Longitudinal risk of suicide outcomes in people with severe mental illness following an emergency department visit and the effects of suicide prevention treatment

Barriers to and enhancement of the utilization of digital mental health interventions in low-resource settings: Perceptions of young people in Uganda

Introduction

Digital mental health (DMH) enhances access to healthcare, particularly in low- and middle-income countries where investment in mental healthcare is low. However, utilization among young people (YP) is low. This study aimed to explore YP's perceptions of the barriers to the using of DMH interventions in low-resource settings.

Methods

A qualitative descriptive approach was used. Six face-to-face focus group discussions were conducted with 50 YP from nine universities in Uganda. The median age was 24 years (range 21-25 years) and respondents were drawn from diverse academic programmes with the majority being medical students (54%). A thematic approach was used to interpret the results.

Results

Three themes were identified from the data including perceptions of using DMH services, the perceived barriers to utilization, and suggestions for enhancement of DMH for YP in low-resource settings. Most respondents had a positive attitude towards DMH. The perceived barriers to utilization of DMH included the fear of stigma, affordability, inequitable access, privacy and confidentiality concerns, and app-related challenges. Access and use of DMH can be enhanced through public engagement, creating awareness, enhanced training, and access to affordable DMH interventions.

Conclusion

DMH was deemed important in extending healthcare to YP, particularly in health systems where traditional mental health services are not readily available. However, several factors hinder equitable access to DMH in low-resource settings. There is a need for long-term investment in digital health technologies.

Recent Interventions for Acute Suicidality Delivered in the Emergency Department: A Scoping Review

Introduction

Suicidality is a growing problem in the US, and the emergency department (ED) is often the front line for the management and effective treatment of acutely suicidal patients. There is a dearth of interventions that emergency physicians may use to manage and effectively treat acutely suicidal patients. To the extent that recently described interventions are available for ED personnel, no review has been conducted to identify them. This scoping review is intended to fill this gap by systematically reviewing the literature to identify recently described interventions that can be administered in the ED to reduce symptoms and stabilize patients.

Methods

We conducted a search of PubMed, SCOPUS, and CINAHL in January 2024 to identify papers published between 2013-2023 for original research trialing recent interventions for the effective treatment of suicidality in the ED. We assessed 16 full-text articles for eligibility, and nine met inclusion criteria. Included studies were evaluated for features and characteristics, the fit of the intervention to the ED environment, and interventional efficacy.

Results

Four studies assessed the efficacy of a single dose of the anesthetic/analgesic agent ketamine. Three studies assessed the efficacy of a brief psychosocial intervention delivered in the ED, two of which paired this intervention with the provision of follow-up care (postcard contact and referral assistance/case management, respectively). The remaining two studies trialed a brief, motivational interviewing-based intervention. Included studies had strong experimental designs (randomized controlled trials) but small sample sizes (average 57). Among the interventions represented across these nine studies, a single dose of ketamine and the brief psychosocial intervention Crisis Response Planning (CRP) show promise as ED-appropriate interventions for suicidality. Ketamine and CRP demonstrated the strongest fit to the ED environment and most robust efficacy findings.

Conclusion

This review identified one drug (ketamine) and four unique psychological/behavioral interventions that have been used to treat acute suicidality in the ED. There is currently insufficient evidence to suggest that these interventions will prove efficacious and well-suited to be delivered in the ED environment. Future studies should continue to test these interventions in the ED setting to determine their feasibility and efficacy.

New pharmacotherapies to tackle the unmet needs in bipolar disorder: a focus on acute suicidality

INTRODUCTION

Suicidal behavior is relatively frequent in patients with bipolar disorder (BD) and constitutes their most frequent cause of death. Suicide rates remain high in patients with BD despite adherence to guidelines recommending lithium as first line, and/or antidepressants, antipsychotics, psychotherapy, psychosocial interventions, and electroconvulsive therapy. Hence the need to identify more effective and rapid anti-suicide interventions.

AREAS COVERED

To tackle the unmet needs of pharmacotherapy, we investigated the PubMed database on 24-25 January 2024 using strategies like ('acute suicid*'[ti] OR 'suicide crisis syndrome' OR 'acute suicidal affective disturbance') AND (lithium[ti] OR clozapine[ti]), which obtained 3 results, and ('acute suicid*'[ti] OR 'suicide crisis syndrome' OR 'acute suicidal affective disturbance') AND (ketamine[ti] OR esketamine[ti] OR NMDA[ti] OR glutamat*[ti]), which yielded 14 results. We explored glutamatergic abnormalities in BD and suicide and found alterations in both. The noncompetitive NMDS antagonist ketamine and its S-enantiomer esketamine reportedly decrease acute suicidality.

EXPERT OPINION

Intranasal esketamine or subcutaneous ketamine, single-bolus or intravenous, and possibly other glutamate receptor modulators may improve suicidal behavior in patients with unipolar and bipolar depression. This may be achieved through prompt remodulation of glutamate activity. The correct use of glutamatergic modulators could reduce acute suicidality and mortality in patients with BD.