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Hu FH, Xu J, Jia YJ, Ge MW, Zhang WQ, Tang W, Zhao DY, Hu SQ, Du W, Shen WQ, Xu H, Zhang WB, Chen HL. Non-pharmacological interventions for preventing suicide attempts: A systematic review and network meta-analysis. Asian J Psychiatr 2024; 93:103913. [PMID: 38219553 DOI: 10.1016/j.ajp.2024.103913] [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: 07/17/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
Suicide attempts can cause serious physical harm or death. It would be crucial to gain a better understanding of the comparative efficacy of non-pharmacological interventions. We aimed to identify which non-pharmacological interventions are more effective in preventing suicide attempts. PubMed, Web of Science, and EMBASE databases were searched systematically from their inception until 3 April 2023. To be eligible for inclusion, randomized controlled trials (RCTs) had to meet the following criteria: Participants were individuals who had suicidal ideation or a history of severe self-harm or attempted suicide. A network meta-analysis was performed using a random effects model to estimate the treatment effect of various non-pharmacological interventions. (PROSPERO registration number: CRD42023411393). We obtained data from 54 studies involving 17,630 participants. Our primary analysis found that Cognitive therapy (CT) (OR=0.19, 95%CI =0.04-0.81), Dialectical Behavior Therapy (DBT) (OR=0.37, 95%CI =0.13-0.97), Cognitive-behavioral therapy (CBT) (OR=0.42, 95%CI =0.17-0.99), and Brief intervention and contact (BIC) (OR=0.65, 95%CI=0.44-0.94) were superior to TAU (within the longest available follow-up time) in preventing suicide attempts, while other intervention methods do not show significant advantages over TAU. Secondary analysis showed that the two intervention measures (CT and BIC) were effective when follow-up time did not exceed 6 months, but there was no effective intervention measure with longer follow-up times. CT, DBT, CBT, and BIC have a better effect in preventing suicide attempts than other non-pharmacological interventions. Additional research is necessary to validate which interventions, as well as which combinations of interventions, are the most effective.
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Affiliation(s)
- Fei-Hong Hu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Jie Xu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Yi-Jie Jia
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Dan-Yan Zhao
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Shi-Qi Hu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wei Du
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wang-Qin Shen
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Hong Xu
- Nantong Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Wei-Bing Zhang
- Nantong Center for Disease Control and Prevention, Nantong, Jiangsu, PR China.
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, PR China.
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Stevens GJ, Sperandei S, Carter GL, Munasinghe S, Hammond TE, Gunja N, de la Riva A, Brakoulias V, Page A. Efficacy of a short message service brief contact intervention (SMS-SOS) in reducing repetition of hospital-treated self-harm: randomised controlled trial. Br J Psychiatry 2024; 224:106-113. [PMID: 38083861 PMCID: PMC10884824 DOI: 10.1192/bjp.2023.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/10/2023] [Accepted: 10/29/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Hospital-treated self-harm is common and costly, and is associated with repeated self-harm and suicide. AIMS To investigate the effectiveness of a brief contact intervention delivered via short message service (SMS) text messages in reducing hospital-treated self-harm re-presentations in three hospitals in Sydney (2017-2019), Australia. Trial registration number: ACTRN12617000607370. METHOD A randomised controlled trial with parallel arms allocated 804 participants presenting with self-harm, stratified by previous self-harm, to a control condition of treatment as usual (TAU) (n = 431) or an intervention condition of nine automated SMS contacts (plus TAU) (n = 373), over 12 months following the index self-harm episode. The primary outcomes were (a) repeat self-harm event rate (number of self-harm events per person per year) at 6-, 12- and 24-month follow-up and (b) the time to first repeat at 24-month follow-up. RESULTS The event rate for self-harm repetition was lower for the SMS compared with TAU group at 6 months (IRR = 0.79, 95% CI 0.61-1.01), 12 months (IRR = 0.78, 95% CI 0.64-0.95) and 24 months (IRR = 0.78, 95% CI 0.66-0.91). There was no difference between the SMS and TAU groups in the time to first repeat self-harm event over 24 months (HR = 0.96, 95% CI 0.72-1.26). There were four suicides in the TAU group and none in the SMS group. CONCLUSIONS The 22% reduction in repetition of hospital-treated self-harm was clinically meaningful. SMS text messages are an inexpensive, scalable and universal intervention that can be used in hospital-treated self-harm populations but further work is needed to establish efficacy and cost-effectiveness across settings.
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Affiliation(s)
- Garry John Stevens
- School of Social Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Sandro Sperandei
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Gregory Leigh Carter
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sithum Munasinghe
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Trent Ernest Hammond
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Penrith, New South Wales, Australia
| | - Naren Gunja
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia; and Emergency Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Anabel de la Riva
- Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Vlasios Brakoulias
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Penrith, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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Shin HD, Durocher K, Sequeira L, Zaheer J, Torous J, Strudwick G. Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review. BMC Health Serv Res 2023; 23:281. [PMID: 36959599 PMCID: PMC10037806 DOI: 10.1186/s12913-023-09254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on ICT-based interventions for suicide prevention implemented in clinical settings and then to identify and characterize implementation barriers and facilitators, as well as evaluation outcomes, and measures. METHODS We conducted this review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was applied to the following six databases between August 17-20, 2021: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Library, Information Science and Technology Abstracts. We also supplemented our search with Google searches and hand-searching reference lists of relevant reviews. To be included in this review, studies must include ICT-based interventions for any spectrum of suicide-related thoughts and behaviours including non-suicidal self-injury. Additionally, these ICTs must be implemented in clinical settings, such as emergency department and in-patient units. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to prepare this full report. RESULTS This review included a total of 75 citations, describing 70 studies and 66 ICT-based interventions for suicide prevention implemented in clinical settings. The majority of ICTs were computerized interventions and/or applications (n = 55). These ICTs were commonly used as indicated strategies (n = 49) targeting patients who were actively presenting with suicide risk. The three most common suicide prevention intervention categories identified were post-discharge follow-up (n = 27), screening and/or assessment (n = 22), and safety planning (n = 20). A paucity of reported information was identified related to implementation strategies, barriers and facilitators. The most reported implementation strategies included training, education, and collaborative initiatives. Barriers and facilitators of implementation included the need for resource supports, knowledge, skills, motivation as well as engagement with clinicians with research teams. Studies included outcomes at patient, clinician, and health system levels, and implementation outcomes included acceptability, feasibility, fidelity, and penetration. CONCLUSION This review presents several trends of the ICT-based interventions for suicide prevention implemented in clinical settings and identifies a need for future research to strengthen the evidence base for improving implementation. More effort is required to better understand and support the implementation and sustainability of ICTs in clinical settings. The findings can also serve as a future resource for researchers seeking to evaluate the impact and implementation of ICTs.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- School of Health, Community Service & Creative Design, Lambton College, Sarnia, Ontario, Canada
| | - Lydia Sequeira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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García Y, Ferrás C. Blended Therapies and Mobile Phones for Improving the Health of Female Victims of Gender Violence. Healthcare (Basel) 2022; 10:445. [PMID: 35326924 PMCID: PMC8955346 DOI: 10.3390/healthcare10030445] [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: 12/29/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
We carried out a case study with a group of female victims of gender violence (n = 39) with the objective of evaluating a blended psychotherapeutic intervention. The results show that blended therapies with mobile text messages combined with face-to-face group therapies significantly improved the health of these women. Mood states and the symptoms of depression were measured with a PHQ-9 personal health questionnaire and evolved positively. In the group of women (n = 39) the scores improved from an initial 13.5 (SD = 7.2, range 3-34) to 6.0 at the end of the period of messages (SD = 5.2, range 0-18), which was a significant difference (t (39) = 2.02; p = 0.000). Most of the women stated that the messages had helped them improve their mood (91.6%) and their general health (83.3%), which made them feel more connected to their social environment (80.6%). We observed that adherence to medication for each woman improved. With mixed therapies and mobile phones, social service professionals can incorporate technology into daily practices and offer personalized attention and daily counseling to victims of gender-based violence.
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Affiliation(s)
- Yolanda García
- Faculty of Education and Social Work, University of Vigo, 32004 Ourense, Spain;
| | - Carlos Ferrás
- Mujeres Vulnerables Lab, Institute of Studies and Development of Galicia (IDEGA), University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Ibragimov K, Palma M, Keane G, Ousley J, Crowe M, Carreño C, Casas G, Mills C, Llosa A. Shifting to Tele-Mental Health in humanitarian and crisis settings: an evaluation of Médecins Sans Frontières experience during the COVID-19 pandemic. Confl Health 2022; 16:6. [PMID: 35164807 PMCID: PMC8845383 DOI: 10.1186/s13031-022-00437-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/01/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND 'Tele-Mental Health (MH) services,' are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its MH activities across humanitarian and resource-constrained settings to remote format. METHODS From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of tele-MH services. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews occurred. RESULTS Respondents in 44 countries (6 geographic regions), mostly from Sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using these interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using telecommunication platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-MH services had some degree of usefulness, notably improved access to care (37.7%) and time efficiency (32.8%). Qualitative results outlined a myriad of challenges, notably in establishing therapeutic alliance, providing care for vulnerable populations and those inherent to the communications infrastructure. CONCLUSION Tele-MH services were perceived to be a feasible alternative solution to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering tele-MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.
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Affiliation(s)
| | - Miguel Palma
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France.
| | - Gregory Keane
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
| | - Janet Ousley
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
| | | | | | - German Casas
- Fundación Santa Fe University Hospital, Universidad de Los Andes, Bogotá, Colombia
| | - Clair Mills
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
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Cliffe B, Tingley J, Greenhalgh I, Stallard P. mHealth Interventions for Self-Harm: Scoping Review. J Med Internet Res 2021; 23:e25140. [PMID: 33929329 PMCID: PMC8122298 DOI: 10.2196/25140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/19/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
Background Self-harm is a growing issue with increasing prevalence rates; however, individuals who self-harm do not often receive treatment. Mobile health (mHealth) interventions are a possible solution to some of the barriers that individuals face when seeking support, and they have also been found to be effective in improving mental health. Thus far, reviews of mHealth interventions for self-harm have been limited by study type. Therefore, we determined that a broader scoping review will provide a more exhaustive understanding of mHealth interventions for self-harm. Objective This scoping review aims to identify mHealth interventions for self-harm within the literature, understand the types and features of interventions that have been developed and evaluated, highlight research findings around mHealth interventions for self-harm, and determine what outcomes are typically used to assess the efficacy of interventions. Methods A search was conducted using Embase, PubMed, PsycINFO, PsycEXTRA, Web of Science, and the Cochrane Library. Studies were included if they described an mHealth intervention designed to have a direct (ie, if the intervention was designed for self-harm or for people who self-harm) or indirect (ie, if self-harm was measured as an outcome) treatment effect and if the paper was available in English. There were no exclusion criteria based on the study design. Results A total of 36 papers were included in the review, and most of them were randomized controlled trials published within the last 4 years. The interventions were mostly smartphone apps and calling or texting services, with 62% (21/34) having underlying therapeutic models to inform the intervention content. They were generally shown to be promising and appealing, but only 5 were widely available for use. Outcomes focused on a reduction of self-harm and suicidality, mood, and the users’ experiences of the intervention. Samples were typically nondiverse, and there was limited variety in the study designs and in the measurements of self-harm recovery. Conclusions Promising and appealing mHealth interventions have been developed but are not widely available. Research could benefit from greater diversity as well as a broader and more nuanced understanding of recovery from self-harm.
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Affiliation(s)
- Bethany Cliffe
- Department for Health, University of Bath, Bath, United Kingdom
| | - Jessica Tingley
- Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, Bristol, United Kingdom
| | - Isobel Greenhalgh
- Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, Bristol, United Kingdom
| | - Paul Stallard
- Department for Health, University of Bath, Bath, United Kingdom.,Child and Adolescent Mental Health Services, Oxford Health NHS Foundation Trust, Bristol, United Kingdom
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2021; 4:CD013668. [PMID: 33884617 PMCID: PMC8094743 DOI: 10.1002/14651858.cd013668.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for SH in adults. This review therefore updates a previous Cochrane Review (last published in 2016) on the role of psychosocial interventions in the treatment of SH in adults. OBJECTIVES To assess the effects of psychosocial interventions for self-harm (SH) compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing interventions of specific psychosocial treatments versus treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, or a combination of these, in the treatment of adults with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratio (ORs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMDs) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 76 trials with a total of 21,414 participants. Participants in these trials were predominately female (61.9%) with a mean age of 31.8 years (standard deviation [SD] 11.7 years). On the basis of data from four trials, individual cognitive behavioural therapy (CBT)-based psychotherapy may reduce repetition of SH as compared to TAU or another comparator by the end of the intervention (OR 0.35, 95% CI 0.12 to 1.02; N = 238; k = 4; GRADE: low certainty evidence), although there was imprecision in the effect estimate. At longer follow-up time points (e.g., 6- and 12-months) there was some evidence that individual CBT-based psychotherapy may reduce SH repetition. Whilst there may be a slightly lower rate of SH repetition for dialectical behaviour therapy (DBT) (66.0%) as compared to TAU or alternative psychotherapy (68.2%), the evidence remains uncertain as to whether DBT reduces absolute repetition of SH by the post-intervention assessment. On the basis of data from a single trial, mentalisation-based therapy (MBT) reduces repetition of SH and frequency of SH by the post-intervention assessment (OR 0.35, 95% CI 0.17 to 0.73; N = 134; k = 1; GRADE: high-certainty evidence). A group-based emotion-regulation psychotherapy may also reduce repetition of SH by the post-intervention assessment based on evidence from two trials by the same author group (OR 0.34, 95% CI 0.13 to 0.88; N = 83; k = 2; moderate-certainty evidence). There is probably little to no effect for different variants of DBT on absolute repetition of SH, including DBT group-based skills training, DBT individual skills training, or an experimental form of DBT in which participants were given significantly longer cognitive exposure to stressful events. The evidence remains uncertain as to whether provision of information and support, based on the Suicide Trends in At-Risk Territories (START) and the SUicide-PREvention Multisite Intervention Study on Suicidal behaviors (SUPRE-MISS) models, have any effect on repetition of SH by the post-intervention assessment. There was no evidence of a difference for psychodynamic psychotherapy, case management, general practitioner (GP) management, remote contact interventions, and other multimodal interventions, or a variety of brief emergency department-based interventions. AUTHORS' CONCLUSIONS Overall, there were significant methodological limitations across the trials included in this review. Given the moderate or very low quality of the available evidence, there is only uncertain evidence regarding a number of psychosocial interventions for adults who engage in SH. Psychosocial therapy based on CBT approaches may result in fewer individuals repeating SH at longer follow-up time points, although no such effect was found at the post-intervention assessment and the quality of evidence, according to the GRADE criteria, was low. Given findings in single trials, or trials by the same author group, both MBT and group-based emotion regulation therapy should be further developed and evaluated in adults. DBT may also lead to a reduction in frequency of SH. Other interventions were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to the use of these interventions is inconclusive at present.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Malakouti SK, Nojomi M, Ghanbari B, Rasouli N, Khaleghparast S, Farahani IG. Aftercare and Suicide Reattempt Prevention in Tehran, Iran. CRISIS 2021; 43:18-27. [PMID: 33563037 DOI: 10.1027/0227-5910/a000754] [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: A previous suicide attempt is one of the strongest risk factors for subsequent suicide. Effective care following a suicide attempt may reduce the risk of suicide reattempts. Aims: We aimed to investigate the effect of a brief educational intervention and contact program on suicide reattempts. Method: This study was performed as a randomized clinical trial (RCT) recruiting 305 individuals who had attempted suicide (brief intervention and contact = 153 individuals, BIC; treatment as usual = 152 individuals, TAU) who were referred to Baharlu Hospital in Tehran. The SUPRE-MISS questionnaire and a discharge follow-up questionnaire were used for data collection. Cox proportional hazard models and log-rank tests were used to assess the association of the variable with the event (reattempt). Kaplan-Meier curves were used to depict the time to the event of reattempt. Results: In the BIC group, 11% of the individuals had attempted suicide once, and 25% of the TAU group had attempted suicide once (12.4%), twice (9.3%), and three times (3.8%), respectively. The results of Kaplan-Meier analysis indicated the mean time of reattempt in the BIC (0.76) and TAU groups (0.25) as the fourth and second months of follow-up, respectively (log rank, χ2 = 12.48, p < .001). The hazard ratio for the TAU group was 2.57 (95% CI [1.4, 5.9]). Limitations: Loss to follow-up due to stigma is one of the serious problems of follow-up services. Conclusion: Implementing a brief educational intervention and contact program on suicide reattempts is feasible and effective in reducing the rate of reattempt; however, it should be accommodated within the mental health services of the county.
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Affiliation(s)
- Seyed Kazem Malakouti
- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Department of Community and Family Medicine, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Ghanbari
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nafee Rasouli
- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Shiva Khaleghparast
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Robinson J, Witt K, Lamblin M, Spittal MJ, Carter G, Verspoor K, Page A, Rajaram G, Rozova V, Hill NTM, Pirkis J, Bleeker C, Pleban A, Knott JC. Development of a Self-Harm Monitoring System for Victoria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249385. [PMID: 33333970 PMCID: PMC7765445 DOI: 10.3390/ijerph17249385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/28/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022]
Abstract
The prevention of suicide and suicide-related behaviour are key policy priorities in Australia and internationally. The World Health Organization has recommended that member states develop self-harm surveillance systems as part of their suicide prevention efforts. This is also a priority under Australia’s Fifth National Mental Health and Suicide Prevention Plan. The aim of this paper is to describe the development of a state-based self-harm monitoring system in Victoria, Australia. In this system, data on all self-harm presentations are collected from eight hospital emergency departments in Victoria. A natural language processing classifier that uses machine learning to identify episodes of self-harm is currently being developed. This uses the free-text triage case notes, together with certain structured data fields, contained within the metadata of the incoming records. Post-processing is undertaken to identify primary mechanism of injury, substances consumed (including alcohol, illicit drugs and pharmaceutical preparations) and presence of psychiatric disorders. This system will ultimately leverage routinely collected data in combination with advanced artificial intelligence methods to support robust community-wide monitoring of self-harm. Once fully operational, this system will provide accurate and timely information on all presentations to participating emergency departments for self-harm, thereby providing a useful indicator for Australia’s suicide prevention efforts.
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Affiliation(s)
- Jo Robinson
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Correspondence: ; Tel.: +61-393-420-2866
| | - Katrina Witt
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010 Australia; (M.J.S.); (J.P.)
| | - Greg Carter
- Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia;
- Calvary Mater Newcastle, Callaghan, NSW 2308, Australia
| | - Karin Verspoor
- School of Computing and Information Systems, The University of Melbourne, Parkville, VIC 3052, Australia; (K.V.); (V.R.)
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, VIC 3000, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia;
| | - Gowri Rajaram
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Vlada Rozova
- School of Computing and Information Systems, The University of Melbourne, Parkville, VIC 3052, Australia; (K.V.); (V.R.)
| | - Nicole T. M. Hill
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010 Australia; (M.J.S.); (J.P.)
| | - Caitlin Bleeker
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Alex Pleban
- Mid-West Area Mental Health Service, Emergency Department, Sunshine Hospital, Sunshine, VIC 3021, Australia;
| | - Jonathan C. Knott
- Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010, Australia;
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10
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Ganapathy S, de Korne DF, Chong NK, Car J. The Role of Text Messaging and Telehealth Messaging Apps. Pediatr Clin North Am 2020; 67:613-621. [PMID: 32650857 DOI: 10.1016/j.pcl.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article focuses on the role of text messaging and messaging applications, discusses technical and legal issues, and reviews current examples of the application of text messaging in the clinical adult and pediatric practice. Reviews of current examples of text messaging in adult and pediatric practice show uptake has been increasing substantially in recent years. In pediatric care text messaging has been used for behavior intervention and outcomes tracking. Although applications are promising, the potential of nonsynchronic messaging in the formal delivery of care is still in the neonatal phase compared with its grown-up existence in day-to-day modern life.
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Affiliation(s)
- Sashikumar Ganapathy
- KK Women's & Children's Hospital, 100, Bukit Timah Road 229899 Singapore; Duke-NUS School of Medicine, Singapore, Singapore
| | - Dirk F de Korne
- Duke-NUS School of Medicine, Singapore, Singapore; Medical Innovation & Care Transformation, KK Women's & Children's Hospital, Singapore, Singapore; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands; Care & Welfare, SVRZ Cares in Zeeland, Middelburg, SVRZ, Koudekerkseweg 143, Middelburg 4335 SM, Netherlands. https://twitter.com/dirkdekorne
| | - Ng Kee Chong
- KK Women's & Children's Hospital, 100, Bukit Timah Road 229899 Singapore; Duke-NUS School of Medicine, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Clinical Sciences Building, 11 Mandalay Road, Singapore 308232, Singapore.
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11
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Effectiveness of a Psychosocial Therapy with SMS in Immigrant Women with Different Degrees of Depression. SOCIAL SCIENCES-BASEL 2020. [DOI: 10.3390/socsci9050063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Immigrant women who are forced to adapt to a new cultural context often live in low income situations, have informal jobs, and experience social inclusion difficulties; these women frequently have mental health and social relationship problems. We conducted an experimental investigation with a group of vulnerable immigrant women who were receiving support from public social services. Our goal was to analyze the effectiveness of a bio-psychosocial therapy system with text messages to personal mobile phones. We grouped women by different degrees of depression. We studied psychosocial characteristics from personalized interviews and developed message banks to advise healthy habits and accompany moods. We programmed a remote delivery system, and for 26 days, each woman (n = 44) received four of our messages. We analyzed changes in mood and depression at the beginning and at the end of therapy and observed positive changes. The analysis of the initial and final (Personal Health Questionnaire) PHQ−9 quartile intervals shows that text messages significantly improve the mood and depression symptoms of immigrant women when the initial PHQ−9 value is greater than 5 (moderate depression).
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12
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Ivbijaro G, Kolkiewicz L, Goldberg D, Riba MB, N'jie INS, Geller J, Kallivayalil R, Javed A, Švab I, Summergrad P, Laher S, Enum Y. Preventing suicide, promoting resilience: Is this achievable from a global perspective? Asia Pac Psychiatry 2019; 11:e12371. [PMID: 31709743 DOI: 10.1111/appy.12371] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022]
Abstract
Suicide continues to be a major health concern globally despite many initiatives to identify risk factors and methods for suicide prevention. We have carried out a detailed narrative review of the literature from 2016 to 2019 using the headings of Personal resilience (P1), People (P2), Places (P3), Prevention (P4), Promoting collaboration (P5), and Promoting research (P6) in order to support an integrated approach to suicide prevention and the promotion of personal and population resilience. We have made 10 key recommendations on how this can be moved forward.
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Affiliation(s)
- Gabriel Ivbijaro
- Faculdade de Ciências Médicas, NOVA Medical School Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.,Faculty of Management, Law and Social Sciences, University of Bradford, UK.,World Federation for Mental Health.,The World Dignity Project
| | - Lucja Kolkiewicz
- Faculdade de Ciências Médicas, NOVA Medical School Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.,East London NHS Foundation Trust, London, UK
| | | | - Michelle B Riba
- Depression Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Jeffrey Geller
- World Federation for Mental Health.,American Psychiatric Association, USA.,Psychiatry, University of Massachusetts Medical School, USA
| | - Roy Kallivayalil
- World Association of Social Psychiatry.,Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
| | - Afzal Javed
- World Psychiatric Association.,Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | - Igor Švab
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Slovenia
| | - Paul Summergrad
- Department of Psychiatry, Tufts University School of Medicine, USA.,Tufts Medical Center, Boston, MA, USA
| | - Sumaya Laher
- Department of Psychology, University of the Witwatersrand, South Africa
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