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Shoib S, Shaheen N, Anwar A, Saad AM, Mohamed Akr L, I Saud A, Kundu M, Nahidi M, Chandradasa M, Swed S, Saeed F. The effectiveness of telehealth interventions in suicide prevention: A systematic review and meta-analysis. Int J Soc Psychiatry 2024; 70:415-423. [PMID: 37994403 DOI: 10.1177/00207640231206059] [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: 11/24/2023]
Abstract
BACKGROUND Suicidal attempt is a significant risk factor for future attempts, with the highest risk during the first-year post-suicide. Telepsychiatry has shown promise by providing easy access to evidence-based interventions during mental health crises. AIMS investigation the effectiveness of telehealth interventions in suicide prevention. METHODS Four electronic databases (PubMed, Scopus, Web of Science, and Ovid) were systematically searched for studies on patients undergoing telepsychiatry intervention (TPI) up to June 2022. Following PRISMA guidelines, a systematic review and meta-analysis were conducted to investigate the effectiveness of telehealth interventions in suicide prevention. Continuous data were pooled as standardised mean difference (SMD), and dichotomous data were pooled as risk ratio using the random effects model with the corresponding 95% confidence intervals (CI). RESULTS Sixteen studies were included in the review. Most studies were case-control and randomised controlled trials conducted in Europe and North America. The findings of the studies generally showed that TPIs are effective in reducing suicide rates (odds ratio = 0.68; 95% CI [-0.47, 0.98], p = .04) and suicidal reattempts. The interventions were also found to be well-accepted, with high retention rates. CONCLUSION Our results suggest that TPIs are well-accepted and effective in reducing suicide rates and reattempts. It is recommended to maintain telephone follow-ups for at least 12 months. Further research is needed to understand the potential of telepsychiatry in suicide prevention fully.
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Affiliation(s)
- Sheikh Shoib
- Department of Health Services, Srinagar, India
- Sharda University, Greater Noida, India (SSh)
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Healing Mind and Wellness Initiative Nawab Bazar Srinagar
| | | | | | | | | | - Alaa I Saud
- Faculty of Medicine, Kasr Alainy University, Cairo, Egypt
| | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | - Mahsa Nahidi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Sarya Swed
- Faculty of Medicine, Aleppo University, Syria
| | - Fahimeh Saeed
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Santillanes G, Foster AA, Ishimine P, Berg K, Cheng T, Deitrich A, Heniff M, Hooley G, Pulcini C, Ruttan T, Sorrentino A, Waseem M, Saidinejad M. Management of youth with suicidal ideation: Challenges and best practices for emergency departments. J Am Coll Emerg Physicians Open 2024; 5:e13141. [PMID: 38571489 PMCID: PMC10989674 DOI: 10.1002/emp2.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 04/05/2024] Open
Abstract
Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self-harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self-harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home- and community-based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on-site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community- and home-based services, pediatric-receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.
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Affiliation(s)
- Genevieve Santillanes
- Department of Emergency Medicine, Keck School of Medicine of USCLos Angeles General Medical CenterLos AngelesCaliforniaUSA
| | - Ashley A. Foster
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Paul Ishimine
- Departments of Emergency Medicine and PediatricsUniversity of California, San Diego School of Medicine, UC San Diego Health and Rady Children's HospitalSan DiegoCaliforniaUSA
| | - Kathleen Berg
- Department of Pediatrics, Dell Medical SchoolThe University of TexasAustinTexasUSA
| | - Tabitha Cheng
- Department of Emergency MedicineHarbor UCLA Medical CenterDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Ann Deitrich
- Division Chief Pediatric Emergency MedicineDepartment of Emergency MedicinePrisma HealthUniversity of South Carolina School of MedicineGreenvilleSouth CarolinaUSA
| | - Melanie Heniff
- Departments of Emergency Medicine and PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Gwen Hooley
- Division of Emergency and Transport MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Christian Pulcini
- Department of Emergency Medicine and PediatricsUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Timothy Ruttan
- Department of PediatricsDell Medical SchoolThe University of Texas at Austin. US Acute Care SolutionsCantonOhioUSA
| | - Annalise Sorrentino
- Department of Pediatrics, Division of Emergency MedicineUniversity of AlabamaBirminghamAlabamaUSA
| | - Muhammad Waseem
- Lincoln Medical Center, Bronx New York; Weill Cornell MedicineNew YorkUSA
| | - Mohsen Saidinejad
- Departments of Emergency Medicine and PediatricsDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
- The Lundquist Institute for Biomedical Innovation at Harbor UCLATorranceCaliforniaUSA
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Li S, Qu Z, Li Y, Ma X. Efficacy of e-health interventions for smoking cessation management in smokers: a systematic review and meta-analysis. EClinicalMedicine 2024; 68:102412. [PMID: 38273889 PMCID: PMC10809126 DOI: 10.1016/j.eclinm.2023.102412] [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: 10/25/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Background Smoking is one of the major risk factors for shortened lifespan and disability, while smoking cessation is currently the only guaranteed method to reduce the harm caused by smoking. E-health is a field that utilizes information and communication technology to support the health status of its users. The emergence of this digital health approach has provided a new way of smoking cessation support for smokers seeking help, and an increasing number of researchers are attempting to use e-health for a wide range of effective smoking cessation interventions. We conducted a systematic review and meta-analysis of studies that used e-health as a smoking cessation support tool. Methods This systematic review and meta-analysis searched the PubMed, Embase, and Cochrane Library databases until December 2022. The included studies were randomized controlled trials (RCTs) comparing the use of e-health interventions and traditional offline smoking cessation care interventions. The primary outcome of the studies was the point smoking cessation rate (7-day and 30-day), and the secondary outcome was sustained smoking cessation rates. Studies were excluded if there was no clear e-health intervention described or if standard-compliant cessation outcomes were not clearly reported. Fixed-effects meta-analysis and meta-regression analyses were performed on the included study data to evaluate the effectiveness of the interventions. The meta-analysis outcome was the risk ratio (RR) and a 95% confidence interval. The study was registered with PROSPERO, CRD42023388667. Findings We collectively screened 2408 articles, and ultimately included 39 articles with a total of 17,351 eligible participants, of which 44 studies were included in the meta-analysis. The meta-analysis revealed that compared to traditional smoking cessation interventions, e-health interventions can increase point quit rates (RR 1.86, 95% CI 1.69-2.04) as well as sustained quit rates in the long-term (RR 1.79, 95% CI 1.60-2.00) among smokers. Subgroup analysis showed that text and telephone interventions in e-health significantly improved short-term quit rates for up to 7 days (RR 2.10, 95% CI 1.77-2.48). Website and app interventions also had a positive impact on improving short-term quit rates for up to 7 days (RR 1.74, 95% CI 1.56-1.94). The heterogeneity of the study results was low, demonstrating the significant smoking cessation advantages of e-health interventions. Interpretation We have found that personalized e-health interventions can effectively help smokers quit smoking. The diverse remote intervention methods of e-health can provide more convenient options for further customization. Additionally, further follow-up research is needed to evaluate the sustained effectiveness of interventions on smokers' continuous abstinence over a longer period (greater than one year). In the future, e-health can further optimize smoking cessation strategies. Funding No funding.
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Affiliation(s)
- Shen Li
- Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Zhan Qu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yiyang Li
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
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Knettel BA, Amiri I, Minja L, Martinez AJ, Knippler ET, Madundo K, Staton C, Vissoci JRN, Mwobobia J, Mmbaga BT, Kaaya S, Relf MV, Goldston DB. Brief Report: Task-Shifting "Gold Standard" Clinical Assessment and Safety Planning for Suicide Risk Among People Living With HIV: A Feasibility and Fidelity Evaluation in Tanzania. J Acquir Immune Defic Syndr 2023; 93:374-378. [PMID: 37159427 PMCID: PMC10524299 DOI: 10.1097/qai.0000000000003217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Suicide is a leading cause of death among people living with HIV (PLWH) worldwide, with suicide deaths occurring twice as frequently among PLWH than among the general public. In Tanzania, resources for mental health care are sorely lacking, with 55 psychiatrists and psychologists providing treatment for 60 million people. In light of this shortage, nonspecialists play a crucial role. The objective of this study was to assess feasibility of implementing task-shifted screening, assessment, and safety planning for suicide risk among PLWH. SETTING Two adult HIV clinics in Kilimanjaro, Tanzania. METHODS Registered professional nurses in the HIV clinics were trained to administer brief screening of suicidal ideation in the past month. Patients experiencing suicidal ideation were referred to bachelor's-level counselors for further assessment and safety planning, supervised by specialist providers who reviewed audio recordings for quality assurance. RESULTS During 180 days of implementation, nurses screened patients attending 2745 HIV appointments. Sixty-one (2.2%) endorsed suicidal ideation and were linked to further assessment and safety planning. We cross-checked screening with clinic attendance logs on 7 random days and found high fidelity to screening (206 of 228 screened, 90%). Quality assurance ratings demonstrated key assessment pieces were consistently completed (mean = 9.3/10 possible), with "Good" to "Excellent" counseling skills (mean = 23.7/28) and "Good" to "Excellent" quality (mean = 17.1/20), including appropriate referral for higher levels of care. CONCLUSIONS Brief screening can be implemented and paired with task-shifted counseling to facilitate high-quality assessment of suicide risk. This model shows excellent potential to extend mental health services for PLWH in low-resource settings.
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Affiliation(s)
- Brandon A. Knettel
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Ismail Amiri
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Elizabeth T. Knippler
- Duke University School of Nursing, Durham, NC, USA
- Duke Center for AIDS Research, Durham, NC, USA
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Catherine Staton
- Duke Global Health Institute, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | - Joao Ricardo N. Vissoci
- Duke Global Health Institute, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | | | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael V. Relf
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
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Shin HD, Durocher K, Sequeira L, Zaheer J, Torous J, Strudwick G. Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review. BMC Health Serv Res 2023; 23:281. [PMID: 36959599 PMCID: PMC10037806 DOI: 10.1186/s12913-023-09254-5] [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: 07/29/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on ICT-based interventions for suicide prevention implemented in clinical settings and then to identify and characterize implementation barriers and facilitators, as well as evaluation outcomes, and measures. METHODS We conducted this review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was applied to the following six databases between August 17-20, 2021: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Library, Information Science and Technology Abstracts. We also supplemented our search with Google searches and hand-searching reference lists of relevant reviews. To be included in this review, studies must include ICT-based interventions for any spectrum of suicide-related thoughts and behaviours including non-suicidal self-injury. Additionally, these ICTs must be implemented in clinical settings, such as emergency department and in-patient units. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to prepare this full report. RESULTS This review included a total of 75 citations, describing 70 studies and 66 ICT-based interventions for suicide prevention implemented in clinical settings. The majority of ICTs were computerized interventions and/or applications (n = 55). These ICTs were commonly used as indicated strategies (n = 49) targeting patients who were actively presenting with suicide risk. The three most common suicide prevention intervention categories identified were post-discharge follow-up (n = 27), screening and/or assessment (n = 22), and safety planning (n = 20). A paucity of reported information was identified related to implementation strategies, barriers and facilitators. The most reported implementation strategies included training, education, and collaborative initiatives. Barriers and facilitators of implementation included the need for resource supports, knowledge, skills, motivation as well as engagement with clinicians with research teams. Studies included outcomes at patient, clinician, and health system levels, and implementation outcomes included acceptability, feasibility, fidelity, and penetration. CONCLUSION This review presents several trends of the ICT-based interventions for suicide prevention implemented in clinical settings and identifies a need for future research to strengthen the evidence base for improving implementation. More effort is required to better understand and support the implementation and sustainability of ICTs in clinical settings. The findings can also serve as a future resource for researchers seeking to evaluate the impact and implementation of ICTs.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- School of Health, Community Service & Creative Design, Lambton College, Sarnia, Ontario, Canada
| | - Lydia Sequeira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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