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Tisdale C, de Andrade D, Leung J, Campbell G, Hides L. The risk of repeated suicidal presentations following residential treatment for substance use disorders: A recurrent event analysis using linked administrative data. J Affect Disord 2024; 360:364-375. [PMID: 38810779 DOI: 10.1016/j.jad.2024.05.129] [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: 01/07/2024] [Revised: 05/10/2024] [Accepted: 05/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Individuals seeking alcohol and other drug (AOD) treatment consistently experience higher rates of suicidal behaviours and death by suicide when compared to the general population. By linking residential AOD treatment data to administrative healthcare and death datasets, we aimed to examine suicide-related behaviours and identify risk and protective factors for these events following discharge from residential treatment. METHODS Participants included 1056 individuals aged 18-69 (M = 32.06, SD = 9.55, male = 696,65.9 %) admitted to three residential treatment facilities in Queensland, Australia from January 1, 2014 to December 31, 2016. Treatment data was linked to administrative hospital, emergency department (ED), mental health service, and Registry of Deaths data 2-years post-discharge. ICD-10 codes were used to identify and analyse suicide-related events. RESULTS Within 2-years post-discharge, 175 (16.6 %) individuals had a suicide-related event (n = 298 episodes). The highest proportion of episodes (11.1 %) occurred within 1-month of discharge. Higher risk of a recurrent suicide-related event was associated with receiving a Disability Support Pension (aHR = 1.69 (95%CI:1.10,2.59), two or more previous episodes of residential AOD treatment (aHR = 1.49 (95%CI:1.30,2.15). Completing residential treatment was associated with a lower risk of suicide-related events (aHR = 0.54 (95%CI:0.35,0.83). LIMITATIONS The amalgamation of suicidal ideation, attempts, and death into a single outcome oversimplifies their complex nature and interplay. The exclusive focus on one service provider limits generalisability, and data constraints and missingness preclude many analyses. CONCLUSIONS Understanding suicidal behaviours and critical risk periods following discharge from residential treatment is crucial for improving continuing care, developing effective suicide prevention, and implementing targeted interventions among this high-risk population.
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Affiliation(s)
- Calvert Tisdale
- National Drug and Alcohol Research Centre (NDARC), UNSW Medicine & Health, University of New South Wales, Sydney, Australia; National Centre for Youth Substance Use Research (NCYSUR), School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
| | - Dominique de Andrade
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia; Griffith Criminology Institute, Griffith University, Brisbane, Australia; Griffith Centre for Mental Health, Griffith University, Brisbane, Australia; Centre for Drug Use, Addictive, and Anti-social Behaviour Research, Deakin University, Geelong, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research (NCYSUR), School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Gabrielle Campbell
- National Centre for Youth Substance Use Research (NCYSUR), School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Leanne Hides
- National Centre for Youth Substance Use Research (NCYSUR), School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
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Bommersbach TJ, Olfson M, Rhee TG. National Trends in Emergency Department Visits for Suicide Attempts and Intentional Self-Harm. Am J Psychiatry 2024:appiajp20230397. [PMID: 38831705 DOI: 10.1176/appi.ajp.20230397] [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: 06/05/2024]
Abstract
OBJECTIVE This study estimated national annual trends and characteristics of emergency department visits for suicide attempts and intentional self-harm in the United States from 2011 to 2020. METHODS Data were from the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national sample survey of emergency departments. Visits for suicide attempts and intentional self-harm were identified using discharge diagnosis codes (ICD-9-CM for 2011-2015; ICD-10-CM for 2016-2020) or reason-for-visit codes. The annual proportion of emergency department visits for suicide attempts and intentional self-harm was estimated. RESULTS The weighted number of emergency department visits for suicide attempts and intentional self-harm increased from 1.43 million, or 0.6% of total emergency department visits, in 2011-2012 to 5.37 million, or 2.1% of total emergency department visits in 2019-2020 (average annual percent change, 19.5%, 95% CI=16.9, 22.2). Visits per capita increased from 261 to 871 visits per 100,000 persons (average annual percent change, 18.8%, 95% CI=17.6, 20.0). The increase in visits was widely distributed across sociodemographic groups. While suicide attempt and intentional self-harm visits were most common among adolescents, adults age 65 or older demonstrated the largest increase (average annual percent change, 30.2%, 95% CI=28.5, 32.0). Drug-related diagnoses were the most common co-occurring diagnosis among suicide attempt and intentional self-harm visits. Despite the rise in emergency department visits for suicide attempts and intentional self-harm, less than 16% included an evaluation by a mental health professional. CONCLUSIONS A significant national increase in emergency department visits for suicide attempts and intentional self-harm occurred from 2011 to 2020, as a proportion of total emergency department visits and as visits per capita. These trends underscore an urgent need to improve the continuum of mental health care for individuals with suicidal symptoms.
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Affiliation(s)
- Tanner J Bommersbach
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Bommersbach); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, and New York State Psychiatric Institute, New York (Olfson); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Conn., and Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington (Rhee)
| | - Mark Olfson
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Bommersbach); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, and New York State Psychiatric Institute, New York (Olfson); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Conn., and Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington (Rhee)
| | - Taeho Greg Rhee
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Bommersbach); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, and New York State Psychiatric Institute, New York (Olfson); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Conn., and Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington (Rhee)
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3
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Pitts BH, Doyle R, Wood L, Dar R, De Jesus Ayala S, Sharma T, St Pierre M, Anthony B. Brief Interventions for Suicidal Youths in Medical Settings: A Meta-Analysis. Pediatrics 2024; 153:e2023061881. [PMID: 38356411 DOI: 10.1542/peds.2023-061881] [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: 11/03/2023] [Indexed: 02/16/2024] Open
Abstract
CONTEXT Most youths who die by suicide have interfaced with a medical system in the year preceding their death, placing outpatient medical settings on the front lines for identification, assessment, and intervention. OBJECTIVE Review and consolidate the available literature on suicide risk screening and brief intervention with youths in outpatient medical settings and examine common outcomes. DATA SOURCES The literature search looked at PubMed, OVID, CINAHL, ERIC, and PsychInfo databases. STUDY SELECTION Interventions delivered in outpatient medical settings assessing and mitigating suicide risk for youths (ages 10-24). Designs included randomized controlled trials, prospective and retrospective cohort studies, and case studies. DATA EXTRACTION Authors extracted data on rates of referral to behavioral health services, initiation/adjustment of medication, follow-up in setting of assessment, suicidal ideation at follow-up, and suicide attempts and/or crisis services visited within 1 year of initial assessment. RESULTS There was no significant difference in subsequent suicide attempts between intervention and control groups. Analysis on subsequent crisis service could not be performed due to lack of qualifying data. Key secondary findings were decreased immediate psychiatric hospitalizations and increased mental health service use, along with mild improvement in subsequent depressive symptoms. LIMITATIONS The review was limited by the small number of studies meeting inclusion criteria, as well as a heterogeneity of study designs and risk of bias across studies. CONCLUSIONS Brief suicide interventions for youth in outpatient medical settings can increase identification of risk, increase access to behavioral health services, and for crisis interventions, can limit psychiatric hospitalizations.
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Affiliation(s)
- Brian H Pitts
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
- Partners for Children's Mental Health, Aurora, Colorado
| | - Reina Doyle
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
- Partners for Children's Mental Health, Aurora, Colorado
| | - Lauren Wood
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | - Reuven Dar
- School of Psychological Sciences,Tel Aviv University, Tel Aviv, Israel
| | - Stephanie De Jesus Ayala
- Children's Hospital Colorado, Aurora, Colorado
- Partners for Children's Mental Health, Aurora, Colorado
| | - Tripti Sharma
- Children's Hospital Colorado, Aurora, Colorado
- Partners for Children's Mental Health, Aurora, Colorado
| | | | - Bruno Anthony
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
- Partners for Children's Mental Health, Aurora, Colorado
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4
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Sumlin E, Hill R, Asim N, Busby D, Brown JL, Sharp C. Quantifying the Representation of Black Adolescents in Suicide Intervention Research. Res Child Adolesc Psychopathol 2024; 52:159-168. [PMID: 37702875 DOI: 10.1007/s10802-023-01113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/14/2023]
Abstract
This systematic review aimed to quantify the representation of Black youth in U.S. suicide intervention research. Specifically, we sought to evaluate Black youth representation in terms of (a) equity of inclusion (i.e., the inclusion of Black youth in research study samples at a rate consistent with the overall national rate of Black adolescents in the US) and (b) equity of intervention efficacy (i.e., evaluating the presence of racial disparities in intervention efficacy/effect sizes). In addition, we aimed to evaluate whether an association existed between funding status of research and representation of Black youth in studies, and to provide recommendations for future research in this area. To this end, the present study extracted and analyzed demographic information of studies included in recent meta-analyses conducted by Robinson and colleagues (2018), which were not previously analyzed, in addition to new literature published between September 2017 and January 2021. Results showed that the prevalence of Black youth included in studies was representative (14.67%; ntotal = 4451, nBlack = 664), with a median inclusion rate of 13%; however, absolute sample and group sizes were so small that it precluded comparison of differential treatment outcomes for Black youth. Thus, out of 22 studies identified, only one was able to investigate treatment outcomes for suicide in Black youth specifically. This study points to the conclusion that without adequately powered studies, disparities in treatment efficacy for Black youth cannot be compared or addressed, and the existing disparity in suicidal outcomes for Black youth will grow even larger.
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Affiliation(s)
- E Sumlin
- University of Houston, Houston, TX, USA
| | - R Hill
- Louisiana State University, Baton Rouge, LA, USA
| | - N Asim
- University of Houston, Houston, TX, USA
| | - D Busby
- University of Texas Medical Branch Galveston, Galveston, TX, USA
| | - J L Brown
- Purdue University, Lafayette, IN, USA
| | - C Sharp
- University of Houston, Houston, TX, USA.
- University of the Free State, Bloemfontein, South Africa.
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5
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Balasa R, Lightfoot S, Cleverley K, Stremler R, Szatmari P, Alidina Z, Korczak D. Effectiveness of emergency department-based and initiated youth suicide prevention interventions: A systematic review. PLoS One 2023; 18:e0289035. [PMID: 38051744 DOI: 10.1371/journal.pone.0289035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/07/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE This systematic review examined the effectiveness of Emergency Department-based and initiated youth suicide prevention interventions for suicide attempts, suicidal ideation, hospitalization, family system functioning, and other mental health symptoms. METHODS We searched five databases for randomized controlled trial (RCT) studies that examined Emergency Department-based and initiated suicide prevention interventions among youth aged 10 to 18 years old between May 2020 to June 2022. Using Cohen's d and 95% confidence interval as our standardised metrics, we followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and Synthesis Without Meta-Analysis in Systematic Reviews (SWiM) guidelines when synthesizing, interpreting, and reporting the findings of this review. RESULTS Five studies were included in this review. Findings were first synthesized according to the targeted population of the study intervention and this review's outcomes. Two interventions were effective for decreasing depressive symptoms, hospitalization recidivism, and/or increasing family empowerment. There were no interventions that reduced subsequent suicide attempts. A meta-analysis was not conducted due to the heterogeneity of the data. CONCLUSION A need exists to develop and evaluate Emergency Department-based and initiated youth suicide prevention interventions that can be successfully and sustainably implemented in practice. Future research should focus on evaluating the components of interventions that effectively mitigate suicide risk among high-risk youth.
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Affiliation(s)
- Rebecca Balasa
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
| | - Peter Szatmari
- Temerty Faculty of Medicine, Division of Child and Youth Mental Health, University of Toronto, Toronto, Canada
- The Hospital for Sick Children and Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Canada
| | - Zenita Alidina
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Daphne Korczak
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
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Laporte N, Hechtman L, Rousseau C, Greenfield B. Striking a balance: triage and crisis intervention models within the pediatric emergency room. Front Psychiatry 2023; 14:1277095. [PMID: 37920538 PMCID: PMC10618677 DOI: 10.3389/fpsyt.2023.1277095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Nicolas Laporte
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Lily Hechtman
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Montreal Children's Hospital, Montreal, QC, Canada
| | - Cécile Rousseau
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Montreal Children's Hospital, Montreal, QC, Canada
| | - Brian Greenfield
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Montreal Children's Hospital, Montreal, QC, Canada
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7
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Dobias ML, Chen S, Fox KR, Schleider JL. Brief Interventions for Self-injurious Thoughts and Behaviors in Young People: A Systematic Review. Clin Child Fam Psychol Rev 2023; 26:482-568. [PMID: 36715874 PMCID: PMC9885418 DOI: 10.1007/s10567-023-00424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/31/2023]
Abstract
Rates of self-injurious thoughts and behaviors (SITBs) increase sharply across adolescence and remain high in young adulthood. Across 50 years of research, existing interventions for SITBs remain ineffective and inaccessible for many young people in particular need of mental healthcare. Briefer intervention options may increase access to care. However, many traditional interventions for SITBs take 6 months or more to complete-making it difficult for providers to target SITBs under real-world time constraints. The present review (1) identifies and (2) summarizes evaluations of brief psychosocial interventions for SITBs in young people, ages 10-24 years. We conducted searches for randomized and quasi-experimental trials conducted in the past 50 years that evaluated effects of "brief interventions" (i.e., not exceeding 240 min, or four 60-min sessions in total length) on SITBs in young people. Twenty-six articles were identified for inclusion, yielding a total of 23 brief interventions. Across all trials, results are mixed; only six interventions reported any positive intervention effect on at least one SITB outcome, and only one intervention was identified as "probably efficacious" per standard criteria for evidence-based status. While brief interventions for SITBs exist, future research must determine if, how, and when these interventions should be disseminated.
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Affiliation(s)
- Mallory L Dobias
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA.
| | - Sharon Chen
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, Denver, CO, 80210, USA
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
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8
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Bommersbach TJ, McKean AJ, Olfson M, Rhee TG. National Trends in Mental Health-Related Emergency Department Visits Among Youth, 2011-2020. JAMA 2023; 329:1469-1477. [PMID: 37129655 PMCID: PMC10155071 DOI: 10.1001/jama.2023.4809] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/13/2023] [Indexed: 05/03/2023]
Abstract
Importance There has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health-related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs. Objective To estimate annual trends in mental health-related ED visits among US children, adolescents, and young adults between 2011 and 2020. Design, Setting, and Participants Data from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health-related visits for youths aged 6 to 24 years (unweighted = 49 515). Main Outcomes and Measures Mental health-related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health-related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health-related ED visits controlling for period effects. Results From 2011 to 2020, the weighted number of pediatric mental health-related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health-related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P < .001). Conclusions and Relevance Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.
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Affiliation(s)
| | - Alastair J McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- New England Mental Illness, Research Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington
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9
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Scheibe S, Luna IJ. Development of guidelines for hospital care of suicide attempts in adolescence. CIENCIA & SAUDE COLETIVA 2023; 28:863-874. [PMID: 36888869 DOI: 10.1590/1413-81232023283.10182022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/12/2022] [Indexed: 03/08/2023] Open
Abstract
This article aims to describe a qualitative and quantitative study of the construction and validation of guidelines for hospital care of adolescents with suicide attempts. The methodological approach involved an integrative literature review with thematic content analysis of 27 articles, which generated 3 categories: assessment of suicidal behavior in the context of the emergency department; intervention in suicidal behavior, and hospital multidisciplinary team. The content of these categories was the basis for the construction of an instrument with 15 statements about the performance of adolescents in suicidal crisis assisted in the hospital setting. This instrument was applied with 20 healthcare professionals selected from two hospital institutions in southern Brazil, who acted as judges/evaluators of the proposed statements. The content of the 15 statements was validated as guidelines through the Percentage of Concordance Calculation and the Score Calculation. The constructed guidelines may help multidisciplinary hospital teams when facing adolescents with suicide attempts, to base their conduct on criteria that guide actions of reception, assessment, intervention, and referral.
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Affiliation(s)
- Simone Scheibe
- Serviço de Psicologia, Hospital Infantil Joana de Gusmão. R. Rui Barbosa 152, Agronômica. 88025-301 Florianópolis SC Brasil.
| | - Ivânia Jann Luna
- Programa de Mestrado Profissional em Saúde Mental e Atenção Psicossocial, Departamento de Saúde Pública, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
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10
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Scheibe S, Luna IJ. Development of guidelines for hospital care of suicide attempts in adolescence. CIENCIA & SAUDE COLETIVA 2023. [DOI: 10.1590/1413-81232023283.10182022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Abstract This article aims to describe a qualitative and quantitative study of the construction and validation of guidelines for hospital care of adolescents with suicide attempts. The methodological approach involved an integrative literature review with thematic content analysis of 27 articles, which generated 3 categories: assessment of suicidal behavior in the context of the emergency department; intervention in suicidal behavior, and hospital multidisciplinary team. The content of these categories was the basis for the construction of an instrument with 15 statements about the performance of adolescents in suicidal crisis assisted in the hospital setting. This instrument was applied with 20 healthcare professionals selected from two hospital institutions in southern Brazil, who acted as judges/evaluators of the proposed statements. The content of the 15 statements was validated as guidelines through the Percentage of Concordance Calculation and the Score Calculation. The constructed guidelines may help multidisciplinary hospital teams when facing adolescents with suicide attempts, to base their conduct on criteria that guide actions of reception, assessment, intervention, and referral.
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11
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Itzhaky L, Stanley B. The Safety Planning Intervention for Children (C-SPI): Rationale and Case Illustration. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Viswanathan M, Wallace IF, Cook Middleton J, Kennedy SM, McKeeman J, Hudson K, Rains C, Vander Schaaf EB, Kahwati L. Screening for Depression and Suicide Risk in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:1543-1556. [PMID: 36219399 DOI: 10.1001/jama.2022.16310] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Depression, suicidal ideation, and self-harm behaviors in youth are associated with functional impairment and suicide. Objective To review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force (USPSTF). Data Sources PubMed, Cochrane Library, PsycINFO, CINAHL, and trial registries through July 19, 2021; references, experts, and surveillance through June 1, 2022. Study Selection English-language, randomized clinical trials (RCTs) of screening for depression or suicide risk; diagnostic test accuracy studies; RCTs of psychotherapy and first-line pharmacotherapy; RCTs, observational studies, and systematic reviews reporting harms. Data Extraction and Synthesis Two reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted. Main Outcomes and Measures Test accuracy, symptoms, response, remission, loss of diagnosis, mortality, functioning, suicide-related events, and adverse events. Results Twenty-one studies (N = 5433) were included for depression and 19 studies (N = 6290) for suicide risk. For depression, no studies reported on the direct effects of screening on health outcomes, and 7 studies (n = 3281) reported sensitivity of screening instruments ranging from 0.59 to 0.94 and specificity from 0.38 to 0.96. Depression treatment with psychotherapy was associated with improved symptoms (Beck Depression Inventory pooled standardized mean difference, -0.58 [95% CI, -0.83 to -0.34]; n = 471; 4 studies; and Hamilton Depression Scale pooled mean difference, -2.25 [95% CI, -4.09 to -0.41]; n = 262; 3 studies) clinical response (3 studies with statistically significant results using varying thresholds), and loss of diagnosis (relative risk, 1.73 [95% CI, 1.00 to 3.00; n = 395; 4 studies). Pharmacotherapy was associated with improvement on symptoms (Children's Depression Rating Scale-Revised mean difference, -3.76 [95% CI, -5.95 to -1.57; n = 793; 3 studies), remission (relative risk, 1.20 [95% CI, 1.00 to 1.45]; n = 793; 3 studies) and functioning (Children's Global Assessment Scale pooled mean difference, 2.60 (95% CI, 0.78 to 4.42; n = 793; 3 studies). Other outcomes were not statistically significantly different. Differences in suicide-related outcomes and adverse events for pharmacotherapy when compared with placebo were not statistically significant. For suicide risk, no studies reported on the direct benefits of screening on health outcomes, and 2 RCTs (n = 2675) reported no harms of screening. One study (n = 581) reported on sensitivity of screening, ranging from 0.87 to 0.91; specificity was 0.60. Sixteen RCTs (n = 3034) reported on suicide risk interventions. Interventions were associated with lower scores for the Beck Hopelessness Scale (pooled mean difference, -2.35 [95% CI, -4.06 to -0.65]; n = 644; 4 RCTs). Findings for other suicide-related outcomes were mixed or not statistically significantly different. Conclusion and Relevance Indirect evidence suggested that some screening instruments were reasonably accurate for detecting depression. Psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.
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Affiliation(s)
- Meera Viswanathan
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Ina F Wallace
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Jennifer Cook Middleton
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Sara M Kennedy
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Joni McKeeman
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Kesha Hudson
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Caroline Rains
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Emily B Vander Schaaf
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill
| | - Leila Kahwati
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
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13
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Sun FK, Chiu NM, Yao Y, Wu MK, Hung CF, Chen CC, Lee YH, Chiang CY. The effects of logotherapy on meaning in life, depression, hopelessness, and suicidal ideation, in patients with depression: An intervention study. Perspect Psychiatr Care 2022; 58:1891-1899. [PMID: 34923643 DOI: 10.1111/ppc.13003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 11/23/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the efficacy of logotherapy on meaning in life, depression, hopelessness, and suicide ideation in patients with depression. DESIGN AND METHODS A quasi-experimental approach was used and 86 participants were recruited from a psychiatric department in Taiwan. The experimental group received logotherapy for 12 weeks. The control group received depression education as usual. FINDINGS The results revealed significant differences between and within the groups for meaning in life, depression, hopelessness, and suicide ideation. PRACTICE IMPLICATIONS Logotherapy was an effective method for increasing meaning in life, reducing the degree of depression, hopelessness, and suicidal ideation for patients with depression.
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Affiliation(s)
- Fan-Ko Sun
- Department of Nursing, I-Shou University, Kaohsiung City, Taiwan
| | - Nien-Mu Chiu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - YuChun Yao
- Department of Nursing, I-Shou University, Kaohsiung City, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Chien-Chih Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Yung-Hsuan Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Chun-Ying Chiang
- Department of Nursing, I-Shou University, Kaohsiung City, Taiwan
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14
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Virk F, Waine J, Berry C. A rapid review of emergency department interventions for children and young people presenting with suicidal ideation. BJPsych Open 2022; 8:e56. [PMID: 35241211 PMCID: PMC8935937 DOI: 10.1192/bjo.2022.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Suicidal ideation is an increasingly common presentation to the paediatric emergency department. The presence of suicidal ideation is linked to acute psychiatric hospital admission and increased risk of suicide. The paediatric emergency department plays a critical role in reducing risk of suicide, strengthening protective factors and encouraging patient engagement with ongoing care. AIMS This rapid review aims to synthesise evidence on interventions that can be implemented in the paediatric emergency department for children and adolescents presenting with suicidal ideation. METHOD Six electronic databases were searched for studies published since January 2010: PubMed, Web of Science, Medline, PsycINFO, CINAHL and Cochrane. Outcomes of interest included suicidal ideation, engagement with out-patient services, incidence of depressive symptoms, hopelessness, family empowerment, hospital admission and feasibility of interventions. The Cochrane risk-of-bias tool was used to evaluate the quality of studies. RESULTS Six studies of paediatric emergency department-initiated family-based (n = 4) and motivational interviewing interventions (n = 2) were narratively reviewed. The studies were mainly small and of varying quality. The evidence synthesis suggests that both types of intervention, when initiated by the paediatric emergency department, reduce suicidal ideation and improve patient engagement with out-patient services. Family-based interventions also showed a reduction in suicidality and improvement in family empowerment, hopelessness and depressive symptoms. CONCLUSIONS Paediatric emergency department-initiated interventions are crucial to reduce suicidal ideation and risk of suicide, and to enhance ongoing engagement with out-patient services. Further research is needed; however, family-based and motivational interviewing interventions could be feasibly and effectively implemented in the paediatric emergency department setting.
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Affiliation(s)
- Farazi Virk
- Brighton and Sussex Medical School, University of Sussex, UK
| | - Julie Waine
- Mental Health Liaison Team, Queen Alexandra Hospital, UK
| | - Clio Berry
- Brighton and Sussex Medical School, University of Sussex, UK
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15
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Itzhaky L, Davaasambuu S, Ellis SP, Cisneros-Trujillo S, Hannett K, Scolaro K, Stanley BH, Mann JJ, Wainberg ML, Oquendo MA, Sublette ME. Twenty-six years of psychosocial interventions to reduce suicide risk in adolescents: Systematic review and meta-analysis. J Affect Disord 2022; 300:511-531. [PMID: 34974074 PMCID: PMC11085995 DOI: 10.1016/j.jad.2021.12.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND During adolescence, suicide risk increases; effective treatments are needed to reduce risk. METHODS Databases were searched (1995-2020) for randomized controlled trials (RCTs) concerning psychosocial treatments for suicide prevention in adolescents (10-18 yrs). Data were extracted from the timepoint closest to 6 months. Cohen's ds were estimated for reducing suicidal ideation (SI), self-harming behaviors (SHB) excluding strictly non-suicidal self-injury, and suicide attempts (SA) and analyzed using generalized least square regression. Meta-analytic innovations included within-person correlations to reflect trait suicidality; annualization to control for exposure; estimated lifetime risk based on ages; and modeling inclusion/exclusion criteria. Alternate approaches included relative risk and comparison of intervention and control treatments to baseline. RESULTS Of 30 RCTs, 6 assessing SHB (4 measuring SA), and 7 assessing SI demonstrated treatment effectiveness. Overall, interventions decreased SI (n = 25) with low effect size (d = 0.08, p = 0.01), non-significant after controlling for publication bias (d = 0.05, p = 0.1); interventions were non-significant for SHB (n = 25, d = 0.001, p = 0.97) or SA (n = 18, d = 0.03, p = 0.52). To prevent one SHB, the number needed to treat (NNT) was 45[26,156]; for SA, NNT=42[24,149]. Non-superiority may relate to effectiveness of control treatments. Thus, experimental and control treatments also were compared to baseline: both reduced SI (p < 0.0001), and effectiveness improved for SHB (NNT=12) and SA (NNT=11). LIMITATIONS Study heterogeneity and inconsistent statistical reporting limited meta-analysis. CONCLUSIONS Psychosocial interventions for suicide risk in adolescents showed little effectiveness compared with control treatments; suicide outcomes improved in both groups compared to baseline. Different approaches may be needed, including precision medicine methodologies and standardized statistical reporting criteria.
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Affiliation(s)
- Liat Itzhaky
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA; Geha Mental Health Center, Petah-Tikva, Israel
| | - Sara Davaasambuu
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Steven P Ellis
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | | | - Katrina Hannett
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | | | - Barbara H Stanley
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA; Department of Radiology, Columbia University, New York, NY, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Elizabeth Sublette
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA.
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16
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Engagement With Personalized Feedback for Emotional Distress Among College Students at Elevated Suicide Risk. Behav Ther 2022; 53:365-375. [PMID: 35227410 PMCID: PMC8894794 DOI: 10.1016/j.beth.2021.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 11/21/2022]
Abstract
Depression and suicidal ideation have substantially increased among college students, yet many students with clinically significant symptoms do not perceive their distress as warranting mental health services. Personalized feedback (PF) interventions deliver objective data, often electronically, comparing an individual's reported symptoms or behaviors to a group norm. Several studies have shown promise for PF interventions in the context of mood and depression, yet little is known regarding how, and for whom, mood-focused PF interventions might be best deployed. The primary aim of this study was to examine the sociodemographic, clinical, and treatment-seeking factors associated with reviewing PF reports on emotional distress among college students (N = 1,673) screening positive for elevated suicide risk and not receiving mental health treatment. Results indicated that PF engagement was greatest among those with higher depression scores, and those reporting privacy/stigma concerns as barriers to treatment. Sexual minority students were more likely to review their PF than heterosexual students. Taken together, PF interventions may be a useful tool for engaging those with greater clinical acuity, and those hesitant to seek in-person care. Further research is warranted to examine the circumstances in which PF interventions might be used in isolation, or as part of a multitiered intervention strategy.
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17
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Casher GA, Sutton B, Roosevelt G, Simpson SA. Evaluation of an Integrated Psychology Service in a Pediatric Emergency Department and Urgent Care. Pediatr Emerg Care 2022; 38:e697-e702. [PMID: 34137565 DOI: 10.1097/pec.0000000000002328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Children visiting emergency departments (EDs) are disproportionately affected by mental health disorders. Integrated behavioral health models hold promise for improving care among ED patients. We implemented and evaluated a novel behavioral health service integrated psychology trainees in a safety net hospital's pediatric ED and urgent care. METHODS Consultations and interventions provided were identified from the service's patient registry. Patients treated by the service were matched based on age, sex, day, and month of presentation to control patients who received a brief assessment by a specialized psychiatric nurse or patients receiving comprehensive management in a psychiatric emergency service. Rates of ED return visits were obtained from local hospital records, and insurance claims were used to identify rates of psychiatric hospitalization and outpatient follow-up care. RESULTS The most commonly provided interventions among 71 intervention patients were assistance with connection to follow-up behavioral health treatment (65%), relaxation training (41%), and motivational interviewing (31%). These patients were matched with 142 comparison patients. There was no difference among groups in return rates within 90 days among intervention versus nurse assessment or psychiatric emergency service patients (25% vs 23% vs 13%, P = 0.14). Insurance claims data were available for 115 patients (54%): within 90 days, integrated care patients were less likely to have at least 1 outpatient claim (52% vs 78% vs 84%, P < 0.01), and there was no difference in rates of psychiatric hospital admission (18% vs 20% vs 24%, P = 0.83). CONCLUSIONS Although this psychology-led integrated behavioral health service delivered a range of brief psychotherapeutic interventions, its impact on outpatient, inpatient, and emergency care was mixed. This lower follow-up rate among intervention patients may reflect the success of active psychological treatment in the ED, lower acuity among intervention patients, or implications of the study's safety net setting. The authors discuss this model's potential for enhancing mental health care in pediatric EDs.
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18
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Fang A, Hersh M, Birgisson N, Saynina O, Wang NE. "Could we have predicted this?" The association of a future mental health need in young people with a non-specific complaint and frequent emergency department visits. J Am Coll Emerg Physicians Open 2021; 2:e12556. [PMID: 34632448 PMCID: PMC8495458 DOI: 10.1002/emp2.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/17/2021] [Accepted: 08/24/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Mental health emergencies among young people are increasing. There is growing pressure for emergency departments to screen patients for mental health needs even when it is not their chief complaint. We hypothesized that young people with an initial non-specific condition and emergency department (ED) revisits have increased mental health needs. METHODS Retrospective, observational study of the California Office of Statewide Health Planning and Development Emergency Department Discharge Dataset (2010-2014) of young people (11-24 years) with an index visit for International Classification of Diseases, Ninth Revision diagnostic codes of "Symptoms, signs, and ill-defined conditions" (Non-Specific); "Diseases of the respiratory system" (Respiratory) and "Unintentional injury" (Trauma) who were discharged from a California ED. Patients were excluded if they had a prior mental health visit, chronic disease, or were pregnant. ED visit frequency was counted over 12 months. Regression models were created to analyze characteristics associated with a mental health visit. RESULTS Patients in the Non-Specific category compared to the Respiratory category had 1.2 times the odds of a future mental health visit (OR 1.20; 95% CI 1.17-1.24). Patients with ≥1 ED revisit, regardless of diagnostic category, had 1.3 times the odds of a future mental health visit. Patients with both a Non-Specific index visit and 1, 2, and 3 or more revisits with non-specific diagnoses had increasing odds of a mental health visit (OR 1.38; 95% CI 1.29-1.47; OR 1.70; 95% CI 1.46-1.98; OR 2.20; 95% CI 1.70-2.87, respectively.). CONCLUSIONS Young people who go to the ED for non-specific conditions and revisits may benefit from targeted ED mental health screening.
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Affiliation(s)
- Andrea Fang
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Melissa Hersh
- Department of Emergency MedicineValley Children's HospitalMaderaCaliforniaUSA
| | - Natalia Birgisson
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Olga Saynina
- Stanford Center for PolicyOutcomes and PreventionStanfordCaliforniaUSA
| | - Nancy E Wang
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
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19
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Bahji A, Pierce M, Wong J, Roberge JN, Ortega I, Patten S. Comparative Efficacy and Acceptability of Psychotherapies for Self-harm and Suicidal Behavior Among Children and Adolescents: A Systematic Review and Network Meta-analysis. JAMA Netw Open 2021; 4:e216614. [PMID: 33861328 PMCID: PMC8052594 DOI: 10.1001/jamanetworkopen.2021.6614] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Self-harm and suicidal behavior are associated with substantial morbidity and mortality among children and adolescents. The comparative performance of psychotherapies for suicidality is unclear because few head-to-head clinical trials have been conducted. OBJECTIVE To compare the efficacy of psychotherapies for the treatment of self-harm and suicidality among children and adolescents. DATA SOURCES Four major bibliographic databases (PubMed, MEDLINE, PsycINFO, and Embase) were searched for clinical trials comparing psychotherapy with control conditions from inception to September 2020. STUDY SELECTION Randomized clinical trials comparing psychotherapies for suicidality and/or self-harm with control conditions among children and adolescents were included after a blinded review by 3 independent reviewers (A.B., M.P., and J.W.). DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed for data abstraction, and the Cochrane risk of bias tool was used to evaluate study-level risk of bias. Data abstraction was performed by 1 reviewer (A.B.) and confirmed by 2 independent blinded reviewers (J.W. and M.P.). Data were analyzed from October 15, 2020, to February 15, 2021. MAIN OUTCOMES AND MEASURES The primary outcomes were dichotomized self-harm and retention in treatment. The secondary outcomes were dichotomized all-cause treatment discontinuation and scores on instruments measuring suicidal ideation and depressive symptoms. Effect sizes were pooled using frequentist random-effects network meta-analysis models to generate summary odds ratios (ORs) and Cohen d standardized mean differences (SMDs). Negative Cohen d SMDs or ORs less than 1 indicated that the treatment reduced the parameter of interest relative to the control condition (eg, signifying a beneficial association with suicidal ideation). RESULTS The systematic search generated 1272 unique records. Of those, 44 randomized clinical trials (5406 total participants; 4109 female participants [76.0%]) from 49 articles were selected (5 follow-up studies were merged with their primary clinical trials to avoid publication bias). The selected clinical trials spanned January 1, 1995, to December 31, 2020. The median duration of treatment was 3 months (range, 0.25-12.00 months), and the median follow-up period was 12 months (range, 1-36 months). None of the investigated psychotherapies were associated with increases in study withdrawals or improvements in retention in treatment compared with treatment as usual. Dialectical behavioral therapies were associated with reductions in self-harm (OR, 0.28; 95% CI, 0.12-0.64) and suicidal ideation (Cohen d SMD, -0.71; 95% CI, -1.19 to -0.23) at the end of treatment, while mentalization-based therapies were associated with decreases in self-harm (OR, 0.38; 95% CI, 0.15-0.97) and suicidal ideation (Cohen d SMD, -1.22; 95% CI, -2.18 to -0.26) at the end of follow-up. The quality of evidence was downgraded because of high risk of bias overall, heterogeneity, publication bias, inconsistency, and imprecision. CONCLUSIONS AND RELEVANCE Although some psychotherapeutic modalities appear to be acceptable and efficacious for reducing self-harm and suicidality among children and adolescents, methodological issues and high risk of bias prevent a consistent estimate of their comparative performance.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Pierce
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
- Division of Child and Youth Mental Health, Queen’s University, Kingston, Ontario, Canada
| | - Jennifer Wong
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
- Division of Child and Youth Mental Health, Queen’s University, Kingston, Ontario, Canada
| | - Johanne N. Roberge
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
- Division of Child and Youth Mental Health, Queen’s University, Kingston, Ontario, Canada
| | - Iliana Ortega
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Scott Patten
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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20
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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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21
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Doupnik SK, Rudd B, Schmutte T, Worsley D, Bowden CF, McCarthy E, Eggan E, Bridge JA, Marcus SC. Association of Suicide Prevention Interventions With Subsequent Suicide Attempts, Linkage to Follow-up Care, and Depression Symptoms for Acute Care Settings: A Systematic Review and Meta-analysis. JAMA Psychiatry 2020; 77:1021-1030. [PMID: 32584936 PMCID: PMC7301305 DOI: 10.1001/jamapsychiatry.2020.1586] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/19/2020] [Indexed: 12/22/2022]
Abstract
Importance To prevent suicide deaths, acute care settings need tools to ensure individuals at risk of suicide access mental health care and remain safe until they do so. Objective To examine the association of brief acute care suicide prevention interventions with patients' subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up. Data Sources Ovid MEDLINE, Scopus, CINAHL, PsychINFO, Embase, and references of included studies using concepts of suicide, prevention, and clinical trial to identify relevant articles published January 2000 to May 2019. Study Selection Studies describing clinical trials of single-encounter suicide prevention interventions were included. Two reviewers independently reviewed all articles to determine eligibility for study inclusion. Data Extraction and Synthesis Two reviewers independently abstracted data according to PRISMA guidelines and assessed studies' risk of bias using the Cochrane Risk of Bias tool. Data were pooled for each outcome using random-effects models. Small study effects including publication bias were assessed using Peter and Egger regression tests. Main Outcomes and Measures Three primary outcomes were examined: subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up. Suicide attempts and linkage to follow-up care were measured using validated patient self-report measures and medical record review; odds ratios and Hedges g standardized mean differences were pooled to estimate effect sizes. Depression symptoms were measured 2 to 3 months after the encounter using validated self-report measures, and pooled Hedges g standardized mean differences were used to estimate effect sizes. Results A total of 14 studies, representing outcomes for 4270 patients, were included. Pooled-effect estimates showed that brief suicide prevention interventions were associated with reduced subsequent suicide attempts (pooled odds ratio, 0.69; 95% CI, 0.53-0.89), increased linkage to follow-up (pooled odds ratio, 3.04; 95% CI, 1.79-5.17) but were not associated with reduced depression symptoms (Hedges g = 0.28 [95% CI, -0.02 to 0.59). Conclusions and Relevance In this meta-analysis, breif suicide prevention interventions were associated with reduced subsequent suicide attempts. Suicide prevention interventions delivered in a single in-person encounter may be effective at reducing subsequent suicide attempts and ensuring that patients engage in follow-up mental health care.
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Affiliation(s)
- Stephanie K. Doupnik
- PolicyLab, Center for Pediatric Clinical Effectiveness, Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Brittany Rudd
- Center for Mental Health, University of Pennsylvania, Philadelphia
- now with Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Chicago
| | - Timothy Schmutte
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Diana Worsley
- PolicyLab, Center for Pediatric Clinical Effectiveness, Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cadence F. Bowden
- PolicyLab, Center for Pediatric Clinical Effectiveness, Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Erin McCarthy
- PolicyLab, Center for Pediatric Clinical Effectiveness, Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elliott Eggan
- PolicyLab, Center for Pediatric Clinical Effectiveness, Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Jeffrey A. Bridge
- Research Institute at Nationwide Children’s Hospital, Department of Pediatrics, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus
| | - Steven C. Marcus
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Mental Health, University of Pennsylvania, Philadelphia
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22
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Tracey M, Finkelstein Y, Schachter R, Cleverley K, Monga S, Barwick M, Szatmari P, Moretti ME, Willan A, Henderson J, Korczak DJ. Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention. BMC Med Res Methodol 2020; 20:231. [PMID: 32928140 PMCID: PMC7490899 DOI: 10.1186/s12874-020-01117-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency Departments (EDs) are a first point-of-contact for many youth with mental health and suicidality concerns and can serve as an effective recruitment source for randomized controlled trials (RCTs) of mental health interventions. However, recruitment in acute care settings is impeded by several challenges. This pilot RCT of a youth suicide prevention intervention recruited adolescents aged 12 to 17 years presenting to a pediatric hospital ED with suicide related behaviors. METHODS Recruitment barriers were identified during the initial study recruitment period and included: the time of day of ED presentations, challenges inherent to study presentation, engagement and participation during an acute presentation, challenges approaching and enrolling acutely suicidal patients and families, ED environmental factors, and youth and parental concerns regarding the study. We calculated the average recruitment productivity for published trials of adolescent suicide prevention strategies which included the ED as a recruitment site in order to compare our recruitment productivity. RESULTS In response to identified barriers, an enhanced ED-centered recruitment strategy was developed to address low recruitment rate, specifically (i) engaging a wider network of ED and outpatient psychiatry staff (ii) dissemination of study pamphlets across multiple areas of the ED and relevant outpatient clinics. Following implementation of the enhanced recruitment strategy, the pre-post recruitment productivity, a ratio of patients screened to patients randomized, was computed. A total of 120 patients were approached for participation, 89 (74.2%) were screened and 45 (37.5%) were consented for the study from March 2018 to April 2019. The screening to randomization ratio for the study period prior to the introduction of the enhanced recruitment strategies was 3:1, which decreased to 1.8:1 following the implementation of enhanced recruitment strategies. The ratio for the total recruitment period was 2.1:1. This was lower than the average ratio of 3.2:1 for published trials. CONCLUSIONS EDs are feasible sites for participant recruitment in RCTs examining new interventions for acute mental health problems, including suicidality. Engaging multi-disciplinary ED staff to support recruitment for such studies, proactively addressing anticipated concerns, and creating a robust recruitment pathway that includes approach at outpatient appointments can optimize recruitment. TRIAL REGISTRATION ClinicalTrials.gov : NCT03488602 , retrospectively registered April 4, 2018.
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Affiliation(s)
- Matthew Tracey
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Yaron Finkelstein
- Divisions of Paediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Hospital for Sick Children, 525 University Avenue, Toronto, ON, M5G 2L3, Canada
| | - Reva Schachter
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, 130-155 College Street, Toronto, ON, M5P 1T8, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Psychiatry, University of Toronto, 250 College St, Toronto, ON, M5T 1R8, Canada
| | - Melanie Barwick
- Department of Psychiatry, University of Toronto, 250 College St, Toronto, ON, M5T 1R8, Canada.,Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Peter Szatmari
- Department of Psychiatry, University of Toronto, 250 College St, Toronto, ON, M5T 1R8, Canada
| | - Myla E Moretti
- Clinical Trial Unit, Ontario Child Health Support Unit, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Andrew Willan
- Clinical Trial Unit, Ontario Child Health Support Unit, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, 5226-88 Workman Way, Toronto, ON, M5J 1H4, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. .,Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
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Kar Ray M, Wyder M, Crompton D, Kousoulis AA, Arensman E, Hafizi S, Van Bortel T, Lombardo C. PROTECT: Relational safety based suicide prevention training frameworks. Int J Ment Health Nurs 2020; 29:533-543. [PMID: 31880076 DOI: 10.1111/inm.12685] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 11/29/2022]
Abstract
Preventing suicide is a global priority, and staff training is a core prevention strategy. However, frontline pressures make translating training into better care and better outcomes difficult. The aim of the paper was to highlight challenges in suicide risk assessment and management and introduce training frameworks to assist with mindful practice so professionals can strike a balance between risk and recovery. We combined the scientific literature with contemporary practice from two successful initiatives from Cambridgeshire, UK: 333 - a recovery-oriented model of inpatient/community crisis care and PROMISE - a programme to reduce coercion in care by enhancing patient experience. The resulting PROTECT (PROactive deTECTion) frameworks operationalize ongoing practice of relational safety in these programmes. PROTECT is a combination of novel concepts and adaptations of well-established therapeutic approaches. It has four training frameworks: AWARE for reflection on clinical decisions; DESPAIR for assessment; ASPIRE for management; and NOTES for documentation. PROTECT aims to improve self-awareness of mental shortcuts and risk-taking thresholds and increase rigour through time-efficient cross-checks. The training frameworks should support a relational approach to self-harm/suicide risk detection, mitigation, and documentation, making care safer and person-centred. The goal is to enthuse practitioners with recovery-oriented practice that draws on the strengths of the person in distress and their natural circle of support. It will provide the confidence to engage in participatory approaches to seek out unique individualized solutions to the overwhelming psychological pain of suicidal distress. Future collaborative research with people with lived and carer experience is needed for fine-tuning.
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Affiliation(s)
- Manaan Kar Ray
- Addictions and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia.,Southside Clinical Unit, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia.,Adult Mental Health Services, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Marianne Wyder
- Addictions and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - David Crompton
- Addictions and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia.,Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, Queensland, Australia.,Neuro-imaging Facility, Translational Research Institute (TRI), Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | - Ella Arensman
- School of Public Health, National Suicide Research Foundation, University College Cork, National University of Ireland, Cork, Ireland
| | - Sepehr Hafizi
- Adult Mental Health Services, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Tine Van Bortel
- Institute for Health and Human Development, University of East London, London, UK.,Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Chiara Lombardo
- Adult Mental Health Services, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK.,Research and Development, Mental Health Foundation, London, UK.,Institute for Health and Human Development, University of East London, London, UK
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24
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Attridge MM, Holmstrom SE, Sheehan KM. Injury Prevention Opportunities in the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Valles NL, Billups D, Sampson T, Harris TB. Management of Suicidal Adolescents Presenting to the Emergency Department. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676609666190730094236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Increasingly, adolescents are presented to hospital emergency departments
with suicidal ideation (SI) and depression. Even among those who come in with
other complaints, depression and SI are common. Emergency personnel are placed in the default
position of providing care for these patients, but often lack sufficient knowledge and
skills to do this effectively.
Objective:
The aim of this paper is to offer guidance to emergency personnel and describe
goals and strategies for screening and brief interventions.
Method:
We review risk factors, assessment tools and evidence-based interventions that can
be utilized by mental health professionals working in EDs and by ED staff in the absence of
mental health professionals.
Conclusion:
Emergency departments can serve a critical role in risk management and treatment
of adolescent depression and suicidal ideation. All patients presenting to the ED should
be screened for current and past depression and suicidal ideation or attempts. Brief interventions
can be delivered in the ED that can increase the likelihood that patients will receive follow-
up care.
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Affiliation(s)
| | - Dana Billups
- Baylor College of Medicine, Houston, TX 77030, United States
| | - Topaz Sampson
- Baylor College of Medicine, Houston, TX 77030, United States
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26
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Kothgassner OD, Robinson K, Goreis A, Ougrin D, Plener PL. Does treatment method matter? A meta-analysis of the past 20 years of research on therapeutic interventions for self-harm and suicidal ideation in adolescents. Borderline Personal Disord Emot Dysregul 2020; 7:9. [PMID: 32426138 PMCID: PMC7216729 DOI: 10.1186/s40479-020-00123-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-harm is a clinically relevant and prevalent behaviour which peaks in adolescence. Given the high prevalence of self-harm, the high levels of psychiatric comorbidity, and its role as a risk factor for suicide, delivering evidence-based care is critical. METHODS We conducted a systematic review and meta-analysis of the literature on treating self-harm in adolescents (12-19 years) published in the last 20 years, identifying 25 randomised controlled trials. We calculated the effect of treatment interventions relative to active control conditions in reducing self-harm, suicidal ideation and depressive symptoms. RESULTS Overall, treatment interventions fared slightly better than active controls in decreasing self-harm (d = 0.13, 95% CI 0.04-0.22, p = .004), suicidal ideation (d = 0.31, 95% CI 0.12-0.50, p = .001) and depressive symptoms (d = 0.22, 95% CI 0.07-0.38, p = .006). Subgroup analysis of specific therapies revealed moderate effects of DBT-A in reducing self-harm (d = 0.51, 95% CI 0.18-0.85, p = .002) and suicidal ideation (d = 0.48, 95% CI 0.17-0.80, p = .003), as well as moderate effects of family-centred therapy in the treating suicidal ideation (d = 0.58, 95% CI 0.01-1.15, p = .049). CONCLUSIONS The findings of our meta-analysis indicate that, overall, currently available treatments are effective in treating self-harm, suicidal ideation, and depressive symptoms in adolescence. Although the treatment intervention conditions showed only small to moderate effects in comparison to active controls, these differences were statistically significant and are clinically important. Further research is needed to understand the reduction in self-harm within active controls, which may arise due to the natural course of self-harm, or the potential efficacy of treatment as usual and enhanced usual care. Given the significant reduction of self-harm in active control conditions, delivering effective care to a large number of adolescents with self-harm may require developing stepped-care models in clinical practice. Expensive and poorly available treatments should be targeted at young people who most need them.
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Affiliation(s)
- Oswald D Kothgassner
- 1Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Kealagh Robinson
- 2School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Andreas Goreis
- 3Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria.,4Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Dennis Ougrin
- 5Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul L Plener
- 1Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,6Department of Child- and Adolescent Psychiatry and Psychotherapy, Medical University of Ulm, Ulm, Germany
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27
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Grupp-Phelan J, Stevens J, Boyd S, Cohen DM, Ammerman RT, Liddy-Hicks S, Heck K, Marcus SC, Stone L, Campo JV, Bridge JA. Effect of a Motivational Interviewing-Based Intervention on Initiation of Mental Health Treatment and Mental Health After an Emergency Department Visit Among Suicidal Adolescents: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1917941. [PMID: 31860104 PMCID: PMC6991223 DOI: 10.1001/jamanetworkopen.2019.17941] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/27/2019] [Indexed: 11/14/2022] Open
Abstract
Importance Emergency department (ED) visits present opportunities to identify and refer suicidal youth for outpatient mental health care, although this practice is not routine. Objective To examine whether a motivational interviewing-based intervention increases linkage of adolescents to outpatient mental health services and reduces depression symptoms and suicidal ideation in adolescents seeking emergency care for non-mental health-related concerns who screen positive for suicide risk. Design, Setting, and Participants In this randomized clinical trial, adolescents aged 12 to 17 years who screened positive on the Ask Suicide Screening Questions (ASQ) during a nonpsychiatric ED visit at 2 academic pediatric EDs in Ohio were recruited from April 2013 to July 2015. Intention-to-treat analyses were performed from September 2018 to October 2019. Interventions The Suicidal Teens Accessing Treatment After an Emergency Department Visit (STAT-ED) intervention included motivational interviewing to target family engagement, problem solving, referral assistance, and limited case management. The enhanced usual care (EUC) intervention consisted of brief mental health care consultation and referral. Main Outcomes and Measures Primary outcomes were mental health treatment initiation and attendance within 2 months of ED discharge and suicidal ideation (assessed by the Suicidal Ideation Questionnaire JR) and depression symptoms (assessed by the Center for Epidemiologic Studies-Depression scale) at 2 and 6 months. Exploratory outcomes included treatment initiation and attendance and suicide attempts at 6 months. Results A total of 168 participants were randomized and 159 included in the intention-to-treat analyses (mean [SD] age, 15.0 [1.5] years; 126 [79.2%] female; and 80 [50.3%] white). Seventy-nine participants were randomized to receive the STAT-ED intervention and 80 to receive EUC. At 2 months, youth in the STAT-ED group had similar rates of mental health treatment initiation compared with youth in the EUC group as assessed by parent report (29 [50.9%] vs 22 [34.9%]; adjusted odds ratio [OR], 2.08; 95% CI, 0.97-4.45) and administrative data from mental health care agencies (19 [29.7%] vs 11 [19.3%]; adjusted OR, 1.77; 95% CI, 0.76-4.15). At 2 months, youth in the STAT-ED group and the EUC group had similar rates of treatment attendance (1 appointment: 6 [9.7%] vs 2 [3.6%]; adjusted OR, 2.97; 95% CI, 0.56-15.73; ≥2 appointments: 10 [16.1%] vs 7 [12.7%]; adjusted OR, 1.43; 95% CI, 0.50-4.11). There were no significant group × time differences in suicidal ideation (F = 0.28; P = .72) and depression symptoms (F = 0.49; P = .60) during the 6-month follow-up period. In exploratory analyses, at 6 months, STAT-ED participants had significantly higher rates of agency-reported mental health treatment initiation (adjusted OR, 2.48; 95% CI, 1.16-5.28) and more completed appointments (t99.7 = 2.58; P = .01). Conclusions and Relevance This study's findings indicate that no differences were found on any primary outcome by study condition. However, STAT-ED was more efficacious than EUC at increasing mental health treatment initiation and attendance at 6 months. Trial Registration ClinicalTrials.gov identifier: NCT01779414.
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Affiliation(s)
- Jacqueline Grupp-Phelan
- Division of Pediatric Emergency Medicine, UCSF (University of California, San Francisco) Benioff Children’s Hospitals, San Francisco, California
| | - Jack Stevens
- Department of Pediatrics, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Stephanie Boyd
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Daniel M. Cohen
- Division of Emergency Medicine, Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - Robert T. Ammerman
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stacey Liddy-Hicks
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Kendra Heck
- Department of Pediatrics, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Steven C. Marcus
- University of Pennsylvania School of Social Policy and Practice, Philadelphia
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - John V. Campo
- Department of Behavioral Medicine and Psychiatry, West Virginia University and the Rockefeller Neuroscience Institute, Morgantown
| | - Jeffrey A. Bridge
- Department of Pediatrics, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus
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Abstract
Although recent years have seen large decreases in the overall global rate of suicide fatalities, this trend is not reflected everywhere. Suicide and suicidal behaviour continue to present key challenges for public policy and health services, with increasing suicide deaths in some countries such as the USA. The development of suicide risk is complex, involving contributions from biological (including genetics), psychological (such as certain personality traits), clinical (such as comorbid psychiatric illness), social and environmental factors. The involvement of multiple risk factors in conveying risk of suicide means that determining an individual's risk of suicide is challenging. Improving risk assessment, for example, by using computer testing and genetic screening, is an area of ongoing research. Prevention is key to reduce the number of suicide deaths and prevention efforts include universal, selective and indicated interventions, although these interventions are often delivered in combination. These interventions, combined with psychological (such as cognitive behavioural therapy, caring contacts and safety planning) and pharmacological treatments (for example, clozapine and ketamine) along with coordinated social and public health initiatives, should continue to improve the management of individuals who are suicidal and decrease suicide-associated morbidity.
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29
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Glenn CR, Esposito EC, Porter AC, Robinson D. Evidence Base Update of Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2019; 48:357-392. [PMID: 31046461 PMCID: PMC6534465 DOI: 10.1080/15374416.2019.1591281] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The current review provides an evidence base update of psychosocial treatments for self-injurious thoughts and behaviors (SITBs) in youth. A systematic search was conducted of 2 major scientific databases (PsycInfo and PubMed) and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) published prior to June 2018. The search identified 26 RCTs examining interventions for SITBs in youth: 17 were included in the 2015 review and 9 trials were new to this update. The biggest change since the prior review was the evaluation of Dialectical Behavior Therapy for adolescents (DBT-A) as the first Level 1: Well-established intervention for reducing deliberate self-harm (composite of nonsuicidal and suicidal self-injury) and suicide ideation in youth and Level 2: Probably efficacious for reducing nonsuicidal self-injury and suicide attempts. Five other interventions were rated as Level 2: Probably efficacious for reducing SITBs in youth, with the new addition of Integrated Family Therapy. This evidence base update indicates that there are a few promising treatments for reducing SITBs in youth. Efficacious interventions typically include a significant family or parent training component as well as skills training (e.g., emotion regulation skills). Aside from DBT-A, few treatments have been examined in more than one RCT. Given that replication by independent research groups is needed to evaluate an intervention as Well-established, future research should focus on replicating the five promising interventions currently evaluated as Probably efficacious. In addition, an important future direction is to develop brief efficacious interventions that may be scalable to reach large numbers of youth.
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30
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Robinson J, Bailey E, Witt K, Stefanac N, Milner A, Currier D, Pirkis J, Condron P, Hetrick S. What Works in Youth Suicide Prevention? A Systematic Review and Meta-Analysis. EClinicalMedicine 2018; 4-5:52-91. [PMID: 31193651 PMCID: PMC6537558 DOI: 10.1016/j.eclinm.2018.10.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Young people require specific attention when it comes to suicide prevention, however efforts need to be based on robust evidence. METHODS We conducted a systematic review and meta-analysis of all studies examining the impact of interventions that were specifically designed to reduce suicide-related behavior in young people. FINDINGS Ninety-nine studies were identified, of which 52 were conducted in clinical settings, 31 in educational or workplace settings, and 15 in community settings. Around half were randomized controlled trials. Large scale interventions delivered in both clinical and educational settings appear to reduce self-harm and suicidal ideation post-intervention, and to a lesser extent at follow-up. In community settings, multi-faceted, place-based approaches seem to have an impact. Study quality was limited. INTERPRETATION Overall whilst the number and range of studies is encouraging, gaps exist. Few studies were conducted in low-middle income countries or with demographic populations known to be at increased risk. Similarly, there was a lack of studies conducted in primary care, universities and workplaces. However, we identified that specific youth suicide-prevention interventions can reduce self-harm and suicidal ideation; these types of intervention need testing in high-quality studies.
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Affiliation(s)
- Jo Robinson
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
| | - Eleanor Bailey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
| | - Katrina Witt
- Turning Point, Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, VIC 3121, Australia
| | - Nina Stefanac
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
| | - Allison Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie Street, Vic 3010, Australia
| | - Dianne Currier
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie Street, Vic 3010, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie Street, Vic 3010, Australia
| | - Patrick Condron
- University Library, The University of Melbourne, Parkville, Vic 3010, Australia
| | - Sarah Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Vic 3052, Australia
- Department of Psychological Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Support Building Auckland Hospital, 2 Park Rd, Auckland 1142, New Zealand
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31
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Czyz EK, King CA, Biermann BJ. Motivational Interviewing-Enhanced Safety Planning for Adolescents at High Suicide Risk: A Pilot Randomized Controlled Trial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:250-262. [PMID: 30142300 DOI: 10.1080/15374416.2018.1496442] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This pilot randomized controlled trial examined the feasibility and acceptability of a motivational interview (MI)-enhanced safety planning intervention (MI-SafeCope) for teens hospitalized due to suicide risk and explored proximal outcomes (possible mechanisms of change). Participants were 36 hospitalized adolescents (ages 13-17; 78.8% female) with last-week suicidal ideation and/or past-month suicide attempts. Adolescents were randomized to MI-SafeCope, a three-component intervention (individual and family sessions, postdischarge call), or to treatment as usual. Primary outcomes were feasibility and acceptability. We also explored differences in proximal outcomes assessed at 2 weeks, 1 month, and 3 months (family connectedness, motivation for safety plan use, parental motivation to encourage safety plan use), as well as daily for 4 weeks (self-efficacy, coping behavior, safety plan use). Participation and retention rates and intervention satisfaction ratings indicate feasibility and acceptability. Mixed-effects models of daily assessments indicated, for the MI-SafeCope group, significantly higher self-efficacy to refrain from suicidal action (B = 1.15, p = .030), greater reliance on self to cope with suicidal ideation (B = 1.56, p = .042), and higher likelihood of safety plan use to manage suicidal thoughts (B = 0.25, p = .004). Parents in the MI-SafeCope group reported higher motivation to encourage safety plan use (B = 1.04, p = .031). Safety planning incorporating MI is feasible and acceptable with hospitalized teens. Preliminary findings suggest that MI strategies may be promising in maintaining adherence to safety plans, increasing self-efficacy and coping, and in fostering parents' motivation to encourage safety plan use. Our study also highlights the benefit of daily-level assessment of individuals' response to suicide-specific interventions.
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Affiliation(s)
- E K Czyz
- a Department of Psychiatry , University of Michigan
| | - C A King
- a Department of Psychiatry , University of Michigan
| | - B J Biermann
- a Department of Psychiatry , University of Michigan
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McCabe R, Garside R, Backhouse A, Xanthopoulou P. Effectiveness of brief psychological interventions for suicidal presentations: a systematic review. BMC Psychiatry 2018; 18:120. [PMID: 29724203 PMCID: PMC5934886 DOI: 10.1186/s12888-018-1663-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Every year, more than 800,000 people worldwide die by suicide. The aim of this study was to conduct a systematic review of the effectiveness of brief psychological interventions in addressing suicidal thoughts and behaviour in healthcare settings. METHODS Following PRISMA guidelines, systematic searches were conducted in MEDLINE, CINAHL, EMBASE, the Cochrane Central Register of Controlled Trials and PsycINFO databases. A predefined search strategy was used. Two independent reviewers screened titles and abstracts followed by full texts against predefined inclusion criteria. Backward and forward citation tracking of included papers was conducted. Quality appraisal was conducted using the Cochrane Risk of Bias Tool for Randomized Controlled Trials and the CASP tool for randomised controlled trials. The small number and heterogeneity of studies did not allow for meta-analysis to be conducted. A narrative synthesis was conducted. RESULTS Four controlled studies of brief psychological interventions were included, conducted in Switzerland, the U.S. and across low and middle-income countries. Three studies were conducted with adults and one with adolescents. All studies were judged to be at low risk of bias. All of the interventions were implemented with patients after attending emergency departments and involved 3412 participants. The main outcomes were suicide, suicide attempts, suicidal ideation, depression and hospitalization. The components of the interventions were early therapeutic engagement, information provision, safety planning and follow-up contact for at least 12 months. The interventions drew to, different degrees, on psychological theory and techniques. Two trials that measured suicidal ideation found no impact. Two studies showed fewer suicide attempts, one showed fewer suicides and one found an effect on depression. CONCLUSIONS Although the evidence base is small, brief psychological interventions appear to be effective in reducing suicide and suicide attempts. All studies to date have been conducted with people who had attended the ED but the interventions could potentially be adopted for inpatient and other outpatient settings. Early engagement and therapeutic intervention based on psychological theories of suicidal behaviour, sustained in follow-up contacts, may be particularly beneficial. TRIAL REGISTRATION Systematic review registration: PROSPERO CRD42015025867.
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Affiliation(s)
- Rose McCabe
- University of Exeter Medical School, Heavitree Road, Exeter, EX1 2LU, UK
| | - Ruth Garside
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, UK
| | - Amy Backhouse
- University of Exeter Medical School, Heavitree Road, Exeter, EX1 2LU, UK
| | - Penny Xanthopoulou
- University of Exeter Medical School, Heavitree Road, Exeter, EX1 2LU, UK.
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Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk. J Clin Psychol Med Settings 2018; 24:8-20. [PMID: 28251427 DOI: 10.1007/s10880-017-9486-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Suicide is the tenth leading cause of death in the United States, accounting for more than 42,000 deaths in 2014. Although this tragedy cuts across groups defined by age, gender, race/ethnicity, and geographic location, it is striking that nearly four times as many males as females die by suicide in the U.S. We describe the current regulations and recommendations for suicide risk screening in healthcare systems and also describe the aspirational goal of "Zero Suicide," put forth by the National Action Alliance for Suicide Prevention. We then provide information about suicide risk screening tools and steps to take when a patient screens positive for suicide risk. Given the substantially higher suicide rate among males than females, we argue that it is important to consider how we could optimize suicide risk screening strategies to identify males at risk and females at risk. Further research is needed to accomplish this goal. It is recommended that we consider multi-factorial suicide risk screens that incorporate risk factors known to be particularly important for males as well as computerized, adaptive screens that are tailored for the specific risk considerations of the individual patient, male or female. These strategies are not mutually exclusive. Finally, universal suicide risk screening in healthcare settings, especially primary care, specialty medical care, and emergency department settings, is recommended.
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Asarnow JR, Babeva K, Horstmann E. The Emergency Department: Challenges and Opportunities for Suicide Prevention. Child Adolesc Psychiatr Clin N Am 2017; 26:771-783. [PMID: 28916013 PMCID: PMC6768433 DOI: 10.1016/j.chc.2017.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Emergency departments (EDs) can offer life-saving suicide prevention care. This article focuses on the ED and emergency services as service delivery sites for suicide prevention. Characteristics of EDs, models of emergency care, ED screening and brief intervention models, and practice guidelines and parameters are reviewed. A care process model for youths at risk for suicide and self-harm is presented, with guidance for clinicians based on the scientific evidence. Strengthening emergency infrastructure and integrating effective suicide prevention strategies derived from scientific research are critical for advancing suicide prevention objectives.
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Affiliation(s)
- Joan Rosenbaum Asarnow
- David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, 300 Medical Plaza, Suite 3310, Los Angeles, CA 90095, USA.
| | - Kalina Babeva
- David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, 300 Medical Plaza, Suite 3310, Los Angeles, CA 90095, USA
| | - Elizabeth Horstmann
- David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, 300 Medical Plaza, Suite 3310, Los Angeles, CA 90095, USA
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35
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Brown RC. [Psychotherapeutic interventions for suicidal adolescents – a systematic review of the current literature]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2017; 45:499-508. [PMID: 28771078 DOI: 10.1024/1422-4917/a000538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although suicidal thoughts and behaviors are common in adolescents, the German guidelines for suicidality in children and adolescents state a lack of evidence for the effectiveness of specific psychotherapies for those patients. The aim of this systematic review was to summarize and critically discuss newest advances in the evaluation of specific therapeutic approaches for suicidality in youths. Building on other recent systematic reviews, 11 manuscripts published between 2013 and 2017 were included in this review. Included are studies on interventions in emergency departments, psychotherapeutic approaches specifically targeting suicidality despite other psychopathology, interventions for youth with specific disorders or risk-factors, and one study evaluating an online-intervention. First positive effects can be claimed for family interventions in emergency departments (regarding lower hospitalization rates) as well as cognitive-behavioral, dialectical-behavioral, and family-oriented interventions (regarding reducing suicidality). Promising results were also found in a pilot study on an online-intervention. However, further research is necessary, as replication of outcomes has not been attempted or published in most cases and studies including large sample sizes with long-term follow-up evaluation are very rare.
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Affiliation(s)
- Rebecca C Brown
- 1 Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsklinikum Ulm
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Horwitz AG, Berona J, Czyz EK, Yeguez CE, King CA. Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression, Suicidal Ideation, and Suicidal Behavior in High-Risk Adolescents. Suicide Life Threat Behav 2017; 47:168-176. [PMID: 27371943 PMCID: PMC5205576 DOI: 10.1111/sltb.12273] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/16/2016] [Indexed: 11/28/2022]
Abstract
The relationship between hopelessness and depression in predicting suicide-related outcomes varies based on the anticipation of positive versus negative events. In this prospective study of adolescents at elevated risk for suicide, we used two Beck Hopelessness Scale subscales to assess the impact of positive and negative expectations in predicting depression, suicidal ideation, and suicidal behavior over a 2- to 4-year period. In multivariate regressions controlling for depression, suicidal ideation, and negative-expectation hopelessness, positive-expectation hopelessness was the only significant predictor of depressive symptoms and suicidal behavior. Clinical interventions may benefit from bolstering positive expectations and building optimism.
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Affiliation(s)
- Adam G. Horwitz
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48104
| | - Johnny Berona
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48104
| | - Ewa K. Czyz
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48104
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109
| | - Carlos E. Yeguez
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109
| | - Cheryl A. King
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48104
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109
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Autobiography of Cheryl A. King: One Clinical Scientist's Journey, Supported by Many. J Clin Psychol Med Settings 2017; 24:3-7. [PMID: 28251429 DOI: 10.1007/s10880-017-9487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ballard ED, Cwik M, Van Eck K, Goldstein M, Alfes C, Wilson ME, Virden JM, Horowitz LM, Wilcox HC. Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 18:174-182. [PMID: 27678381 PMCID: PMC5247314 DOI: 10.1007/s11121-016-0717-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The pediatric emergency department (ED) is a critical location for the identification of children and adolescents at risk for suicide. Screening instruments that can be easily incorporated into clinical practice in EDs to identify and intervene with patients at increased suicide risk is a promising suicide prevention strategy and patient safety objective. This study is a retrospective review of the implementation of a brief suicide screen for pediatric psychiatric ED patients as standard of care. The Ask Suicide Screening Questions (ASQ) was implemented in an urban pediatric ED for patients with psychiatric presenting complaints. Nursing compliance rates, identification of at-risk patients, and sensitivity for repeated ED visits were evaluated using medical records from 970 patients. The ASQ was implemented with a compliance rate of 79 %. Fifty-three percent of the patients who screened positive (237/448) did not present to the ED with suicide-related complaints. These identified patients were more likely to be male, African American, and have externalizing behavior diagnoses. The ASQ demonstrated a sensitivity of 93 % and specificity of 43 % to predict return ED visits with suicide-related presenting complaints within 6 months of the index visit. Brief suicide screening instruments can be incorporated into standard of care in pediatric ED settings. Such screens can identify patients who do not directly report suicide-related presenting complaints at triage and who may be at particular risk for future suicidal behavior. Results have the potential to inform suicide prevention strategies in pediatric EDs.
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Affiliation(s)
- Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-3345, MSC 1282, Bethesda, MD, 20892, USA.
| | - Mary Cwik
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn Van Eck
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clarissa Alfes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Ellen Wilson
- Pediatric Emergency Department, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jane M Virden
- Pediatric Emergency Department, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lisa M Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Holly C Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
Suicide is the second leading cause of death among youth ages 10-24. An estimated 1.5 million US adolescents receive their primary health care in the emergency department (ED); this is particularly true for low-income and minority youths who often lack a regular source of care. ED visits can provide a window of opportunity to screen and identify youths with suicide and mental health risk, triage youths based on need, and facilitate effective follow-up care. Recently developed brief therapeutic assessment approaches have demonstrated success in improving rates of follow-up care after discharge from the ED. Furthermore, there is some data supporting clinical benefits when youths receive evidence-based outpatient follow-up care. ED screening combined with effective follow-up, therefore, may provide one strategy for improving mental health and reducing health disparities in our nation. This paper reviews the context in which ED screenings occur, available tools and strategies, and evidence for the effectiveness of tested approaches.
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Affiliation(s)
- Kalina Babeva
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, 90095, USA.
| | - Jennifer L Hughes
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9119, USA
| | - Joan Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, 90095, USA
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Hill RM, Pettit JW. Pilot Randomized Controlled Trial of LEAP: A Selective Preventive Intervention to Reduce Adolescents’ Perceived Burdensomeness. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 48:S45-S56. [DOI: 10.1080/15374416.2016.1188705] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ryan M. Hill
- Department of Psychology, Florida International University
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King CA, Berona J, Czyz E, Horwitz AG, Gipson PY. Identifying adolescents at highly elevated risk for suicidal behavior in the emergency department. J Child Adolesc Psychopharmacol 2015; 25:100-8. [PMID: 25746114 PMCID: PMC4367522 DOI: 10.1089/cap.2014.0049] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The feasibility and concurrent validity of adolescent suicide risk screening in medical emergency departments (EDs) has been documented. The objectives of this short-term prospective study of adolescents who screened positive for suicide risk in the ED were: 1) to examine adolescents' rate of suicidal behavior during the 2 months following their ED visits and compare it with reported rates for psychiatric samples; and 2) to identify possible predictors of acute risk for suicidal behavior in this at-risk sample. METHOD Participants were 81 adolescents, ages 14-19 years, seeking services for psychiatric and nonpsychiatric chief complaints, who screened positive for suicide risk because of recent suicidal ideation, a suicide attempt, and/or depression plus alcohol or substance misuse. A comprehensive assessment of suicidal behavior, using the Columbia-Suicide Severity Rating Scale, was conducted at baseline and 2 month follow-up. RESULTS Six adolescents (7.4%) reported a suicide attempt and 15 (18.5%) engaged in some type of suicidal behavior (actual, aborted, or interrupted suicide attempt; preparatory behavior) during the 2 months following their ED visit. These rates suggest that this screen identified a high-risk sample. Furthermore, adolescents who screened positive for suicidal ideation and/or attempt plus depression and alcohol/substance misuse were most likely to engage in future suicidal behavior (38.9%). CONCLUSIONS In this study, use of a higher screen threshold (multiple suicide risk factors) showed promise for identifying highly elevated acute risk for suicidal behavior.
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Affiliation(s)
- Cheryl A. King
- Department of Psychiatry, University of Michigan Depression Center, Ann Arbor, Michigan.,Department of Psychology, University of Michigan Depression Center, Ann Arbor, Michigan
| | - Johnny Berona
- Department of Psychiatry, University of Michigan Depression Center, Ann Arbor, Michigan.,Department of Psychology, University of Michigan Depression Center, Ann Arbor, Michigan
| | - Ewa Czyz
- Department of Psychiatry, University of Michigan Depression Center, Ann Arbor, Michigan.,Department of Psychology, University of Michigan Depression Center, Ann Arbor, Michigan
| | - Adam G. Horwitz
- Department of Psychiatry, University of Michigan Depression Center, Ann Arbor, Michigan.,Department of Psychology, University of Michigan Depression Center, Ann Arbor, Michigan
| | - Polly Y. Gipson
- Department of Psychiatry, University of Michigan Depression Center, Ann Arbor, Michigan
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