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Gomes KD, Collette TL, Schlenk M, Judkins J, Sanchez-Cardona I, Channer B, Ross P, Fredrick G, Moore BA. Posttraumatic Stress Disorder, Suicidal ideation, and Stress: The Moderating Role of Dysfunctional and Recovery Cognitions. Arch Suicide Res 2024; 28:569-584. [PMID: 37073774 DOI: 10.1080/13811118.2023.2199798] [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: 04/20/2023]
Abstract
OBJECTIVE Trauma and stressor-related behavioral health conditions are prevalent in military populations and have become a major public health concern in recent years. Individuals who commonly report suicidal ideation often have comorbid mental health diagnoses (i.e., posttraumatic stress disorder; PTSD). However, the mechanisms associated with stress, suicidal ideation, and PTSD are unclear. METHOD The present study examined the moderating role of dysfunctional and recovery cognitions between (i) PTSD and suicidal ideation, and (ii) stress and suicidal ideation in two distinct samples. Sample 1 was composed of civilians and military personnel (N = 322). Sample 2 was composed of (N = 377) student service members and veterans (SSM/Vs). RESULTS In Study 1, we found that low recovery cognitions at higher and moderate levels of PTSD symptoms were significantly associated with increased suicidal ideation. High dysfunctional cognitions were significantly associated with suicidal ideation at higher levels of PTSD symptoms. In Study 2, we found no differences in any level of recovery cognitions at low and moderate stress levels with suicidal ideation. Higher levels of stress were associated with high dysfunctional cognitions and suicidal ideation. CONCLUSION Promoting higher levels of recovery cognitions and reducing dysfunctional cognitions are important in addressing stress, suicidal ideation, and comorbid conditions such as PTSD. Future research should focus on examining the clinical utility of the Dispositional Recovery and Dysfunction Inventory (DRDI) in other populations (i.e., firefighters and paramedics). This could contribute to efforts of suicide prevention and the promotion of the well-being of individuals experiencing suicidal ideation.
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Krupnik V, Danilova N. To be or not to be: The active inference of suicide. Neurosci Biobehav Rev 2024; 157:105531. [PMID: 38176631 DOI: 10.1016/j.neubiorev.2023.105531] [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: 09/12/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024]
Abstract
Suicide presents an apparent paradox as a behavior whose motivation is not obvious since its outcome is non-existence and cannot be experienced. To address this paradox, we propose to frame suicide in the integrated theory of stress and active inference. We present an active inference-based cognitive model of suicide as a type of stress response hanging in cognitive balance between predicting self-preservation and self-destruction. In it, self-efficacy emerges as a meta-cognitive regulator that can bias the model toward either survival or suicide. The model suggests conditions under which cognitive homeostasis can override physiological homeostasis in motivating self-destruction. We also present a model proto-suicidal behavior, programmed cell death (apoptosis), in active inference terms to illustrate how an active inference model of self-destruction can be embodied in molecular mechanisms and to offer a hypothesis on another puzzle of suicide: why only humans among brain-endowed animals are known to practice it.
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Affiliation(s)
- Valery Krupnik
- Department of Mental Health, Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA.
| | - Nadia Danilova
- Department of Cell Biology, UCLA (retired), Los Angeles, CA, USA
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Kelly LM, Alessi SM, Rash CJ, Zajac K. Predictors of Suicidal Ideation and Continued Substance Use Problems Among Patients Receiving Methadone Maintenance Treatment Who Have Co-Occurring Cocaine Use Disorder. Subst Use Misuse 2024; 59:752-762. [PMID: 38225874 PMCID: PMC10962756 DOI: 10.1080/10826084.2024.2302131] [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: 01/17/2024]
Abstract
BACKGROUND Persons with polysubstance use problems are at high suicide risk, which may complicate substance use treatment. The purpose of this study was to a) examine cross-sectional and longitudinal risk factors for suicidality among persons in methadone maintenance treatment who present with co-occurring cocaine use disorder and b) evaluate whether suicidality impacts substance use outcomes independently and differentially depending on treatment type (i.e. standard methadone care [SC] vs. contingency management plus standard care [CM + SC]). METHODS Data come from five randomized controlled trials of CM conducted within methadone clinics (N = 562). Participants were categorized (mutually exclusive) as no history of suicidality (56.4%, n=317), past suicidal ideation (SI; 11%, n=62), recent SI (3.6%, n=20), or lifetime suicide attempt (29%, n=163). RESULTS Suicidality groups differed by sex and baseline employment, income, trauma history, and psychosocial functioning. Suicide attempt history was positively associated with years of polysubstance use, prior drug treatments, and unintentional overdose history. Baseline psychological problem severity and emotional abuse history were associated with SI likelihood 12 weeks later. Past SI was associated with longer durations of abstinence than no suicidality. Unexpectedly, those with recent SI reported lower drug use severity at 12 week if they received SC compared to CM + SC. Effects were small to medium. CONCLUSIONS Despite greater polysubstance use history, patients with suicide attempts did not show worse substance use outcomes than persons without suicidality. Patients with past SI fared better than those without suicidality on abstinence over 12 wk. Methadone clinics could be key points of entrance and continued services for suicide prevention.
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Affiliation(s)
- Lourah M. Kelly
- University of Massachusetts Chan Medical School
- University of Connecticut School of Medicine
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Bai P. Application and Mechanisms of Internet-Based Cognitive Behavioral Therapy (iCBT) in Improving Psychological State in Cancer Patients. J Cancer 2023; 14:1981-2000. [PMID: 37497400 PMCID: PMC10367931 DOI: 10.7150/jca.82632] [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: 01/13/2023] [Accepted: 04/18/2023] [Indexed: 07/28/2023] Open
Abstract
This review article is an overview of the effectiveness of internet-based cognitive behavioral therapy (iCBT) in Improving Psychological State in Cancer Patients. iCBT's effectiveness has been investigated in treating and managing conditions like depression, psychiatric disorders, generalized anxiety disorder (GAD), panic disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), adjustment disorder, bipolar disorder, chronic pain, and phobias. iCBT's role in the treatment of medical conditions such as diabetes mellitus with comorbid psychiatric illnesses was also explored. We conducted a thorough literature search using PubMed, Embase, Google Scholar, and Wanfang with no restrictions on the date. iCBT's role in treating and controlling psychiatric illnesses in cancer patients has been established in the literature. Development and popularization of iCBT, treament forms of iCBT, platforms for iCBT, application of iCBT, strategies and efficacy of iCBT for insomnia in cancer patients, current status of iCBT application, and genetic researches on iCBT for anxiety disorders were all reviewed and discussed in this review. From the data compiled, we conclude that iCBT is useful in treating or improving psychological state in cancer patients.
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Affiliation(s)
- Ping Bai
- Department of Operating Rooms, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Operating Rooms, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, 065001, China
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Peters S, Awenat Y, Gooding PA, Harris K, Cook L, Huggett C, Jones S, Lobban F, Pratt D, Haddock G. What is important to service users and staff when implementing suicide-focused psychological therapies for people with psychosis into mental health services? Front Psychiatry 2023; 14:1154092. [PMID: 37252139 PMCID: PMC10213358 DOI: 10.3389/fpsyt.2023.1154092] [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: 01/30/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Suicide is a leading cause of death globally. People with psychosis are at increased risk of suicide death and up to half experience suicidal thoughts and/or engage in suicidal behaviors in their lifetime. Talking therapies can be effective in alleviating suicidal experiences. However, research is yet to be translated into practice, demonstrating a gap in service provision. The barriers and facilitators in therapy implementation require a thorough investigation including the perspectives of different stakeholders such as service users and mental health professionals. This study aimed to investigate stakeholders' (health professionals and service users) perspectives of implementing a suicide-focused psychological therapy for people experiencing psychosis in mental health services. Methods Face-to-face, semi-structured interviews with 20 healthcare professionals and 18 service users were conducted. Interviews were audio recorded and transcribed verbatim. Data were analyzed and managed using reflexive thematic analysis and NVivo software. Results For suicide-focused therapy to be successfully implemented in services for people with psychosis, there are four key aspects that need to be considered: (i) Creating safe spaces to be understood; (ii) Gaining a voice; (iii) Accessing therapy at the right time; and (iv) Ensuring a straightforward pathway to accessing therapy. Discussion Whilst all stakeholders viewed a suicide-focused therapy as valuable for people experiencing psychosis, they also recognize that enabling successful implementation of such interventions will require additional training, flexibility, and resources to existing services.
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Affiliation(s)
- Sarah Peters
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Manchester Centre for Health Psychology, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Yvonne Awenat
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
| | - Patricia A. Gooding
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kamelia Harris
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Leanne Cook
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Charlotte Huggett
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Steven Jones
- Lancashire and South Cumbria NHS Foundation Trust, Lancashire, United Kingdom
- Department of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Fiona Lobban
- Lancashire and South Cumbria NHS Foundation Trust, Lancashire, United Kingdom
- Department of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Melhem N, Moutier CY, Brent DA. Implementing Evidence-Based Suicide Prevention Strategies for Greatest Impact. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:117-128. [PMID: 37201145 PMCID: PMC10172552 DOI: 10.1176/appi.focus.20220078] [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
Suicide remains a leading cause of death in the United States and globally. In this review, epidemiological trends in mortality and suicide risk are presented, with consideration given to the impact of the COVID-19 pandemic. A public health model of suicide prevention with a community and clinical framework, along with advances in scientific discovery, offer new solutions that await widespread implementation. Actionable interventions with evidence for reducing risk for suicidal behavior are presented, including universal and targeted strategies at community, public policy, and clinical levels. Clinical interventions include screening and risk assessment; brief interventions (e.g., safety planning, education, and lethal means counseling) that can be done in primary care, emergency, and behavioral health settings; psychotherapies (cognitive-behavioral, dialectical behavior, mentalization therapy); pharmacotherapy; and systemwide procedures for health care organizations (training, policies, workflow, surveillance of suicide indicators, use of health records for screening, care steps). Suicide prevention strategies must be prioritized and implemented at scale for greatest impact.
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Affiliation(s)
- Nadine Melhem
- Department of Psychiatry (Melhem), Department of Clinical and Translational Science (Melhem, Brent), and Departments of Pediatric Psychiatry, Epidemiology, and Suicide Studies (Brent), University of Pittsburgh, Pittsburgh; American Foundation for Suicide Prevention, New York (Moutier)
| | - Christine Yu Moutier
- Department of Psychiatry (Melhem), Department of Clinical and Translational Science (Melhem, Brent), and Departments of Pediatric Psychiatry, Epidemiology, and Suicide Studies (Brent), University of Pittsburgh, Pittsburgh; American Foundation for Suicide Prevention, New York (Moutier)
| | - David A Brent
- Department of Psychiatry (Melhem), Department of Clinical and Translational Science (Melhem, Brent), and Departments of Pediatric Psychiatry, Epidemiology, and Suicide Studies (Brent), University of Pittsburgh, Pittsburgh; American Foundation for Suicide Prevention, New York (Moutier)
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Suicide Preventive Interventions and Knowledge. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:178-179. [PMID: 37201137 PMCID: PMC10172550 DOI: 10.1176/appi.focus.23021002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
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Acolin J. Economic Evaluation of Dialectical Behavioral Therapy Versus Cognitive Behavioral Therapy for Suicide Prevention. THE JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS 2022; 25:123-131. [PMID: 36535910 PMCID: PMC10809732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Suicide is a leading cause of death for adults aged 18-64 in the United States, and suicide risk is highest among those with previous attempts. Two evidence-based treatments for suicide prevention exist: dialectical behavioral therapy (DBT), a year-long intensive treatment, and cognitive behavioral therapy (CBT), a brief (10-12 session) treatment. To our knowledge, no direct comparison of the two treatments yet exists AIMS: To analyze the cost-effectiveness of DBT compared to CBT, in terms of both cost and quality of life, for the prevention of future suicide attempt among previous attempters. METHODS A Markov Model was developed to estimate the incremental cost-effectiveness ratio (ICER) in 2022 US dollars per quality-adjusted life-year (QALY). Published literature was reviewed to identify parameter estimates. The target population was US adults aged 18-64 with a previous suicide attempt. A time horizon of one year was used, and costs were calculated from the health care system perspective. RESULTS Compared to CBT, DBT is associated with an estimated incremental cost of USD26,362 per QALY gained. One-way sensitivity analysis (OWSA) revealed consistent results, with DBT being cost-effective in most cases at a maximum threshold of USD50,000 per QALY. DISCUSSION Results suggest that, compared to CBT, DBT is associated with comparable costs and mortality but higher quality of life. Due to the limited evidence base, caution is recommended when interpreting and generalizing results. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE Given comparable cost and efficacy, patient preference for CBT or DBT must be incorporated in treatment selection. Ensuring patients play an active role in treatment selection has the potential to lead to improved clinical and health system outcomes. IMPLICATIONS FOR HEALTH POLICIES As manualized treatments, both DBT and CBT are appropriate for trained master's level clinicians to deliver. Allowing master's level clinicians to provide evidence-based care for suicide prevention may be a cost-effective strategy for quality service provision. IMPLICATIONS FOR FUTURE RESEARCH Future research grounded in conceptual theories of suicide that distinguish suicide risk from more general psychiatric risks are needed.
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Affiliation(s)
- Jessica Acolin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA,
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Rainbow C, Blashki G, Melvin G. Reducing suicidal ideation in young adults: online tools to address perceived burdensomeness. AUSTRALIAN PSYCHOLOGIST 2022. [DOI: 10.1080/00050067.2022.2135983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher Rainbow
- Beyond Blue, Melbourne, Australia
- School of Psychology, Deakin University, Melbourne, Australia
| | - Grant Blashki
- Beyond Blue, Melbourne, Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Melbourne, Australia
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Nobile B, Olié E, Dubois J, Benramdane M, Guillaume S, Courtet P. Characterization of suicidal depression: a one-year prospective study. Eur Psychiatry 2022; 65:1-40. [PMID: 35431010 PMCID: PMC9058444 DOI: 10.1192/j.eurpsy.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Suicidal ideation (SI) is an important risk factor of death by suicide. Recent data suggest that suicidal depression (i.e., moderate to severe depression with SI) could be a specific depression subtype with worse clinical outcomes than nonsuicidal depression (i.e., without SI). Methods Among 898 French adult inpatients (67% women, mean age: 41.23 [SD: 14.33]) with unipolar depression, 71.94% had moderate to severe depression (defined using the cut-offs of validated scales: beck depression inventory, clinician-rated 30-item inventory depression symptomatology, and quick inventory of depressive symptomatology) and among them, 63.6% had SI according to the suicidal item (score ≥ 2) of the depression scale they filled in. Clinical features (anxiety, psychological pain, and hopelessness) were assessed at baseline. The occurrence of a suicide attempt (SA) or a suicide event (SE) (i.e., actual, aborted or interrupted SA, or hospitalization for SI) was recorded during the 1-year follow-up. The risk of actual SA and SE was compared between groups with adjusted Cox regression models. Results The risk of actual SA and SE during the follow-up was 2- and 1.8-fold higher, respectively, in patients with suicidal depression, independently of potential cofounders such as history of lifetime SA, age, sex, and baseline depression severity. Conclusions Suicidal depression is associated with poorer prognosis in terms of actual SA/SE, despite optimal care (i.e., care in a hospital department specialized in the management of suicidal crisis). Specific therapeutic strategies might be needed for these patients.
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Affiliation(s)
- Bénédicte Nobile
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
- FondaMental Foundation, Montpellier, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
- FondaMental Foundation, Montpellier, France
| | - Jonathan Dubois
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Myriam Benramdane
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
- FondaMental Foundation, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- IGF, CNRS, INSERM, University of Montpellier, Montpellier, France
- FondaMental Foundation, Montpellier, France
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Nobile B, Olié E, Dubois J, Guillaume S, Gorwood P, Courtet P. Characteristics and treatment outcome of suicidal depression: Two large naturalistic cohorts of depressed outpatients. Aust N Z J Psychiatry 2022; 56:347-364. [PMID: 34281409 DOI: 10.1177/00048674211025697] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The emergence of new drugs for managing suicidal ideation (e.g. ketamine) raises the question of whether suicidal depression (i.e. moderate to severe depression with concomitant suicidal ideation) is a specific depression phenotype. Therefore, this study characterized patients with suicidal depression (baseline clinical characteristics, suicidal ideation and depression evolutions, suicide risk) in two large cohorts of outpatients with depression. METHODS LUEUR and GENESE are two large, prospective, naturalistic cohorts of French adult outpatients with depression (Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria), treated and followed up for 6 weeks. Depression severity was assessed with the Hospital Anxiety and Depression Scale, and suicidal ideation with the suicidal item of the Montgomery-Åsberg Depression Rating Scale. Patients with moderate or severe depression (Hospital Anxiety and Depression Scale-Depression subscale score >11) were selected and classified as without suicidal ideation (suicidal item of the Montgomery-Åsberg Depression Rating Scale <2), with moderate suicidal ideation (suicidal item of the Montgomery-Åsberg Depression Rating Scale [2; 3]) and with severe suicidal ideation (suicidal item of the Montgomery-Åsberg Depression Rating Scale ⩾4). RESULTS Baseline clinical features were more severe (e.g. higher anxiety and depression scores) in depressed patients with moderate/severe suicidal ideation. Depression remission after treatment was less frequent among patients with severe suicidal ideation. The risk of suicide attempt during the follow-up was threefold higher in patients with suicidal ideation among those 10% had persistent suicidal ideation. CONCLUSION Suicidal depression could be a specific depression phenotype with more severe clinical characteristics, less frequent depression remission, suicidal ideation persistence and higher suicide attempt risk, despite antidepressant treatment. It seems that novel therapeutic strategies could be needed.
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Affiliation(s)
- Bénédicte Nobile
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Jonathan Dubois
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Sebastien Guillaume
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Philip Gorwood
- Inserm UMRS1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, Montpellier, France.,IGF, Hôpital La Colombière, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
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Changes of functional connectivity of the subgenual anterior cingulate cortex and precuneus after cognitive behavioral therapy combined with fluoxetine in young depressed patients with suicide attempt. Behav Brain Res 2022; 417:113612. [PMID: 34600960 DOI: 10.1016/j.bbr.2021.113612] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/05/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022]
Abstract
This single-center, randomized, single-blind, parallel-controlled study aimed to analyze the changes in resting-state functional connectivity (RSFC) in young patients with a suicide attempt caused by depression before and after cognitive-behavioral therapy (CBT) combined with fluoxetine or fluoxetine alone by functional magnetic resonance imaging (fMRI). Before treatment, functional connectivity of the right subgenual anterior cingulate cortex (R-sgACC), left subgenual anterior cingulate cortex (L-sgACC) and right precuneus (R-PCu) was lower in depressed patients with a suicide attempt than that of healthy controls. After treatment, compared with the fluoxetine group, functional connectivity between the R-sgACC and left posterior cerebellar lobe in the CBT group was increased, while this group also showed increased RSFC between the L-sgACC and right anterior cingulate cortex/ medial prefrontal cortex. On the contrary, the functional connectivity between the R-PCu and right parietal lobe was reduced (P < 0.001). It was also found there were some changes in different brain regions in pre- and post-treatment within both the CBT and MG group. The functional connectivity of the R-sgACC and the left posterior cerebellum lobe was negatively correlated with the SSI score. The functional connectivity of the R-PCu and right middle frontal cortex was negatively correlated with the HAMD score before treatment. After treatment, functional connectivity between the R-PCu and right superior frontal gyrus was positively correlated with the SSI scores in the CBT group. After 8 weeks of combined CBT, the strength of the functional connectivity in the bilateral sgACC and bilateral PCu was significantly changed.
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Einsatzführung bei suizidalen Personen. Notf Rett Med 2022. [DOI: 10.1007/s10049-021-00969-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rainbow C, Baldwin P, Hosking W, Gill P, Blashki G, Shand F. Psychological Distress and Suicidal Ideation in Australian Online Help-Seekers: The Mediating Role of Perceived Burdensomeness. Arch Suicide Res 2021; 27:439-452. [PMID: 34935605 DOI: 10.1080/13811118.2021.2020191] [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: 10/19/2022]
Abstract
BACKGROUND Psychological distress, an umbrella term encompassing emotional anguish and cognitive-behavioral symptoms of anxiety and depression, is closely linked to suicidal ideation. However, the mechanism of this relationship is unclear, dampening the utility of distress screening in suicide prevention. PURPOSE This study aimed to identify potential mediators of this relationship, and whether effects are sex-specific. METHOD AND PARTICIPANTS A sample of online help-seekers who had just completed the K10 psychological distress checklist on the Beyond Blue website [N = 1,528] consented to complete measures of help-seeking intentions, financial wellbeing, alcohol use, social connection (belongingness), sense of being a burden on others (burdensomeness); and suicidal ideation. Moderated mediation analysis examined the indirect effects of psychological distress on suicidal ideation through these risk factors, and whether effects were moderated by sex. RESULTS The model accounted for 44% of the variance in suicidal ideation. The majority of participants had experienced very high psychological distress (77.3%) and at least some suicidal ideation (74.7%) in the past four weeks. A significant indirect effect of burdensomeness was found for both men and women. No other risk factors produced significant indirect effects. CONCLUSIONS Perceived burdensomeness appears to be central in determining how psychological distress might progress to suicidal thinking. The experience of distress may lead a person to believe that loved ones would be better off without them, prompting suicidal thinking.HighlightsPsychological distress screening is an early intervention opportunity for suicide.Intervention plans could be improved by including perceived burdensome measures.Online screening for distress is a potential bridge to offline-help seeking.
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Penadés R, Forte F, Mezquida G, Rodríguez AG, García-Rizo C, Catalán R, Bernardo M. Effectiveness of Cognitive Behavioural Therapy for Suicide in Schizophrenia: A Systematic Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082218666211220164527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Suicide is probably one of the worst potential complications for people with schizophrenia. Even though the use of antipsychotic medication is essential in reducing suicidal behaviour, the use of psychological treatments seems to be in the same way necessary. Cognitive Behavioural Therapy (CBT) is an evidence-based form of psychotherapy that is constantly trying to synchronise with the latest recommendations from the research. The goal of the present work is to systematically review the scientific evidence from published studies testing the effectiveness of CBT designed to deal with suicide in patients with schizophrenia.
Methods:
We searched using multiple terms related to suicide prevention based on CBT in schizophrenia. Two databases (Medline and SCOPUS) were scrutinised for the electronic search and different reference lists from previous reviews were also hand checked.
Results:
We identified 5 randomised and controlled trials of CBT that included suicide-related cognitions or behaviours as a primary outcome measure. CBT focusing on suicidal cognitions and behaviours was found to be effective in reducing suicidal ideation. As the number of studies fulfilling the inclusion criteria is small and the assessment of outcomes is heterogeneous, we did not perform a meta-analysis and we present results in a narrative way.
Conclusion:
Research on CBT focused on suicide prevention in patients with schizophrenia is promising but current evidence is notoriously insufficient. Although those therapies seemed to be efficacious in the prevention of suicide, scarcity of randomised clinical trials specifically focusing on suicide is probably the most important issue to be faced. Given the current evidence, clinicians should be familiar with CBT techniques focusing on suicidal cognitions. However, suicide prevention and treatment in those with schizophrenia is complex, and many other factors such as possible earlier use of clozapine, optimizing adherence to medication, and other psychosocial aspects should be addressed. Combination of different strategies appears to be mandatory.
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Affiliation(s)
- Rafael Penadés
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
| | - Florencia Forte
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
| | | | | | - Rosa Catalán
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Barcelona, Spain
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van Bentum JS, van Bronswijk SC, Sijbrandij M, Lemmens LHJM, Peeters FFPML, Drukker M, Huibers MJH. Cognitive therapy and interpersonal psychotherapy reduce suicidal ideation independent from their effect on depression. Depress Anxiety 2021; 38:940-949. [PMID: 33755280 PMCID: PMC8451935 DOI: 10.1002/da.23151] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/05/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical guidelines suggest that psychological interventions specifically aimed at reducing suicidality may be beneficial. We examined the impact of two depression treatments, cognitive therapy (CT) and interpersonal psychotherapy (IPT) on suicidal ideation (SI) and explored the temporal associations between depression and SI over the course of therapy. METHODS Ninety-one adult (18-65) depressed outpatients from a large randomized controlled trial who were treated with CT (n = 37) and IPT (n = 54) and scored at least ≥1 on the Beck Depression Inventory II (BDI-II) suicide item were included. Linear (two-level) mixed effects models were used to evaluate the impact of depression treatments on SI. Mixed-effects time-lagged models were applied to examine temporal relations between the change in depressive symptoms and the change in SI. RESULTS SI decreased significantly during treatment and there were no differential effects between the two intervention groups (B = -0.007, p = .35). Depressive symptoms at the previous session did not predict higher levels of SI at the current session (B = 0.016, p = .16). However, SI measured at the previous session significantly predicted depressive symptoms at the current session (B = 2.06, p < .001). CONCLUSIONS Both depression treatments seemed to have a direct association with SI. The temporal association between SI and depression was unidirectional with SI predicting future depressive symptoms during treatment. Our findings suggest that it may be most beneficial to treat SI first.
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Affiliation(s)
- Jaël S. van Bentum
- Department of Clinical, Neuro‐ and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Suzanne C. van Bronswijk
- Department of Clinical Psychological Science, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro‐ and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
- World Health Organization Collaborating Centre for Research and Dissemination of Psychological InterventionsVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Lotte H. J. M. Lemmens
- Department of Clinical Psychological Science, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Frenk F. P. M. L. Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Marcus J. H. Huibers
- Department of Clinical, Neuro‐ and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Luk JW, Pruitt LD, Smolenski DJ, Tucker J, Workman DE, Belsher BE. From everyday life predictions to suicide prevention: Clinical and ethical considerations in suicide predictive analytic tools. J Clin Psychol 2021; 78:137-148. [PMID: 34195998 DOI: 10.1002/jclp.23202] [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: 03/26/2021] [Revised: 06/02/2021] [Accepted: 06/13/2021] [Indexed: 11/08/2022]
Abstract
Advances in artificial intelligence and machine learning have fueled growing interest in the application of predictive analytics to identify high-risk suicidal patients. Such application will require the aggregation of large-scale, sensitive patient data to help inform complex and potentially stigmatizing health care decisions. This paper provides a description of how suicide prediction is uniquely difficult by comparing it to nonmedical (weather and traffic forecasting) and medical predictions (cancer and human immunodeficiency virus risk), followed by clinical and ethical challenges presented within a risk-benefit conceptual framework. Because the misidentification of suicide risk may be associated with unintended negative consequences, clinicians and policymakers need to carefully weigh the risks and benefits of using suicide predictive analytics across health care populations. Practical recommendations are provided to strengthen the protection of patient rights and enhance the clinical utility of suicide predictive analytics tools.
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Affiliation(s)
- Jeremy W Luk
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
| | - Larry D Pruitt
- Department of Psychiatry and Behavioral Sciences, VA Puget Sound Healthcare System & University of Washington School of Medicine, Seattle, Washington, USA
| | - Derek J Smolenski
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
| | - Jennifer Tucker
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
| | - Don E Workman
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
| | - Bradley E Belsher
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
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18
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19
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O'Neill C, Pratt D, Kilshaw M, Ward K, Kelly J, Haddock G. The relationship between self-criticism and suicide probability. Clin Psychol Psychother 2021; 28:1445-1456. [PMID: 33847028 DOI: 10.1002/cpp.2593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/25/2021] [Indexed: 11/07/2022]
Abstract
The relationship of self-to-self relating and suicide has received attention in explanatory models of suicide. However, exploration of specific types of self-relationships, namely feelings of inadequacy (associated with perfectionism), self-attacking and the ability to be kind and nurturing towards the self has received limited attention in a suicidal population. The present study assessed the relative contribution of self-criticism to suicide probability, alongside established predictors of suicidal ideation; hopelessness, depression, defeat and entrapment. Participants completed measures of inadequacy, self-attacking, self-reassurance, defeat, entrapment, depression and hopelessness (N = 101). A correlation, regression and mediation analysis was undertaken. Results demonstrated that self-attacking has a direct relationship with suicide probability, alongside established predictors; entrapment and hopelessness. Depressive symptomology was not found to be a significant predictor of suicide probability in this population. Addressing particularly hostile forms of self-criticism may be a promising area in terms of future research and clinical practice. Entrapment continues to be a significant predictor of suicide risk and interventions that target this experience should be explored.
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Affiliation(s)
- Catherine O'Neill
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, England, UK
| | - Daniel Pratt
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, England, UK
| | - Meryl Kilshaw
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, England, UK
| | - Kate Ward
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, England, UK
| | - James Kelly
- Early Intervention in Psychosis Team, Lancashire Care NHS Trust, Preston, UK
| | - Gillian Haddock
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, England, UK
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Fordham B, Sugavanam T, Edwards K, Hemming K, Howick J, Copsey B, Lee H, Kaidesoja M, Kirtley S, Hopewell S, das Nair R, Howard R, Stallard P, Hamer-Hunt J, Cooper Z, Lamb SE. Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health Technol Assess 2021; 25:1-378. [PMID: 33629950 PMCID: PMC7957459 DOI: 10.3310/hta25090] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. OBJECTIVES This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy. DATA SOURCES The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. REVIEW METHODS Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. RESULTS A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. LIMITATIONS Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. CONCLUSION Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. FUTURE WORK Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. STUDY REGISTRATION This study is registered as PROSPERO CRD42017078690. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Thavapriya Sugavanam
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katherine Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Bethan Copsey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Milla Kaidesoja
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roshan das Nair
- Department of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | | | | | - Zafra Cooper
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Bozzay ML, Primack JM, Swearingen HR, Barredo J, Philip NS. Combined transcranial magnetic stimulation and brief cognitive behavioral therapy for suicide: study protocol for a randomized controlled trial in veterans. Trials 2020; 21:924. [PMID: 33183345 PMCID: PMC7663863 DOI: 10.1186/s13063-020-04870-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND At least 17 veterans die every day from suicide. Although existing treatments such as brief cognitive behavioral therapy (BCBT) have been found to reduce suicide attempts in military personnel, a number of patients go on to attempt suicide after completing therapy. Thus, finding ways to enhance treatment efficacy to reduce suicide is critical. Repetitive transcranial magnetic stimulation (TMS) is a noninvasive technique that can be used to stimulate brain regions that are impaired in suicidal patients, that has been successfully used to augment treatments for psychiatric disorders implicated in suicide. The goal of this study is to test whether augmenting BCBT with TMS in suicidal veterans reduces rates of suicidal ideation, attempts, and other deleterious treatment outcomes. METHODS One hundred thirty veterans with a suicide plan or suicidal behavior in the prior 2 weeks will be recruited from inpatient and outpatient settings at the Providence VA Medical Center in the USA. Veterans will be randomly assigned to receive 30 daily sessions of active or sham TMS in concert with a 12-week BCBT protocol in a parallel group design. Veterans will complete interviews and questionnaires related to psychiatric symptoms, suicidal ideation and behavior, treatment utilization, and functioning during a baseline assessment prior to treatment, at treatment endpoint, and 6- and 12-month follow-ups. Primary analyses will use mixed effect regressions to examine effects of treatment condition on suicidal behaviors, improvements in psychosocial functioning, and psychiatric hospitalization. Similar models as well as exploratory latent growth curve analyses will examine mediators and moderators of treatment effects. DISCUSSION This protocol provides a framework for designing multilayered treatment studies for suicide. When completed, this study will be the first clinical trial evaluating the efficacy of augmenting BCBT for suicide with TMS. The results of this trial will have implications for treatment of suicide ideation and behaviors and implementation of augmented treatment designs. If positive, results from this study can be rapidly implemented across the VA system and will have a direct and meaningful impact on veteran suicide. TRIAL REGISTRATION This study was registered prior to participant enrollment with ClinicalTrials.gov NCT03952468 . Registered on May 16, 2019. TRIAL SPONSOR CONTACT Robert O'Brien (VA Health Services R&D), robert.obrien7@va.gov.
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Affiliation(s)
- Melanie L. Bozzay
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912 USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, 830 Chalkstone Boulevard, Providence, RI 02908 USA
| | - Jennifer M. Primack
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912 USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, 830 Chalkstone Boulevard, Providence, RI 02908 USA
| | - Hannah R. Swearingen
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, 830 Chalkstone Boulevard, Providence, RI 02908 USA
| | - Jennifer Barredo
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912 USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, 830 Chalkstone Boulevard, Providence, RI 02908 USA
| | - Noah S. Philip
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912 USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, 830 Chalkstone Boulevard, Providence, RI 02908 USA
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22
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Shu Y, Kuang L, Huang Q, He L. Fractional amplitude of low-frequency fluctuation (fALFF) alterations in young depressed patients with suicide attempts after cognitive behavioral therapy and antidepressant medication cotherapy: A resting-state fMRI study. J Affect Disord 2020; 276:822-828. [PMID: 32738667 DOI: 10.1016/j.jad.2020.07.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/13/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Fractional amplitude of low-frequency fluctuation (fALFF) alterations in young depressed patients with suicide attempts after cognitive behavioral therapy (CBT) and antidepressant medication cotherapy were evaluated. METHODS Seventy-eight subjects (age: 18-28) were recruited from April 2017 to March 2019. Forty young depressed patients who attempted suicide were divided into CBT (8 weeks of structured CBT sessions and antidepressant medication cotherapy) and monotherapy (MG: antidepressant therapy alone) groups, and 38 healthy volunteers constituted a healthy control (HC) group. Resting-state functional magnetic resonance imaging (rs-fMRI) was conducted before and after treatment. RESULTS Before treatment, spontaneous brain activity in the left posterior cerebellar lobe (L-PCL), right anterior cingulate cortex, left caudate nucleus and left superior frontal cortex was higher in untreated patients than in HCs. After treatment, fALFF in the left middle occipital cortex and left precuneus was significantly increased in the CBT compared with the HC group. fALFF in the right middle frontal cortex, right inferior frontal cortex, l-PCL, and left anterior cerebellar lobe (L-ACL) were increased, while fALFF in the l-mPFC and l-SgACC were reduced, in the CBT compared with the MG group. Pearson correlation analyses provided information about clinical scale scores and mean fALFF relationships. LIMITATIONS There was insufficient evidence to confirm that these spontaneous brain activity alterations were the result of CBT or spontaneous recovery. CONCLUSION CBT and medication cotherapy can significantly change spontaneous activity in the left cerebellum and default-mode network, thereby regulating and reshaping emotional and cognitive processing.
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Affiliation(s)
- Yanping Shu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, Chongqing 400016, China; Department of Psychology, The Second People's Hospital of Guizhou Province, No. 318, The Southern Section of new Road, Yunyan district, Guiyang 550004, Guizhou, China
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, Chongqing 400016, China.
| | - Qiankun Huang
- Zunyi Medical University, no. 201, Dalian road, Inovance distric, Zunyi, China
| | - Lihui He
- Zunyi Medical University, no. 201, Dalian road, Inovance distric, Zunyi, China
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Kaniuka AR, Oakey-Frost N, Moscardini EH, Tucker RP, Rasmussen S, Cramer RJ. Grit, humor, and suicidal behavior: Results from a comparative study of adults in the United States and United Kingdom. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2020.110047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cognitive behavioral therapy for suicide prevention in youth admitted to hospital following an episode of self-harm: A pilot randomized controlled trial. J Affect Disord 2020; 266:686-694. [PMID: 32056945 DOI: 10.1016/j.jad.2020.01.178] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/29/2019] [Accepted: 01/28/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Self-harm (SH) is among the strongest risk factors for eventual suicide death yet there are limited data on which interventions are most effective for treating SH in youth. METHODS This single-blind, pilot randomized controlled trial examined brief cognitive behavioral therapy (BCBT) for suicide prevention vs. minimally-directive supportive psychotherapy in youth (aged 16-26) hospitalized following SH. Both therapies included 10 acute sessions over 15 weeks with three booster sessions occurring at three month intervals thereafter. The primary feasibility outcome was ≥70% retention at study endpoint. Efficacy measures, including repeat SH, were secondary outcomes. RESULTS Twenty-four subjects were enrolled (12 per group) with one BCBT subject and two controls dropping out prior to the first therapy session. Five (45%) of the remaining BCBT subjects and seven (70%) control subjects completed all 10 acute therapy sessions. All subjects who completed five sessions went on to complete 10. There were significantly fewer instances of repeat SH in BCBT subjects (7 of 62 weeks of acute follow-up; 11%) compared to control subjects (24 of 79 weeks; 30%)(OR 0.34, 95%CI:0.13-0.92). Three subjects, all in the control condition, made a total of five suicide attempts during the study. LIMITATIONS This study had a modest sample size and retention rate. CONCLUSIONS This study failed to achieve its primary feasibility retention goal for BCBT. However, it did demonstrate that initial adherence to follow-up predicted study completion. Despite small numbers, it also found a significant reduction in repeat SH in the BCBT group, a finding which requires replication.
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25
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Bentley KH, Sauer-Zavala S, Stevens KT, Washburn JJ. Implementing an evidence-based psychological intervention for suicidal thoughts and behaviors on an inpatient unit: Process, challenges, and initial findings. Gen Hosp Psychiatry 2020; 63:76-82. [PMID: 30293841 DOI: 10.1016/j.genhosppsych.2018.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Barriers to implementing evidence-based psychological treatments for suicidal thoughts and behaviors in busy hospital settings exist. Transdiagnostic interventions may serve to facilitate training in evidence-based treatment and more efficiently treat individuals with multiple psychiatric comorbidities. We describe the rationale for, process of, and initial data from implementing the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) on an inpatient unit for adults with suicidal thoughts and behaviors and affective disorders. METHOD We analyzed clinical intake and outcome data from a subsample of patients admitted during the six months before and six months after UP implementation (n = 133 and n = 61, respectively), and available acceptability and fidelity data from the month following UP implementation. RESULTS Patients improved significantly over the course of inpatient treatment before and after UP implementation. Effects for depression, suicidal ideation, anxiety, and emotion regulation were similar before and after UP implementation. Patients generally reported high acceptability of the UP and clinician fidelity to the protocol was variable during the month following UP implementation. CONCLUSIONS The UP may be a promising evidence-based intervention for inpatient settings that treat individuals with suicidal thoughts and behaviors. Well-controlled, randomized trials are needed to determine efficacy, particularly regarding suicidal behavior after discharge.
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Affiliation(s)
- Kate H Bentley
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America.
| | - Shannon Sauer-Zavala
- Center for Anxiety and Related Disorders, Boston University, United States of America
| | - Kimberly T Stevens
- Institute of Living Anxiety Disorders Center, United States of America; AMITA Health Behavioral Medicine, United States of America
| | - Jason J Washburn
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States of America; AMITA Health Behavioral Medicine, United States of America
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Abstract
Throughout the world, approximately 800,000 people die by suicide every year, accounting for 1.5% of all deaths. Suicide is the 10th leading cause of death in North America and the foremost cause of death worldwide among persons 15 to 24 years of age.
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Affiliation(s)
- Seena Fazel
- From the Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (S.F.); and the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (B.R.)
| | - Bo Runeson
- From the Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (S.F.); and the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (B.R.)
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27
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Melia R, Francis K, Hickey E, Bogue J, Duggan J, O'Sullivan M, Young K. Mobile Health Technology Interventions for Suicide Prevention: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e12516. [PMID: 31939744 PMCID: PMC6996750 DOI: 10.2196/12516] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 05/17/2019] [Accepted: 08/02/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Digital interventions are proposed as one way by which effective treatments for self-harm and suicidal ideation may be improved and their scalability enhanced. Mobile devices offer a potentially powerful medium to deliver evidence-based interventions with greater specificity to the individual when the intervention is needed. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice. OBJECTIVE This review aimed to examine the effectiveness of currently available mobile health (mHealth) technology tools in reducing suicide-specific outcomes. METHODS The following databases were searched: Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, and relevant sources of gray literature. All published and unpublished randomized controlled trials (RCTs), pseudo-RCTs, and pre-post observational studies that evaluated the effectiveness of mHealth technology in suicide prevention delivered via mobile computing and communication technology were included. Studies were included if they measured at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, and suicidal behavior). A total of 2 review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, on July 31, 2018. Owing to the heterogeneity of outcomes found across studies, results were not amenable for pooled synthesis, and a meta-analysis was not performed. A narrative synthesis of the available research is presented here. RESULTS A total of 7 studies met criteria for inclusion . Four published articles that reported on the effectiveness of the following mobile phone apps were included: iBobbly, Virtual Hope Box, BlueIce, and Therapeutic Evaluative Conditioning. Results demonstrated some positive impacts for individuals at elevated risk of suicide or self-harm, including reductions in depression, psychological distress, and self-harm and increases in coping self-efficacy. None of the apps evaluated demonstrated the ability to significantly decrease suicidal ideation compared with a control condition. In addition, 3 unpublished and recently completed trials also met criteria for inclusion in the review. CONCLUSIONS Further research is needed to evaluate the efficacy of stand-alone mHealth technology-based interventions in suicide prevention. The small number of studies reported in this review tentatively indicate that such tools may have a positive impact on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing the following 3 main methodological limitations : (1) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies; (2) ecological validity: the tendency to exclude potential participants because of the elevated suicide risk may reduce generalizability within clinical settings; and (3) app regulation and definition: the lack of a standardized classification system for mHealth intervention type points to the need for better definition of the scope of such technologies to promote safe practice. TRIAL REGISTRATION PROSPERO CRD42017072899; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72899. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.8635.
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Affiliation(s)
- Ruth Melia
- School of Psychology, National University of Ireland Galway, Galway, Ireland
- Psychology Department, Health Service Executive Mid-West, Ennis, Ireland
| | - Kady Francis
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Emma Hickey
- Psychology Department, Health Service Executive Mid-West, Limerick, Ireland
| | - John Bogue
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jim Duggan
- Discipline of Information Technology, National University of Ireland Galway, Galway, Ireland
| | - Mary O'Sullivan
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Karen Young
- Insight-Centre, Discipline of Information Technology, National University of Ireland Galway, Galway, Ireland
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Rojas SM, Carter SP, McGinn MM, Reger MA. A Review of Telemental Health as a Modality to Deliver Suicide-Specific Interventions for Rural Populations. Telemed J E Health 2019; 26:700-709. [PMID: 31502929 DOI: 10.1089/tmj.2019.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Despite recent advancements in the development of new suicide prevention interventions, suicide rates continue to rise in the United States. As such, suicide prevention efforts must continue to focus on expanding dissemination of suicide-specific interventions. Methods: This review explores telemental health through two-way synchronous clinical video telehealth (CVT) technologies as one approach to improving access to suicide-specific interventions. Results: Studies were reviewed if (1) the modality of interest was telemental health by CVT and (2) management, assessment, or intervention of suicidal thoughts or behaviors was discussed. A total of 22 studies were included. Conclusions: Findings from the limited existing studies are synthesized, and recommendations are provided for future research, clinical, and educational advancements.
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Affiliation(s)
- Sasha M Rojas
- VA Puget Sound Health Care System, Seattle, Washington.,University of Arkansas, Fayetteville, Arkansas, USA
| | - Sarah P Carter
- VA Puget Sound Health Care System, Seattle, Washington.,Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Meghan M McGinn
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mark A Reger
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Navin K, Kuppili PP, Menon V, Kattimani S. Suicide Prevention Strategies for General Hospital and Psychiatric Inpatients: A Narrative Review. Indian J Psychol Med 2019; 41:403-412. [PMID: 31548762 PMCID: PMC6753714 DOI: 10.4103/ijpsym.ijpsym_169_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/18/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In-patient (IP) suicides contribute a small but significant proportion of overall suicides. Despite this, suicide prevention strategies focusing on the general hospital IP population remain relatively underresearched. This paper is intended to provide an overview of various proposed suicide prevention approaches in the general hospital, including psychiatric IP, settings, and their evidence base. METHODOLOGY Electronic searches of MEDLINE through PubMed, ScienceDirect, and Google Scholar databases were performed to identify potentially relevant articles from inception till January 2019. The generated abstracts were systematically screened for their eligibility to be included in the review. Included articles were grouped under five broad themes: environmental modification, staff education, pharmacotherapy, psychotherapy, and brain stimulation. Data extraction was done using a structured proforma. RESULTS Environmental modifications and educating the health care professionals appear to be the most promising strategies to reduce suicide-related mortality among IPs. Among pharmacological methods, ketamine has shown initial promise in reducing suicidal ideations. Follow-up data are lacking for most of the described methods. Limited but positive evidence exists for cognitive therapies focusing on the immediate postadmission period and brain stimulation techniques, and it warrants further replication. CONCLUSION There is a striking paucity of original research on IP suicide prevention. Given the ethical and methodological issues in carrying out studies with IP suicide as the primary outcome, there is a need to focus on intermediate suicide outcome measures, such as knowledge, attitude, and skills among staff handlers of suicidal patients.
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Affiliation(s)
- Karthick Navin
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pooja Patnaik Kuppili
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Martínez-Miranda J, Martínez A, Ramos R, Aguilar H, Jiménez L, Arias H, Rosales G, Valencia E. Assessment of users' acceptability of a mobile-based embodied conversational agent for the prevention and detection of suicidal behaviour. J Med Syst 2019; 43:246. [PMID: 31240494 DOI: 10.1007/s10916-019-1387-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/14/2019] [Indexed: 12/01/2022]
Abstract
The use of embodied conversational agents in mental health has increased in the last years. Several studies exist describing the benefits and advantages of this technology as a complement to psychotherapeutic interventions for the prevention and treatment of depression, anxiety, or post-traumatic stress disorder, to name a few. A small number of these works implement capabilities in the virtual agent focused on the detection and prevention of suicidality risks. The work presented in this paper describes the development of an embodied conversational agent used as the main interface in HelPath, a mobile-based application addressed to individuals detected with any of the suicidal behaviours: ideation, planning or attempt. The main objective of HelPath is to continuously collect user's information that, complemented with data from the electronic health record, supports the identification of risks associated with suicidality. Through the virtual agent, the users also receive information and suggestions based on cognitive behaviour therapy that would help them to maintain a healthy condition. The paper also presents the execution of an exploratory pilot to assess the acceptability, perception and adherence of users towards the virtual agent. The obtained results are presented and discussed, and some actions for further improvement of the embodied conversational agent are also identified.
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Affiliation(s)
- Juan Martínez-Miranda
- CONACYT - Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica, Tepic, Mexico.
| | | | - Roberto Ramos
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica, Tepic, Mexico
| | | | | | | | - Giovanni Rosales
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica, Tepic, Mexico
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Chiurliza B, Joiner TE. The Influence of Acetaminophen and Observational Conditioning on the Acquired Capability for Suicide. Behav Ther 2018; 49:681-690. [PMID: 30146136 DOI: 10.1016/j.beth.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 11/19/2022]
Abstract
The effects of acetaminophen and a reading task on physical pain tolerance and fearlessness about death were tested in 106 undergraduate students. Participants were randomized into four groups, each receiving either acetaminophen or no medication, along with either a control or experimental reading task. It was predicted that acetaminophen would increase pain tolerance and fearlessness about death, that the experimental reading task would decrease both outcomes, and that the interventions would interact (i.e., acetaminophen would dampen the effects of the reading task). Multivariate analysis of variance was used to test hypotheses. No significant interaction was found (p = .17) and there was no effect for acetaminophen (p = .56), but individuals administered the experimental reading task demonstrated significantly higher physical pain tolerance (p < .05).
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Assari S, Moghani Lankarani M. Depressive Symptoms and Self-Esteem in White and Black Older Adults in the United States. Brain Sci 2018; 8:E105. [PMID: 29891800 PMCID: PMC6024986 DOI: 10.3390/brainsci8060105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 05/24/2018] [Accepted: 06/09/2018] [Indexed: 01/03/2023] Open
Abstract
Background. Poor self-esteem is a core element of depression. According to recent research, some racial groups may vary in the magnitude of the link between depression and poor self-esteem. Using a national sample, we compared Black and White older Americans for the effect of baseline depressive symptoms on decline in self-esteem over time. Methods. This longitudinal study used data from the Religion, Aging, and Health Survey, 2001⁻2004. The study followed 1493 older adults (734 Black and 759 White) 65 years or older for three years. Baseline depressive symptoms (CES-D), measured in 2001, was the independent variable. Self-esteem, measured at the end of the follow up, was the dependent variable. Covariates included baseline demographic characteristics (age and gender), socioeconomic factors (education, income, and marital status), health (self-rated health), and baseline self-esteem. Race/ethnicity was the moderator. Linear multi-variable regression models were used for data analyses. Results. In the pooled sample, higher depressive symptoms at baseline were predictive of a larger decline in self-esteem over time, net of covariates. We found a significant interaction between race/ethnicity and baseline depressive symptoms on self-esteem decline, suggesting a weaker effect for Blacks compared to Whites. In race/ethnicity-specific models, high depressive symptoms at baseline was predictive of a decline in self-esteem for Whites but not Blacks. Conclusion. Depressive symptoms may be a more salient contributor to self-esteem decline for White than Black older adults. This finding has implications for psychotherapy and cognitive behavioral therapy of depression of racially diverse populations.
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Affiliation(s)
- Shervin Assari
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA.
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA.
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2700, USA.
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