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Brousseau-Paradis C, Genest C, Maltais N, Séguin M, Rassy J. Emergency department care experience of suicidal patients: A qualitative analysis of patients' perspectives. Int Emerg Nurs 2024; 74:101449. [PMID: 38669791 DOI: 10.1016/j.ienj.2024.101449] [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: 01/08/2024] [Revised: 03/24/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Individuals experiencing suicidal ideation or behavior frequently seek assistance at the emergency department (ED), yet the care they receive does not consistently align with their needs. This study explores the ED care experience of suicidal patients from their own perspective and offers recommendations to improve ED care for this population. METHOD This qualitative study uses a descriptive interpretative design. Semi-structured interviews were conducted with 7 individuals who sought care in an ED due to suicidal ideation or behavior. Transcripts were analyzed using thematic analysis. FINDINGS Participants' experiences were marked by an unsuited physical environment described as uncomfortable, noisy, and depressing. The organization of care was perceived as inadequate as patients complained about limited front-line access to mental health expertise, long waiting times, overworked staff, and inequities between patients with physical injuries and those with mental health concerns. Participants reported feelings of being trapped, left on their own and mistreated during their ED stay. Most found their care experience unhelpful or distressing, leaving them reluctant to reconsult. Specific recommendations based on patients' testimonials and literature are provided to enhance the ED care experience of suicidal patients. CONCLUSION This study highlights several areas for improvement of the ED care experience of suicidal patients. Changes in current practices are needed to offer suicidal patients the satisfying care experience they deserve.
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Affiliation(s)
- Camille Brousseau-Paradis
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, 2900 boul. Édouard-Montpetit, bureau S-750, H3T 1J4 Montreal, QC, Canada; Research Center of the University Institute in Mental Health of Montreal, 7331 Hochelaga Street, Montreal H1N 3V2, QC, Canada.
| | - Christine Genest
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada; Research Center of the University Institute in Mental Health of Montreal, Trauma Study Center, Montreal, QC, Canada; Center for Research and Intervention on Suicide, Ethical Issues and End-of- Life Practices, Montreal, QC, Canada.
| | - Nathalie Maltais
- Department of Health Sciences, University of Quebec at Rimouski, Rimouski, QC, Canada; Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, QC, Canada.
| | - Monique Séguin
- Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, QC, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada.
| | - Jessica Rassy
- Research Center of the University Institute in Mental Health of Montreal, 7331 Hochelaga Street, Montreal H1N 3V2, QC, Canada; Quebec Network on Suicide, Mood Disorders and Associated Disorders, Montreal, QC, Canada; Quebec Network on Nursing Intervention Research, Montreal, QC, Canada; School of Nursing, University of Sherbrooke, Longueuil, QC, Canada.
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Strauss P, Marion L, Hill NT, Gilbey D, Waters Z, Moore JK, Costanza M, Lamblin M, Robinson J, Lin A, Perry Y. Development of best practice guidelines for clinical and community service providers to prevent suicide in LGBTQA+ young people: A Delphi expert consensus study. Aust N Z J Psychiatry 2024; 58:425-434. [PMID: 38217434 DOI: 10.1177/00048674231223697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
OBJECTIVE The aim of this study was to develop best practice guidelines for preventing suicide and reducing suicidal thoughts and behaviours in LGBTQA+ young people (lesbian, gay, bisexual, trans, queer/questioning, asexual, and those of other diverse sexualities and genders) within clinical and community service settings in Australia. METHODS We conducted a Delphi expert consensus study. A systematic literature search and interviews with key informants informed an initial 270-item questionnaire. Two expert panels completed the questionnaire, delivered over two rounds: (1) Australian professionals with expertise in LGBTQA+ mental health/suicide prevention and (2) Australian LGBTQA+ young people aged 14-25 with lived experience of suicidal thoughts and/or behaviours. Items endorsed as 'essential' or 'important' by >80% of both expert panels were included in the guidelines. RESULTS A total of 115 people participated in the Delphi process; n = 52 professionals completed Round 1, and n = 42 completed Round 2; n = 63 LGBTQA+ young people completed Round 1, and n = 50 completed Round 2. A total of 290 items were included in the guidelines and grouped into: (1) general principles for creating an affirming and inclusive environment for LGBTQA+ young people; (2) assessing suicide risk and working with suicidal LGBTQA+ young people; (3) considerations for specific LGBTQA+ populations; and (4) advocating for LGBTQA+ young people. CONCLUSION These guidelines are the first of their kind in Australia. They provide practical support to service providers regardless of prior training in LGBTQ+ identities or mental health, with the aim of reducing suicidal thoughts and behaviours, and preventing suicide, in LGBTQA+ young people.
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Affiliation(s)
- Penelope Strauss
- Telethon Kids Institute, Nedlands, WA, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | | | - Nicole Tm Hill
- Telethon Kids Institute, Nedlands, WA, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Dylan Gilbey
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Zoe Waters
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Julia K Moore
- The Gender Diversity Service, Child and Adolescent Health Service - Mental Health, Perth Children's Hospital, Perth, WA, Australia
| | - Marco Costanza
- Telethon Kids Institute, Nedlands, WA, Australia
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michelle Lamblin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jo Robinson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Yael Perry
- Telethon Kids Institute, Nedlands, WA, Australia
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Huber JP, Milton A, Brewer MC, Norrie LM, Hartog SM, Glozier N. The effectiveness of brief non-pharmacological interventions in emergency departments and psychiatric inpatient units for people in crisis: A systematic review and narrative synthesis. Aust N Z J Psychiatry 2024; 58:207-226. [PMID: 38140961 DOI: 10.1177/00048674231216348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Heterogeneous brief non-pharmacological interventions and guidelines exist to treat the burgeoning presentations to both emergency department and inpatient settings, for those in a crisis of mental ill-health. We systematically reviewed the literature to create a taxonomy of these brief non-pharmacological interventions, and review their evaluation methods and effectiveness. METHOD We conducted a systematic review across Cochrane, CINAHL, DARE, Embase, MEDLINE, PsycINFO databases. Studies meeting quality criteria, using Joanna Briggs Institute tools, were eligible. Interventions were categorised, and outcomes synthesised. RESULTS Thirty-nine studies were included: 8 randomised controlled trials, 17 quasi-experimental, 11 qualitative studies, and 3 file audits. Taxonomy produced six coherent intervention types: Skills-focussed, Environment-focussed, Special Observation, Psychoeducation, Multicomponent Group and Multicomponent Individual. Despite this, a broad and inconsistent range of outcome measures reflected different outcome priorities and prevented systematic comparison of different types of intervention or meta-analysis. Few brief non-pharmacological interventions had consistent evidential support: sensory modulation rooms consistently improved distress in inpatient settings. Short admissions may reduce suicide attempts and readmission, if accompanied by psychotherapy. Suicide-specific interventions in emergency departments may improve depressive symptoms, but not suicide attempt rates. There was evidence that brief non-pharmacological interventions did not reduce incidence of self-harm on inpatient wards. We found no evidence for frequently used interventions such as no-suicide contracting, special observation or inpatient self-harm interventions. CONCLUSION Categorising brief non-pharmacological interventions is feasible, but an evidence base for many is severely limited if not missing. Even when there is evidence, the inconsistency in outcomes often precludes clinicians from making inferences, although some interventions show promise.
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Affiliation(s)
- Jacqueline P Huber
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- Centre of Excellence for Children and Families over the Life Course, Australian Research Council, Canberra, ACT, Australia
- Mental Health, St Vincent's Hospital Sydney, Sydney, NSW, Australia
| | - Alyssa Milton
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- Centre of Excellence for Children and Families over the Life Course, Australian Research Council, Canberra, ACT, Australia
| | - Matthew C Brewer
- Mental Health, St Vincent's Hospital Sydney, Sydney, NSW, Australia
| | - Louisa M Norrie
- Mental Health, St Vincent's Hospital Sydney, Sydney, NSW, Australia
| | - Saskia M Hartog
- Centre of Excellence for Children and Families over the Life Course, Australian Research Council, Canberra, ACT, Australia
| | - Nick Glozier
- Centre of Excellence for Children and Families over the Life Course, Australian Research Council, Canberra, ACT, Australia
- Mental Health, St Vincent's Hospital Sydney, Sydney, NSW, Australia
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Lengvenyte A, Giner L, Jardon V, Olié E, Perez V, Saiz P, Gonzalez Pinto A, Courtet P. Assessment and management of individuals consulting for a suicidal crisis: A European Delphi method-based consensus guidelines. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00113-8. [PMID: 38158127 DOI: 10.1016/j.sjpmh.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Managing patient with suicidal thoughts and behaviours presents significant challenges due to the scarcity of robust evidence and clear guidance. This study sought to develop a comprehensive set of practical guidelines for the assessment and management of suicidal crises. MATERIALS AND METHODS Utilizing the Delphi methodology, 80 suicide clinician and research experts agreed on a series of recommendations. The process involved two iterative rounds of surveys to assess agreement with drafted recommendations, inviting panellists to comment and vote, culminating in 43 consensus recommendations approved with at least 67% agreement. These consensus recommendations fall into three main categories: clinical assessment, immediate care, and long-term approaches. RESULTS The panel formulated 43 recommendations spanning suicidal crisis recognition to continuous long-term care. These guidelines underscore systematic proactive suicide risk screening, in-depth medical and toxicological assessment, and suicide risk appraisal considering personal, clinical factors and collateral information from family. The immediate care directives emphasize a secure environment, continuous risk surveillance, collaborative decision-making, including potential hospitalization, sensible pharmacological management, safety planning, and lethal means restriction counselling. Every discharge should be accompanied by prompt follow-up care incorporating proactive case management and multi-modal approach involving crisis lines, brief contact, and psychotherapeutic and pharmacological interventions. CONCLUSIONS This study generated comprehensive guidelines addressing care for individuals in suicidal crises, covering pre- to post-discharge care. These practical recommendations can guide clinicians in managing patients with suicidal thoughts and behaviours, improve patient safety, and ultimately contribute to the prevention of future suicidal crises.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Lucas Giner
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
| | - Vincent Jardon
- CHU Lille, Hôpital Fontan, Service de Psychiatrie Adulte, Lille, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Victor Perez
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain; CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain
| | - Pilar Saiz
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Ana Gonzalez Pinto
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain; Department of Psychiatry, BIOARABA, Araba University Hospital, University of the Basque Country, Vitoria, Spain; Faculty of Medicine, Department of Neurosciences, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
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Ropaj E, Haddock G, Pratt D. Developing a consensus of recovery from suicidal ideations and behaviours: A Delphi study with experts by experience. PLoS One 2023; 18:e0291377. [PMID: 37729121 PMCID: PMC10511083 DOI: 10.1371/journal.pone.0291377] [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: 11/25/2022] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Understanding recovery in mental health has received significant attention and consequently, recovery has been incorporated into health policy across many countries in the Global North. In comparison, the concept of 'recovery' from suicidal thoughts and behaviours has received little attention. However, the few studies in this area appear to suggest that recovery is a complex and an idiosyncratic process with many contributing factors. This can present a challenge for clinicians and services seeking to become more recovery focused. Thus, it seems of importance to develop a consensus on how recovery from suicidal thoughts and behaviours is conceptualised. AIM The study aimed to use the Delphi design to establish a consensus of how recovery is defined by those with lived experience of suicidal thoughts and behaviours. The Delphi method draws on the expertise of a panel, often involving clinicians, researchers and lived experience experts to develop consensus over a topic by inviting them to rate the importance of, often a series of statements to a given topic area. METHOD Lived experience experts were asked to complete two rounds of questionnaires distributed online to capture their views on recovery. RESULTS A total of 196 individuals gave their views on the first round of the study and 97 gave their views on the second round. A final list of 110 statements was developed that 80% or more of participants defined as essential or important. Statements covered items that were important in defining, facilitation and hindering the process of recovery. CONCLUSION Findings are consistent with the wider literature that suggests that recovery is an idiosyncratic process, but with many commonly shared features. Here we also show that a comprehensive definition of recovery must include factors that hinder the process of recovery. Implications and recommendations for practice, policy development and future research are discussed.
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Affiliation(s)
- Esmira Ropaj
- Division of Psychology & Mental Health, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology & Mental Health, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology & Mental Health, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Hawgood J, Spafford SG, Evans A, Webster A, Koo YW. Suicide risk assessment fears, attitudes and behaviours of lifeline crisis supporters. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5083-e5094. [PMID: 35915919 PMCID: PMC10087418 DOI: 10.1111/hsc.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 05/11/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Lifeline Australia operates crisis support services through Lifeline Crisis Supporters. An integral part of their role is to conduct online suicide risk assessments with help-seekers. However, there is limited literature regarding suicide risk assessment practices for this population. This study aimed to examine how suicide prevention training, vicarious trauma and fears impacted suicide risk assessment behaviours of Lifeline Crisis Supporters. A cross-sectional survey design was used to recruit a volunteer convenience sample of 125 Lifeline Australia Crisis Supporters (75.2% females; Mage = 54.9) in 2018 to participate in an online survey. Findings revealed that those with more suicide-specific training had less risk assessment-related fears, and that fears were not related to attitudes towards suicide prevention. There was no significant relationship between vicarious trauma and amount of training or years of experience in the role. Further, participants with higher levels of vicarious trauma demonstrated significantly more negative attitudes towards suicide prevention. Overall, training appears to be a significant factor in suicide risk assessment practice behaviours of Lifeline Crisis Supporters, highlighting a need for ongoing training and support for them. This research also suggests that whilst fears exist, they do not significantly impair Lifeline Crisis Supporters' ability to undertake suicide risk assessment.
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Affiliation(s)
- Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention; School of Applied PsychologyGriffith UniversityBrisbaneQueenslandAustralia
| | - Sarah G. Spafford
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention; School of Applied PsychologyGriffith UniversityBrisbaneQueenslandAustralia
- Department of Counseling Psychology and Human ServicesUniversity of OregonEugeneOregonUSA
| | - Ann Evans
- Lifeline AustraliaSydneyNew South WalesAustralia
| | - Amy Webster
- Lifeline AustraliaSydneyNew South WalesAustralia
| | - Yu Wen Koo
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention; School of Applied PsychologyGriffith UniversityBrisbaneQueenslandAustralia
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Bayliss LT, Christensen S, Lamont-Mills A, du Plessis C. Suicide capability within the ideation-to-action framework: A systematic scoping review. PLoS One 2022; 17:e0276070. [PMID: 36301944 PMCID: PMC9612581 DOI: 10.1371/journal.pone.0276070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide capability is theorised to facilitate the movement from suicidal ideation to suicide attempt. Three types of contributors are posited to comprise suicide capability: acquired, dispositional, and practical. Despite suicide capability being critical in the movement from ideation-to-attempt, there has been no systematic synthesis of empirical evidence relating to suicide capability that would enable further development and refinement of the concept. This study sought to address this synthesis gap. A scoping review was conducted on suicide capability studies published January 2005 to January 2022. Eleven electronic databases and grey literature sources were searched returning 5,212 potential studies. After exclusion criteria application, 90 studies were included for final analysis. Results synthesis followed a textual narrative approach allocating studies based on contributors of suicide capability. Most studies focused on investigating only one factor within contributors. Painful and provocative events appear to contribute to acquired capability more so than fearlessness about death. Whilst emerging evidence for dispositional and practical contributors is promising, the small number of studies prevents further conclusions from being drawn. An unexpected additional cognitive contributor was identified. The focus of a single factor from most studies and the limited number of studies on contributors other than acquired capability limits the theoretical development and practical application of suicide capability knowledge. Given that suicide is a complex and multifaceted behaviour, future research that incorporates a combination of contributors is more likely to advance our understandings of suicide capability.
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They Told Me "This Isn't a Hotel": Young People's Experiences and Perceptions of Care When Presenting to the Emergency Department with Suicide-Related Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031377. [PMID: 35162409 PMCID: PMC8834737 DOI: 10.3390/ijerph19031377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 11/16/2022]
Abstract
In Australia, the number of young people presenting to the emergency department with mental health concerns, in particular, suicidal behaviour (defined here as suicidal ideation, thoughts, intent and attempts) is increasing. Little is known about the experiences of Australian young people who present to hospital emergency departments with suicidal behaviour. In this qualitative study, we conducted a series of focus groups with 55 young people aged 16–25 years, with a view to developing a framework for youth suicide prevention for Western Australia. The data were analysed using a general inductive analysis approach. We explored the experiences and perceptions of the care and management of 35 young people presenting to Western Australian hospital emergency departments. Participants described a range of negative experiences relating to the emergency department environment, staff attitudes and their treatment by staff. We argue that adapting ED practices and approaches to young people presenting with suicidal thoughts and behaviours based on these findings will result in lower rates of repeated presentations and admissions to hospital and lower rates of suicide attempts and deaths by suicide.
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Cleverley K, McCann E, O’Brien D, Davies J, Bennett K, Brennenstuhl S, Courey L, Henderson J, Jeffs L, Miller J, Pignatiello T, Rong J, Rowland E, Stevens K, Szatmari P. Prioritizing core components of successful transitions from child to adult mental health care: a national Delphi survey with youth, caregivers, and health professionals. Eur Child Adolesc Psychiatry 2022; 31:1739-1752. [PMID: 34089382 PMCID: PMC9666300 DOI: 10.1007/s00787-021-01806-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/15/2021] [Indexed: 02/07/2023]
Abstract
Youth accessing mental health care often experience a disruption in care as they attempt to transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). Few studies have evaluated interventions seeking to improve the experience and outcomes of CAMHS-AMHS transitions, in part due to lack of consensus on what constitutes best practices in intervention success. As such, the aim of this study was to engage patients, caregivers, and clinicians to prioritize core components of successful CAMHS-AMHS transitions which can be used in the design or evaluation of transition interventions. As such, a Delphi study was conducted to determine core components of successful CAMHS-AMHS transitions. Guided by the principles of patient-oriented research, three balanced expert panels consisting of youth, caregivers, and clinicians ranked and provided feedback on the importance and feasibility of core components of CAMHS-AMHS transitions. Components endorsed as feasible or important with ≥ 70% agreement from any panel moved to the next round. As a result, a list of 26 core components of CAMHS-AMHS transitions has been refined which can be used in the design, implementation, or evaluation of interventions intended to improve transition experiences and outcomes for youth in mental health care. Youth and families were engaged in an expert advisory role throughout the research process, contributing their important perspectives to the design and implementation of this study, as well as interpretation of the findings.
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Affiliation(s)
- Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada. .,Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada. .,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Emma McCann
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada
| | | | - Julia Davies
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada ,grid.155956.b0000 0000 8793 5925Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Kathryn Bennett
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Sarah Brennenstuhl
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada
| | - Lynn Courey
- grid.491040.8Sashbear Foundation, Toronto, Canada
| | - Joanna Henderson
- grid.155956.b0000 0000 8793 5925Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lianne Jeffs
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada ,grid.250674.20000 0004 0626 6184Lunenfeld-Tanenbaum Research Institute, Sinai Health, System, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada ,grid.415502.7Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada
| | - Joshua Miller
- grid.155956.b0000 0000 8793 5925Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada ,grid.17063.330000 0001 2157 2938Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Tony Pignatiello
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada ,grid.42327.300000 0004 0473 9646Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Jessica Rong
- grid.155956.b0000 0000 8793 5925Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Emily Rowland
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada
| | - Katye Stevens
- grid.155956.b0000 0000 8793 5925Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Peter Szatmari
- grid.155956.b0000 0000 8793 5925Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada ,grid.42327.300000 0004 0473 9646Centre for Brain and Mental Health and Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada ,grid.155956.b0000 0000 8793 5925The Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Canada
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Ross V, Mathieu S, Hawgood J, Turner K, Stapelberg NJC, Welch M, Davies A, Sveticic J, Walker S, Kõlves K. Consumer and Carer Perspectives of a Zero Suicide Prevention Program: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10634. [PMID: 34682380 PMCID: PMC8535550 DOI: 10.3390/ijerph182010634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022]
Abstract
This study explored the experiences of healthcare consumers who had recently attempted suicide, and their carers, following placement on a Suicide Prevention Pathway based on the Zero Suicide framework. Qualitative interviews were conducted with 10 consumers and 5 carers using a semi-structured interview schedule. Interviews were transcribed and thematic analysis was applied to identify prominent themes and sub-themes. Three interrelated themes were identified. The first theme was 'Feeling safe and valued' with the associated sub-theme pertaining to perceived stigmatizing treatment and self-stigma. The second was 'Intersection of consumer and staff/organizational needs' with a related sub-theme of time pressure and reduced self-disclosure. The final theme was 'Importance of the 'whole picture', highlighting the relevance of assessing and addressing psychosocial factors when planning for consumer recovery. Overall, consumers and their carers reported a favorable experience of the Suicide Prevention Pathway; however, there were several areas identified for improvement. These included reconciling the time-pressures of a busy health service system, ensuring consumers and carers feel their psychosocial concerns are addressed, and ensuring that adequate rapport is developed. Key to this is ensuring consumers feel cared for and reducing perceptions of stigma.
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Affiliation(s)
- Victoria Ross
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Sharna Mathieu
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Kathryn Turner
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Nicolas J. C. Stapelberg
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Matthew Welch
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Angela Davies
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Jerneja Sveticic
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Sarah Walker
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
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11
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Rheinberger D, Macdonald D, McGillivray L, Maple M, Torok M, Nicolopoulos A, Shand F. "A Sustained, Productive, Constructive Relationship with Someone Who Can Help"-A Qualitative Exploration of the Experiences of Help Seekers and Support Persons Using the Emergency Department during a Suicide Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910262. [PMID: 34639571 PMCID: PMC8508062 DOI: 10.3390/ijerph181910262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 12/14/2022]
Abstract
For Australians experiencing a suicide crisis, the emergency department (ED) is the recommended point of contact for intervention and to ensure personal safety. However, negative ED experiences can deter individuals from returning, thus impacting future suicide risk. In order to improve the ED environment for individuals in suicidal crisis, an in-depth understanding of this experience is needed. In-depth semi-structured interviews with 17 help seekers and 16 support persons were conducted. A grounded theory approach uncovered a core organising concept—all participants wanted a “a sustained, productive, constructive relationship with someone who can help” during the ED visit—which guided analysis. Thematic analysis resulted in two themes and four subthemes exploring the systemic and interpersonal aspects of the ED visit and the roadblocks and pathways to development of the relationship. Interpersonal factors included aspects of staff interaction and presence of a support person. Systemic factors related to aspects controlled by the physical space and internal policies and procedures and included aspects such as the chaotic environment, long waiting times, and access to staff. Overwhelmingly, there were more roadblocks than pathways reported by participants. Improving the ED environment, increasing staff training and encouraging the presence of support persons may help mitigate some of these roadblocks.
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Affiliation(s)
- Demee Rheinberger
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
- Correspondence:
| | - Diane Macdonald
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
| | - Myfanwy Maple
- Faculty of Medicine and Health, University of New England, Armidale, NSW 2351, Australia;
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
| | - Alexandra Nicolopoulos
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia; (D.M.); (L.M.); (M.T.); (A.N.); (F.S.)
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12
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Wilson MP, Kaur J, Blake L, Oliveto AH, Thompson RG, Pyne JM, Wolf L, Walker AP, Waliski AD, Nordstrom K. Adherence to guideline creation recommendations for suicide prevention in the emergency department: A systematic review. Am J Emerg Med 2021; 50:553-560. [PMID: 34547697 DOI: 10.1016/j.ajem.2021.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/21/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Suicide rates in the United States rose 35.2% from 1999-2018. As emergency department (ED) providers often have limited training in management of suicidal patients and minimal access to mental health experts, clinical practice guidelines (CPGs) may improve care for these patients. However, clinical practice guidelines that do not adhere to quality standards for development may be harmful both to patients, if they promote practices based on flawed evidence, and to ED providers, if used in malpractice claims. In 2011, the Institute of Medicine created standards to determine the trustworthiness of CPGs. This review assessed the adherence of suicide prevention CPGs, intended for the ED, to these standards. Secondary objectives were to assess the association of adherence both with first author/organization specialty (ED vs non-ED) and with inclusion of recommendations on substance use, a potent risk factor for suicide. METHODS This is a systematic review of available suicide-prevention CPGs for the ED in both peer-reviewed and gray literature. This review followed the PRISMA standards for reporting systematic reviews. RESULTS Of 22 included CPGs, the 7 ED-sponsored CPGs had higher adherence to quality standards (3.1 vs 2.4) and included the highest-rated CPG (ICAR2E) identified by this review. Regardless of specialty, nearly all CPGs included some mention of identifying or managing substance use. CONCLUSIONS Most suicide prevention CPGs intended for the ED are written by non-ED first authors or organizations and have low adherence to quality standards. Future CPGs should be developed with more scientific rigor, include a multidisciplinary writing group, and be created by authors working in the practice environment to which the CPG applies.
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Affiliation(s)
- Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Jaskiran Kaur
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lindsay Blake
- Academic Affairs, UAMS Library, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Alison H Oliveto
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Jeffrey M Pyne
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lisa Wolf
- Emergency Nurses Association, Schaumburg, Illinois
| | - A Paige Walker
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Angela D Waliski
- Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare System, Little Rock, AR, United States of America
| | - Kimberly Nordstrom
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
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13
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King PR, Beehler GP, Donnelly K, Funderburk JS, Wray LO. A Practical Guide to Applying the Delphi Technique in Mental Health Treatment Adaptation: The Example of Enhanced Problem-Solving Training (E-PST). ACTA ACUST UNITED AC 2021; 52:376-386. [PMID: 34446984 DOI: 10.1037/pro0000371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Expert consensus methods, such as the Delphi procedure, are commonly employed in consumer, education, and health services research. However, the utility of this methodology has not widely been described in relation to mental health treatment adaptation efforts. This gap is noteworthy given that evidence-based treatments are often modified in terms of core intervention content, method of delivery, and target populations. Expert consensus methods such as the Delphi procedure offer multiple practical benefits (e.g., flexibility, resource-efficiency) for psychologists who need to adapt existing treatments to meet new research and clinical practice needs. The purpose of this paper is to provide a brief overview of the Delphi procedure, and to offer a practical guide to using this method for treatment adaptation. An example is offered using our team's application of a three-round Delphi procedure to render content and context modifications to an existing problem-solving intervention to optimize its use with a new treatment population. Data were collected from Department of Veterans Affairs clinical subject matter experts. Round 1 utilized semi-structured interviews to determine necessary protocol features and modifications. Rounds 2-3 utilized a forced-choice survey and feedback loop to evaluate expert consensus. More than 91% of rated items reached consensus following Round 2, with the remainder following Round 3. Recommended modifications included minor structural and content edits, and re-balancing time allotments. We conclude that consensus methods may facilitate treatment adaptation efforts, enhance treatment feasibility, and promote content and ecological validity. Considerations for future Delphi-based treatment adaptations are offered.
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Affiliation(s)
- Paul R King
- VA Center for Integrated Healthcare, Buffalo, NY
- Department of Counseling, School, and Educational Psychology, Graduate school of Education, University at Buffalo, Buffalo, NY
| | - Gregory P Beehler
- VA Center for Integrated Healthcare, Buffalo, NY
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Kerry Donnelly
- Department of Counseling, School, and Educational Psychology, Graduate school of Education, University at Buffalo, Buffalo, NY
- VA Western New York Healthcare System, Buffalo, NY
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse, NY
- Department of Psychology, Syracuse University, Syracuse, NY
| | - Laura O Wray
- VA Center for Integrated Healthcare, Buffalo, NY
- Division of Geriatrics/ Gerontology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
- Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo, NY
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14
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Saini P, Clements C, Gardner KJ, Chopra J, Latham C, Kumar R, Taylor P. Identifying Suicide and Self-Harm Research Priorities in North West England. CRISIS 2021; 43:35-45. [PMID: 33475010 DOI: 10.1027/0227-5910/a000757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Understanding and effectively managing self-harm and suicide require collaborative research between stakeholders focused on shared priorities. Aims: We aimed to develop a consensus about suicide and self-harm research priorities in the North West of England using the Delphi method. Method: Items for the Delphi survey were generated through group discussions at a workshop with 88 stakeholders and subsequent thematic analysis of key themes. A total of 44 participants who were experts-by-experience, researchers, and clinicians based within health services including third-sector organizations completed the Delphi survey. Results: A three-round survey reached consensus on 55 research priority items identifying key priorities in each of the following groups: offenders, children and young people, self-harm in community settings, and crisis care in the community. Limitations: The pool of delegates at the workshop and subsequent self-selection into the Delphi may have introduced bias into the study. Conclusion: The current paper highlights specific actionable priorities were identified in four areas that can be used to inform research efforts and future policy and practice, based on shared areas of perceived importance and concern. Future work is needed to confirm the significance of these priority areas, including the use of evidence synthesis approaches to ascertain the extent to which these priorities have already been investigated and where gaps in understanding remain.
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Affiliation(s)
- Pooja Saini
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Caroline Clements
- The Manchester Self-Harm Project, Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, UK
| | | | - Jennifer Chopra
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | | | - Rohit Kumar
- School of Medicine, University of Nottingham, UK
| | - Peter Taylor
- Division of Psychology & Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, UK
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15
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Rosebrock H, Chen N, Tye M, Mackinnon A, Calear AL, Batterham PJ, Maple M, Rasmussen VM, Schroeder L, Cutler H, Shand F. Study protocol for a mixed methods prospective cohort study to explore experiences of care following a suicidal crisis in the Australian healthcare system. BMJ Open 2020; 10:e033814. [PMID: 32801189 PMCID: PMC7430469 DOI: 10.1136/bmjopen-2019-033814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION For individuals presenting to the emergency department (ED) for a suicide attempt, the period after discharge from hospital is marked by heightened vulnerability for further suicide attempts. Effective care following a suicidal crisis has the potential to significantly decrease this risk. The current study aims to examine the impact of the LifeSpan multilevel suicide prevention model on experiences of care following a suicidal crisis. Perspectives from healthcare consumers (individuals who have presented to the ED following a suicidal crisis), carers, and health professionals will be explored. The LifeSpan model is currently being evaluated as a high-fidelity trial in four geographically defined regions in New South Wales, Australia. METHODS AND ANALYSIS This study will use a mixed methods prospective cohort design. Quantitative data collection includes a structured survey, administered to healthcare consumers from LifeSpan sites and control sites. Two cohorts of healthcare consumers will be recruited 12 months apart with baseline assessment occurring within 18 months of the ED presentation, and follow-up 12 months after the initial assessment. Survey participants will be recruited online and through participating EDs, mental health organisations and aftercare services. Qualitative interview data from healthcare consumers, carers who have accompanied a loved one to the ED following a suicidal crisis and health professionals who provide care to people at risk of suicide will be collected concurrently with the recruitment of the first cohort of survey participants. Purposive and convenience sampling techniques will be used for recruitment of interview participants. The primary outcome for this study will be healthcare consumers' experiences of service provided at the ED. Analysis will be undertaken of the change over time within LifeSpan sites, as well as between LifeSpan sites and control sites, using mixed effects repeated measures models as principal means of data analysis. ETHICS AND DISSEMINATION This research has been approved by the Hunter New England Human Research Ethics Committee (HREC/17/HNE/144). Results will be disseminated via conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12617000457347.
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Affiliation(s)
| | - Nicola Chen
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Michelle Tye
- Black Dog Institute, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | | | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Myfanwy Maple
- School of Health, University of New England, Armidale, New South Wales, Australia
| | | | - Liz Schroeder
- Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia
| | - Henry Cutler
- Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia
| | - Fiona Shand
- Black Dog Institute, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
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16
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Shand F, Torok M, Cockayne N, Batterham PJ, Calear AL, Mackinnon A, Martin D, Zbukvic I, Mok K, Chen N, McGillivray L, Phillips M, Cutler H, Draper B, Sara G, Christensen H. Protocol for a stepped-wedge, cluster randomized controlled trial of the LifeSpan suicide prevention trial in four communities in New South Wales, Australia. Trials 2020; 21:332. [PMID: 32293516 PMCID: PMC7161184 DOI: 10.1186/s13063-020-04262-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite increasing investment in suicide prevention, Australian suicide rates have increased steadily in the past decade. In response to growing evidence for multicomponent intervention models for reducing suicide, the LifeSpan model has been developed as the first multicomponent, evidence-based, system-wide approach to suicide prevention in Australia. The LifeSpan model consists of nine evidence-based strategies. These include indicated, selective and universal interventions which are delivered simultaneously to community and healthcare systems over a 2-year implementation period. This study will evaluate the effectiveness of the LifeSpan model in reducing suicide attempts and suicide deaths in four geographically defined regions in New South Wales, Australia. METHODS We outline the protocol for a stepped-wedge, cluster randomized controlled trial. Following a 6-month transition phase, the trial sites will move to the 2-year active implementation phase in 4-monthly intervals with evaluation extending a minimum of 24 months after establishment of the full active period. Analysis will be undertaken of the change attributable to the invention across the four sites. The primary outcome for the study is the rate of attempted suicide in the regions involved. Rate of suicide deaths within each site is a secondary outcome. DISCUSSION If proven effective, the LifeSpan model for suicide prevention could be more widely delivered in Australian communities, providing a valuable new approach to tackle rising suicide rates. LifeSpan has the potential to significantly contribute to the mental health of Australians by improving help-seeking for suicide, facilitating early detection, and improving aftercare to reduce re-attempts. The findings from this research should also contribute to the evidence base for multilevel suicide prevention programs internationally. TRIAL REGISTRATION Australia New Zealand Clinical Trials Register, ID: ACTRN12617000457347. Prospectively registered on 28 March 2017. https://www.anzctr.org.au/TrialSearch.aspx#&&conditionCode=&dateOfRegistrationFrom=&interventionDescription=&interventionCodeOperator=OR&primarySponsorType=&gender=&distance=&postcode=&pageSize=20&ageGroup=&recruitmentCountryOperator=OR Protocol Version: 1.0, 31 May 2019.
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Affiliation(s)
- Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Nicole Cockayne
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, NSW, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, NSW, Australia
| | - Andrew Mackinnon
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Dean Martin
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Isabel Zbukvic
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Katherine Mok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Nicola Chen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Phillips
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Henry Cutler
- Macquarie University Centre for Health Economics, Macquarie University, Sydney, NSW, Australia
| | - Brian Draper
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Grant Sara
- System Information and Analytics Branch, NSW Ministry of Health, Sydney, NSW, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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