Demographic predictors of treatment attendance among adolescent suicide attempters

The feasibility and potential use of case-tracked client journeys in primary healthcare: a pilot study

OBJECTIVES

To determine the feasibility of case-tracking methods in documenting client journeys at primary healthcare (PHC) services in order to investigate the comprehensiveness of service responses and the experiences of clients.

DESIGN

Prospective pilot study. Quantitative and qualitative case management data were collected from staff via questionnaire or interview.

SETTING

Five Australian multidisciplinary PHC services were involved including four South Australian state-managed and one Northern Territory Aboriginal community-controlled PHC service.

PARTICIPANTS

Clients using services for depression (95) or diabetes (185) at the PHC services were case tracked over a 12-month period to allow construction of client journeys for these two conditions. Clients being tracked were invited to participate in two semi-structured interviews (21) and complete a health log.

RESULTS

Though a number of challenges were encountered, the case-tracking methods were useful in documenting the complex nature of client journeys for those with depression or diabetes accessing PHC services and the need to respond to the social determinants of health. A flexible research design was crucial to respond to the needs of staff and changing organisational environments.

CONCLUSIONS

The client journeys provided important information about the services' responses to depression and diabetes, and about aspects unique to comprehensive PHC such as advocacy and work that takes into account the social determinants of health.

Suicidal Individuals and Mental Health Treatment: A Novel Approach to Engagement

To determine the feasibility and acceptability of a novel, manualized problem-solving and comprehensive contact intervention (PS-CCI) aimed at improving treatment engagement of suicidal individuals. The PS-CCI was administered to 44 individuals with mood disorders presenting to the ER with suicidal ideation and/or behavior. The PS-CCI has two components: (1) a problem-solving interview administered upon admission to the emergency room (ER), and (2) follow-up contact post-discharge from the ER. The average age of participants was 33.45 years (SD = ±12.30). The PS-CCI was completed by 75 % of patients. No subject (0 %) withdrew during the 3-month follow-up period; however, 27.2 % were unable to be reached for follow-up assessment. We have concluded that the intervention has a good feasibility because of high acceptability and adherence and further testing of its efficacy seems feasible.

Clinical features of adolescents with deliberate self-harm: A case control study in Lisbon, Portugal

Deliberate self-harm (DSH) among adolescents is a high-risk condition for suicide. The aim of the present study is to describe the characteristic clinical features of adolescents with DSH according to our local context (Lisbon, Portugal), using easily available information from clinical settings. A case control study was constructed from a sample of 100 adolescents (aged 12 to 21 years). The sample was divided into two groups: adolescents with and without DSH. Case files were examined and data was completed by clinical interviews. Demographic, psychosocial, and psychopathological data were assessed and compared. Ninety-eight subjects completed the protocol. The DSH group was associated with the following: suicidal ideation or suicidal behavior as consultation motive, emergency room referral, previous follow-up attempts, suicidal ideation, psychosocial difficulties, or lack of therapeutic goals. There was a nonsignificant trend towards diagnosis of depression in the DSH group. These results reflect our clinical practice with adolescents and add data about teenagers who self-harm to the literature. Prevention and early recognition of DSH (and frequently associated depression) in adolescents are essential and could be life-saving measures. An integrated approach, which takes into account psychosocial difficulties, family dysfunction, and negative expectations, seems to be of great importance.

Treatment attendance among homeless youth: the impact of childhood abuse and prior suicide attempts

Treatment engagement and retention is a significant challenge for those who serve adolescent substance abusers. Homeless youth are considered especially challenging to engage and maintain in intervention efforts given their lack of residence and range of associated problems. This study examined predictors of treatment attendance and its impact on substance use outcome among a sample of substance abusing homeless youth (n = 133). Stepwise regression results indicated that a history of sexual abuse and suicide attempts were the two strongest predictors of the treatment attendance rate, higher attendance among those with these histories. Youths who attended greater than 6 treatment sessions showed a significant reduction in alcohol use at post-treatment, but attendance rates did not impact other substance use. Identifying predictors of treatment attendance among this subgroup of adolescents is vital given that much research suggests that treatment attendance alone is associated with better short and long term outcomes.