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Mortier P, Amigo F, Bhargav M, Conde S, Ferrer M, Flygare O, Kizilaslan B, Latorre Moreno L, Leis A, Mayer MA, Pérez-Sola V, Portillo-Van Diest A, Ramírez-Anguita JM, Sanz F, Vilagut G, Alonso J, Mehlum L, Arensman E, Bjureberg J, Pastor M, Qin P. Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project. BMC Psychiatry 2024; 24:220. [PMID: 38509500 PMCID: PMC10956300 DOI: 10.1186/s12888-024-05659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Self-harm presents a significant public health challenge. Emergency departments (EDs) are crucial healthcare settings in managing self-harm, but clinician uncertainty in risk assessment may contribute to ineffective care. Clinical Decision Support Systems (CDSSs) show promise in enhancing care processes, but their effective implementation in self-harm management remains unexplored. METHODS PERMANENS comprises a combination of methodologies and study designs aimed at developing a CDSS prototype that assists clinicians in the personalized assessment and management of ED patients presenting with self-harm. Ensemble prediction models will be constructed by applying machine learning techniques on electronic registry data from four sites, i.e., Catalonia (Spain), Ireland, Norway, and Sweden. These models will predict key adverse outcomes including self-harm repetition, suicide, premature death, and lack of post-discharge care. Available registry data include routinely collected electronic health record data, mortality data, and administrative data, and will be harmonized using the OMOP Common Data Model, ensuring consistency in terminologies, vocabularies and coding schemes. A clinical knowledge base of effective suicide prevention interventions will be developed rooted in a systematic review of clinical practice guidelines, including quality assessment of guidelines using the AGREE II tool. The CDSS software prototype will include a backend that integrates the prediction models and the clinical knowledge base to enable accurate patient risk stratification and subsequent intervention allocation. The CDSS frontend will enable personalized risk assessment and will provide tailored treatment plans, following a tiered evidence-based approach. Implementation research will ensure the CDSS' practical functionality and feasibility, and will include periodic meetings with user-advisory groups, mixed-methods research to identify currently unmet needs in self-harm risk assessment, and small-scale usability testing of the CDSS prototype software. DISCUSSION Through the development of the proposed CDSS software prototype, PERMANENS aims to standardize care, enhance clinician confidence, improve patient satisfaction, and increase treatment compliance. The routine integration of CDSS for self-harm risk assessment within healthcare systems holds significant potential in effectively reducing suicide mortality rates by facilitating personalized and timely delivery of effective interventions on a large scale for individuals at risk of suicide.
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Grants
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- ESF+; CP21/00078 ISCIII-FSE Miguel Servet co-funded by the European Social Fund Plus
- PI22/00107 ISCIII and co-funded by the European Union
- PI22/00107 ISCIII and co-funded by the European Union
- PI22/00107 ISCIII and co-funded by the European Union
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- FI23/00004 PFIS ISCIII
- FI23/00004 PFIS ISCIII
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- ERAPERMED2022 the Health Research Board Ireland
- ERAPERMED2022 the Health Research Board Ireland
- no. 2022-00549 the Swedish Innovation Agency
- no. 2022-00549 the Swedish Innovation Agency
- project no. 342386 the Research Council of Norway
- project no. 342386 the Research Council of Norway
- project no. 342386 the Research Council of Norway
- the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- CIBER of Epidemiology & Public Health
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Affiliation(s)
- Philippe Mortier
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain.
| | - Franco Amigo
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Madhav Bhargav
- School of Public Health & National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Susana Conde
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
| | - Montse Ferrer
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Oskar Flygare
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Busenur Kizilaslan
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura Latorre Moreno
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
| | - Angela Leis
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miguel Angel Mayer
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Víctor Pérez-Sola
- Neuropsychiatry and Drug Addiction Institute, Barcelona MAR Health Park Consortium PSMAR, Barcelona, Spain
- CIBER of Mental Health and Carlos III Health Institute (CIBERSAM, ISCIII), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ana Portillo-Van Diest
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ferran Sanz
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- National Bioinformatics Institute - ELIXIR-ES (IMPaCT-Data-ISCIII), Barcelona, Spain
| | - Gemma Vilagut
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Jordi Alonso
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ella Arensman
- School of Public Health & National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Manuel Pastor
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Pollak OH, Shin KE, Baroni A, Gerson RS, Bell KA, Tezanos KM, Fernandes SN, Robinaugh DJ, Schacter DL, Spirito A, Cha CB. An examination of episodic future thinking in the emergency department among youth experiencing suicidal thoughts and behaviors. Eur Child Adolesc Psychiatry 2024; 33:923-933. [PMID: 37162586 DOI: 10.1007/s00787-023-02219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
Youth experiencing suicidal thoughts and/or behaviors (STBs) frequently present to emergency departments for acute psychiatric care. These settings offer a transitory yet pivotal opportunity to assess, intervene on, and plan continued care for STBs. This study examined a clinically relevant, understudied aspect of psychological functioning among youth experiencing STBs in the emergency department: episodic future thinking, or the ability to imagine discrete autobiographical future events. A sample of 167 youths (10-17 years) presenting to a pediatric psychiatric emergency department for STBs completed a performance-based measure of episodic future thinking assessing richness in detail and subjective characteristics of imagined future events. STB recurrence was assessed 6 months later. Immediately following a suicide-related crisis, youth demonstrated mixed abilities to imagine their future: they generated some concrete future event details but did not subjectively perceive these events as being very detailed or likely to occur. Older adolescents (i.e., 15-17) generated more episodic details than pre-/younger adolescents (i.e., 10-14), particularly those pertaining to actions or sensory perceptions. There was no evidence linking less detailed episodic future thinking and greater likelihood of STBs following the emergency department visit; instead, hopelessness was a more robust risk factor. Findings underscore the importance and clinical utility of better understanding the psychological state of youth during or immediately following a suicide-related crisis. In particular, assessing youths' future thinking abilities in the emergency department may directly inform approaches to acute care delivery.
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Affiliation(s)
- Olivia H Pollak
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599, USA.
| | - Ki Eun Shin
- Department of Behavioral Sciences, Long Island University, Post Campus, Brookville, NY, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Ruth S Gerson
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Kerri-Anne Bell
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Katherine M Tezanos
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
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3
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Soderlund PD, Cheung EH, Cadiz MP, Siddiq H, Yerstein M, Lee S, Wells K, Heilemann MV. Bridging the gap: a qualitative study of providers' perceptions of a partnered crisis follow-up program for suicidal patients post-emergency department discharge. BMC Psychiatry 2023; 23:854. [PMID: 37978360 PMCID: PMC10655296 DOI: 10.1186/s12888-023-05106-y] [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] [Received: 01/20/2023] [Accepted: 08/11/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Effective interventions are needed to address suicide risk following discharge from the hospital emergency department or inpatient setting. Studies that examine follow-up contact methods show promise, but little is known about how follow-up programs are implemented in the real world and who is benefitting. The purpose of this formative evaluation and analysis was to gain insight about the usefulness and value of a partnered suicide prevention follow-up program (academic medical center emergency department partnered with a regional suicide prevention center) from the standpoint of psychiatry resident physicians providing direct care and suicide prevention center crisis counselors making follow-up outreach telephone calls to patients. METHODS A qualitative thematic analysis was conducted with focus group data from a convenience sample of psychiatry residents who performed consultations in the emergency department setting and counselors at the suicide prevention center crisis follow-up program. Focus group sessions, using semi-structured question guides, were completed at each participant group's workplace. Grounded theory techniques were used to guide coding and analytic theme development. RESULTS Analyses resulted in four overarching themes: valuing the program's utility and benefit to patients, desiring to understand what happens from emergency department discharge to program follow-up, having uncertainty about which patients would benefit from the program, and brainstorming to improve the referral process. Psychiatry residents appreciated the option of an "active" referral service (one that attempts to actively engage a patient after discharge through outreach), while suicide prevention crisis counselors valued their ability to offer a free and immediate service that had potential for fostering meaningful relationships. Both participant groups desired a better understanding of their partner's program operations, a uniform and smooth referral process, and awareness of who may or may not benefit from program services. CONCLUSION Results revealed the need for improved communication and implementation, such as expanded inter-agency contacts, consistent provider training, more documentation of the requirements and rules, a consistent message about program logistics for patients, and coordination between the program elements.
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Affiliation(s)
- Patricia D Soderlund
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, 624 East 1St St, Duluth, MN, 20155805, USA.
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, National Clinician Scholars Program, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA.
| | - Erick H Cheung
- David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Madonna P Cadiz
- Luskin School of Public Affairs, University of California Los Angeles, 337 Charles E Young Dr E, Los Angeles, CA, 90095, USA
| | - Hafifa Siddiq
- Charles R. Drew University College of Nursing, 1731 E. 120th St., Los Angeles, CA, 90059, USA
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
| | - Maria Yerstein
- Boston University School of Medicine, St. Elizabeth's Medical Center, 736 Cambridge St, Brighton, MA, 02135, USA
| | - Sae Lee
- Didi Hirsch Mental Health Services, 4760 S. Sepulveda Blvd, Culver City, CA. 90230, USA
| | - Kenneth Wells
- David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
- Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Suite 17.369B, Los Angeles, CA, 90024, USA
- David Geffen School of Medicine, National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
- Department of Mental Health, Veterans Affairs Greater Los Angeles HealthCare System, 11301 Wilshire Boulevard, Los Angeles, CA, 90073, USA
| | - MarySue V Heilemann
- School of Nursing, Factor Building, University of California Los Angeles, Box 6919, Los Angeles, CA, 90095, USA
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, National Clinician Scholars Program, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
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4
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Rheinberger D, Baffsky R, McGillivray L, Zbukvic I, Dadich A, Larsen ME, Lin PI, Gan DZQ, Kaplun C, Wilcox HC, Eapen V, Middleton PM, Torok M. Examining the Feasibility of Implementing Digital Mental Health Innovations Into Hospitals to Support Youth in Suicide Crisis: Interview Study With Young People and Health Professionals. JMIR Form Res 2023; 7:e51398. [PMID: 37971790 PMCID: PMC10690533 DOI: 10.2196/51398] [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: 07/30/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Hospitals are insufficiently resourced to appropriately support young people who present with suicidal crises. Digital mental health innovations have the potential to provide cost-effective models of care to address this service gap and improve care experiences for young people. However, little is currently known about whether digital innovations are feasible to integrate into complex hospital settings or how they should be introduced for sustainability. OBJECTIVE This qualitative study explored the potential benefits, barriers, and collective action required for integrating digital therapeutics for the management of suicidal distress in youth into routine hospital practice. Addressing these knowledge gaps is a critical first step in designing digital innovations and implementation strategies that enable uptake and integration. METHODS We conducted a series of semistructured interviews with young people who had presented to an Australian hospital for a suicide crisis in the previous 12 months and hospital staff who interacted with these young people. Participants were recruited from the community nationally via social media advertisements on the web. Interviews were conducted individually, and participants were reimbursed for their time. Using the Normalization Process Theory framework, we developed an interview guide to clarify the processes and conditions that influence whether and how an innovation becomes part of routine practice in complex health systems. RESULTS Analysis of 29 interviews (n=17, 59% young people and n=12, 41% hospital staff) yielded 4 themes that were mapped onto 3 Normalization Process Theory constructs related to coherence building, cognitive participation, and collective action. Overall, digital innovations were seen as a beneficial complement to but not a substitute for in-person clinical services. The timing of delivery was important, with the agreement that digital therapeutics could be provided to patients while they were waiting to be assessed or shortly before discharge. Staff training to increase digital literacy was considered key to implementation, but there were mixed views on the level of staff assistance needed to support young people in engaging with digital innovations. Improving access to technological devices and internet connectivity, increasing staff motivation to facilitate the use of the digital therapeutic, and allowing patients autonomy over the use of the digital therapeutic were identified as other factors critical to integration. CONCLUSIONS Integrating digital innovations into current models of patient care for young people presenting to hospital in acute suicide crises is challenging because of several existing resource, logistical, and technical barriers. Scoping the appropriateness of new innovations with relevant key stakeholders as early as possible in the development process should be prioritized as the best opportunity to preemptively identify and address barriers to implementation.
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Affiliation(s)
- Demee Rheinberger
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rachel Baffsky
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Isabel Zbukvic
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Parramatta, NSW, Australia
| | - Mark Erik Larsen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Ping-I Lin
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- Mental Health Research Unit, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Academic Unit of Infant Child and Adolescent Services (AUCS), South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Daniel Z Q Gan
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Catherine Kaplun
- Transforming Early Education and Child Health (TeEACH) Research Centre, Western Sydney University, Sydney, NSW, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Valsamma Eapen
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Infant Child and Adolescent Services (AUCS), South Western Sydney Local Health District, Liverpool, NSW, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Paul M Middleton
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Emergency Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Emergency Research Institute (SWERI), Ingham Institute, Liverpool, NSW, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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Wellen BCM, Wright NM, Bickford MA, Bakken EH, Riley AR. Integrated behavioral health services in pediatric primary care and emergency department utilization for suicide risk. Front Psychiatry 2023; 14:1241642. [PMID: 38025456 PMCID: PMC10666189 DOI: 10.3389/fpsyt.2023.1241642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Universal screening for suicide risk in primary care settings is a promising avenue for preventing self-harm and improving health outcomes. Triaging youth to an appropriate level of care, including diverting lower-risk patients from the emergency department (ED) is a meaningful goal. Previous research indicates integrated behavioral health (IBH) may prevent unnecessary admission to the ED on the day of suicide risk screening. We hypothesized that youth who received an IBH consultation the same day as suicide risk screening would be less likely to be admitted to the ED, but more likely to contact IBH services and utilize primary care in the following month. Methods We conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization. Results Among the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities. Discussion In the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care.
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Affiliation(s)
- Brianna C. M. Wellen
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Naomi M. Wright
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
| | - Mira A. Bickford
- Build EXITO Scholars Program, Portland State University, Portland, OR, United States
| | - Eliza Hayes Bakken
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
| | - Andrew R. Riley
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
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6
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Saidinejad M, Duffy S, Wallin D, Hoffmann JA, Joseph MM, Schieferle Uhlenbrock J, Brown K, Waseem M, Snow S, Andrew M, Kuo AA, Sulton C, Chun T, Lee LK. The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies. Pediatrics 2023; 152:e2023063256. [PMID: 37584106 DOI: 10.1542/peds.2023-063256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/17/2023] Open
Abstract
Mental and behavioral health (MBH) visits of children and youth to emergency departments are increasing in the United States. Reasons for these visits range from suicidal ideation, self-harm, and eating and substance use disorders to behavioral outbursts, aggression, and psychosis. Despite the increase in prevalence of these conditions, the capacity of the health care system to screen, diagnose, and manage these patients continues to decline. Several social determinants also contribute to great disparities in child and adolescent (youth) health, which affect MBH outcomes. In addition, resources and space for emergency physicians, physician assistants, nurse practitioners, and prehospital practitioners to manage these patients remain limited and inconsistent throughout the United States, as is financial compensation and payment for such services. This technical report discusses the role of physicians, physician assistants, and nurse practitioners, and provides guidance for the management of acute MBH emergencies in children and youth. Unintentional ingestions and substance use disorder are not within the scope of this report and are not specifically discussed.
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Affiliation(s)
- Mohsen Saidinejad
- Department of Clinical Emergency Medicine & Pediatrics, David Geffen School of Medicine at UCLA, Institute for Health Services and Outcomes Research, The Lundquist Institute for Biomedical Innovation at Harbor UCLA, and Department of Emergency Medicine, Harbor UCLA Medical Center, Los Angeles, California
| | - Susan Duffy
- Department of Emergency Medicine, Brown University School of Medicine, Providence, Rhode Island
| | - Dina Wallin
- Department of Emergency Medicine, University of California San Francisco, UCSF Benioff Children's Hospital, San Francisco, California
| | - Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Evanston, Illinois
| | - Madeline M Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, University of Florida Health Sciences Center, Jacksonville, Jacksonville, Florida
| | | | - Kathleen Brown
- Emergency Medicine and Trauma Center, Children's National Hospital, Washington, District of Columbia
| | - Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York
| | - Sally Snow
- Independent Consultant, Pediatric Emergency and Trauma Nursing
| | | | - Alice A Kuo
- Departments of Medicine and Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Carmen Sulton
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, CPG Sedation Services, Children's Healthcare of Atlanta, Egleston, Atlanta, Georgia
| | - Thomas Chun
- Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Hasbro Children's Hospital, Warren Alpert Medical School of Medicine at Brown University, Providence, Rhode Island
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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7
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Keller S, Tilbor E, Shwiki A, Florentin S, Laufer S, Bonne O, Canetti L, Reuveni I. Psychiatric referrals to the general hospital emergency department: are we being effective? Front Psychiatry 2023; 14:1166191. [PMID: 37599892 PMCID: PMC10433187 DOI: 10.3389/fpsyt.2023.1166191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction General hospital emergency departments (GHEDs) are notoriously overcrowded. This is caused, in part, by ineffective referrals, that is to say referrals that do not require medical examination or other interventions in the context of a general hospital. This study aims to investigate the contribution of psychiatric referrals to this issue, to identify potential determinants of these referrals and offer means to reduce them. Materials and methods Retrospective data were collected from psychiatric admission files within a GHED of a tertiary-care city hospital over a 1 year period. Two experienced clinicians separately reviewed each file to determine rationale of referrals according to predetermined criteria. Results A total of 2,136 visits included a psychiatric examination, 900 (42.1%) were determined "effective," and 1,227 (57.4%) were deemed "potentially ineffective." The leading causes for potentially ineffective referrals to a GHED were psychiatric illness exacerbation (43.4%), and suicidal ideations (22%). Most referrals (66.9%) were initiated by the patient or their family, and not by a primary care physician or psychiatrist. Conclusion More than half of the psychiatric referrals did not necessarily require the services of a general hospital, and may be more suitable for referral to a dedicated psychiatric facility. Ineffective referrals to the GHED pose a burden on general hospital resources, and may be less effective for the psychiatric patients. This calls for clear guidelines for the provision of optimal emergency treatment for mental-health patients.
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Affiliation(s)
- Shikma Keller
- Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Einat Tilbor
- Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Afnan Shwiki
- Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sharon Florentin
- Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sofia Laufer
- Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omer Bonne
- Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Laura Canetti
- Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Inbal Reuveni
- Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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8
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Bossé Chartier G, Lam F, Bergmans Y, Lofchy J, Bolton JM, Klonsky ED, Zaheer J, Kealy D. "Psychotherapy in the Pressure Cooker": A Systematic Review of Single Session Psychosocial Interventions in Emergency Departments for Suicide-related Thoughts or Behaviors. J Psychiatr Pract 2023; 29:291-307. [PMID: 37449827 DOI: 10.1097/pra.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Up to 20% of individuals who die by suicide have visited an emergency department (ED) within 4 weeks of their death. Limited guidance is available regarding the modification of clinical outcomes following a psychosocial intervention in the ED for pediatric and adult populations. METHODS A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to identify studies focused on single-session psychosocial interventions for pediatric and adult patients experiencing suicide-related thoughts or behaviors (SRTB) in the ED. Two reviewers independently screened articles identified using the key terms suicide/self-harm, emergency department, and interview. Medline, PubMed, Embase, PsycINFO, CINAHL, and CENTRAL were searched from inception to August 2018. RESULTS After screening 3234 abstracts, 29 articles were selected for full-text review and 14 articles, representing 8 distinct studies (N=782), were included. A high level of heterogeneity was present in the included articles, with 7 randomized-controlled trials, 2 nonrandomized-controlled trials, 2 cohort studies, 2 observational studies, and 1 feasibility study. Most of the included studies focused on adolescents (6 articles) or military veterans (7 articles). Strong statistical evidence of ED interventions improving outpatient service linkage was supported (χ2: 81.80, P<0.0001, 7 studies). CONCLUSIONS The findings of this study suggested promising outcomes for patients presenting to the ED with SRTB who receive a single-session psychosocial intervention. All of the studies that measured such outcomes found significantly increased follow-up care in the intervention arm. Further research is needed to strengthen the evidence base, provide better patient representation, and improve our understanding of the mechanisms by which the psychosocial intervention for SRTB in the ED ameliorates patient outcomes (CRD42020156496).
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Affiliation(s)
- Gabrielle Bossé Chartier
- BOSSÉ CHARTIER, LAM, and KEALY: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; BERGMANS and ZAHEER: Department of Psychiatry, University of Toronto, Toronto, ON, Canada; LOFCHY: Adult Acute Care Psychiatry, St. Joseph's Health Centre and University of Toronto, Toronto, ON, Canada; BOLTON: Department of Psychiatry, University of Manitoba, and Shared Health Manitoba Crisis Response Centre, Winnipeg, MB, Canada; KLONSKY: Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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9
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Bowden CF, Worsley D, Esposito JM, Cutler GJ, Doupnik SK. Pediatric emergency departments' readiness for change toward improving suicide prevention: A mixed-methods study with US leaders. J Am Coll Emerg Physicians Open 2022; 3:e12839. [PMID: 36311338 PMCID: PMC9597096 DOI: 10.1002/emp2.12839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 09/14/2022] [Accepted: 09/29/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To assess pediatric emergency departments' (PEDs) current suicide prevention practices and climate for change to improve suicide prevention for youth. Methods We conducted an explanatory, sequential mixed-methods study. First, we deployed a national, cross-sectional survey of PED leaders identified through publicly available data in Fall 2020, and then we conducted follow-up interviews with those who expressed interest. The survey queried each PED's suicide prevention practices and measured readiness for change to improve suicide prevention practices using questions scored on a 5-point Likert scale. Interviews gathered further, in-depth descriptions of PEDs' practices and culture. Interviews were audio-recorded, transcribed verbatim, and analyzed using a rapid analysis approach. Results Of 135 PED directors eligible to complete the survey, 64 responded (response rate 47%). A total of 64% of PEDs had a mental health specialist available 24 hours/day, 7 days/week; 80% reported practicing mental health disposition planning, and 41% reported practicing psychiatric medication management. Altogether 91% of directors agreed or strongly agreed that their PED had a positive culture and 92% agreed/strongly agreed that their PED was ready for change. However, 31% disagreed/strongly disagreed that their PED had tools for evaluation and quality measurement. Resources needed for change (including budget, staffing, training, and facilities) varied across institutions. Interviews with our convenience sample of 21 directors revealed varying suicide prevention practices and confirmed that standardization, evaluation, and quality improvement initiatives were needed at most institutions. Leaders reported a high interest in improving care. Conclusions PED leaders reported high motivation to improve suicide prevention services for young people, and reported needing quality improvement infrastructure to monitor and guide improvement.
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Affiliation(s)
- Cadence F. Bowden
- Division of General PediatricsClinical Futures, and PolicyLabChildren'sHospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Diana Worsley
- Division of General PediatricsClinical Futures, and PolicyLabChildren'sHospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Jeremy M. Esposito
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Gretchen J. Cutler
- Children's Minnesota Research InstituteChildren's MinnesotaMinneapolisMinnesotaUSA
| | - Stephanie K. Doupnik
- Division of General PediatricsClinical Futures, and PolicyLabChildren'sHospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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10
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Ahmadi N, Pynoos R, Leuchter A, Kopelowicz A. Reminder-Focused Positive Psychiatry: Suicide Prevention Among Youths With Comorbid Posttraumatic Stress Disorder and Suicidality. Am J Psychother 2022; 75:114-121. [PMID: 35903914 DOI: 10.1176/appi.psychotherapy.20200061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to investigate the effect of brief reminder-focused positive psychiatry and suicide prevention (RFPP-S) on suicidal ideation, posttraumatic stress disorder (PTSD) symptoms, and clinical outcomes among youths with PTSD treated in psychiatric emergency rooms. METHODS This study included youths with PTSD and suicidality who received either RFPP-S (N=50) or treatment as usual (N=150). The Columbia Suicide Severity Rating Scale (C-SSRS), Clinician-Administered PTSD Scale for children and adolescents, University of California, Los Angeles Trauma Reminder Inventory, Patient Health Questionnaire-9, Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment Scale, and positive psychiatry test batteries were administered at baseline, on day 2, and 1 week and 1 month after discharge. RESULTS On day 2, the RFPP-S group showed a greater reduction in PTSD symptoms (55%) and reactivity to trauma and loss reminders (80%) compared with the control group (10% for both) (p=0.001). A significantly greater reduction in C-SSRS score for RFPP-S (80%), compared with treatment as usual (15%), was noted (p=0.001), and RFPP-S showed more rapid stabilization (mean±SD=2.0±0.5 days) and enhanced postdischarge follow-up (100%) compared with treatment as usual (5.0±2.0 days and 50%, respectively) (p<0.05). RFPP-S, but not treatment as usual, was associated with significant increases in well-being, flexible thinking, and coping skills (p<0.05). Hospital readmission due to suicidality 1 month after discharge was 0% for the RFPP-S group and 20% for the control group. CONCLUSIONS RFPP-S was associated with reduced PTSD symptoms, enhanced coping skills while experiencing trauma reminders, adoption of safety skills, rapid stabilization of acute crises of PTSD with suicidality, adherence to post-emergency room visits and treatment, and favorable clinical outcomes.
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Affiliation(s)
- Naser Ahmadi
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles (all authors); Olive View-UCLA Medical Center, Sylmar, California (Ahmadi, Kopelowicz)
| | - Robert Pynoos
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles (all authors); Olive View-UCLA Medical Center, Sylmar, California (Ahmadi, Kopelowicz)
| | - Andrew Leuchter
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles (all authors); Olive View-UCLA Medical Center, Sylmar, California (Ahmadi, Kopelowicz)
| | - Alex Kopelowicz
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles (all authors); Olive View-UCLA Medical Center, Sylmar, California (Ahmadi, Kopelowicz)
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11
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Indian Academy of Pediatrics Consensus Guidelines on Prevention and Management of Suicidal Behavior in Adolescents. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Renaud J, MacNeil SL, Vijayakumar L, Spodenkiewicz M, Daniels S, Brent DA, Turecki G. Suicidal ideation and behavior in youth in low- and middle-income countries: A brief review of risk factors and implications for prevention. Front Psychiatry 2022; 13:1044354. [PMID: 36561636 PMCID: PMC9763724 DOI: 10.3389/fpsyt.2022.1044354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Although global rates of suicide have dropped in the last 30 years, youth in low- and middle-income countries (LMICs) continue to be highly represented in suicide statistics yet underrepresented in research. In this review we present the epidemiology of suicide, suicidal ideation, and suicide attempts among youth in LMICs. We also describe population-level (attitudes toward suicide, socioeconomic, and societal factors) and individual-level clinical and psychosocial risk factors, highlighting specific considerations pertaining to youth in LMICs. These specific considerations in risk factors within this population can inform how multi-level prevention strategies may be targeted to meet their specific needs. Prevention and intervention strategies relying on the stepped-care framework focusing on population-, community-, and individual level targets while considering locally- and culturally relevant practices are key in LMICs. In addition, systemic approaches favoring school-based and family-based interventions are important among youth. Cross-culturally adapted multimodal prevention strategies targeting the heterogeneity that exists in healthcare systems, suicide rates, and risk factors in these countries should be accorded a high priority to reduce the burden of suicide among youth in LMICs.
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Affiliation(s)
- Johanne Renaud
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, QC, Canada.,Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | | | | | - Michel Spodenkiewicz
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, QC, Canada.,Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.,Pôle de Santé Mentale, CIC-EC 1410, Université et CHU de La Réunion Sainte-Pierre, Saint-Pierre, France.,INSERM UMR-1178 Moods Team CESP Le Kremlin-Bicêtre France, Le Kremlin-Bicêtre, France
| | - Sylvanne Daniels
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, QC, Canada.,Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - David A Brent
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, QC, Canada.,Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
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13
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Kahn G, Tumin D, Vasquez-Rios V, Smith A, Buckman C. Prior health care utilization among adolescents treated for a suicide attempt at a rural ED. J Rural Health 2021; 38:748-753. [PMID: 34784070 DOI: 10.1111/jrh.12630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To characterize prior contact with a rural academic health system among young people treated for a suicide attempt in the system's emergency departments (EDs). METHODS We retrospectively examined electronic medical records from a health system serving 29 medically underserved rural counties in the Southeastern United States. Patients ages 10-25 years were included in the study if they were admitted to the ED for a suicide attempt in 2015-2018. Patients were stratified according to whether they had any encounter in the same health system in the 12 months prior to the attempt. FINDINGS Of 236 patients meeting inclusion criteria, only 10% had contact with the health system in the 12 months prior to ED treatment for a suicide attempt. Patients who lived farther than 25 km from the flagship hospital were less likely to have had prior contact (odds ratio [OR]: 0.10, 95% confidence interval [CI]: 0.02-0.34). Young adults ages 19-25 years were also less likely to have prior contact than adolescents (OR: 0.27, 95% CI: 0.08-0.76). CONCLUSIONS Few adolescents and young adults in this rural region received prior health care from the same health system where they were treated for a suicide attempt. Hospitals operating in rural areas need to partner with community health care providers to ensure adequate reach of screening and treatment programs to prevent youth suicide and reduce care fragmentation.
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Affiliation(s)
- Geoffrey Kahn
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Virginia Vasquez-Rios
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Aimee Smith
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Cierra Buckman
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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14
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Greenfield B, Jolicoeur-Martineau A, Brown M, Kandiyoti A, Henry M, Sasson T, Ahmadi S, Vivani T, Harnden B, de Castro F, Tran B, Boodaghians L, Weiss M, Atsaidis Z, Wazana A. Frequent follow-up of suicidal youth assessed in the emergency room: Long-term trajectory and predictors of suicidality. Prev Med 2021; 152:106737. [PMID: 34538378 DOI: 10.1016/j.ypmed.2021.106737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
UNLABELLED Suicide was the second‑leading cause of US deaths in 2018 among 15-24-year-olds. Suicide attempts, a risk factor for completions, and suicide ideation have doubled among pediatric emergency room (ER) patients during the past decade. Borderline Personality Disorder (BPD), a comorbid condition, has a 10% suicide rate. We examined the 4-year outcome of a cohort of suicidal adolescents, many also suffering from BPD and having undergone some form of treatment, to identify baseline factors which could inform intervention that would minimize suicidality 4 years post-discharge. METHODS We conducted a prospective longitudinal study of suicidality at twelve points (four assessment occasions) for 286 suicidal youth presenting to a pediatric ER, most suffering from BPD, with 36 suicide ratings from baseline to 2-, 6- and 48-month follow-up evaluations. We examined the trajectory and predictors of persisting suicidality. RESULTS Suicidality rapidly decreased within 2 months post-ER-discharge, subsequently remaining low throughout 48 months. Baseline functioning, female sex, stressful life events and BPD impulsiveness were most predictive of persisting suicidality at 48-month follow-up. CONCLUSION Most suicidal youth, many meeting BPD criteria, no longer feel suicidal 2 months after ER discharge. Management of participants' baseline poor functioning stressful life events and the impulsiveness component of BPD specifically in females could impact suicidality 4 years later, and guide treatment options. The absence of the BPD cognitive and affective subscales as predictors of suicidality at 4-year follow-up may reflect treatment received. Further investigation of treatment effects is warranted and under way.
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Affiliation(s)
- Brian Greenfield
- Department of Psychiatry, Faculty of Medicine, McGill University, Canada
| | - Alexia Jolicoeur-Martineau
- Mila, University of Montréal, Montréal, QC, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Maria Brown
- Department of Educational & Counselling Psychology, McGill University, Montréal, QC, Canada
| | - Alegra Kandiyoti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Melissa Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; Segal Cancer Centre, Jewish General Hospital, Canada
| | - Tania Sasson
- Department of Physical Medicine & Rehabilitation, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Tania Vivani
- Department of Psychology, Universite de Quebec a Montreal, Montréal, QC, Canada
| | - Bonnie Harnden
- Department of Creative Arts Therapies, Faculty of Fine Arts, Concordia University, Montréal, QC, Canada
| | - Filipa de Castro
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Brian Tran
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Levon Boodaghians
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Margaret Weiss
- Child Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
| | - Zoe Atsaidis
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Ashley Wazana
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; Centre for Child Development and Mental Health, Jewish General Hospital, Montréal, QC, Canada.
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15
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Dimeff LA, Jobes DA, Tyndal T, Zhang I, Stefan S, Kako N, Lawrence H, Ilac M. Using the Delphi Method for Determining Key Performance Elements for Delivery of Optimal Suicide-Specific Interventions in Emergency Departments. Arch Suicide Res 2021; 27:246-260. [PMID: 34632952 DOI: 10.1080/13811118.2021.1984347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Evidence-based suicide prevention interventions directed to those seeking psychiatric crisis services for suicidality in the emergency department (ED) can reduce death by suicide and related suffering. Best practice guidelines for the care of suicidal patients in the ED exist but are not accompanied by fidelity tools for use in determining whether the interventions were applied, particularly when more than one intervention is delivered concurrently. We sought to develop a universal, treatment-agnostic Suicide Care Fidelity Checklist comprised of Key Performance Elements (KPE) across the recommended suicide-specific ED interventions. METHOD A comprehensive review of published care standards was first conducted to determine suicide-specific ED best practice treatment domains and KPEs. Subject matter experts (SMEs) were identified for each domain. Using the Delphi Consensus method, SMEs iteratively revised and refined the KPEs within their domain until achieving KPE item consensus. RESULTS A total of three iterations was required to obtain consensus in five of six domains: comprehensive suicide assessment, lethal means counseling, suicide crisis planning, behavioral skills training, and psychoeducation about suicidality. Consensus was not fully attained for the domain involving engagement with people with lived experience. CONCLUSIONS We successfully identified six intervention domains and 74 KPEs across domains (60 deemed essential, and 14 deemed optional), with full consensus reached for 70 KPEs. While replication of the initial findings is required, the Suicide Care Fidelity Checklist can be used as a fidelity checklist to verify delivery of suicide-specific ED interventions.HIGHLIGHTSApplied Delphi Consensus method with suicide-specific subject matter experts.Generated a treatment-agnostic, universal set of suicide prevention KPEs for EDs.Expert-derived KPEs help real-world settings to assess suicide care fidelity.
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Rheinberger D, Macdonald D, McGillivray L, Maple M, Torok M, Nicolopoulos A, Shand F. "A Sustained, Productive, Constructive Relationship with Someone Who Can Help"-A Qualitative Exploration of the Experiences of Help Seekers and Support Persons Using the Emergency Department during a Suicide Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910262. [PMID: 34639571 PMCID: PMC8508062 DOI: 10.3390/ijerph181910262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 12/14/2022]
Abstract
For Australians experiencing a suicide crisis, the emergency department (ED) is the recommended point of contact for intervention and to ensure personal safety. However, negative ED experiences can deter individuals from returning, thus impacting future suicide risk. In order to improve the ED environment for individuals in suicidal crisis, an in-depth understanding of this experience is needed. In-depth semi-structured interviews with 17 help seekers and 16 support persons were conducted. A grounded theory approach uncovered a core organising concept—all participants wanted a “a sustained, productive, constructive relationship with someone who can help” during the ED visit—which guided analysis. Thematic analysis resulted in two themes and four subthemes exploring the systemic and interpersonal aspects of the ED visit and the roadblocks and pathways to development of the relationship. Interpersonal factors included aspects of staff interaction and presence of a support person. Systemic factors related to aspects controlled by the physical space and internal policies and procedures and included aspects such as the chaotic environment, long waiting times, and access to staff. Overwhelmingly, there were more roadblocks than pathways reported by participants. Improving the ED environment, increasing staff training and encouraging the presence of support persons may help mitigate some of these roadblocks.
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Affiliation(s)
- Demee Rheinberger
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
- Correspondence:
| | - Diane Macdonald
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
| | - Myfanwy Maple
- Faculty of Medicine and Health, University of New England, Armidale, NSW 2351, Australia;
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
| | - Alexandra Nicolopoulos
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
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17
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A Qualitative Account of Young People's Experiences Seeking Care from Emergency Departments for Self-Harm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062892. [PMID: 33808995 PMCID: PMC8000083 DOI: 10.3390/ijerph18062892] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 12/20/2022]
Abstract
Many young people who engage in self-harm do not seek help from health services. For those that do, emergency departments (EDs) are a key point of contact. Substantial gaps remain in current knowledge related to young consumers’ experiences and views on optimal treatment of self-harm in the ED. In this study, semi-structured interviews were conducted with thirteen young people (Mage = 21.2 years), who were engaged with care at headspace early intervention centers and had presented to an ED with a self-inflicted physical injury. Participants were asked to describe their experience in the ED and the care they received. Data were analyzed thematically. Three inter-related themes were identified: 1. The ED was experienced through a lens of significant distress, 2. The ED environment and processes were counter-therapeutic, and 3. Staff were perceived to be disinterested, dismissive, and lacking in knowledge. The study highlights the overwhelmingly negative nature of participants’ experiences, and presents recommendations for service and practice improvements, such as the provision of staff training and increased aftercare.
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Dimeff LA, Jobes DA, Koerner K, Kako N, Jerome T, Kelley-Brimer A, Boudreaux ED, Beadnell B, Goering P, Witterholt S, Melin G, Samike V, Schak KM. Using a Tablet-Based App to Deliver Evidence-Based Practices for Suicidal Patients in the Emergency Department: Pilot Randomized Controlled Trial. JMIR Ment Health 2021; 8:e23022. [PMID: 33646129 PMCID: PMC7961404 DOI: 10.2196/23022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Emergency departments (EDs) have the potential to provide evidence-based practices for suicide prevention to patients who are acutely suicidal. However, few EDs have adequate time and personnel resources to deliver recommended evidence-based assessment and interventions. To raise the clinical standard of care for patients who are suicidal and seeking psychiatric crisis services in the ED, we developed Jaspr Health, a tablet-based app for direct use by such patients, which enables the delivery of 4 evidence-based practices. OBJECTIVE This study aims to evaluate the feasibility, acceptability, and effectiveness of Jaspr Health among suicidal adults in EDs. METHODS Patients who were acutely suicidal and seeking psychiatric crisis services participated in an unblinded pilot randomized controlled trial while in the ED. Participants were randomly assigned to Jaspr Health (n=14) or care as usual (control; n=17) groups. Participants were assessed at baseline, and a 2-hour posttest using self-report measures and a semistructured interview were conducted. RESULTS Conditions differed significantly at baseline with regard to age but not other demographic variables or baseline measures. On average, participants had been in the ED for 17 hours before enrolling in the study. Over their lifetime, 84% (26/31) of the sample had made a suicide attempt (mean 3.4, SD 6.4) and 61% (19/31) had engaged in nonsuicidal self-injurious behaviors, with an average rate of 8.8 times in the past 3 months. All established feasibility and acceptability criteria were met: no adverse events occurred, participants' app use was high, Jaspr Health app user satisfaction ratings were high, and all participants using Jaspr Health recommended its use for other suicidal ED patients. Comparisons between study conditions provide preliminary support for the effectiveness of the app: participants using Jaspr Health reported a statistically significant increase in receiving 4 evidence-based suicide prevention interventions and overall satisfaction ratings with their ED experience. In addition, significant decreases in distress and agitation, along with significant increases in learning to cope more effectively with current and future suicidal thoughts, were observed among participants using Jaspr Health compared with those receiving care as usual. CONCLUSIONS Even with limited statistical power, the results showed that Jaspr Health is feasible, acceptable, and clinically effective for use by ED patients who are acutely suicidal and seeking ED-based psychiatric crisis services. TRIAL REGISTRATION ClinicalTrials.gov NCT03584386; https://clinicaltrials.gov/ct2/show/NCT03584386.
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Affiliation(s)
- Linda A Dimeff
- Evidence Based Practice Institute, Inc, Seattle, WA, United States
| | - David A Jobes
- The Catholic University of America, Washington, DC, United States
| | - Kelly Koerner
- Evidence Based Practice Institute, Inc, Seattle, WA, United States
| | - Nadia Kako
- Evidence Based Practice Institute, Inc, Seattle, WA, United States
| | - Topher Jerome
- Evidence Based Practice Institute, Inc, Seattle, WA, United States
| | | | - Edwin D Boudreaux
- Department of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | | | - Paul Goering
- Mental Health and Addiction, Allina Health, Minneapolis, MN, United States
| | - Suzanne Witterholt
- Mental Health and Addiction, Allina Health, Minneapolis, MN, United States
| | - Gabrielle Melin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Vicki Samike
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Kathryn M Schak
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Arango A, Gipson PY, Votta JG, King CA. Saving Lives: Recognizing and Intervening with Youth at Risk for Suicide. Annu Rev Clin Psychol 2021; 17:259-284. [PMID: 33544628 DOI: 10.1146/annurev-clinpsy-081219-103740] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Suicide is the second leading cause of death for youth in the United States. Fortunately, substantial advances have been achieved in identifying and intervening with youth at risk. In this review, we first focus on advances in proactive suicide risk screening and psychoeducation aimed at improving the recognition of suicide risk. These strategies have the potential to improve our ability to recognize and triage youth at risk who may otherwise be missed. We then review recent research on interventions for youth at risk. We consider a broad range of psychotherapeutic interventions, including crisis interventions in emergency care settings. Though empirical support remains limited for interventions targeting suicide risk in youth, effective and promising approaches continue to be identified. We highlight evidence-based screening and intervention approaches as well as challenges in these areas and recommendations for further investigation.
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Affiliation(s)
- Alejandra Arango
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
| | - Polly Y Gipson
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
| | - Jennifer G Votta
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
| | - Cheryl A King
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA;
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Kiran T, Chaudhry N, Bee P, Tofique S, Farooque S, Qureshi A, Taylor AK, Husain N, Chew-Graham CA. Clinicians' Perspectives on Self-Harm in Pakistan: A Qualitative Study. Front Psychiatry 2021; 12:607549. [PMID: 34093256 PMCID: PMC8172994 DOI: 10.3389/fpsyt.2021.607549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Suicide is a serious public health problem, ranked amongst the leading causes of death worldwide. There are no official data on self-harm and suicide in Pakistan; both are illegal acts, and are socially and religiously condemned. This study explored the views of clinicians, including general practitioners (GPs) and hospital physicians (HPs) on self-harm, about their management of people who self-harm and what interventions might be appropriate in Pakistan. Methods: This qualitative study, generating data using semi-structured interviews, was nested within a Randomized Controlled Trial (RCT) of a psychosocial intervention for people following self-harm. Clinicians (n = 18) with experience of treating people who self-harm were recruited from public hospitals and general practices. Results: Face-to-face interviews were conducted in Urdu and digitally recorded with consent, transcribed and translated into English. Transcripts were checked for cultural and interpretive interpretations by the research team, then analyzed thematically using the principles of constant comparison. The following themes will be presented: encountering people with self-harming behaviors; challenges encountered in managing people who self-harm; barriers to accessing care, and what ideal care might look like. Participants identified their lack of training and expertise in the management of people with self-harm behavior. Conclusions: This is the first study to explore clinicians' perspectives on self-harm in Pakistan. The study highlighted the need for training for doctors in the identification and management of mental health problems, including the management of people who self-harm.
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Affiliation(s)
- Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
| | - Sehrish Tofique
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Sana Farooque
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Afshan Qureshi
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Anna K Taylor
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
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21
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Abstract
Suicide is the second leading cause of death among adolescents worldwide, yet adequate mental health services for children and adolescents are lacking across the globe. Likewise, youth who engage in non-suicidal self-injury (NSSI) are at heightened risk for suicide, but few pediatric settings have established protocols for screening and responding to youth who engage in NSSI and/or endorse thoughts of suicide. In this article, we highlight similarities and differences of managing suicide and NSSI across cultures, including persisting stigma associated with youth at risk for self-harm. We summarize current guidelines for screening youth at risk for suicide and NSSI across services, consider the use of online and telehealth services, and offer recommendations for a multidisciplinary approach to treating youth who engage in self-harming behaviors as well as how healthcare professionals can communicate with each other using common, non-stigmatizing language. We conclude with a discussion of future policy recommendations and areas for research.
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Affiliation(s)
- Nicholas J Westers
- Department of Psychiatry, Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, USA
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria
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22
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Barczyk AN, Gillon JT, Piper K, Crocker CL, Christie LM, Lawson KA. Predictors of Traumatic Suicide Attempts in Youth Presenting to Hospitals with Level I Trauma Centers. J Emerg Med 2020; 59:178-185. [PMID: 32451186 DOI: 10.1016/j.jemermed.2020.02.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/24/2020] [Accepted: 02/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Limited research exists examining the predictors of suicide attempts by mechanism. OBJECTIVE The purpose of this study was to examine predictors of traumatic suicide attempts in youth. METHODS Data came from patients 5-18 years of age presenting because of a suicide attempt at 2 hospitals in Central Texas with level I trauma centers. Univariate logistic regression examined the association between traumatic suicide attempts and variables describing the patient's demographic, mental health, and social information. We used the Mann-Whitney U test to examine the association between traumatic suicide attempts and the continuous variable of age. RESULTS Of 231 patients included in this study, most were female (75.8%), non-Hispanic white (48.1%), and had a median age of 15.0 years (interquartile range 14-16). Compared with patients presenting because of an intentional overdose, patients presenting because of traumatic suicide attempts were associated with a reported criminal history (odds ratio [OR] 14.50 [95% confidence interval {CI} 3.84-54.82]), reported Child Protective Services history (OR 3.26 [95% CI 0.99-10.77]), being publicly insured or uninsured (OR 1.80 [95% CI 1.02-3.19]), male (OR 2.37 [95% CI 1.28-4.38]), and identifying as Hispanic (OR 2.01 [95% CI 1.10-3.68). CONCLUSIONS Our findings inform targeted preventative resources and education efforts to populations of greatest need.
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Affiliation(s)
- Amanda N Barczyk
- Dell Children's Trauma and Injury Research Center, Austin, Texas
| | - Jason T Gillon
- Dell Children's Medical Center of Central Texas, Austin, Texas
| | - Karen Piper
- Dell Children's Trauma and Injury Research Center, Austin, Texas
| | | | | | - Karla A Lawson
- Dell Children's Trauma and Injury Research Center, Austin, Texas
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Guzmán EM, Tezanos KM, Chang BP, Cha CB. Examining the impact of emergency care settings on suicidal patients: A call to action. Gen Hosp Psychiatry 2020; 63:9-13. [PMID: 30077397 DOI: 10.1016/j.genhosppsych.2018.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/15/2018] [Accepted: 07/19/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The emergency department (ED) offers a critical and unique opportunity to assess and intervene on suicide risk. Despite its potential benefits, the ED setting presents several potential sources of stress. The present paper calls attention to how suicidal patients may be especially vulnerable to stressful ED experiences. METHOD This research synthesis cites the growing literature on ED-related stressors, as they have been shown to affect both psychiatric and nonpsychiatric patient populations. RESULTS We identified specific interpersonal, physical, and temporal features of the ED that have been shown to affect multiple patient populations, including suicidal individuals. Beyond this, there appears to be broad underutilization of therapeutic care in ED settings. CONCLUSIONS It is important to consider how the ED setting may be both helpful and harmful toward suicidal patients. We conclude with recommended domains of study and methodological considerations when pursuing these future directions. The proposed research agenda would help address this known high risk period around hospitalization and discharge, and ultimately optimize suicide prevention efforts.
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Affiliation(s)
- Eleonora M Guzmán
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
| | - Katherine M Tezanos
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Medical Center, United States of America
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America.
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Mikami K, Inomata S, Onishi Y, Orihashi Y, Yamamoto K, Matsumoto H. Gender Differences in the Suicide Attempts of Adolescents in Emergency Departments: Focusing on Individuals with Autism Spectrum Disorder. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676609666190617144453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background:
Few studies on gender-based diagnostic characteristics of adolescent
suicide attempters in emergency departments (EDs) have included individuals with
autism spectrum disorder (ASD).
Objective:
This study aimed to examine the clinical features of adolescent suicide attempts in
EDs, focusing on gender differences and considering individuals with ASD.
Method:
Ninety-four adolescent patients, aged less than 20 years, who had attempted suicide
and had been hospitalized in an emergency department, participated in this study. Psychiatric
diagnoses according to DSM-IV criteria and clinical features were compared between
male and female patients.
Results:
The number (%) of males was 15 (16.0), and that of females was 79 (84.0). The mean
age (SD) of males was 17.1 (1.5), and that of females was 16.9 (1.6). The attempt methods
were more serious, length of stay in the emergency room longer, and rate of outpatient treatment
lower in males. In addition, suicide attempters with ASD were significantly more frequent
in male. Adjusting for age and gender, adjustment disorder was significantly associated with
the presence of suicide attempters with ASD using a multivariable logistic regression.
Conclusion:
Males were less likely to visit psychiatric service previous to attempting suicides,
and may be likely to complete suicides. In addition, suicide attempters with ASD are
characteristic in male, and likely to have comorbid adjustment disorder. ED visits offer a
window of opportunity to provide suicide prevention interventions for adolescents, and
therefore, psychiatrists in EDs have a crucial role as gatekeepers of preventing suicide reattempts,
especially in adolescent males including individuals with ASD having adjustment
disorder.
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Affiliation(s)
- Katsunaka Mikami
- Department of Psychiatry, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Seiji Inomata
- Department of Psychiatry, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yuichi Onishi
- Department of Psychiatry, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yasushi Orihashi
- Department of Clinical Pharmacology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kenji Yamamoto
- Department of Psychiatry, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Hideo Matsumoto
- Department of Psychiatry, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Rhodes AE, Sinyor M, Boyle MH, Bridge JA, Katz LY, Bethell J, Newton AS, Cheung A, Bennett K, Links PS, Tonmyr L, Skinner R. Emergency Department Presentations and Youth Suicide: A Case-Control Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:88-97. [PMID: 30282479 PMCID: PMC6405805 DOI: 10.1177/0706743718802799] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We estimate associations between emergency department (ED) diagnoses and suicide among youth to guide ED care. METHOD This ED-based case-control study used data from the Office of the Chief Coroner and all EDs in Ontario, Canada. Cases ( n = 697 males and n = 327 females) were aged 10 to 25 years who died by suicide in Ontario between April 2003 and March 2014, with an ED contact in the year before their death. Same-aged ED-based controls were selected during this time frame. Crude and adjusted odds ratios (aORs) and 95% confidence intervals were calculated. RESULTS Among youth diagnosed with a mental health problem at their most recent ED contact (41.9% cases, 5% controls), suicide was elevated among nonfatal self-inflicted: 'other' injuries, including hanging, strangulation, and suffocation in both sexes (aORs > 14); cut/pierce injuries in males (aOR > 5); poisonings in both sexes (aORs > 2.2); and mood and psychotic disorders in males (aORs > 1.7). Among those remaining, 'undetermined' injuries and poisonings in both sexes (aORs > 5), 'unintentional' poisonings in males (aOR = 2.1), and assault in both sexes (aORs > 1.8) were significant. At least half of cases had ED contact within 106 days. CONCLUSIONS The results highlight the need for timely identification and treatment of mental health problems. Among those with an identified mental health problem, important targets for suicide prevention efforts are youth with self-harm and males with mood and psychotic disorders. Among others, youth with unintentional poisonings, undetermined events, and assaults should raise concern.
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Affiliation(s)
- Anne E Rhodes
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,2 Institute for Clinical Evaluative Sciences, Toronto, Ontario.,3 Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario
| | - Mark Sinyor
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,5 Sunnybrook Health Sciences Centre, Toronto, Ontario.,6 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Michael H Boyle
- 3 Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario.,7 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Jeffrey A Bridge
- 8 Center for Suicide Prevention and Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,9 Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Laurence Y Katz
- 10 Child and Adolescent Mental Health, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Jennifer Bethell
- 11 The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Amanda S Newton
- 12 Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Amy Cheung
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,5 Sunnybrook Health Sciences Centre, Toronto, Ontario.,6 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Kathryn Bennett
- 3 Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario.,7 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Paul S Links
- 4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario
| | - Lil Tonmyr
- 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa
| | - Robin Skinner
- 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa
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Goldman-Mellor S, Kwan K, Boyajian J, Gruenewald P, Brown P, Wiebe D, Cerdá M. Predictors of self-harm emergency department visits in adolescents: A statewide longitudinal study. Gen Hosp Psychiatry 2019; 56:28-35. [PMID: 30553125 PMCID: PMC6353680 DOI: 10.1016/j.genhosppsych.2018.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study investigated patient- and area-level characteristics associated with adolescent emergency department (ED) patients' risk of subsequent ED visits for self-harm. METHOD Retrospective analysis of adolescent patients presenting to a California ED in 2010 (n = 480,706) was conducted using statewide, all-payer, individually linkable administrative data. We examined associations between multiple predictors of interest (patient sociodemographic factors, prior ED utilization, and residential mobility; and area-level characteristics) and odds of a self-harm ED visit in 2010. Patients with any self-harm in 2010 were followed up over several years to assess predictors of recurrent self-harm. RESULTS Self-harm patients (n = 5539) were significantly more likely than control patients (n = 16,617) to have prior histories of ED utilization, particularly for mental health problems, substance abuse, and injuries. Residential mobility also increased risk of self-harm, but racial/ethnic minority status and residence in a disadvantaged zipcode decreased risk. Five-year cumulative incidence of recurrent self-harm was 19.3%. Admission as an inpatient at index visit, Medicaid insurance, and prior ED utilization for psychiatric problems or injury all increased recurrent self-harm risk. CONCLUSIONS A range of patient- and area-level characteristics observable in ED settings are associated with risk for subsequent self-harm among adolescents, suggesting new targets for intervention in this clinical context.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Kevin Kwan
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Jonathan Boyajian
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA 94612, USA.
| | - Paul Brown
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Deborah Wiebe
- Department of Psychology, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Magdalena Cerdá
- Violence Prevention Research Program, University of California, Davis, Sacramento, CA 95817, USA.
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Franzen M, Keller F, Brown RC, Plener PL. Emergency Presentations to Child and Adolescent Psychiatry: Nonsuicidal Self-Injury and Suicidality. Front Psychiatry 2019; 10:979. [PMID: 32010000 PMCID: PMC6978280 DOI: 10.3389/fpsyt.2019.00979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022] Open
Abstract
Nonsuicidal Self-Injury (NSSI) and suicidality are common reasons for emergency presentations in child and adolescent psychiatry. Therefore, we focused on reasons for emergency presentations as well as specific characteristics of those presenting with NSSI or suicidality to an emergeny psychiatric service. We analyzed data from a German university hospital regarding emergency presentations during a 78 months' period. NSSI and suicidality were rated according to the Columbia Classification Algorithm of Suicide Assessment (C-CASA). Data from 546 emergency presentations was recorded, of which 347 (63.5%) presented for NSSI or suicidality. Given the high percentage, thorough assessment of sucidality as well as providing adequate treatment in emergency settings to establish further care, is of utmost importance.
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Affiliation(s)
- Monika Franzen
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.,Department of Ear-Nose-Throat, Vidia Hospital Karslruhe, Karslruhe, Germany
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Rebecca C Brown
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
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Abstract
Mental illness among children and adolescents is an increasing burden, projected to become one of the world's leading disabilities in near future. A dearth of specialized services and personnel to provide optimal care affects the disease burden, prevalence, health care services, and health care costs. The increasing demand weighs down on generalized systems of care such as emergency department (ED) services, in which the lack of specific training, personnel, and specialized protocols tends to prolong length of stay, recidivism, and suboptimal care. This article reviews outcomes and trends of overburdened ED systems in the context of pediatric mental health care management, guidelines of care, and strategies to manage common pediatric mental health emergencies and expand services within the ED. [Pediatr Ann. 2018;47(8):e328-e333.].
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