, Ryan JM, Schoenbaum M, Sterling S, Stewart C, Yarborough BJH, Yeh HH, Ahmedani B. Suicide Screening, Risk Assessment, and Lethal Means Counseling During Zero Suicide Implementation. Psychiatr Serv 2024; 75:638-645. [PMID: 38566561 DOI: 10.1176/appi.ps.20230211] [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] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The authors measured implementation of Zero Suicide (ZS) clinical practices that support identification of suicide risk and risk mitigation, including screening, risk assessment, and lethal means counseling, across mental health specialty and primary care settings. METHODS Six health care systems in California, Colorado, Michigan, Oregon, and Washington participated. The sample included members ages ≥13 years from 2010 to 2019 (N=7,820,524 patients). The proportions of patients with suicidal ideation screening, suicide risk assessment, and lethal means counseling were estimated. RESULTS In 2019, patients were screened for suicidal ideation in 27.1% (range 5.0%-85.0%) of mental health visits and 2.5% (range 0.1%-35.0%) of primary care visits among a racially and ethnically diverse sample (44.9% White, 27.2% Hispanic, 13.4% Asian, and 7.7% Black). More patients screened positive for suicidal ideation in the mental health setting (10.2%) than in the primary care setting (3.8%). Of the patients screening positive for suicidal ideation in the mental health setting, 76.8% received a risk assessment, and 82.4% of those identified as being at high risk received lethal means counseling, compared with 43.2% and 82.4%, respectively, in primary care. CONCLUSIONS Six health systems that implemented ZS showed a high level of variation in the proportions of patients receiving suicide screening and risk assessment and lethal means counseling. Two opportunities emerged for further study to increase frequency of these practices: expanding screening beyond patients with regular health care visits and implementing risk assessment with lethal means counseling in the primary care setting directly after a positive suicidal ideation screening.
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Affiliation(s)
- Jennifer M Boggs
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Julie Richards
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Gregory Simon
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Erika M Aguirre-Miyamoto
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Lee J Barton
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Arne Beck
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Rinad S Beidas
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Cambria Bruschke
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Edward T Buckingham
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Stuart Buttlaire
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Gregory Clarke
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Karen Coleman
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Jean P Flores
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Catherine Frank
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Robert B Penfold
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Laura Richardson
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Jacqueline M Ryan
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Michael Schoenbaum
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Stacy Sterling
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Christine Stewart
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Bobbi Jo H Yarborough
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Hsueh-Han Yeh
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Brian Ahmedani
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
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Grumet JG, Jobes DA. Zero Suicide - What About "Treat"? CRISIS 2024; 45:167-172. [PMID: 38698717 DOI: 10.1027/0227-5910/a000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
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Setkowski K, van Balkom AJLM, Hoogendoorn AW, Franx G, Veerbeek M, de Winter RFP, Gilissen R. Reducing suicides in mental healthcare: results from a 4-year follow-up implementation study in the Netherlands (SUPRANET). Front Psychiatry 2024; 15:1080235. [PMID: 38707617 PMCID: PMC11068092 DOI: 10.3389/fpsyt.2024.1080235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/09/2024] [Indexed: 05/07/2024] Open
Abstract
Objective In 2016, the SUicide PRevention Action NETwork (SUPRANET) was launched. The SUPRANET intervention aims at better implementing the suicide prevention guideline. An implementation study was developed to evaluate the impact of SUPRANET over time on three outcomes: 1) suicides, 2) registration of suicide attempts, and 3) professionals' knowledge and adherence to the guideline. Methods This study included 13 institutions, and used an uncontrolled longitudinal prospective design, collecting biannual data on a 2-level structure (institutional and team level). Suicides and suicide attempts were extracted from data systems. Professionals' knowledge and adherence were measured using a self-report questionnaire. A three-step interrupted time series analysis (ITSA) was performed for the first two outcomes. Step 1 assessed whether institutions executed the SUPRANET intervention as intended. Step 2 examined if institutions complied with the four guideline recommendations. Based on steps 1 and 2, institutions were classified as below or above average and after that, included as moderators in step 3 to examine the effect of SUPRANET over time compared to the baseline. The third outcome was analyzed with a longitudinal multilevel regression analysis, and tested for moderation. Results After institutions were labeled based on their efforts and investments made (below average vs above average), we found no statistically significant difference in suicides (standardized mortality ratio) between the two groups relative to the baseline. Institutions labeled as above average did register significantly more suicide attempts directly after the start of the intervention (78.8 per 100,000 patients, p<0.001, 95%CI=(51.3 per 100,000, 106.4 per 100,000)), and as the study progressed, they continued to report a significantly greater improvement in the number of registered attempts compared with institutions assigned as below average (8.7 per 100,000 patients per half year, p=0.004, 95%CI=(3.3 per 100,000, 14.1 per 100,000)). Professionals working at institutions that invested more in the SUPRANET activities adhered significantly better to the guideline over time (b=1.39, 95%CI=(0.12,2.65), p=0.032). Conclusion Institutions labeled as above average registered significantly more suicide attempts and also better adhered to the guideline compared with institutions that had performed less well. Although no convincing intervention effect on suicides was found within the study period, we do think that this network is potentially able to reduce suicides. Continuous investments and fully implementing as many guideline recommendations as possible are essential to achieve the biggest drop in suicides.
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Affiliation(s)
- Kim Setkowski
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Anton J. L. M. van Balkom
- Amsterdam University Medical Center (UMC), location Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and GGZ inGeest (Mental Health Institution), Amsterdam, Netherlands
| | - Adriaan W. Hoogendoorn
- Department of Psychiatry, Amsterdam Public Health Institute, Amsterdam University Medical Center (UMC), location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gerdien Franx
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | | | - Remco F. P. de Winter
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
- GGZ Rivierduinen (Mental Health Institution), Leiden, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
- The School for Mental Health and Neuroscience (MHeNs) Maastricht University, Maastricht, Netherlands
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
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Arakelian M, Barnett B, Weleff J. The Zero Suicide Model in Addiction Treatment Settings: Recognizing the Need for Feasibility and Implementation Data. Psychiatr Serv 2024; 75:378-380. [PMID: 37933133 DOI: 10.1176/appi.ps.20230175] [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: 11/08/2023]
Abstract
The Zero Suicide (ZS) model is a promising approach for preventing all suicides across health care settings. ZS provides guidelines for health care systems to implement best practices in suicide prevention. Patients with substance use disorders are at increased risk for suicide, but no known research has investigated how to integrate the ZS model into addiction treatment settings. This Open Forum encourages clinicians and researchers to integrate ZS into such settings and to study its feasibility and effectiveness. ZS integration into addiction treatment may improve both suicide and addiction outcomes, but additional research is needed.
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Affiliation(s)
- Miranda Arakelian
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland (Arakelian, Barnett); Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland (Barnett); Department of Psychiatry, Yale University School of Medicine, New Haven (Weleff)
| | - Brian Barnett
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland (Arakelian, Barnett); Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland (Barnett); Department of Psychiatry, Yale University School of Medicine, New Haven (Weleff)
| | - Jeremy Weleff
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland (Arakelian, Barnett); Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland (Barnett); Department of Psychiatry, Yale University School of Medicine, New Haven (Weleff)
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Simon GE, Cruz M, Shortreed SM, Sterling SA, Coleman KJ, Ahmedani BK, Yaseen ZS, Mosholder AD. Stability of Suicide Risk Prediction Models During Changes in Health Care Delivery. Psychiatr Serv 2024; 75:139-147. [PMID: 37587793 DOI: 10.1176/appi.ps.20230172] [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: 08/18/2023]
Abstract
OBJECTIVE The authors aimed to use health records data to examine how the accuracy of statistical models predicting self-harm or suicide changed between 2015 and 2019, as health systems implemented suicide prevention programs. METHODS Data from four large health systems were used to identify specialty mental health visits by patients ages ≥11 years, assess 311 potential predictors of self-harm (including demographic characteristics, historical risk factors, and index visit characteristics), and ascertain fatal or nonfatal self-harm events over 90 days after each visit. New prediction models were developed with logistic regression with LASSO (least absolute shrinkage and selection operator) in random samples of visits (65%) from each calendar year and were validated in the remaining portion of the sample (35%). RESULTS A model developed for visits from 2009 to mid-2015 showed similar classification performance and calibration accuracy in a new sample of about 13.1 million visits from late 2015 to 2019. Area under the receiver operating characteristic curve (AUC) ranged from 0.840 to 0.849 in the new sample, compared with 0.851 in the original sample. New models developed for each year for 2015-2019 had classification performance (AUC range 0.790-0.853), sensitivity, and positive predictive value similar to those of the previously developed model. Models selected similar predictors from 2015 to 2019, except for more frequent selection of depression questionnaire data in later years, when questionnaires were more frequently recorded. CONCLUSIONS A self-harm prediction model developed with 2009-2015 visit data performed similarly when applied to 2015-2019 visits. New models did not yield superior performance or identify different predictors.
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Affiliation(s)
- Gregory E Simon
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Maricela Cruz
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Susan M Shortreed
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Stacy A Sterling
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Karen J Coleman
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Brian K Ahmedani
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Zimri S Yaseen
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Andrew D Mosholder
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
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Minian N, Gayapersad A, Coroiu A, Dragonetti R, Zawertailo L, Zaheer J, O’Neill B, Lange S, Thomson N, Crawford A, Kennedy SH, Selby P. Prototyping the implementation of a suicide prevention protocol in primary care settings using PDSA cycles: a mixed method study. Front Psychiatry 2024; 15:1286078. [PMID: 38333892 PMCID: PMC10850298 DOI: 10.3389/fpsyt.2024.1286078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction In Canada, approximately 4,500 individuals die by suicide annually. Approximately 45% of suicide decedents had contact with their primary care provider within the month prior to their death. Current versus never smokers have an 81% increased risk of death by suicide. Those who smoke have additional risks for suicide such as depression, chronic pain, alcohol, and other substance use. They are more likely to experience adverse social determinants of health. Taken together, this suggests that smoking cessation programs in primary care could be facilitators of suicide prevention, but this has not been studied. Study objectives The objectives of the study are to understand barriers/facilitators to implementing a suicide prevention protocol within a smoking cessation program (STOP program), which is deployed by an academic mental health and addiction treatment hospital in primary care clinics and to develop and test implementation strategies to facilitate the uptake of suicide screening and assessment in primary care clinics across Ontario. Methods The study employed a three-phase sequential mixed-method design. Phase 1: Conducted interviews guided by the Consolidated Framework for Implementation Research exploring barriers to implementing a suicide prevention protocol. Phase 2: Performed consensus discussions to map barriers to implementation strategies using the Expert Recommendations for Implementing Change tool and rank barriers by relevance. Phase 3: Evaluated the feasibility and acceptability of implementation strategies using Plan Do Study Act cycles. Results Eleven healthcare providers and four research assistants identified lack of training and the need of better educational materials as implementation barriers. Participants endorsed and tested the top three ranked implementation strategies, namely, a webinar, adding a preamble before depression survey questions, and an infographic. After participating in the webinar and reviewing the educational materials, all participants endorsed the three strategies as acceptable/very acceptable and feasible/very feasible. Conclusion Although there are barriers to implementing a suicide prevention protocol within primary care, it is possible to overcome them with strategies deemed both acceptable and feasible. These results offer promising practice solutions to implement a suicide prevention protocol in smoking cessation programs delivered in primary care settings. Future efforts should track implementation of these strategies and measure outcomes, including provider confidence, self-efficacy, and knowledge, and patient outcomes.
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Affiliation(s)
- Nadia Minian
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Allison Gayapersad
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Adina Coroiu
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosa Dragonetti
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Laurie Zawertailo
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Braden O’Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Shannon Lange
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicole Thomson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Arthur Sommer Rotenberg Program in Suicide Studies, Unity Health Toronto, Toronto, ON, Canada
| | - Peter Selby
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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9
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Gallagher K, O’ Brien C, O’ Driscoll M, Ní Dhálaigh D, Corcoran P, Griffin E. Suicide prevention curriculum development for health and social care students: Protocol for a scoping review. PLoS One 2023; 18:e0285231. [PMID: 38060488 PMCID: PMC10703193 DOI: 10.1371/journal.pone.0285231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
Suicide has become a serious public health concern and international research has shown that the majority of individuals who die by suicide had receive healthcare in the year prior to their death. This presents an opportunity for suicide prevention by strategically training healthcare students in suicide prevention knowledge and skills. The objective of this scoping review is to identify literature that describes the design, development, implementation and/or evaluation of suicide prevention training for healthcare and/or social care students in higher education settings. Studies will only be considered eligible for inclusion if they describe the design, development, implementation and/or evaluation of suicide prevention curricula being delivered to healthcare or social care degree students in higher education. Quantitative, qualitative, and mixed method studies published between 2011 and 2023 (inclusive) and in the English language will be considered eligible. This scoping review will be conducted according to the PRISMA guidelines for scoping reviews (PRISMA-ScR). The developed search strategy will be implemented across six databases: PubMed, ERIC (Education Resources Information Center), PsycINFO, Embase, CINAHL and Web of Science. Several grey literature sources will also be consulted. Further potential results will be located by hand-searching the reference lists of included articles. The search strategy will include variations of the terms: 'student', 'suicide prevention' and 'education'. The search will be limited to titles, abstracts, and keywords in databases that allow it. Two reviewers will complete the screening using the predefined inclusion criteria. A third reviewer will resolve any conflicts during the screening and eligibility appraisal processes. Results will be presented in the form of tabulated results and an accompanying narrative summary, describing key findings and context related to learning outcomes, methodologies employed and implementation of the identified programmes.
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Affiliation(s)
| | | | | | | | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Eve Griffin
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
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10
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Cunningham JK, Solomon TGA, Ritchey J, Weiss BD. Alcohol Use Disorder Visits and Suicide Ideation Diagnosis: Racial/Ethnic Differences at Emergency Departments. Am J Prev Med 2023; 65:1113-1123. [PMID: 37348661 DOI: 10.1016/j.amepre.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Nationally, suicide ideation prevalence is comparable among White, American Indian/Alaska Native, Black, and Hispanic adults experiencing alcohol use disorder. This study examines whether such comparability extends to the probability of receiving a suicide ideation diagnosis when presenting with alcohol use disorder at emergency departments. The probability of hospitalization following such diagnosis is examined as well. METHODS National Emergency Department Sample (2019) data were used. Logistic and multilevel logistic regression analyses were performed in 2022-2023 with suicide ideation diagnosis and subsequent hospitalization as the outcome variables. Control variables included demographics, payor, alcohol use disorder level, comorbidities, and emergency department facility. Adjusted probabilities were computed. RESULTS Age-adjusted probabilities of suicide ideation diagnoses for American Indian/Alaska Native, Black, and Hispanic patients with alcohol use disorder were 5.4%, 6.7%, and 4.9% (95% CIs=3.7, 7.1; 6.0, 7.4; 4.4, 5.4), respectively; all less than that for White counterparts (8.7%; 95% CI=8.2, 9.2). Among patients with alcohol use disorder plus suicide ideation diagnoses, the age-adjusted probability of hospitalization for American Indians/Alaska Natives (32.4%; 95% CI=20.9, 44.0) was less than that for Whites, Blacks, and Hispanics (49.8%, 52.3%, and 49.9%; 95% CIs=46.7, 52.8; 47.1, 57.5; and 43.9, 55.8, respectively). In regressions with multiple control variables, the racial/ethnic differences remained statistically significant (p<0.05). CONCLUSIONS Diagnosis of suicide ideation, a key step in emergency department suicide prevention care, occurred significantly less often for patients of color with alcohol use disorder than for White counterparts. American Indians/Alaska Natives, the racial/ethnic group known to have the nation's highest suicide rate, had the lowest probability of being hospitalized after a diagnosis of alcohol use disorder plus suicide ideation.
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Affiliation(s)
- James K Cunningham
- Department of Family and Community Medicine, The University of Arizona, Tucson, Arizona; American Indian Research Center for Health, The University of Arizona, Tucson, Arizona.
| | - Teshia G Arambula Solomon
- Department of Family and Community Medicine, The University of Arizona, Tucson, Arizona; American Indian Research Center for Health, The University of Arizona, Tucson, Arizona
| | - Jamie Ritchey
- Tribal Epidemiology Center, Inter Tribal Council of Arizona, Inc., Phoenix, Arizona
| | - Barry D Weiss
- Department of Family and Community Medicine, The University of Arizona, Tucson, Arizona
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11
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Wislocki K, Jager-Hyman S, Brady M, Weiss M, Schaechter T, Khazanov G, Young S, Becker-Haimes E. Freely Available Training Videos for Suicide Prevention: Scoping Review. JMIR Ment Health 2023; 10:e48404. [PMID: 37921847 PMCID: PMC10656652 DOI: 10.2196/48404] [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: 04/22/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Freely available and asynchronous implementation supports can reduce the resource burden of evidence-based practice training to facilitate uptake. Freely available web-based training videos have proliferated, yet there have been no efforts to quantify their breadth, depth, and content for suicide prevention. OBJECTIVE This study presents results from a scoping review of freely available training videos for suicide prevention and describes a methodological framework for reviewing such videos. METHODS A scoping review of freely available training videos (≥2 minutes) for suicide prevention practices was conducted using 4 large video-sharing platforms: YouTube, Vimeo, Bing Video, and Google Video. Identified suicide prevention training videos (N=506) were reviewed and coded. RESULTS Most content was targeted toward gatekeepers or other lay providers (n=370) versus clinical providers (n=136). Videos most commonly provided content related to suicidal thoughts or behaviors (n=420). Many videos (n=274, 54.2%) included content designed for certain communities or organizations. Less than half (n=232, 45.8%) of training videos included formal clinical content pertaining to assessment or intervention for suicide prevention. CONCLUSIONS Results suggested an abundance of videos providing broad informational content (eg, "signs and symptoms of someone at risk for suicide") and a limited portion of videos with instructional content aimed at clinical providers delivering formal evidence-based assessments or interventions for suicide prevention. Development of resources to address identified gaps may be needed. Future work may leverage machine learning techniques to expedite the review process.
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Affiliation(s)
- Katherine Wislocki
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Megan Brady
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Michal Weiss
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Temma Schaechter
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Gabriela Khazanov
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Sophia Young
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Emily Becker-Haimes
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, United States
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12
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Blais RK, Xie Z, Kirby AV, Marlow NM. Suicide Ideation, Plans, and Attempts Among Military Veterans vs Nonveterans With Disability. JAMA Netw Open 2023; 6:e2337679. [PMID: 37831452 PMCID: PMC10576218 DOI: 10.1001/jamanetworkopen.2023.37679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/27/2023] [Indexed: 10/14/2023] Open
Abstract
Importance People with disability are at heightened risk for suicide ideation, planning, and attempt, with risk growing as the number of disabling limitations increases. Military veterans have higher rates of suicide deaths and disability relative to nonveterans. Objective To evaluate whether veteran status is associated with greater risk for suicide in those with disability. Design, Setting, and Participants This survey study used cross-sectional self-reported data from US adults who participated in the 2015-2020 National Survey on Drug Use and Health. Data were weighted to represent the population. Data analysis was conducted from July to August 2022. Main Outcomes and Measures Suicide ideation, planning, and attempt served as primary outcomes. Disability status (present or absent) and number of disabling limitations (1, 2, or ≥3) served as factors. Veteran status was determined based on self-report (veteran or nonveteran). Multivariable logistic regression examined suicide ideation, planning, and attempt as a function of veteran status and disability variables. Results Participants included 231 099 US veterans and nonveterans, representing 236 551 727 US adults, of whom 20.03% (weighted n = 47 397 876) reported a disabling limitation, 8.92% were veterans (weighted n = 21 111 727; 16.0% aged 35-49 years; 91.0% men; 6.7% Hispanic; 10.9% non-Hispanic Black; and 78.4% non-Hispanic White) and 91.08% were nonveterans (weighted n = 215 440 000; 25.4% aged 35-49 years; 44.0% male; 16.5% Hispanic; 11.7% non-Hispanic Black; and 63.3% non-Hispanic White). Overall, 4.39% reported suicide ideation, planning, or attempt (weighted n = 10 401 065). Among those with no disability, veteran status was associated with higher risk of suicide planning (adjusted odds ratio [AOR], 1.71; 95% CI, 1.17-2.49). Among those with 1 or 2 disabling limitations, being a veteran was associated with a lower risk of suicide planning (AOR, 0.57; 95% CI, 0.34-0.95) and history of attempt (AOR, 0.46; 95% CI, 0.24-0.88). Conclusions and Relevance In this study of how suicide risk differs as a function of disability and veteran status, risk for death by suicide was lower among veterans with disability relative to nonveterans with disability. Veteran status may mitigate risk for suicide given increased receipt of more disability-related care through the Department of Veterans Affairs. Further research would extend this line of inquiry by examining the cause and type of disability as well as perceptions of disability on self-worth. It is possible that physical wounds of war are protective because of the meaning and value of service to one's country.
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Affiliation(s)
| | - Zhigang Xie
- Department of Public Health, University of North Florida, Jacksonville
| | - Anne V. Kirby
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City
| | - Nicole M. Marlow
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville
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Katayama ES, Moazzam Z, Woldesenbet S, Lima HA, Endo Y, Azap L, Yang J, Dillhoff M, Ejaz A, Cloyd J, Pawlik TM. Suicidal Ideation Among Patients with Gastrointestinal Cancer. Ann Surg Oncol 2023; 30:3929-3938. [PMID: 37061648 DOI: 10.1245/s10434-023-13471-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/22/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Mental illness (MI) and suicidal ideation (SI) often are associated with a diagnosis of cancer. We sought to define the incidence of MI and SI among patients with gastrointestinal cancers, as well as ascertain the predictive factors associated with SI. METHODS Patients diagnosed between 2004 and 2016 with stomach, liver, pancreatic, and colorectal cancer were identified from the SEER-Medicare database. County-level social vulnerability index (SVI) was extracted from the Centers for Disease Control database. Multivariable logistic regression was used to identify factors associated with SI. RESULTS Among 382,266 patients, 83,514 (21.9%) individuals had a diagnosis of MI. Only 1410 (0.4%) individuals experienced SI, and 359 (0.1%) committed suicide. Interestingly, SI was least likely among patients with pancreatic cancer (ref: hepatic cancer; odds ratio [OR] 0.67, 95% confidence interval [CI] 0.52-0.86; p = 0.002), as well as individuals with stage III/IV disease (OR 0.59, 95% CI 0.52-067; p < 0.001). In contrast, male (OR 1.34, 95% CI 1.19-1.50), White (OR 1.34, CI 1.13-1.59), and single (OR 2.03, 95% CI 1.81-2.28) patients were at higher odds of SI risk (all p < 0.001). Furthermore, individuals living in relative privilege (low SVI) had markedly higher risk of SI (OR 1.33, 95% CI 1.14-1.54; p < 0.001). Moreover, living in a county with a shortage of mental health professionals was associated with increased odds of developing SI (OR 1.21, 95% CI 1.04-1.40; p = 0.012). CONCLUSIONS Oncology care teams should incorporate routine mental health and SI screening in the treatment of patients with gastrointestinal cancers, as well as target suicide prevention towards patients at highest risk.
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Affiliation(s)
- Erryk S Katayama
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lovette Azap
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jason Yang
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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14
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Zhang C, Zafari Z, Slejko JF, Camelo Castillo W, Reeves GM, dosReis S. Impact of different interventions on preventing suicide and suicide attempt among children and adolescents in the United States: a microsimulation model study. Front Psychiatry 2023; 14:1127852. [PMID: 37333921 PMCID: PMC10275605 DOI: 10.3389/fpsyt.2023.1127852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Despite considerable investment in suicide prevention since 2001, there is limited evidence for the effect of suicide prevention interventions among children and adolescents. This study aimed to estimate the potential population impact of different interventions in preventing suicide-related behaviors in children and adolescents. Methods A microsimulation model study used data from national surveys and clinical trials to emulate the dynamic processes of developing depression and care-seeking behaviors among a US sample of children and adolescents. The simulation model examined the effect of four hypothetical suicide prevention interventions on preventing suicide and suicide attempt in children and adolescents as follows: (1) reduce untreated depression by 20, 50, and 80% through depression screening; (2) increase the proportion of acute-phase treatment completion to 90% (i.e., reduce treatment attrition); (3) suicide screening and treatment among the depressed individuals; and (4) suicide screening and treatment to 20, 50, and 80% of individuals in medical care settings. The model without any intervention simulated was the baseline. We estimated the difference in the suicide rate and risk of suicide attempts in children and adolescents between baseline and different interventions. Results No significant reduction in the suicide rate was observed for any of the interventions. A significant decrease in the risk of suicide attempt was observed for reducing untreated depression by 80%, and for suicide screening to individuals in medical settings as follows: 20% screened: -0.68% (95% credible interval (CI): -1.05%, -0.56%), 50% screened: -1.47% (95% CI: -2.00%, -1.34%), and 80% screened: -2.14% (95% CI: -2.48%, -2.08%). Combined with 90% completion of acute-phase treatment, the risk of suicide attempt changed by -0.33% (95% CI: -0.92%, 0.04%), -0.56% (95% CI: -1.06%, -0.17%), and -0.78% (95% CI: -1.29%, -0.40%) for reducing untreated depression by 20, 50, and 80%, respectively. Combined with suicide screening and treatment among the depressed, the risk of suicide attempt changed by -0.27% (95% CI: -0.dd%, -0.16%), -0.66% (95% CI: -0.90%, -0.46%), and -0.90% (95% CI: -1.10%, -0.69%) for reducing untreated depression by 20, 50, and 80%, respectively. Conclusion Reducing undertreatment (the untreated and dropout) of depression and suicide screening and treatment in medical care settings may be effective in preventing suicide-related behaviors in children and adolescents.
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Affiliation(s)
- Chengchen Zhang
- Shanghai Children's Medical Center Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Zafar Zafari
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Julia F. Slejko
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Wendy Camelo Castillo
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Gloria M. Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Susan dosReis
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
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15
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Pisani AR, Boudreaux ED. Systems Approach to Suicide Prevention: Strengthening Culture, Practice, and Education. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:152-159. [PMID: 37201147 PMCID: PMC10172554 DOI: 10.1176/appi.focus.20220081] [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
Contemporary approaches to suicide prevention extend beyond an individual's interactions with care providers to seek opportunities for improvement in the wider care system. A systems-based analysis can yield opportunities to improve prevention and recovery across the care continuum. This article uses an example of an individual seeking care in an emergency department to show how a traditional clinical case formulation can be framed in terms of the outer and inner contexts of the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to illuminate the impact of systemic factors on outcomes and to identify opportunities for improvement. Three mutually reinforcing domains (a culture of safety and prevention; best practices, policies, and pathways; and workforce education and development) of a systems approach to suicide prevention are outlined, along with their defining characteristics. A culture of safety and prevention requires engaged, informed leaders who prioritize prevention; lived experience integrated into leadership teams; and adverse events review in a Restorative Just Culture focused on healing and improvement. Best practices, policies, and pathways that promote safety, recovery, and health require codesign of processes and services and evolve through continuous measurement and improvement. To support a culture of safety and prevention, and caring, competent application of policy, organizations benefit from a longitudinal approach to workforce education. This includes a common framework and language; models clinical and lived experience collaboration; and supports continuous learning, as well as onboarding of new staff, rather than following a "one-and-done" approach, so that suicide prevention training remains top of mind across the workforce.
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Affiliation(s)
- Anthony R Pisani
- Departments of Psychiatry and Pediatrics, University of Rochester Medical Center, Rochester, New York (Pisani); Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux)
| | - Edwin D Boudreaux
- Departments of Psychiatry and Pediatrics, University of Rochester Medical Center, Rochester, New York (Pisani); Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux)
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16
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Shortreed SM, Walker RL, Johnson E, Wellman R, Cruz M, Ziebell R, Coley RY, Yaseen ZS, Dharmarajan S, Penfold RB, Ahmedani BK, Rossom RC, Beck A, Boggs JM, Simon GE. Complex modeling with detailed temporal predictors does not improve health records-based suicide risk prediction. NPJ Digit Med 2023; 6:47. [PMID: 36959268 PMCID: PMC10036475 DOI: 10.1038/s41746-023-00772-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/07/2023] [Indexed: 03/25/2023] Open
Abstract
Suicide risk prediction models can identify individuals for targeted intervention. Discussions of transparency, explainability, and transportability in machine learning presume complex prediction models with many variables outperform simpler models. We compared random forest, artificial neural network, and ensemble models with 1500 temporally defined predictors to logistic regression models. Data from 25,800,888 mental health visits made by 3,081,420 individuals in 7 health systems were used to train and evaluate suicidal behavior prediction models. Model performance was compared across several measures. All models performed well (area under the receiver operating curve [AUC]: 0.794-0.858). Ensemble models performed best, but improvements over a regression model with 100 predictors were minimal (AUC improvements: 0.006-0.020). Results are consistent across performance metrics and subgroups defined by race, ethnicity, and sex. Our results suggest simpler parametric models, which are easier to implement as part of routine clinical practice, perform comparably to more complex machine learning methods.
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Affiliation(s)
- Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA, 98101, USA.
- Department of Biostatistics, University of Washington, 1705 NE Pacific St, Seattle, WA, 98195, USA.
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA, 98101, USA
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA, 98101, USA
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA, 98101, USA
| | - Maricela Cruz
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA, 98101, USA
- Department of Biostatistics, University of Washington, 1705 NE Pacific St, Seattle, WA, 98195, USA
| | - Rebecca Ziebell
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA, 98101, USA
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA, 98101, USA
- Department of Biostatistics, University of Washington, 1705 NE Pacific St, Seattle, WA, 98195, USA
| | - Zimri S Yaseen
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA, 98101, USA
| | - Brian K Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA
| | - Rebecca C Rossom
- HealthPartners Institute, Division of Research, 8170 33rd Ave S, Minneapolis, MN, 55425, USA
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, 2550 S. Parker Road, Suite 200, Aurora, CO, 80014, USA
| | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, 2550 S. Parker Road, Suite 200, Aurora, CO, 80014, USA
| | - Greg E Simon
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA, 98101, USA
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Bloch-Elkouby S, Zilcha-Mano S, Rogers ML, Park JY, Manlongat K, Krumerman M, Galynker I. Who are the patients who deny suicidal intent? Exploring patients' characteristics associated with self-disclosure and denial of suicidal intent. Acta Psychiatr Scand 2023; 147:205-216. [PMID: 36263445 DOI: 10.1111/acps.13511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients' non-disclosure of suicidal ideation and intent concealment represent a major obstacle to the effective assessment of suicide risk and to the delivery of suicide prevention treatments. The present study aimed to investigate this phenomenon and to assess (1) if outpatient psychiatric patients are more or less likely to disclose intent to mental health clinicians in the context of psychiatric/psychological treatment than they are to in the context of research interviews with non-clinicians; and (2) if certain demographic, trait-like, and state-like characteristics may predict such disclosure differences. METHODS A total of 780 psychiatric outpatient participants aged 18 to 84 and 193 clinician participants aged 25 to 54 were included in the study. The proportion of patients who disclosed to clinicians only, to research assistants (RAs) only, to both, and to none, was compared using a z-test. Univariate analyses were used to compare the participants' variables across disclosure groups, and significant individual predictors were included in multilevel regression analyses. RESULTS Participants were more significantly more likely to disclose to RAs (10.4%) than to clinicians (5.6%), p < 0.001. Neuroticism and trait anxiety predicted disclosure to RAs vs no disclosure; low extraversion predicted disclosure to clinician versus no disclosure; and extraversion and trait anxiety predicted disclosure to RAs versus to clinicians. DISCUSSION Patients' disclosure patterns, the personality variables predicting them, and their clinical implications were discussed in the context of the extant literature on patients' reasons for concealing suicidal ideation and intent.
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Affiliation(s)
- Sarah Bloch-Elkouby
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai Beth Israel, New York, USA
| | | | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Ji Yoon Park
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai Beth Israel, New York, USA
| | - Katherine Manlongat
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai Beth Israel, New York, USA
| | - Mia Krumerman
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai Beth Israel, New York, USA
| | - Igor Galynker
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai Beth Israel, New York, USA
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18
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Porter JE, Dabkowski E, Connolly O, Prokopiv V. Compliance with the Zero Suicide Initiative by Mental Health Clinicians at a Regional Mental Health Service: Development and Testing of a Clinical Audit Tool. NURSING REPORTS 2022; 13:29-42. [PMID: 36648977 PMCID: PMC9844327 DOI: 10.3390/nursrep13010003] [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: 11/08/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022] Open
Abstract
AIM The aim of this study is to investigate the compliance of mental health clinicians in applying the Zero Suicide (ZS) approach to their clinical practice in a rural and regional health community setting. METHODS A retrospective clinical audit of six mental health teams was undertaken at a single site. A clinical audit tool was developed and validated using a six-step approach. The data was extracted and analysed via descriptive and inferential statistics and compared to a specialised mental health team, experienced with the ZS approach. RESULTS A total of 334 clinical records were extracted for January, April, August, November 2019 and June 2020. The clinical audit and analysis confirmed that the mental health teams are not consistently using the assessments from their training and are therefore not implementing all of these elements into their practice. This could have implications for the risk formulation and treatment for people at risk of suicide. CONCLUSIONS The use of a validated clinical audit tool can be beneficial to establish compliance with the mental health clinicians and to determine any areas requiring further improvement. Further education and reinforcement may be required to ensure consistency with incorporating the elements of ZS into everyday clinical practice.
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Affiliation(s)
- Joanne E. Porter
- Collaborative Evaluation & Research Group, Federation University Australia, Churchill 3842, Australia
- Correspondence: (J.E.P.); (E.D.)
| | - Elissa Dabkowski
- Collaborative Evaluation & Research Group, Federation University Australia, Churchill 3842, Australia
- Correspondence: (J.E.P.); (E.D.)
| | - Owen Connolly
- Mental Health Services, Latrobe Regional Hospital, Traralgon 3844, Australia
| | - Valerie Prokopiv
- Collaborative Evaluation & Research Group, Federation University Australia, Churchill 3842, Australia
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19
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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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20
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Simon GE, Shortreed SM, Boggs JM, Clarke GN, Rossom RC, Richards JE, Beck A, Ahmedani BK, Coleman KJ, Bhakta B, Stewart CC, Sterling S, Schoenbaum M, Coley RY, Stone M, Mosholder AD, Yaseen ZS. Accuracy of ICD-10-CM encounter diagnoses from health records for identifying self-harm events. J Am Med Inform Assoc 2022; 29:2023-2031. [PMID: 36018725 PMCID: PMC9667165 DOI: 10.1093/jamia/ocac144] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/02/2022] [Accepted: 08/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Assess the accuracy of ICD-10-CM coding of self-harm injuries and poisonings to identify self-harm events. MATERIALS AND METHODS In 7 integrated health systems, records data identified patients reporting frequent suicidal ideation. Records then identified subsequent ICD-10-CM injury and poisoning codes indicating self-harm as well as selected codes in 3 categories where uncoded self-harm events might be found: injuries and poisonings coded as undetermined intent, those coded accidental, and injuries with no coding of intent. For injury and poisoning encounters with diagnoses in those 4 groups, relevant clinical text was extracted from records and assessed by a blinded panel regarding documentation of self-harm intent. RESULTS Diagnostic codes selected for review include all codes for self-harm, 43 codes for undetermined intent, 26 codes for accidental intent, and 46 codes for injuries without coding of intent. Clinical text was available for review for 285 events originally coded as self-harm, 85 coded as undetermined intent, 302 coded as accidents, and 438 injury events with no coding of intent. Blinded review of full-text clinical records found documentation of self-harm intent in 254 (89.1%) of those originally coded as self-harm, 24 (28.2%) of those coded as undetermined, 24 (7.9%) of those coded as accidental, and 48 (11.0%) of those without coding of intent. CONCLUSIONS Among patients at high risk, nearly 90% of injuries and poisonings with ICD-10-CM coding of self-harm have documentation of self-harm intent. Reliance on ICD-10-CM coding of intent to identify self-harm would fail to include a small proportion of true self-harm events.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado, USA
| | - Gregory N Clarke
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | | | - Julie E Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado, USA
| | - Brian K Ahmedani
- Center for Health Policy and Services Research, Henry Ford Health, Detroit, Michigan, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, California, USA
| | - Bhumi Bhakta
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, California, USA
| | - Christine C Stewart
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Stacy Sterling
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | | | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Marc Stone
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Zimri S Yaseen
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Yuan Y, Barooah A, Lapane KL, Mack D, Rothschild AJ, Ulbricht CM. Health profiles of older nursing home residents by suicidal ideation: A latent class analysis. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5829. [PMID: 36281640 PMCID: PMC10165533 DOI: 10.1002/gps.5829] [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: 05/09/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Identify the health profiles of older nursing home residents with and without at-admission self-reported suicidal ideation (SI) and examine the association between the identified profiles and self-reported SI at 90 days. METHODS Using the Minimum Data Set 3.0 and the ninth Patient Health Questionnaire-9 (PHQ-9) item, we identified 15,277 older residents with and 562,184 without self-reported SI at nursing home admission. Latent class analysis, using frailty, cognitive impairment, palliative care index, pain, and remaining PHQ-9 items as indicators, identified health profiles by at-admission SI and the BCH method estimated their association with SI at 90 days. RESULTS Profiles identified for residents without at-admission SI were: (1) frail and depressedNoSI (prevalence: 33.9%); (2) frail and severe cognitive impairmentNoSI (38.1%); (3) pre-frailNoSI (28.0%). Residents in the frail and depressedNoSI group had greater odds [adjusted OR: 2.80; 95% Confidence Interval: 2.60-3.00] while those in the frail and severe cognitive impairmentNoSI group had lower odds [aOR: 0.79; 95% CI: 0.71-0.86] of 90-day SI than those in the pre-frailNoSI group. Profiles identified for residents with at-admission SI were: (1) frail and all depressive symptomsSI (22.8%); (2) frail and some depressive symptomsSI (32.2%); (3) frail and severe cognitive impairmentSI (22.9%); (4) pre-frailSI (22.0%). Compared to those in the pre-frailSI group, residents in the frail and all depressive symptomsSI group had greater odds of continuing reporting SI at 90 days [aOR: 1.22; 95% CI:1.09-1.35]. CONCLUSIONS Findings indicated unique health profiles of nursing home residents at higher risk of new onset of or continued SI.
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Affiliation(s)
- Yiyang Yuan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Adrita Barooah
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Kate L. Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Deborah Mack
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Anthony J. Rothschild
- Department of Psychiatry, University of Massachusetts Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts, USA
| | - Christine M. Ulbricht
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Global Evidence and Outcomes, Takeda, Cambridge, Massachusetts, USA
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Liller KD, Thomas N, Ramirez J, Amoros E, Diblanda A, Salinas A, Agrawal K, Trejos R. The Florida Violent Death Reporting System 2019 Data Findings Including a Qualitative Focus on Suicide Deaths of Young Black Males. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221136523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Florida Violent Death Reporting System (FLVDRS) includes violent death data abstracted from death certificates (DC), medical examiner (ME) reports, and law enforcement (LE) records. Abstractors also produce narratives from the ME and LE information. This manuscript focuses on the findings from the 2019 FLVDRS. Quantitative data were reviewed using SPSS and STATA and MAXQDA was used for the qualitative analysis. Results showed that most deaths were suicides (69.0%). Males comprised most of all the violent deaths (77.4%). Qualitative analysis focused on available narratives of Black males regardless of ethnicity, ages 10–24 years, who died of suicide (n = 19). The most prominent codes from the qualitative analysis included scene location, suicide method, engagement with LE, known history of psychiatric conditions, known history of self-injurious behavior, and recent life events. Subcodes related to the parent codes are also provided for further explanation of the findings. Future research will allow confirmation of findings and development of targeted intervention programs.
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Affiliation(s)
- Karen D. Liller
- University of South Florida College of Public Health, Tampa, FL, USA (KDL, NT, JR, EA, AD, AS, KA, RT)
| | - Nicholas Thomas
- University of South Florida College of Public Health, Tampa, FL, USA (KDL, NT, JR, EA, AD, AS, KA, RT)
| | - Jennifer Ramirez
- University of South Florida College of Public Health, Tampa, FL, USA (KDL, NT, JR, EA, AD, AS, KA, RT)
| | - Elizabeth Amoros
- University of South Florida College of Public Health, Tampa, FL, USA (KDL, NT, JR, EA, AD, AS, KA, RT)
| | - Alexis Diblanda
- University of South Florida College of Public Health, Tampa, FL, USA (KDL, NT, JR, EA, AD, AS, KA, RT)
| | - Abraham Salinas
- University of South Florida College of Public Health, Tampa, FL, USA (KDL, NT, JR, EA, AD, AS, KA, RT)
| | - Kelli Agrawal
- University of South Florida College of Public Health, Tampa, FL, USA (KDL, NT, JR, EA, AD, AS, KA, RT)
| | - Rolando Trejos
- University of South Florida College of Public Health, Tampa, FL, USA (KDL, NT, JR, EA, AD, AS, KA, RT)
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Saving lives by asking questions: nurses' experiences of suicide risk assessment in telephone counselling in primary health care. Prim Health Care Res Dev 2022; 23:e65. [PMID: 36285522 PMCID: PMC9641664 DOI: 10.1017/s146342362200055x] [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] [Indexed: 11/29/2022] Open
Abstract
AIM To explore nurses' experiences of suicide risk assessment in telephone counselling (TC) in primary health care (PHC). BACKGROUND Globally, priority is given to developing suicide prevention work in PHC. However, suicide risk assessments in TC are not included in these interventions even though these are a common duty of nurses in PHC. More expertise in the field can contribute to knowledge important for developing nurses' tasks within PHC. METHODS A qualitative interview study was conducted with 15 nurses. Data were analysed using conventional content analysis. FINDINGS As suicide risk assessment in TC is a common duty for nurses in PHC, they need to be listened to and given the right conditions to perform this work. The nurses lack training in how to carry out suicide risk assessments and are forced to learn through experience. Intuition guides them in their work. A prerequisite for making correct assessments over the telephone is that the nurses are given time as well as the right competence. The PHC organisation needs to create these conditions. Furthermore, interventions to support suicide prevention need to include strategies to help nurses perform suicide assessment in TC.
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Wärdig RE, Hultsjö S, Lind M, Klavebäck I. Nurses' Experiences of Suicide Prevention in Primary Health Care (PHC) - A Qualitative Interview Study. Issues Ment Health Nurs 2022; 43:903-912. [PMID: 35793075 DOI: 10.1080/01612840.2022.2089789] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM The purpose was to describe nurses' experiences of suicide prevention work in primary health care (PHC). BACKGROUND Suicide is the tenth most common cause of death among adults. PHC has an important role in suicide prevention work, as patients often had contact with PHC before their suicide rather than with specialist psychiatric care. Nurses often have the first contact with the patient and are responsible for triage and assessment, making them important in suicide prevention work. Previous studies shed light on suicide prevention in a primary care context, but the nurses' voices are missing. METHODS Fifteen qualitative interviews were conducted with nurses in primary health care. Data was analyzed according to conventional content analysis techniques. FINDINGS Nurses may avoid asking questions about suicidality for fear of what to do with the answer. To support the nurses' ability in suicide prevention work, both educational and practical experience are fundamental. There was a lack of clarity about who is carrying responsibility for the patient, and it turned out to be difficult to help the patient move further to the next care institution. There was a need for guidelines as well as routines for collaboration with other care actors in suicide prevention work. CONCLUSION The PHC organization does not support nurses in suicide prevention, therefore they need the right conditions for their work. Suicide prevention needs to be given greater focus and space within education as well as training in the ongoing clinical work, which can be performed with less extensive efforts.
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Affiliation(s)
- Rikard Erik Wärdig
- Division of Nursing and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Sally Hultsjö
- Department of Psychiatry, Ryhov County Hospital and Division of Nursing and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Malin Lind
- Department of Psychiatry, Ryhov County Hospital and Division of Nursing and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Isabella Klavebäck
- Department of Psychiatry, Ryhov County Hospital and Division of Nursing and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
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25
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Sakai-Bizmark R, Kumamaru H, Estevez D, Bedel LEM, Marr EH, Mena LA, Kaplan MS. Association between suicide attempt and previous healthcare utilization among homeless youth. Suicide Life Threat Behav 2022; 52:994-1001. [PMID: 35765815 DOI: 10.1111/sltb.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/14/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to examine the association between prior emergency department (ED) visit or hospitalization and subsequent suicide attempt among homeless youth aged 10-17 years old. METHODS With New York statewide databases, a case-control design was conducted. Cases and controls were homeless patients with an ED visit or hospitalization due to suicide attempt (cases) or appendicitis (controls) between April and December. We examined ED and inpatient records for 90 days prior to the visit for suicide attempt or appendicitis. The primary exposure variable was prior healthcare utilization for any reason other than the following four reasons: mental health disorder, substance use, self-harm, and other injuries. Multivariable logistic regression models, with year fixed effect and hospital random effect, were used. RESULTS A total of 335 cases and 742 controls were identified. Cases had lower odds of prior healthcare utilization for any reason other than the four reasons listed above. (adjusted Odds Ratio [aOR]: 0.53, p-value = 0.03). CONCLUSIONS The association between prior healthcare utilization and decreased risk of suicide attempt among homeless youth may be due to comprehensive care provided during healthcare utilization. It may also reflect the presence of a social network that provided a protective effect.
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Affiliation(s)
- Rie Sakai-Bizmark
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA.,Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA.,David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Dennys Estevez
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Lauren E M Bedel
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA.,Network for Excellence in Health Innovation (NEHI), Boston, Massachusetts, USA
| | - Emily H Marr
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Laurie A Mena
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Mark S Kaplan
- The Luskin School of Public Affairs, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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Smith M. Suicide Risk Assessments: A Scientific and Ethical Critique. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:481-493. [PMID: 35606610 PMCID: PMC9463356 DOI: 10.1007/s11673-022-10189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/02/2022] [Indexed: 06/15/2023]
Abstract
There are widely held premises that suicide is almost exclusively the result of mental illness and there is "strong evidence for successfully detecting and managing suicidality in healthcare" (Hogan and Grumet, 2016). In this context, 'zero-suicide' policies have emerged, and suicide risk assessment tools have become a normative component of psychiatric practice. This essay discusses how suicide evolved from a moral to a medical problem and how, in an effort to reduce suicide, a paternalistic healthcare response emerged to predict those at high risk. The evidence for the premises is critiqued and shown to be problematic; and it is found that strong paternalistic interventions are being used more often than acknowledged. Using a Principles approach, the ethics of overriding autonomy in suicide prevention is considered. Ethical concerns are identified with the current approach which are potentially amplified by the use of these risk assessments. Furthermore, it is identified that the widespread use of risk assessments in health settings is equivalent to screening without regard to the ethical principles of screening. The essay concludes that this is unethical; that we should abandon the use of standardized suicide risk assessments and 'zero-suicide' policy; and that this may improve outcomes.
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Affiliation(s)
- Mike Smith
- Bioethics Centre, University of Otago, Dunedin, New Zealand.
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Rassy J, Lesage A, Labelle R, Saadi F, Goulet MH, Genest C, Maltais N, Larue C. Assessment and care of individuals at risk of suicide in Emergency Department: The SecUrgence protocol. Int Emerg Nurs 2022; 64:101199. [PMID: 36027701 DOI: 10.1016/j.ienj.2022.101199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/23/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
Almost half (48,5%) of all individuals who die by suicide visited the Emergency Department (ED) in the year preceding their death by suicide and for almost a third (29,5%) of these individuals, the ED visit occurred within the month preceding their death by suicide. The ED is a key location for suicide prevention. The aim of this study was to develop and reach a consensus on the SecUrgence Protocol, a clinical protocol that intends to assess and provide care for individuals at risk of suicide that present themselves to the ED. This project was conducted in 3 stages: 1) Review of the literature, 2) Development of the list of the protocol statements by a first panel of experts, and 3) Validation, using the Delphi consensus method, on the final statements to include in the SecUrgence Protocol by a second panel of experts. Two rounds of the Delphi questionnaire were conducted until a final consensus of over 75% was reached. The SecUrgence Protocol is a first scientific step towards improving suicide prevention in the ED in Quebec as it was validated by a rigorous research process that included a consensus by all key stakeholders.
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Affiliation(s)
- Jessica Rassy
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; School of Nursing, University of Sherbrooke, QC, Canada; Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada; Quebec Network on Nursing Intervention Research, QC, Canada; Quebec Network on Suicide, Mood Disorders and Associated Disorders, QC, Canada; Charles-Le Moyne Research Centre, QC, Canada.
| | - Alain Lesage
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Department of Psychiatry, University of Montreal, QC, Canada; Quebec Network on Suicide, Mood Disorders and Associated Disorders, QC, Canada
| | - Réal Labelle
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Department of Psychiatry, University of Montreal, QC, Canada; Department of Psychology, Université du Québec à Montréal, QC, Canada; Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada
| | - Farida Saadi
- Faculty of Nursing, University of Montreal, QC, Canada; CEMTL Maisonneuve Rosemont Hospital, CIUSSS de l'Est-de-l'île-de-Montréal, QC, Canada
| | - Marie-Hélène Goulet
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Faculty of Nursing, University of Montreal, QC, Canada
| | - Christine Genest
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Faculty of Nursing, University of Montreal, QC, Canada; Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada; Quebec Network on Nursing Intervention Research, QC, Canada
| | - Nathalie Maltais
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada; Department of Health Sciences, Université du Québec à Rimouski, QC, Canada
| | - Caroline Larue
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Faculty of Nursing, University of Montreal, QC, Canada; Quebec Network on Nursing Intervention Research, QC, Canada
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Excess healthcare resource utilization and healthcare costs among privately and publicly insured patients with major depressive disorder and acute suicidal ideation or behavior in the United States. J Affect Disord 2022; 311:303-310. [PMID: 35597466 DOI: 10.1016/j.jad.2022.05.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/25/2022] [Accepted: 05/15/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study assessed the healthcare resource utilization (HRU) and cost burden of patients with major depressive disorder (MDD) and acute suicidal ideation or behavior (SIB; MDSI) versus those with MDD without SIB and those without MDD. METHODS Adults were selected from the MarketScan® Databases (10/2015-02/2020). The MDSI cohort received an MDD diagnosis within 6 months of a claim for acute SIB (index date). The index date was a random MDD claim in the MDD without SIB cohort and a random date in the non-MDD cohort. Patients had continuous eligibility ≥12 months pre- and ≥1 month post-index. HRU and costs were compared during 1- and 12-month post-index periods between MDSI and control cohorts matched 1:1 on demographics. RESULTS The MDSI cohort included 73,242 patients (mean age 35 years, 60.6% female, 37.2% Medicaid coverage). At 1 month post-index, the MDSI cohort versus the MDD without SIB/non-MDD cohorts had 12.8/67.2 times more inpatient admissions and 3.3/8.9 times more emergency department visits; they had 2.9 times more outpatient visits versus the non-MDD cohort (all p < 0.001). The MDSI cohort had incremental mean healthcare costs of $5255 and $6674 per-patient-month versus the MDD without SIB and non-MDD cohorts (all p < 0.001); inpatient costs drove up to 89.5% of incremental costs. At 12 months post-index, HRU and costs remained higher in MDSI versus control cohorts. LIMITATIONS SIB are underreported in claims; unobserved confounders may cause bias. CONCLUSIONS MDSI is associated with substantial excess healthcare costs driven by inpatient costs, concentrated in the first month post-index, and persisting during the following year.
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Albright R, Tower D. Suicide Prevention in Podiatry. J Am Podiatr Med Assoc 2022; 112:21-194. [PMID: 34495309 DOI: 10.7547/21-194] [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: 02/03/2023]
Affiliation(s)
- Rachel Albright
- *Stamford Health Medical Group, Stamford, CT; Associate Editor, Research and Public Health, JAPMA
| | - Dyane Tower
- †American Podiatric Medical Association, Bethesda, MD; Executive Editor, JAPMA
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Shaw JL, Beans JA, Noonan C, Smith JJ, Mosley M, Lillie KM, Avey JP, Ziebell R, Simon G. Validating a predictive algorithm for suicide risk with Alaska Native populations. Suicide Life Threat Behav 2022; 52:696-704. [PMID: 35293010 PMCID: PMC9378560 DOI: 10.1111/sltb.12853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The American Indian/Alaska Native (AI/AN) suicide rate in Alaska is twice the state rate and four times the U.S. rate. Healthcare systems need innovative methods of suicide risk detection. The Mental Health Research Network (MHRN) developed suicide risk prediction algorithms in a general U.S. PATIENT POPULATION METHODS We applied MHRN predictors and regression coefficients to electronic health records of AI/AN patients aged ≥13 years with behavioral health diagnoses and primary care visits between October 1, 2016, and March 30, 2018. Logistic regression assessed model accuracy for predicting and stratifying risk for suicide attempt within 90 days after a visit. We compared expected to observed risk and assessed model performance characteristics. RESULTS 10,864 patients made 47,413 primary care visits. Suicide attempt occurred after 589 (1.2%) visits. Visits in the top 5% of predicted risk accounted for 40% of actual attempts. Among visits in the top 0.5% of predicted risk, 25.1% were followed by suicide attempt. The best fitting model had an AUC of 0.826 (95% CI: 0.809-0.843). CONCLUSIONS The MHRN model accurately predicted suicide attempts among AI/AN patients. Future work should develop clinical and operational guidance for effective implementation of the model with this population.
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Affiliation(s)
- Jennifer L Shaw
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Julie A Beans
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | - Julia J Smith
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Mike Mosley
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Kate M Lillie
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Jaedon P Avey
- Division of Organizational Development and Innovation, Research and Data Services Department, Southcentral Foundation, Anchorage, Alaska, USA
| | - Rebecca Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Gregory Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Porter JE, Dabkowski E, Connolly O, Prokopiv V. Exploring mental health clinicians' perceptions of the Zero Suicide Prevention Initiative. Int J Ment Health Nurs 2022; 31:536-543. [PMID: 34967108 DOI: 10.1111/inm.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
Suicide continues to impact rural and regional families and communities across Australia and has become a key focus of healthcare, research, and government policy in recent years. The challenge for healthcare organizations is to translate policy visions and research for clinicians to effectively embed in day to day practice when supporting people who experience suicidal crisis. This study explored the introduction of an evidence-based Zero Suicide framework that includes a suicide prevention pathway and training package to a rural and regional community mental health team in Victoria, Australia. A qualitative semi-structured interview technique was used to explore the perceptions of mental health clinicians of the Zero Suicide approach, the training package and the barriers to inform its implementation across a specialist mental health service. Clinicians were complimentary of the intent of Zero Suicide and the training package and felt they had increased confidence in delivering suicide safe care. Four major themes were identified through thematic analysis: (i) Minimizing risk with realistic expectations; (ii) A good approach to making a difference; (iii) Lessons learnt; and (iv) Barriers to implementation needing to change culture. Overall participants identified the importance of continued regular suicide prevention training for all staff but also in tailoring it to different consumer and clinician needs. In addition, organizational structure and adequate staff resourcing were important to participants as was working within a safety culture.
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Affiliation(s)
- Joanne E Porter
- Collaborative Evaluation Unit (CEU), School of Health, Federation University Australia, Churchill, Victoria, Australia
| | - Elissa Dabkowski
- Collaborative Evaluation Unit (CEU), School of Health, Federation University Australia, Churchill, Victoria, Australia
| | - Owen Connolly
- Latrobe Regional Hospital, Traralgon, Victoria, Australia
| | - Valerie Prokopiv
- Collaborative Evaluation Unit (CEU), School of Health, Federation University Australia, Churchill, Victoria, Australia
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Rogers ML, Bloch-Elkouby S, Galynker I. Differential disclosure of suicidal intent to clinicians versus researchers: Associations with concurrent suicide crisis syndrome and prospective suicidal ideation and attempts. Psychiatry Res 2022; 312:114522. [PMID: 35378454 DOI: 10.1016/j.psychres.2022.114522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
Several patient and setting characteristics have been found to predict disclosure of suicidality to clinicians versus researchers. Less understood, however, is whether differential disclosure of suicidality predicts concurrent indirect indicators of suicide risk and future suicide-related outcomes. The present study examined differential disclosure of suicidal intent in clinical versus research settings as a predictor of (1) concurrent symptoms of the Suicide Crisis Syndrome (SCS); and (2) suicidal ideation and attempts within one month in patients (n = 1039) and their clinicians (n = 144), who completed a battery of self-report and interview measures at baseline. Patients who reported suicidal intent to anyone had higher concurrent SCS symptoms than those who denied suicidal intent, with no differences between those who reported intent to clinicians versus researchers only. Severity of suicidal ideation and rates of suicide attempts at one-month follow-up were higher among those who disclosed suicidal intent to a research assistant than among those who did not-regardless of whether suicidal intent was disclosed to their clinician. Overall, an improved understanding of the factors contributing to differential disclosure will improve both scientific inquiry and patient safety.
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Cervantes PE, Li A, Sullivan KA, Seag DEM, Baroni A, Horwitz SM. Assessing and Managing Suicide Risk in Autistic Youth: Findings from a Clinician Survey in a Pediatric Psychiatric Emergency Setting. J Autism Dev Disord 2022; 53:1755-1763. [PMID: 35122186 DOI: 10.1007/s10803-022-05448-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 12/14/2022]
Abstract
Suicidal thoughts and behaviors (STB) and emergency department (ED) utilization are prevalent in autistic youth. The current study surveyed clinicians in a pediatric psychiatric ED to examine differences in attitudes on suicide-related care for autistic and non-autistic patient populations. While clinicians rated addressing STB in ASD as important and adaptations to care as necessary, less than half identified ASD as a suicide risk factor and confidence ratings were significantly lower for autistic patients. Previous ASD training predicted confidence and accounted for approximately 25% of the variance in confidence scores. Findings highlight the urgency to develop and disseminate ED clinician training, and address the lack of validated assessment tools, adapted suicide prevention practices, and evidence-based treatments for STB in autistic youth.
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Affiliation(s)
- Paige E Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Annie Li
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.,Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Katherine A Sullivan
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Dana E M Seag
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.,Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
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Rajendran S, Mills PD, Watts BV, Gunnar W. Suicide and Suicide Attempts on Veterans Affairs Medical Center Outpatient Clinic Areas, Common Areas, and Hospital Grounds. J Patient Saf 2022; 18:33-39. [PMID: 33273398 DOI: 10.1097/pts.0000000000000796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Few studies have analyzed suicide deaths and attempts occurring outside inpatient units on other hospital locations. We aimed to quantify and analyze suicide deaths and attempts occurring on Department of Veterans Affairs medical center outpatient clinic areas, common areas, and hospital grounds including parking lots to determine whether a relationship with access to mental health care exists and to elucidate potential mitigation strategies. METHODS We conducted a retrospective review of patient safety report (n = 3,186), root cause analysis (n = 234), and issue brief (n = 2,064) national databases between January 1, 2015, and December 31, 2018, to identify occurrences of suicides and attempts. Correlation between mental health access times and hospital-specific rates of suicides and attempts was assessed. Qualitative analyses of root causes and mitigation strategies were conducted. RESULTS Of 192 reports meeting our location criteria, 42 suicides or attempts occurred in outpatient clinic areas, 39 in common spaces, and 111 on outdoor facility areas. Forty-four reports (23%) pertained to suicides, and 148 (77%) pertained to attempts. The predominate methods were death by firearms (64%) and attempt by drug overdose (38%). We identified a weak yet significant relationship between mental health access times for established patients and rates of on-campus suicides and attempts (r = 0.279, P = 0.0013). CONCLUSIONS Clinical changes including environmental assessments and interventions, staff training on identifying suicide risk characteristics, policy changes toward improving contraband search techniques, and medications risk assessment, as well as timely access to care may be effective mitigation strategies toward preventing suicides of this nature.
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Cervantes PE, Seag DEM, Baroni A, Gerson R, Knapp K, Tay ET, Wiener E, Horwitz SM. Universal Suicide Risk Screening for Youths in the Emergency Department: A Systematic Review. Psychiatr Serv 2022; 73:53-63. [PMID: 34106741 PMCID: PMC8655012 DOI: 10.1176/appi.ps.202000881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To address escalating youth suicide rates, universal suicide risk screening has been recommended in pediatric care settings. The emergency department (ED) is a particularly important setting for screening. However, EDs often fail to identify and treat mental health symptoms among youths, and data on implementation of suicide risk screening in EDs are limited. A systematic review was conducted to describe the current literature on universal suicide risk screening in EDs, identify important gaps in available studies, and develop recommendations for strategies to improve youth screening efforts. METHODS A systematic literature search of PubMed, MEDLINE, CINAHL, PsycINFO, and Web of Science was conducted. Studies focused on universal suicide risk screening of youths served in U.S. EDs that presented screening results were coded, analyzed, and evaluated for reporting quality. Eleven studies were included. RESULTS All screening efforts occurred in teaching or children's hospitals, and research staff administered suicide screens in eight studies. Thus scant information was available on universal screening in pediatric community ED settings. Large variation was noted across studies in participation rates (17%-86%) and in positive screen rates (4.1%-50.8%), although positive screen rates were influenced by type of presenting concern (psychiatric versus nonpsychiatric). Only three studies concurrently examined barriers to screening, providing little direction for effective implementation. STROBE guidelines were used to rate reporting quality, which ranged from 51.9% to 87.1%, with three studies having ratings over 80%. CONCLUSIONS Research is needed to better inform practice guidelines and clinical pathways and to establish sustainable screening programs for youths presenting for care in EDs.
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Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Dana E. M. Seag
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Ruth Gerson
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Katrina Knapp
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY
- Pediatric Emergency Medicine, Bellevue Hospital Center, New York, NY
| | - Ee Tein Tay
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY
- Pediatric Emergency Medicine, Bellevue Hospital Center, New York, NY
| | - Ethan Wiener
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY
- Pediatric Emergency Medicine, Bellevue Hospital Center, New York, NY
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
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Ross V, Mathieu S, Hawgood J, Turner K, Stapelberg NJC, Welch M, Davies A, Sveticic J, Walker S, Kõlves K. Consumer and Carer Perspectives of a Zero Suicide Prevention Program: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10634. [PMID: 34682380 PMCID: PMC8535550 DOI: 10.3390/ijerph182010634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022]
Abstract
This study explored the experiences of healthcare consumers who had recently attempted suicide, and their carers, following placement on a Suicide Prevention Pathway based on the Zero Suicide framework. Qualitative interviews were conducted with 10 consumers and 5 carers using a semi-structured interview schedule. Interviews were transcribed and thematic analysis was applied to identify prominent themes and sub-themes. Three interrelated themes were identified. The first theme was 'Feeling safe and valued' with the associated sub-theme pertaining to perceived stigmatizing treatment and self-stigma. The second was 'Intersection of consumer and staff/organizational needs' with a related sub-theme of time pressure and reduced self-disclosure. The final theme was 'Importance of the 'whole picture', highlighting the relevance of assessing and addressing psychosocial factors when planning for consumer recovery. Overall, consumers and their carers reported a favorable experience of the Suicide Prevention Pathway; however, there were several areas identified for improvement. These included reconciling the time-pressures of a busy health service system, ensuring consumers and carers feel their psychosocial concerns are addressed, and ensuring that adequate rapport is developed. Key to this is ensuring consumers feel cared for and reducing perceptions of stigma.
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Affiliation(s)
- Victoria Ross
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Sharna Mathieu
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Kathryn Turner
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Nicolas J. C. Stapelberg
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Matthew Welch
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Angela Davies
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Jerneja Sveticic
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Sarah Walker
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
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Layman DM, Kammer J, Leckman-Westin E, Hogan M, Goldstein Grumet J, Labouliere CD, Stanley B, Carruthers J, Finnerty M. The Relationship Between Suicidal Behaviors and Zero Suicide Organizational Best Practices in Outpatient Mental Health Clinics. Psychiatr Serv 2021; 72:1118-1125. [PMID: 33730886 PMCID: PMC8853689 DOI: 10.1176/appi.ps.202000525] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study tested the hypothesis that fidelity of clinics to Zero Suicide (ZS) organizational practices is inversely related to suicidal behaviors of patients under clinical care. METHODS Using cross-sectional analyses, the authors examined the fidelity of 110 outpatient mental health clinics to ZS organizational best practices and suicidal behaviors of clinic patients in the year before a large-scale Zero Suicide implementation. Fidelity to ZS organizational best practices was assessed over a 1-year period with an adapted version of the ZS Organizational Self-Study instrument (17 items self-rated on a Likert scale of 1-5). Suicidal behaviors of patients were identified by extracting information on suicide attempts and deaths from a mandated statewide incident-reporting system database. Clinics were dichotomized into any or no suicide incidents during the year of observation. Logistic regression analyses were used to adjust for clinic census and population type (majority child or adult). RESULTS The clinics (N=110) served 30,257 patients per week. Clinics' total average fidelity score was 3.1±0.6 (range=1.41-4.12). For each point increase in fidelity, clinics had a significantly reduced likelihood of having a suicide incident (adjusted odds ratio=0.31, 95% confidence interval=0.14-0.69). Exploratory analysis identified significant differences for seven of 17 ZS organizational practices, with the largest effect sizes for suicide-specific quality improvement policies and activities (η2=0.097) and lethal means reduction (η2=0.073). CONCLUSIONS These findings support an association between clinics' use of ZS organizational best practices and lower suicidal behaviors of patients under their care. Findings also support the validity of the ZS Organizational Self-Study instrument.
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Affiliation(s)
- Deborah M Layman
- New York State Office of Mental Health, New York City (Layman, Finnerty) and Albany (Kammer, Leckman-Westin, Carruthers); Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Hogan); Education Development Center, Waltham, Massachusetts (Goldstein Grumet); New York State Psychiatric Institute and Columbia University, New York City (Labouliere, Stanley)
| | - Jamie Kammer
- New York State Office of Mental Health, New York City (Layman, Finnerty) and Albany (Kammer, Leckman-Westin, Carruthers); Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Hogan); Education Development Center, Waltham, Massachusetts (Goldstein Grumet); New York State Psychiatric Institute and Columbia University, New York City (Labouliere, Stanley)
| | - Emily Leckman-Westin
- New York State Office of Mental Health, New York City (Layman, Finnerty) and Albany (Kammer, Leckman-Westin, Carruthers); Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Hogan); Education Development Center, Waltham, Massachusetts (Goldstein Grumet); New York State Psychiatric Institute and Columbia University, New York City (Labouliere, Stanley)
| | - Mike Hogan
- New York State Office of Mental Health, New York City (Layman, Finnerty) and Albany (Kammer, Leckman-Westin, Carruthers); Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Hogan); Education Development Center, Waltham, Massachusetts (Goldstein Grumet); New York State Psychiatric Institute and Columbia University, New York City (Labouliere, Stanley)
| | - Julie Goldstein Grumet
- New York State Office of Mental Health, New York City (Layman, Finnerty) and Albany (Kammer, Leckman-Westin, Carruthers); Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Hogan); Education Development Center, Waltham, Massachusetts (Goldstein Grumet); New York State Psychiatric Institute and Columbia University, New York City (Labouliere, Stanley)
| | - Christa D Labouliere
- New York State Office of Mental Health, New York City (Layman, Finnerty) and Albany (Kammer, Leckman-Westin, Carruthers); Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Hogan); Education Development Center, Waltham, Massachusetts (Goldstein Grumet); New York State Psychiatric Institute and Columbia University, New York City (Labouliere, Stanley)
| | - Barbara Stanley
- New York State Office of Mental Health, New York City (Layman, Finnerty) and Albany (Kammer, Leckman-Westin, Carruthers); Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Hogan); Education Development Center, Waltham, Massachusetts (Goldstein Grumet); New York State Psychiatric Institute and Columbia University, New York City (Labouliere, Stanley)
| | - Jay Carruthers
- New York State Office of Mental Health, New York City (Layman, Finnerty) and Albany (Kammer, Leckman-Westin, Carruthers); Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Hogan); Education Development Center, Waltham, Massachusetts (Goldstein Grumet); New York State Psychiatric Institute and Columbia University, New York City (Labouliere, Stanley)
| | - Molly Finnerty
- New York State Office of Mental Health, New York City (Layman, Finnerty) and Albany (Kammer, Leckman-Westin, Carruthers); Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Hogan); Education Development Center, Waltham, Massachusetts (Goldstein Grumet); New York State Psychiatric Institute and Columbia University, New York City (Labouliere, Stanley)
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Hung P, Shih YW, Brown MJ, Crouch E. Suicide Prevention Programs Across U.S. Outpatient Mental Health Care Settings: Differences by Facility Ownership. Psychiatr Serv 2021; 72:998-1005. [PMID: 33657840 DOI: 10.1176/appi.ps.202000203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to examine whether facility ownership (public, private nonprofit, private for-profit ownership) was associated with provision of suicide prevention programs. METHODS A retrospective cross-sectional study identified self-reported suicide prevention program status across 7,597 mental health facilities with outpatient settings by using data from the 2019 Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Services Locator. Multivariable logistic regression models examined whether facility ownership was associated with availability of these programs. RESULTS In 2019, only 61.2% of facilities provided outpatient suicide prevention programs. Higher odds of program provision were associated with public ownership (adjusted odds ratio [AOR]=1.64, 95% confidence interval [CI]=1.37-1.97, p<0.001), facilities serving young adults (AOR=2.16, 95% CI=1.66-2.82, p<0.001) or serving seniors (AOR=1.44, 95% CI=1.27-1.63, p<0.001), and facilities accepting Medicare (AOR=1.34, 95% CI=1.16-1.53, p<0.001), compared with their counterparts, with significant differences across facility ownership types by rurality of locations. Facilities accepting uninsured patients (AOR=0.81, 95% CI=0.68-0.98, p=0.027) or Medicaid patients (AOR=0.76, 95% CI=0.62-0.92, p=0.006) had lower odds of providing these programs. CONCLUSIONS Facility ownership contributed to significantly different decisions on provision of outpatient suicide prevention programs. Maldistribution of these services should raise concerns, given nationwide efforts to prevent suicide and weak ownership regulations for mental health facilities. Understanding barriers and facilitators for deployment of these programs may improve access to suicide prevention services for all, especially for eligible patients in rural areas.
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Affiliation(s)
- Peiyin Hung
- Department of Health Services Policy and Management (Hung, Shih, Crouch), Department of Epidemiology and Biostatistics (Brown), and Rural and Minority Health Research Center (Hung, Brown, Crouch), University of South Carolina Arnold School of Public Health, Columbia
| | - Yi-Wen Shih
- Department of Health Services Policy and Management (Hung, Shih, Crouch), Department of Epidemiology and Biostatistics (Brown), and Rural and Minority Health Research Center (Hung, Brown, Crouch), University of South Carolina Arnold School of Public Health, Columbia
| | - Monique J Brown
- Department of Health Services Policy and Management (Hung, Shih, Crouch), Department of Epidemiology and Biostatistics (Brown), and Rural and Minority Health Research Center (Hung, Brown, Crouch), University of South Carolina Arnold School of Public Health, Columbia
| | - Elizabeth Crouch
- Department of Health Services Policy and Management (Hung, Shih, Crouch), Department of Epidemiology and Biostatistics (Brown), and Rural and Minority Health Research Center (Hung, Brown, Crouch), University of South Carolina Arnold School of Public Health, Columbia
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Solin P, Tamminen N, Partonen T. Suicide prevention training: self-perceived competence among primary healthcare professionals. Scand J Prim Health Care 2021; 39:332-338. [PMID: 34340646 PMCID: PMC8475147 DOI: 10.1080/02813432.2021.1958462] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: The aim is to report the outcomes of the suicide prevention training in terms of the self-perceived impact on the participants.Design: The three-hour training consisted areas of risk and protective factors, screening and evaluating suicide risk, raising concerns and confronting suicidal patients, and treating suicidal ideation in primary healthcare and the associated referral processes.Subjects: The studied participants consisted of general practitioners, nurses, public health nurses and social work professionals.Main outcome measures: Participants assessed their own competence on online form regarding four training areas prior to and two weeks after the training.Results: The response rate was 25%. The self-perceived competence of the healthcare professionals increased in all training areas and in all occupational groups. The healthcare professionals' competence regarding the risk and protective factors training area saw the greatest increase across all professional groups except nurses. There were, however, differences between the groups.Conclusion: Suicide prevention training for primary healthcare professionals did increase the self-perceived competence of the participants in all areas covered by the training. Regular follow-up training is required in order for these improvements to be further developed and retained.Key pointsAfter the suicide prevention training all participants self-perceived increase in their competence in all training areas.The GPs self-perceived most increase in risk and protective factors and nurses in raising concerns and confronting suicidal patients.The GPs' lowest increase was in the area of treating suicidal ideation in primary health care and the referral processes.
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Affiliation(s)
- Pia Solin
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- CONTACT Pia Solin Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki00271, Finland
| | - Nina Tamminen
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Timo Partonen
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Stapelberg NJC, Sveticic J, Hughes I, Almeida-Crasto A, Gaee-Atefi T, Gill N, Grice D, Krishnaiah R, Lindsay L, Patist C, Engelen HV, Walker S, Welch M, Woerwag-Mehta S, Turner K. Efficacy of the Zero Suicide framework in reducing recurrent suicide attempts: cross-sectional and time-to-recurrent-event analyses. Br J Psychiatry 2021; 219:427-436. [PMID: 33176895 DOI: 10.1192/bjp.2020.190] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The Zero Suicide framework is a system-wide approach to prevent suicides in health services. It has been implemented worldwide but has a poor evidence-base of effectiveness. AIMS To evaluate the effectiveness of the Zero Suicide framework, implemented in a clinical suicide prevention pathway (SPP) by a large public mental health service in Australia, in reducing repeated suicide attempts after an index attempt. METHOD A total of 604 persons with 737 suicide attempt presentations were identified between 1 July and 31 December 2017. Relative risk for a subsequent suicide attempt within various time periods was calculated using cross-sectional analysis. Subsequently, a 10-year suicide attempt history (2009-2018) for the cohort was used in time-to-recurrent-event analyses. RESULTS Placement on the SPP reduced risk for a repeated suicide attempt within 7 days (RR = 0.29; 95% CI 0.11-0.75), 14 days (RR = 0.38; 95% CI 0.18-0.78), 30 days (RR = 0.55; 95% CI 0.33-0.94) and 90 days (RR = 0.62; 95% CI 0.41-0.95). Time-to-recurrent event analysis showed that SPP placement extended time to re-presentation (HR = 0.65; 95% CI 0.57-0.67). A diagnosis of personality disorder (HR = 2.70; 95% CI 2.03-3.58), previous suicide attempt (HR = 1.78; 95% CI 1.46-2.17) and Indigenous status (HR = 1.46; 95% CI 0.98-2.25) increased the hazard for re-presentation, whereas older age decreased it (HR = 0.92; 95% CI 0.86-0.98). The effect of the SPP was similar across all groups, reducing the risk of re-presentation to about 65% of that seen in those not placed on the SPP. CONCLUSIONS This paper demonstrates a reduction in repeated suicide attempts after an index attempt and a longer time to a subsequent attempt for those receiving multilevel care based on the Zero Suicide framework.
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Affiliation(s)
- Nicolas J C Stapelberg
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland; and Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jerneja Sveticic
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ian Hughes
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Alice Almeida-Crasto
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Taralina Gaee-Atefi
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Neeraj Gill
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland; and School of Medicine, Griffith University, Gold Coast, Queensland,Australia
| | - Diana Grice
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ravikumar Krishnaiah
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Luke Lindsay
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Carla Patist
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Heidy Van Engelen
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Sarah Walker
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Matthew Welch
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Sabine Woerwag-Mehta
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland; and Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland,Australia
| | - Kathryn Turner
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
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Pruitt Z, Chapin KP, Eakin H, Glover AL. Telehealth During COVID-19: Suicide Prevention and American Indian Communities in Montana. Telemed J E Health 2021; 28:325-333. [PMID: 34085870 PMCID: PMC8968828 DOI: 10.1089/tmj.2021.0104] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Public health measures that prevent the spread of COVID-19, such as social distancing, may increase the risk for suicide among American Indians due to decreased social connectedness that is crucial to wellbeing. Telehealth represents a potential solution, but barriers to effective suicide prevention may exist. Materials and Methods: In collaboration with Tribal and Urban Indian Health Center providers, this study measured suicide prevention practices during COVID-19. A 44-item Likert-type, web-based survey was distributed to Montana-based professionals who directly provide suicide prevention services to American Indians at risk for suicide. Descriptive statistics were calculated for survey items, and Mann–Whitney U tests examined the differences in telehealth use, training, skills among Montana geographic areas, and barriers between providers and their clients/patients. Results: Among the 80 respondents, two-thirds agreed or strongly agreed that American Indians experienced greater social disconnection since the COVID-19 pandemic began. Almost 98% agreed that telehealth was needed, and 93% were willing to use telehealth for suicide prevention services. Among current users, 75% agreed telehealth was effective for suicide prevention. Over one-third of respondents reported using telehealth for the first time during COVID-19 pandemic, and 30% use telehealth at least “usually” since the COVID-19 pandemic began, up from 6.3%. Compared with their own experiences, providers perceive their American Indian client/patients as experiencing greater barriers to telehealth. Discussion: Telehealth was increasingly utilized for suicide prevention during the COVID-19 pandemic. Opportunities to improve telehealth access should be explored, including investments in telehealth technologies for American Indians at risk for suicide.
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Affiliation(s)
- Zachary Pruitt
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Kate P Chapin
- Center for Children, Families, and Workforce Development, University of Montana Missoula, Missoula, Montana, USA
| | - Haley Eakin
- Center for Children, Families, and Workforce Development, University of Montana Missoula, Missoula, Montana, USA
| | - Annie L Glover
- Center for Children, Families, and Workforce Development, University of Montana Missoula, Missoula, Montana, USA
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Dabkowski E, Porter JE. An exploration into suicide prevention initiatives for mental health nurses: A systematic literature review. Int J Ment Health Nurs 2021; 30:610-623. [PMID: 33856744 DOI: 10.1111/inm.12872] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
Mental health and suicide prevention are national health priorities in Australia, with research currently focussed towards the ZERO Suicide (ZS) initiative. The aim of this review was to evaluate the impact of suicide prevention programmes, in particular the ZS prevention initiative. A systematic review using the PRISMA guidelines was conducted using six EBSCO Host databases; Academic Search Complete, Australian/New Zealand Reference Centre, CINAHL Complete, MEDLINE, APA PsycINFO, and APA Psyc Articles. The data extracted from the eligible papers were analysed using a thematic approach. The final data set consisted of fourteen (n = 14) peer-reviewed articles meeting the eligibility criteria, which included quantitative (n = 10), mixed methods (n = 2), and qualitative studies (n = 2). Results indicated variances between suicide prevention programmes with some papers examining single workshops and others assessing multimodal, organizational interventions. Five major themes were produced from this review including measuring the success of suicide prevention programmes, improvements to the delivery of suicide prevention programmes, barriers to implementing changes, cultural considerations, and further research required for suicide prevention programmes. This review concludes that further long-term research is required to evaluate the implementation and efficacy of suicide prevention programmes in health care. Cultural awareness in suicide prevention training is another area that may benefit from further research. A growing body of evidence establishes the need for multimodal and organizational approaches for suicide prevention initiatives.
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Affiliation(s)
- Elissa Dabkowski
- Collaborative Evaluation Unit, School of Health, Federation University Australia, Churchill, Victoria, Australia
| | - Joanne E Porter
- Collaborative Evaluation Unit, School of Health, Federation University Australia, Churchill, Victoria, Australia
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Thapa P, Lama S, Pradhan N, Thapa K, Kumar R, Basnet M. Attitude Towards Suicide among Caregivers of Patients Admitted with Suicide Attempt to a Tertiary Care Hospital: A Descriptive Cross-sectional Study. ACTA ACUST UNITED AC 2021; 59:374-379. [PMID: 34508530 PMCID: PMC8369585 DOI: 10.31729/jnma.6246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022]
Abstract
Introduction: Understanding the attitude of caregivers towards suicide attempters could be useful in suicide prevention. The objective of this study was to study attitude towards suicide among caregivers of patients with suicide attempt admitted to a tertiary care hospital in Nepal. Methods: A descriptive cross-sectional study was conducted with 52 caregivers of patients with suicide attempt who had been admitted to a tertiary care hospital of Nepal after obtaining ethical clearance from Institutional Review Committee (ref. IRC/0797/016). Data were collected through interviews using the Attitude towards Suicide Questionnaire and in-depth interviews conducted on five caregivers using the interview framework developed in the department for the purpose. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Content analysis was used for qualitative data. Results: Majority of the caregivers 34 (65.4%) had unfavorable attitude towards suicide. Caregivers reported that mental and chronic physical illness, financial difficulty, working environment, and social factors such as undue pressure and failure to perform the task, difficulty maintaining the relationship, abuse, and neglect could be some of the possible causes of suicide. Caring and understanding attitude of family members, health professionals, and society towards the suicidal individuals providing appropriate training and education to the public would help in reducing the stigma and burden of suicidal patients. Conclusions: The overall attitude of the caregivers was unfavorable. Interventions targeted towards improving attitude towards suicide could be helpful in suicide prevention.
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Affiliation(s)
- Prekshya Thapa
- Department of Psychiatric Nursing, College of Nursing, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sami Lama
- Department of Psychiatric Nursing, College of Nursing, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nirmala Pradhan
- Department of Psychiatric Nursing, College of Nursing, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kriti Thapa
- Department of Psychiatric Nursing, College of Nursing, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajesh Kumar
- Department of Psychiatry, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Madhur Basnet
- Department of Psychiatry, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
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Kammer J, Rahman M, Finnerty M, Layman D, Vega K, Galfalvy H, Labouliere C, Brown GK, Green K, Cummings A, Vasan P, Stanley B. Most Individuals Are Seen in Outpatient Medical Settings Prior to Intentional Self-Harm and Suicide Attempts Treated in a Hospital Setting. J Behav Health Serv Res 2021; 48:306-319. [PMID: 32627095 PMCID: PMC7782208 DOI: 10.1007/s11414-020-09717-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this quantitative retrospective study is to understand healthcare patterns prior to self-harm, which may inform prevention efforts and identify intervention sites. Medicaid claims within 30, 60, 90, and 365 days prior to hospital-treated self-harm between 11/1/2015 and 11/1/2016 in New York State (N = 7492) were examined. Numbers and proportions were calculated for all service types. Participants were predominately 15-34, female, and White. Most (97%) had prior-year services, 94% outpatient care (73% behavioral health, 90% medical), 69% emergency department (37% behavioral health, 59% medical), and 42% inpatient services (34% behavioral health, 20% medical). About 86% received services within 90 days and 80% within 60 days. Utilization was high within 30 days prior, with 69% having one or more services. Medical services were more common than behavioral health (94% versus 79% in prior year); outpatient (94%) was more common than emergency (69%) and inpatient (42%) care. Given that most patients received health services within 30 days and almost all saw providers within the year prior, the findings indicate that improved prevention efforts within the healthcare system can reduce the incidence of self-harm.
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Affiliation(s)
- Jamie Kammer
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA.
| | - Mahfuza Rahman
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Molly Finnerty
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Deborah Layman
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Katrina Vega
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Hanga Galfalvy
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA
- Columbia University Irving Medical Center, 630 W. 168th St., New York, NY, 10032, USA
| | - Christa Labouliere
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA
- Columbia University Irving Medical Center, 630 W. 168th St., New York, NY, 10032, USA
| | - Gregory K Brown
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Philadelphia, PA, 19104-3309, USA
| | - Kelly Green
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Philadelphia, PA, 19104-3309, USA
| | - Anni Cummings
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Prabu Vasan
- New York State Office of Mental Health, 75 New Scotland Ave., Albany, NY, 12208, USA
| | - Barbara Stanley
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA
- Columbia University Irving Medical Center, 630 W. 168th St., New York, NY, 10032, USA
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Graure EW, Colborn VA, Miller AM, Jobes DA. An Archival Study of Suicide Status Form Responses Among Crisis Stabilization Center Consumers. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021. [DOI: 10.1007/s10879-021-09491-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Harris BR, Tracy M, Comber KG, Pechenik S, Carruthers JW. Suicide safer care in behavioral health settings: A comparative analysis of perceptions, training completion, and practice between mental health and substance use disorder treatment providers. J Subst Abuse Treat 2021; 126:108330. [PMID: 34116821 DOI: 10.1016/j.jsat.2021.108330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/02/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite prevention and treatment efforts, opioid overdose deaths continue to rise in the United States and totaled 46,802 in 2018. This public health crisis is closely linked with suicide, with those who misuse opioids at six times the risk of death by suicide. Suicide prevention in substance use disorder (SUD) treatment may be a critical step in saving lives and promoting recovery among those at risk for opioid overdose. METHODS We distributed an electronic survey to clinicians in mental health and SUD treatment in nine health systems across New York State from November 2018 to January 2019. The goal of the survey was to assess attitudes, perceptions, practice, and training needs among SUD treatment providers and how they differ from those of mental health providers. RESULTS A total of 633 clinicians responded to the survey (62.4% response rate). Seventy-one percent of SUD providers reported working with a client who attempted suicide. Even so, less than half of SUD providers reported routinely screening new (48.9%) or existing patients (25.6%) for suicidal thoughts/behaviors; overall, 28.4% of SUD providers reported low levels of action to address suicide risk, compared to 9.0% of mental health providers (p < 0.001). Perceived self-efficacy and effectiveness at reducing a patient's risk of suicide and training completion were strongly associated with routine delivery of suicide safer care in adjusted logistic regression models. CONCLUSIONS The results of this study identify key areas for targeted training and technical assistance to increase the provision of quality suicide safer care in SUD treatment.
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Affiliation(s)
- Brett R Harris
- University at Albany School of Public Health, One University Place, Rensselaer, NY 12144, USA.
| | - Melissa Tracy
- University at Albany School of Public Health, One University Place, Rensselaer, NY 12144, USA.
| | - Katharine G Comber
- New York State Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, USA.
| | - Sigrid Pechenik
- New York State Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, USA.
| | - Jay W Carruthers
- New York State Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, USA.
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Pontes NMH, Ayres C, Wunnenberg M, Pontes MCF. Gender differences in the relationship between prescription opioid misuse and depressive symptoms and suicidality among US High School Students. Nurs Outlook 2021; 69:641-651. [PMID: 33579512 DOI: 10.1016/j.outlook.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 11/29/2020] [Accepted: 01/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prescription opioid misuse and suicide among adolescents are significant health challenges. PURPOSE This study investigated whether effects of prescription opioid misuse on depressive symptoms and suicidality are greater among female than male students. METHODS Using the 2017 Youth Risk Behavior Survey (N = 14,765), this research estimated additive interactions using risk differences as well as multiplicative interactions using odds ratios. DISCUSSION Results showed prescription opioid misuse was associated with significantly greater risks among females than males for depressive symptoms (31.1% vs. 20.8%), suicidal ideation (27.3% vs. 19.1%), suicide attempts (18.1% vs. 11.9%) and suicide attempts requiring treatment (8.5% vs. 4.4%). In contrast, multiplicative interactions using odds ratios were all nonsignificant. CONCLUSIONS Among students who misused prescription opioids, females compared to males had much higher average predicted margins of depressive symptoms, suicidal ideation, suicide attempts, and suicide attempts requiring treatment. Screening for depression and suicidality among adolescents who misuse prescription opioids, and vice versa, is paramount.
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Edgcomb JB, Thiruvalluru R, Pathak J, Brooks JO. Machine Learning to Differentiate Risk of Suicide Attempt and Self-harm After General Medical Hospitalization of Women With Mental Illness. Med Care 2021; 59:S58-S64. [PMID: 33438884 PMCID: PMC7810157 DOI: 10.1097/mlr.0000000000001467] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Suicide prevention is a public health priority, but risk factors for suicide after medical hospitalization remain understudied. This problem is critical for women, for whom suicide rates in the United States are disproportionately increasing. OBJECTIVE To differentiate the risk of suicide attempt and self-harm following general medical hospitalization among women with depression, bipolar disorder, and chronic psychosis. METHODS We developed a machine learning algorithm that identified risk factors of suicide attempt and self-harm after general hospitalization using electronic health record data from 1628 women in the University of California Los Angeles Integrated Clinical and Research Data Repository. To assess replicability, we applied the algorithm to a larger sample of 140,848 women in the New York City Clinical Data Research Network. RESULTS The classification tree algorithm identified risk groups in University of California Los Angeles Integrated Clinical and Research Data Repository (area under the curve 0.73, sensitivity 73.4, specificity 84.1, accuracy 0.84), and predictor combinations characterizing key risk groups were replicated in New York City Clinical Data Research Network (area under the curve 0.71, sensitivity 83.3, specificity 82.2, and accuracy 0.84). Predictors included medical comorbidity, history of pregnancy-related mental illness, age, and history of suicide-related behavior. Women with antecedent medical illness and history of pregnancy-related mental illness were at high risk (6.9%-17.2% readmitted for suicide-related behavior), as were women below 55 years old without antecedent medical illness (4.0%-7.5% readmitted). CONCLUSIONS Prevention of suicide attempt and self-harm among women following acute medical illness may be improved by screening for sex-specific predictors including perinatal mental health history.
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Affiliation(s)
- Juliet B Edgcomb
- Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rohith Thiruvalluru
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | - Jyotishman Pathak
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | - John O Brooks
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
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Landes SJ, Jegley SM, Kirchner JE, Areno JP, Pitcock JA, Abraham TH, McBain SA, Singh RS, Bollinger MJ, Painter J, Woods JA, Curtis ND, Jones DE, Matarazzo BB, Reger MA, Comtois KA. Adapting Caring Contacts for Veterans in a Department of Veterans Affairs Emergency Department: Results From a Type 2 Hybrid Effectiveness-Implementation Pilot Study. Front Psychiatry 2021; 12:746805. [PMID: 34721114 PMCID: PMC8548725 DOI: 10.3389/fpsyt.2021.746805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/13/2021] [Indexed: 12/02/2022] Open
Abstract
Transitions in care, such as discharge from an emergency department (ED), are periods of increased risk for suicide and effective interventions that target these periods are needed. Caring Contacts is an evidence-based suicide prevention intervention that targets transitions, yet it has not been widely implemented. This pilot study adapted Caring Contacts for a Department of Veterans Affairs (VA) ED setting and population, created an implementation toolkit, and piloted implementation and evaluation of effectiveness. To inform adaptation, qualitative interviews were conducted with stakeholders. Data were used by an advisory board comprised of stakeholders, experts, and veterans to make adaptations and develop an implementation planning guide to delineate steps needed to implement. Key decisions about how to adapt Caring Contacts included recipients, author, content, and the schedule for sending. Pilot implementation occurred at one VA ED. Caring Contacts involved sending patients at risk of suicide brief, non-demanding expressions of care. Program evaluation of the pilot used a type 2 hybrid effectiveness-implementation design to both pilot an implementation strategy and evaluate effectiveness of Caring Contacts. Evaluation included qualitative interviews with veteran patients during implementation. VA electronic health records were used to evaluate VA service utilization in the 6-month periods immediately before and after veterans were delivered their first Caring Contact. Hundred and seventy-five veterans were mailed Caring Contacts and the facility continued adoption after the pilot. Participants were positive about the intervention and reported feeling cared about and connected to VA as a result of receiving Caring Contacts. This project developed an implementation planning process that successfully implemented Caring Contacts at one site. This can be used to further implement Caring Contacts at additional VA or community EDs.
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Affiliation(s)
- Sara J Landes
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Susan M Jegley
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - JoAnn E Kirchner
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - John P Areno
- South Central VA Health Care Network, Ridgeland, MS, United States
| | - Jeffery A Pitcock
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Traci H Abraham
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Sacha A McBain
- South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - R Sonia Singh
- South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mary J Bollinger
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Jacob Painter
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Jack A Woods
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Nyssa D Curtis
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Donald E Jones
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Bridget B Matarazzo
- Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States.,Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, CO, United States
| | - Mark A Reger
- VA Puget Sound Health Care System, Tacoma, WA, United States
| | - Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
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50
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Richards JE, Simon GE, Boggs JM, Beidas R, Yarborough BJH, Coleman KJ, Sterling SA, Beck A, Flores JP, Bruschke C, Grumet JG, Stewart CC, Schoenbaum M, Westphal J, Ahmedani BK. An implementation evaluation of "Zero Suicide" using normalization process theory to support high-quality care for patients at risk of suicide. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34447940 PMCID: PMC8384258 DOI: 10.1177/26334895211011769] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Suicide rates continue to rise across the United States, galvanizing the need for increased suicide prevention and intervention efforts. The Zero Suicide (ZS) model was developed in response to this need and highlights four key clinical functions of high-quality health care for patients at risk of suicide. The goal of this quality improvement study was to understand how six large health care systems operationalized practices to support these functions-identification, engagement, treatment and care transitions. Methods Using a key informant interview guide and data collection template, researchers who were embedded in each health care system cataloged and summarized current and future practices supporting ZS, including, (1) the function addressed; (2) a description of practice intent and mechanism of intervention; (3) the target patient population and service setting; (4) when/how the practice was (or will be) implemented; and (5) whether/how the practice was documented and/or measured. Normalization process theory (NPT), an implementation evaluation framework, was applied to help understand how ZS had been operationalized in routine clinical practices and, specifically, what ZS practices were described by key informants (coherence), the current state of norms/conventions supporting these practices (cognitive participation), how health care teams performed these practices (collective action), and whether/how practices were measured when they occurred (reflexive monitoring). Results The most well-defined and consistently measured ZS practices (current and future) focused on the identification of patients at high risk of suicide. Stakeholders also described numerous engagement and treatment practices, and some practices intended to support care transitions. However, few engagement and transition practices were systematically measured, and few treatment practices were designed specifically for patients at risk of suicide. Conclusions The findings from this study will support large-scale evaluation of the effectiveness of ZS implementation and inform recommendations for implementation of high-quality suicide-related care in health care systems nationwide.
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Affiliation(s)
- Julie E Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Rinad Beidas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | | | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Jean P Flores
- Care Management Institute, Kaiser Permanente, Oakland, CA, USA
| | | | | | | | - Michael Schoenbaum
- Division of Services and Intervention Research, National Institute of Mental Health, Rockville, MD, USA
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
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