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Rainbow C, Tatnell R, Blashki G, Melvin GA. Safety plan use and suicide-related coping in a sample of Australian online help-seekers. J Affect Disord 2024; 356:492-498. [PMID: 38642900 DOI: 10.1016/j.jad.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Suicide safety plans can improve suicide-related coping skills and reduce suicidal thoughts and behaviours (STBs). However, little is known about their use and impact outside of treatment settings, where most suicidal crises will occur. The current study explored the prevalence of safety plan use among an online sample of help-seekers with lifetime STBs, and whether STBs and suicide-related coping differed between those with and without safety plans. An exploratory aim was to investigate barriers to safety plan use. METHOD Participants (N = 1251) completed an online, anonymous survey at a mental health support website (Beyond Blue). The survey measured lifetime STBs, past-month suicidal ideation, suicide-related coping, help-seeking intentions and behaviour. RESULTS Despite high levels of past-month suicidal ideation and past-year help-seeking, most participants (89.5 %) did not have a safety plan, and most of those were not familiar with the concept (70.5 %). Participants with safety plans reported a higher rate of past suicide attempts, but higher suicide-related coping and help-seeking behaviour. Among participants without safety plans, negative attitudes toward safety planning were positively associated with suicidal ideation and negatively associated with suicide-related coping. LIMITATIONS Participants were primarily female, English-speaking visitors to a mental health support website. Cross-sectional design precludes conclusions being drawn about safety planning effectiveness over time. CONCLUSION This study highlights the low prevalence of safety plan use among online help-seekers with lifetime STBs and the need to better promote safety planning as an intervention with autonomous benefits, including crisis preparedness and improved suicide-related coping skills.
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Affiliation(s)
- Christopher Rainbow
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, Australia
| | - Ruth Tatnell
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, Australia
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Glenn A Melvin
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, Australia
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Hawton K, Pirkis J. Suicide prevention: reflections on progress over the past decade. Lancet Psychiatry 2024; 11:472-480. [PMID: 38754457 DOI: 10.1016/s2215-0366(24)00105-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
Interest in preventing suicides has increased greatly in recent years. In this Personal View, we consider the general global developments related to suicide prevention that have occurred in the decade since The Lancet Psychiatry was first published in 2014. We then review specific advances during this period, first, in relation to public health initiatives, and second, with regard to clinical developments. Finally, we examine some of the challenges that currently confront individuals and organisations responsible for designing and implementing suicide prevention measures.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Lascelles KM, Davey Z, Jackson D, Aveyard H. Experiences and needs of adult informal carers of adults at risk of suicide: A systematic review with mixed methods analysis. J Adv Nurs 2024; 80:1686-1718. [PMID: 38010822 DOI: 10.1111/jan.15940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
AIM To systematically review and synthesize primary research on experiences and needs of adult informal caregivers of adults at risk of suicide. DESIGN Systematic review with a data-based convergent synthesis. DATA SOURCES MEDLINE, PsychINFO and CINAHL were searched in April 2022 and February 2023. English language research focusing on experiences of adult carers of adults was included. METHODS Articles were screened by title (n = 9077) and abstract (n = 132) with additional articles (n = 6) obtained via citation and hand searching. Thirty-one included studies were quality assessed using the Mixed Methods Appraisal Tool and study data were systematically extracted prior to thematic synthesis. RESULTS Five interconnected themes resulted: transitions; living with fear and uncertainty; changing relationships; interface with healthcare professionals and services; what carers need and want. Caring impacts mental, physical and social wellbeing. Relationships are affected in ways which might not be evident when caring for a minor. Repeated suicidal behaviour is particularly challenging with ongoing hypervigilance contributing to burden, burnout and interpersonal strain. Poor carer support exacerbates negative effects; carers need to feel informed, educated, involved and holistically supported. CONCLUSION Timely support for carers is essential. Interventions should address emotional responses, relational changes and effective care recipient support. Longitudinal research is required to understand effects of ongoing caring where there are multiple suicide attempts. IMPLICATIONS Nurses can provide carers with early support and information and longer term psychosocial interventions. If carers are adequately equipped and supported patient safety and wellbeing will be improved. IMPACT Findings of this systematic review include relational changes due to carer hypervigilance reducing autonomy and living with the possibility of suicide. Clinician awareness of the potential for relational shifts will help them prepare and support carers. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution.
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Affiliation(s)
| | - Zoe Davey
- Oxford Institute of Nursing Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Debra Jackson
- University of Sydney, Sydney, New South Wales, Australia
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Robison M, Robertson L, Joiner TE. Why did peri-pandemic suicide death rates decrease among non-Hispanic white people while increasing among most people of color? Suicide Life Threat Behav 2024. [PMID: 38676429 DOI: 10.1111/sltb.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION While suicides in the United States decreased during the COVID-19 pandemic, statistically significant decreases have been limited to White people throughout a large portion of 2020. METHODS This paper outlines possible explanations for racial/ethnic differences in suicidality in the early pandemic phases. RESULTS We propose both distal (i.e., tele-mental health usage, internet and technology access, employment protections, and economic security) and proximal (cultural beliefs, coping strategies, clustering, pulling together, and embracing life) factors that may have helped build and foster community and mental wellness. However, this paper argues these factors did not extend, or did not extend as much, to many communities of color. CONCLUSIONS We argue that these disparities are due to the myriad effects of discrimination and systemic racism, encapsulated broadly by the minority stress theory, and provide suggestions for relief and research.
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Affiliation(s)
- Morgan Robison
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Lee Robertson
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - T E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Chalker SA, Sicotte R, Bornheimer LA, Parrish EM, Wastler H, Ehret B, DeVylder J, Depp CA. A call to action: informing research and practice in suicide prevention among individuals with psychosis. Front Psychiatry 2024; 15:1378600. [PMID: 38711871 PMCID: PMC11073495 DOI: 10.3389/fpsyt.2024.1378600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/22/2024] [Indexed: 05/08/2024] Open
Abstract
Although it is well established that individuals living with psychosis are at increased risk for suicidal ideation, attempts, and death by suicide, several gaps in the literature need to be addressed to advance research and improve clinical practice. This Call-to-Action highlights three major gaps in our understanding of the intersection of psychosis and suicide as determined by expert consensus. The three gaps include research methods, suicide risk screening and assessment tools used with persons with psychosis, and psychosocial interventions and therapies. Specific action steps to address these gaps are outlined to inform research and practice, and thus, improve care and prognoses among persons with psychosis at risk for suicide.
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Affiliation(s)
- Samantha A. Chalker
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Roxanne Sicotte
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Lindsay A. Bornheimer
- University of Michigan, School of Social Work, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Emma M. Parrish
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Heather Wastler
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Jordan DeVylder
- Silver School of Social Work, New York University, New York, NY, United States
| | - Colin A. Depp
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, CA, United States
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Setkowski K, van Balkom AJLM, Hoogendoorn AW, Franx G, Veerbeek M, de Winter RFP, Gilissen R. Reducing suicides in mental healthcare: results from a 4-year follow-up implementation study in the Netherlands (SUPRANET). Front Psychiatry 2024; 15:1080235. [PMID: 38707617 PMCID: PMC11068092 DOI: 10.3389/fpsyt.2024.1080235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/09/2024] [Indexed: 05/07/2024] Open
Abstract
Objective In 2016, the SUicide PRevention Action NETwork (SUPRANET) was launched. The SUPRANET intervention aims at better implementing the suicide prevention guideline. An implementation study was developed to evaluate the impact of SUPRANET over time on three outcomes: 1) suicides, 2) registration of suicide attempts, and 3) professionals' knowledge and adherence to the guideline. Methods This study included 13 institutions, and used an uncontrolled longitudinal prospective design, collecting biannual data on a 2-level structure (institutional and team level). Suicides and suicide attempts were extracted from data systems. Professionals' knowledge and adherence were measured using a self-report questionnaire. A three-step interrupted time series analysis (ITSA) was performed for the first two outcomes. Step 1 assessed whether institutions executed the SUPRANET intervention as intended. Step 2 examined if institutions complied with the four guideline recommendations. Based on steps 1 and 2, institutions were classified as below or above average and after that, included as moderators in step 3 to examine the effect of SUPRANET over time compared to the baseline. The third outcome was analyzed with a longitudinal multilevel regression analysis, and tested for moderation. Results After institutions were labeled based on their efforts and investments made (below average vs above average), we found no statistically significant difference in suicides (standardized mortality ratio) between the two groups relative to the baseline. Institutions labeled as above average did register significantly more suicide attempts directly after the start of the intervention (78.8 per 100,000 patients, p<0.001, 95%CI=(51.3 per 100,000, 106.4 per 100,000)), and as the study progressed, they continued to report a significantly greater improvement in the number of registered attempts compared with institutions assigned as below average (8.7 per 100,000 patients per half year, p=0.004, 95%CI=(3.3 per 100,000, 14.1 per 100,000)). Professionals working at institutions that invested more in the SUPRANET activities adhered significantly better to the guideline over time (b=1.39, 95%CI=(0.12,2.65), p=0.032). Conclusion Institutions labeled as above average registered significantly more suicide attempts and also better adhered to the guideline compared with institutions that had performed less well. Although no convincing intervention effect on suicides was found within the study period, we do think that this network is potentially able to reduce suicides. Continuous investments and fully implementing as many guideline recommendations as possible are essential to achieve the biggest drop in suicides.
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Affiliation(s)
- Kim Setkowski
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Anton J. L. M. van Balkom
- Amsterdam University Medical Center (UMC), location Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and GGZ inGeest (Mental Health Institution), Amsterdam, Netherlands
| | - Adriaan W. Hoogendoorn
- Department of Psychiatry, Amsterdam Public Health Institute, Amsterdam University Medical Center (UMC), location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gerdien Franx
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
| | | | - Remco F. P. de Winter
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
- GGZ Rivierduinen (Mental Health Institution), Leiden, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
- The School for Mental Health and Neuroscience (MHeNs) Maastricht University, Maastricht, Netherlands
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, Netherlands
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Gryglewicz K, Orr VL, McNeil MJ, Taliaferro LA, Hines S, Duffy TL, Wisniewski PJ. Translating Suicide Safety Planning Components Into the Design of mHealth App Features: Systematic Review. JMIR Ment Health 2024; 11:e52763. [PMID: 38546711 PMCID: PMC11009854 DOI: 10.2196/52763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/19/2023] [Accepted: 12/31/2023] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Suicide safety planning is an evidence-based approach used to help individuals identify strategies to keep themselves safe during a mental health crisis. This study systematically reviewed the literature focused on mobile health (mHealth) suicide safety planning apps. OBJECTIVE This study aims to evaluate the extent to which apps integrated components of the safety planning intervention (SPI), and if so, how these safety planning components were integrated into the design-based features of the apps. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we systematically analyzed 14 peer-reviewed studies specific to mHealth apps for suicide safety planning. We conducted an analysis of the literature to evaluate how the apps incorporated SPI components and examined similarities and differences among the apps by conducting a comparative analysis of app features. An independent review of SPI components and app features was conducted by downloading the available apps. RESULTS Most of the mHealth apps (5/7, 71%) integrated SPI components and provided customizable features that expanded upon traditional paper-based safety planning processes. App design features were categorized into 5 themes, including interactive features, individualized user experiences, interface design, guidance and training, and privacy and sharing. All apps included access to community supports and revisable safety plans. Fewer mHealth apps (3/7, 43%) included interactive features, such as associating coping strategies with specific stressors. Most studies (10/14, 71%) examined the usability, feasibility, and acceptability of the safety planning mHealth apps. Usability findings were generally positive, as users often found these apps easy to use and visually appealing. In terms of feasibility, users preferred using mHealth apps during times of crisis, but the continuous use of the apps outside of crisis situations received less support. Few studies (4/14, 29%) examined the effectiveness of mHealth apps for suicide-related outcomes. Positive shifts in attitudes and desire to live, improved coping strategies, enhanced emotional stability, and a decrease in suicidal thoughts or self-harm behaviors were examined in these studies. CONCLUSIONS Our study highlights the need for researchers, clinicians, and app designers to continue to work together to align evidence-based research on mHealth suicide safety planning apps with lessons learned for how to best deliver these technologies to end users. Our review brings to light mHealth suicide safety planning strategies needing further development and testing, such as lethal means guidance, collaborative safety planning, and the opportunity to embed more interactive features that leverage the advanced capabilities of technology to improve client outcomes as well as foster sustained user engagement beyond a crisis. Although preliminary evidence shows that these apps may help to mitigate suicide risk, clinical trials with larger sample sizes and more robust research designs are needed to validate their efficacy before the widespread adoption and use.
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Affiliation(s)
- Kim Gryglewicz
- School of Social Work, University of Central Florida, Orlando, FL, United States
| | - Victoria L Orr
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Marissa J McNeil
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Lindsay A Taliaferro
- Department of Population Health Sciences, University of Central Florida, Orlando, FL, United States
| | - Serenea Hines
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Taylor L Duffy
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Pamela J Wisniewski
- Department of Computer Science, Vanderbilt University, Nashville, TN, United States
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Rainbow C, Tatnell R, Blashki G, Fuller-Tyszkiewicz M, Melvin GA. Digital safety plan effectiveness and use: Findings from a three-month longitudinal study. Psychiatry Res 2024; 333:115748. [PMID: 38277811 DOI: 10.1016/j.psychres.2024.115748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 01/28/2024]
Abstract
Few studies have examined the effectiveness of self-guided smartphone apps for suicide safety planning, despite their increasing use. Participants (n = 610) were self-selected users of the Beyond Now suicide prevention safety planning app with a history of suicidal thoughts and behaviours. Surveys were completed (baseline, one and three months), safety plan content and app usage data was shared. Repeated-measures ANOVAs examined changes in suicidal ideation and suicide-related coping over three months. Multiple regression models were used to predict suicidal ideation and suicide-related coping at one- and three-month follow-ups with plan-related variables: perceived usefulness, personalised content, app use time and co-authoring of the plan with a third party. Significant reductions in suicidal ideation and increases in suicide-related coping were found over three months. Higher suicide-related coping at three months predicted lower suicidal ideation. Higher perceived usefulness and personalised content at three months were associated with higher suicide-related coping, but not suicidal ideation. App use time and co-authoring were not significantly related to suicidal ideation or suicide-related coping. Practitioners should empower clients to create safety plans with personalised (not generic) strategies that a client perceives to be useful. Such plans may strengthen beliefs about coping with suicidal ideation, which in turn reduces suicidal ideation over time.
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Affiliation(s)
- Christopher Rainbow
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia.
| | - Ruth Tatnell
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Level 5, 333 Exhibition Street, VIC 3000, Australia; Beyond Blue, Melbourne, GPO Box 1883, Melbourne VIC 3001, Australia
| | - Matthew Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Glenn A Melvin
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
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Newell S, Rynerson A, Gade P, Bahraini NH, Denneson LM, Dobscha SK. What Now?: Experiences of VHA patients following disclosure of suicidal ideation in primary care and mental health settings. Gen Hosp Psychiatry 2024; 87:7-12. [PMID: 38266442 PMCID: PMC10939769 DOI: 10.1016/j.genhosppsych.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE While screening and treatment options for patients who disclose suicidal ideation in clinical settings have grown in recent decades, little is known about patient experiences following disclosure. We characterize patient perspectives of responses following disclosure of suicidal ideation in Veteran Health Administration (VHA) primary care and mental health settings. METHOD Qualitative thematic analysis using a conventional/directed hybrid approach. RESULTS A national sample comprised of sixty participants who recently screened for suicidal ideation in primary care (n = 28) and mental health (n = 32) settings completed interviews. Many patients described therapeutic experiences following disclosure, including caring staff, timely follow-up care, and offers of multiple treatment options. Other patients, however, reported deficits in staff empathy, long waits for follow-up care, or inadequate treatment options. CONCLUSIONS While many VA clinical settings provided empathic and helpful responses, these experiences were not universal. Our findings reinforce the importance of a patient-centered approach to screening and response to disclosure, including collaboration with patients in treatment planning. Improved follow-up care coordination processes are needed. Following disclosure, contact with the staff who received the disclosure also helps patients feel cared about, and provides opportunity to troubleshoot barriers a patient may experience in accessing care.
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Affiliation(s)
- Summer Newell
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States.
| | - Annabelle Rynerson
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States
| | - Praful Gade
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States
| | - Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, CO, United States of America; Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz School of Medicine, Aurora, CO, United States of America; Department of Psychiatry University of Colorado, Anschutz School of Medicine, Aurora, CO, United States of America
| | - Lauren M Denneson
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States; Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, United States
| | - Steven K Dobscha
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States; Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, United States
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10
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Bettis AH, Burke TA, Scott SR, Bedock C, Ambriano C, Parrish J, Marsh D, Fox KR. Disclosures of self-injurious thoughts and behaviors to parents in the context of adolescent therapy: A qualitative investigation. J Clin Psychol 2024; 80:537-558. [PMID: 38111150 PMCID: PMC10922370 DOI: 10.1002/jclp.23633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/20/2023] [Accepted: 12/02/2023] [Indexed: 12/20/2023]
Abstract
Self-injurious thoughts and behaviors (SITBs), including suicidal thoughts, suicide attempts, and nonsuicidal self-injury, are highly prevalent among adolescents. Identifying adolescents at risk for SITBs relies on their disclosure, and these disclosures commonly occur in therapy context. Moreover, therapists often breach confidentiality to inform adolescents' parent or guardian when they disclose SITBs. Research has explored rates of and barriers to disclosure among adolescents, yet no studies have examined adolescents' experiences of disclosure in the therapy context. Further, no studies have examined adolescents' experiences when their parents are then informed. In this study, we examined qualitative responses from 1495 adolescents who had experienced a SITB disclosure in the therapy context. Qualitative questions included asking adolescents to describe how the SITB disclosure occurred, how their parents were informed, and their parents' reactions. Using open and axial coding, several themes emerged. Adolescents described therapist breaches of confidentiality as collaborative, noncollaborative, or unclear. Adolescents described their parents' affective responses, communication about SITBs, validating and invalidating responses, treatment-oriented responses, and ways that parents restricted their access to people, places, and activities. Findings have implications for the development of clinical guidelines when adolescents disclose SITBs in therapy and highlight areas for future research in adolescent SITB disclosure.
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Affiliation(s)
- Alexandra H Bettis
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Taylor A Burke
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samantha R Scott
- Department of Psychology, University of Denver, Denver, Colorado, USA
| | - Cara Bedock
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Caroline Ambriano
- Department of Psychological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Jordan Parrish
- Department of Psychological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Destinee Marsh
- Department of Psychological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, Denver, Colorado, USA
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Bryan CJ, Bryan AO, Khazem LR, Aase DM, Moreno JL, Ammendola E, Bauder CR, Hiser J, Daruwala SE, Baker JC. Crisis response planning rapidly reduces suicidal ideation among U.S. military veterans receiving massed cognitive processing therapy for PTSD. J Anxiety Disord 2024; 102:102824. [PMID: 38154445 DOI: 10.1016/j.janxdis.2023.102824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
Posttraumatic stress disorder (PTSD) is common among U.S. military veterans and is associated with increased risk of suicidal thoughts and behaviors. Crisis response planning (CRP), a brief safety planning-type intervention, has been shown to rapidly reduce suicidal ideation and suicide attempts in emergency and acute care settings. CRP's effectiveness when combined with trauma-focused therapies remains unknown. In this randomized pragmatic clinical trial with one-year follow-up, 157 U.S. military personnel and veterans were randomly assigned to receive CRP or self-guided safety planning (SP) prior to beginning massed cognitive processing therapy (CPT) for PTSD. Among 51 (32.5 % of sample) participants endorsing suicidal ideation at baseline, reductions in the severity of suicidal ideation were significantly larger and faster in CRP (F(11,672)= 15.8, p < .001). Among 106 participants denying suicidal ideation at baseline, 8.5 % of CRP participants versus 11.9 % of SP participants (OR=0.69, 95 % CI=0.19-2.52) reported new-onset suicidal ideation during any follow-up assessment. PTSD symptoms significantly reduced over time with no differences between groups. Results support the effectiveness of CRP for rapidly reducing suicidal ideation and managing suicide risk during outpatient treatment for PTSD.
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Affiliation(s)
- Craig J Bryan
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA.
| | - AnnaBelle O Bryan
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Lauren R Khazem
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Darrin M Aase
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Jose L Moreno
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Ennio Ammendola
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Christina Rose Bauder
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Jaryd Hiser
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Samantha E Daruwala
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
| | - Justin C Baker
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
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Rainbow C, Tatnell R, Blashki G, Melvin GA. Perceived Usefulness of Self-Guided Versus Collaborative Suicide Safety Plans in Online Help-Seekers. Crisis 2024. [PMID: 38319612 DOI: 10.1027/0227-5910/a000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background: Suicide safety plans were originally devised to be paper-based and clinician-guided, but digital self-guided plans are now common. Aim: This study explored whether plan format (paper vs. digital), assistance (self-authored vs. collaboration), and suicide attempt history were associated with differences in suicidal ideation, suicide-related coping, and perceived usefulness. Method: An online sample of safety plan users (N = 131) completed a survey assessing suicidal ideation, suicide-related coping, and perceived usefulness of their plan. t tests compared outcomes by plan format, collaboration, and suicide attempt history. Pearson correlations explored associations between reasons for plan use, suicidal ideation, and suicide-related coping. Results: Suicidal ideation was significantly higher, and perceived usefulness significantly lower in participants with a past suicide attempt (vs. none) and in those who had collaborated to make their safety plan (vs. self-authored). Collaborators were largely health professionals. No significant differences were found between plan formats. Suicide-related coping was associated with higher perceived usefulness overall. Limitations: Our study design was cross-sectional, utilizing a largely young, female, English-speaking, online help-seeking sample. Conclusions: For clients with prior suicide attempts and higher levels of suicidal ideation, meaningful collaboration may be needed to find safety plan coping strategies that are perceived as useful.
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Affiliation(s)
- Christopher Rainbow
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ruth Tatnell
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
- Beyond Blue, Melbourne, VIC, Australia
| | - Glenn A Melvin
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
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Qing G, Deng W, Zhou Y, Zheng L, Wang Y, Wei B. The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and suicidal ideation in adults: a population-based study in the United States. Lipids Health Dis 2024; 23:17. [PMID: 38218917 PMCID: PMC10788025 DOI: 10.1186/s12944-024-02012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND The ratio of non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) (NHHR) serves as a reliable lipid indicator associated with atherogenic characteristics. Studies have indicated a potential connection between suicidality and lipid metabolism. This research aims to investigate any possible association between the NHHR and the emergence of suicidal ideation within the confines of the study. METHODS This study examined the association between NHHR levels and suicidal ideation using data from the National Health and Nutrition Examination Survey (NHANES), conducted in the United States spanning 2005 and 2016. Calculation of the NHHR corresponds to the proportion of HDL-C to Non-HDL-C. The Patient Health Questionnaire-9's ninth question was implemented for assessing suicidal ideation. Using subgroup analysis, smooth curve fitting, and multivariate logistic regression analysis, the research was conducted. RESULTS Encompassing a cohort of 29,288 participants, the analysis identified that 3.82% of individuals reported suicidal ideation. After using multivariable logistic regression and thorough adjustments, elevated NHHR levels were significantly and positively associated with a heightened likelihood of suicidal ideation, according to the findings (odds ratio [OR] = 1.06; 95% confidence interval [CI]: 1.02-1.11; P = 0.0048). Despite extensive adjustment for various confounding factors, this relationship remained consistent. An inverted U-shaped curve was utilized to illustrate the link between NHHR and suicidal ideation among nonsmokers; the curve's inflection point was situated at 7.80. Subgroup analysis and interaction tests (all P for interaction > 0.05) demonstrated that there was no significant influence of the following variables on this positive relationship: age, sex, race, body mass index, education level, married status, hypertension, diabetes, and smoking status. CONCLUSION Significantly higher NHHR levels were associated with an elevated likelihood of suicidal ideation. Based on these results, it is probable that NHHR may serve as a predictive indicator of suicidal ideation, emphasizing its potential utility in risk assessment and preventive strategies.
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Affiliation(s)
- Guangwei Qing
- Department of Psychiatry, Jiangxi Mental Hospital & Affiliated Mental Hospital of Nanchang University, Nanchang, Jiangxi, 330029, China
- Third Clinical Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Wenpeng Deng
- Department of Psychiatry, Jiangxi Mental Hospital & Affiliated Mental Hospital of Nanchang University, Nanchang, Jiangxi, 330029, China
- Third Clinical Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Yuxin Zhou
- Department of Psychiatry, Jiangxi Mental Hospital & Affiliated Mental Hospital of Nanchang University, Nanchang, Jiangxi, 330029, China
| | - Liyun Zheng
- Department of Psychiatry, Jiangxi Mental Hospital & Affiliated Mental Hospital of Nanchang University, Nanchang, Jiangxi, 330029, China
| | - Yanlai Wang
- Department of Psychiatry, Jiangxi Mental Hospital & Affiliated Mental Hospital of Nanchang University, Nanchang, Jiangxi, 330029, China
| | - Bo Wei
- Department of Psychiatry, Jiangxi Mental Hospital & Affiliated Mental Hospital of Nanchang University, Nanchang, Jiangxi, 330029, China.
- Nanchang City Key Laboratory of Biological Psychiatry, Jiangxi Provincial Clinical Research Center on Mental Disorders, Jiangxi Mental Hospital, Nanchang, Jiangxi, 330029, China.
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Jobes DA, Mandel AA, Kleiman EM, Bryan CJ, Johnson SL, Joiner TE. Facets of Suicidal Ideation. Arch Suicide Res 2024:1-16. [PMID: 38174735 DOI: 10.1080/13811118.2023.2299259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
According to SAMHSA (2023), approximately 16,600,000 American adults and teens reported having serious thoughts of suicide in 2022. While suicide prevention has primarily focused on suicide deaths and attempts, we contend that suicidal ideation (SI) deserves more in-depth investigation and should be an essential intervention target on its own. In support of this point, we provide three examples of ways to improve specificity in understanding of SI through the study of controllability of SI, the language used to assess SI, and measuring SI in real time. We also consider qualitative work on the content of SI, its treatment, and definitional considerations. We thus call for an increased general focus on SI within research, clinical care, and policy.
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Arvilommi P, Valkonen J, Lindholm L, Gaily-Luoma S, Suominen K, Gysin-Maillart A, Ruishalme O, Isometsä E. ASSIP vs. Crisis Counseling for Preventing Suicide Re-attempts: Outcome Predictor Analysis of a Randomized Clinical Trial Data. Arch Suicide Res 2024; 28:184-199. [PMID: 36457297 DOI: 10.1080/13811118.2022.2151957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Knowledge of the effectiveness and limits of the suitability of brief interventions in suicide prevention is greatly needed. We investigated subgroup differences and predictors for suicide re-attempts within a clinical trial population recruited for a brief intervention to prevent re-attempts. METHODS Consenting adult patients receiving treatment for a suicide attempt in Helsinki City general hospital emergency rooms in 2016-2017 (n = 239) were randomly allocated to (a) the Attempted Suicide Short Intervention Program (ASSIP) or (b) Crisis Counseling (CC). Participants also received their usual treatment. Information on primary outcome repeat attempts and secondary outcomes was collected via telephone and from medical and psychiatric records for 2 years. As proportions of re-attempts did not differ significantly between ASSIP and CC (29.2 vs. 35.2%), patients were pooled and predictors for suicide re-attempts were analyzed using Kaplan-Meier and logistic regression analyses. RESULTS Re-attempts were predicted by participants' younger age (OR 0.965 [0.933-0.998]), previous suicide attempts (OR 2.437 [1.106-5.370]), psychiatric hospitalization in the year preceding baseline (OR 3.256 [1.422-7.458]), and clinical diagnosis of a personality disorder (OR 4.244 [1.923-9.370]), especially borderline personality disorder (OR 5.922 [2.558-13.709]). CONCLUSIONS Within a population of suicide attempters consenting to a brief intervention trial, the risk of re-attempt was strongly predicted by subjects' young age, history of previous attempts, psychiatric hospitalizations, and personality disorder, particularly borderline personality disorder. The composition of treated populations with regard to these characteristics may strongly influence the observed success of brief interventions. Their potential as moderators of treatment effectiveness and as indicators of the utility of brief interventions warrants further investigation.HIGHLIGHTSDuring the 2-year follow-up, 32% of trial participants reattempted suicide.Rates of reattempts varied and were strongly predicted by clinical subgroup.Subgroup composition may strongly influence brief interventions' observed outcome.
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Woodward EN, Lunsford A, Brown R, Downing D, Ball I, Gan-Kemp JM, Smith A, Atkinson O, Graham T. Pre-implementation adaptation of suicide safety planning intervention using peer support in rural areas. Front Health Serv 2023; 3:1225171. [PMID: 38188615 PMCID: PMC10766826 DOI: 10.3389/frhs.2023.1225171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
Introduction Currently, seventeen veterans die by suicide daily in the United States (U.S.). There are disparities in suicide behavior and access to preventative treatment. One disparity is the suicide rate in rural areas, including the state of Arkansas-suicide deaths among rural veterans increased 48% in the last 2 decades, double that of urban veterans. One major challenge for veterans in rural areas is the lack of healthcare providers to provide Safety Planning Intervention, which is an effective intervention to reduce suicide attempts in the general adult population and among veterans. One solution is more broadly implementing Safety Planning Intervention, by using peers to deliver the intervention in rural communities. Before implementation, the intervention needs to be adapted for peer-to-peer delivery, and barriers and facilitators identified. Methods Since January 2021, using community-based participatory research, we collaboratively developed and executed a 1 year study to adapt Safety Planning Intervention for peer-to-peer delivery in rural communities and identified implementation barriers and facilitators prior to spread. From July 2022 to February 2023, we conducted group interviews with 12 participants: rural veterans with prior suicidal thoughts or attempts in one U.S. state, their support persons, and healthcare professionals with expertise in veteran suicide prevention, Safety Planning Intervention, and/or peer delivery. We collected qualitative data through interviews during nine, 2 h meetings, and quantitative data from one anonymous survey and real-time anonymous voting-all on the topic of core and adaptable components of Safety Planning Intervention and implementation barriers and facilitators for peer delivery in rural communities. Questions about adaptation were designed according to processes in the ENGAGED for CHANGE community-engaged intervention framework and questions about facilitators and barriers were designed according to the Health Equity Implementation Framework. Participants categorized which Safety Planning Intervention components were core or adaptable, and how freely they could be adapted, using the metaphor of a traffic light in red (do not change), yellow (change with caution), and green (change freely) categories. Results Participants made few actual adaptations (categorized according to the FRAME modification system), but strongly recommended robust training for peers. Participants identified 27 implementation facilitators and 47 barriers, organized using the Health Equity Implementation Framework. Two example facilitators were (1) peer-to-peer safety planning intervention was highly acceptable to rural veterans; and (2) some state counties already had veteran crisis programs that could embed this intervention for spread. Two example barriers were (1) some community organizations that might spread the intervention have been motivated initially, wanting to help right away, yet not able to sustain interventions; and (2) uncertainty about how to reach veterans at moderate suicide risk, as many crisis programs identified them when suicide risk was higher. Discussion Our results provide one of the more comprehensive pre-implementation assessments to date for Safety Planning Intervention in any setting, especially for peer delivery (also referred to as task shifting) outside healthcare or clinical settings. One important next step will be mapping these barriers and facilitators to implementation strategies for peer-to-peer delivery. One finding surprised our research team-despite worse societal context in rural communities leading to disproportionate suicide deaths-participants identified several positive facilitators specifically about rural communities that can be leveraged during implementation.
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Affiliation(s)
- Eva N. Woodward
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
| | - Amanda Lunsford
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Rae Brown
- Arkansas Freedom Fund, Little Rock, AR, United States
| | | | - Irenia Ball
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
| | - Jennifer M. Gan-Kemp
- Department of Medical Humanities and Bioethics, Center for Health Literacy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Anthony Smith
- Arkansas Freedom Fund, Little Rock, AR, United States
| | | | - Thomas Graham
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Reid HE, Pratt D, Edge D, Wittkowski A. Psychological intervention priorities according to perinatal women who experienced suicidal thoughts and perinatal mental health professionals: a Q-methodology study. Front Psychiatry 2023; 14:1286500. [PMID: 38179249 PMCID: PMC10764428 DOI: 10.3389/fpsyt.2023.1286500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Suicide is the leading direct cause of maternal death in the year following birth and the second leading cause during pregnancy, in the UK and Ireland. Currently no evidence-based psychological interventions exist specifically designed to reduce mothers' suicidal experiences during the perinatal period. Reducing suicidal ideation and behaviour in mothers is a priority to prevent deaths and lessen the distress felt by mothers and their families. As Q-methodology measures the consensus and disagreement between individuals on a given topic, the current study used Q-methodology to elicit the priorities for a future psychological intervention aimed at reducing suicidal ideation and behaviour during the perinatal period, from the collective perspectives of both mothers and professionals. Method As part of this Q-methodology study, we developed a Q-set of 75 statements pertaining to possible elements of a psychological intervention that might help reduce a mother's suicidal ideation and behaviour during the perinatal period. Mothers and professionals were recruited via perinatal mental health services and social media advertisements. Results Twenty-one mothers and 11 perinatal mental health professionals ranked each Q-set statement depending on its perceived importance in developing a new intervention. A centroid factor analysis was conducted and two factors, which accounted for 42% of the overall variance, were identified: Factor 1 "supporting the mother to create distance between herself and the appeal of suicide" and Factor 2 "establishing positive connections with the therapist, the baby and motherhood." All participants believed that developing plans to keep the mother safe from suicide was the most important aspect for inclusion in a future intervention. Participants who loaded onto Factor 1 also prioritised supporting mothers to learn more about triggers for their suicidal ideation and behaviour. Ensuring a robust therapeutic alliance was more important for those who loaded onto Factor 2. Conclusion This is the first study using Q-methodology to explore the psychological intervention priorities of mothers and professionals. Findings indicate clear priorities in terms of planning and coping during a crisis, endorsed by all participants, and provide an initial step in the development of a new perinatal suicide prevention intervention.
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Affiliation(s)
- Holly E. Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Sciences Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Sciences Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Sciences Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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de Ganay M, Duroy D, Perozziello A, Lejoyeux M, Geoffroy PA. Study assessing the feasibility and acceptability of implementing the Safety Plan for suicide prevention in a French emergency department. Encephale 2023; 49:656-657. [PMID: 37121806 DOI: 10.1016/j.encep.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/18/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Marie de Ganay
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, hôpital Bichat - Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
| | - David Duroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, hôpital Bichat - Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - Anne Perozziello
- GHU Paris - Psychiatry & Neurosciences, 1, rue Cabanis, 75014 Paris, France
| | - Michel Lejoyeux
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, hôpital Bichat - Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris cité, NeuroDiderot, Inserm, FHU I2-D2, 75019 Paris, France; GHU Paris - Psychiatry & Neurosciences, 1, rue Cabanis, 75014 Paris, France
| | - Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, hôpital Bichat - Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris cité, NeuroDiderot, Inserm, FHU I2-D2, 75019 Paris, France; GHU Paris - Psychiatry & Neurosciences, 1, rue Cabanis, 75014 Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 67000 Strasbourg, France
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Madsen T, Erlangsen A, Egilsdottir E, Andersen PK, Nordentoft M. The effect of the SAFE intervention on post-discharge suicidal behavior: a quasi-experimental study using propensity score matching. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02585-y. [PMID: 37993566 DOI: 10.1007/s00127-023-02585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES The risk of suicidal behavior after discharge from psychiatric admission is high. The aim of this study was to examine whether the SAFE intervention, an implementation of a systematic safer discharge procedure, was associated with a reduction in suicidal behavior after discharge. METHODS The SAFE intervention was implemented at Mental Health Center Copenhagen in March 2018 and consisted of three systematic discharge procedures: (1) A face-to-face meeting between patient and outpatient staff prior to discharge, (2) A face-to-face meeting within the first week after discharge, and (3) Involvement of relatives. Risk of suicide attempt at six-month post-discharge among patients discharged from the SAFE intervention was compared with patients discharged from comparison mental health centers using propensity score matching. RESULTS 7604 discharges took place at the intervention site, which were 1:1 matched with discharges from comparison sites. During the six months of follow-up, a total of 570 suicide attempts and 25 suicides occurred. The rate of suicide attempt was 11,652 per 100,000 person-years at the SAFE site, while it was 10,530 at comparisons sites. No observable difference in suicide attempt 1.10 (95% CI: 0.89-1.35) or death by suicide (OR = 1.27; 95% CI:0.58-2.81) was found between sites at 6-month follow-up. CONCLUSION No difference in suicidal behavior between the sites was found in this pragmatic study. High rates of suicidal behavior were found during the 6-months discharge period, which could suggest that a preventive intervention should include support over a longer post-discharge period than the one-week follow-up offered in the SAFE intervention.
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Affiliation(s)
- Trine Madsen
- Danish Research Institute for Suicide Prevention, CORE- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark.
- Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, CORE- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Eybjørg Egilsdottir
- Danish Research Institute for Suicide Prevention, CORE- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Per Kragh Andersen
- Section of Biostatistics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, CORE- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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De Jaegere E, Dumon E, van Heeringen K, van Landschoot R, Stas P, Portzky G. Mindfulness-Based Cognitive Therapy for Individuals Who Are Suicidal: A Randomized Controlled Trial. Arch Suicide Res 2023:1-21. [PMID: 37994872 DOI: 10.1080/13811118.2023.2282663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
There is a need for well-described treatments targeting individuals at risk for suicidal behaviors. The present study aims to investigate the effectiveness of MBCT adapted to individuals who are suicidal (MBCT-S) in a randomized controlled trial, comparing an intervention group receiving MBCT-S and treatment as usual (TAU) with a control group receiving TAU only. Participants who were 18 years or older and experienced suicidal ideation were included. Assessments on suicidal ideation and symptoms associated with suicidal behavior were carried out at baseline, post-treatment, and 12 weeks after the end of the training. When comparing the intervention group with the control group, a significant reduction was found at follow-up in suicidal ideation and depressive symptoms. When focusing on the intervention group only, a significant reduction was found in suicidal ideation, depressive symptoms, hopelessness, worrying, defeat, and entrapment, and a significant increase in mindfulness both at post-treatment and at follow-up. The findings suggest that MBCT-S is a promising suicide-specific intervention as it may have the potential to reduce suicidal ideation and suicide-related components.
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Shin HD, Zaheer J, Torous J, Strudwick G. Designing Implementation Strategies for a Digital Suicide Safety Planning Intervention in a Psychiatric Emergency Department: Protocol for a Multimethod Research Project. JMIR Res Protoc 2023; 12:e50643. [PMID: 37943582 PMCID: PMC10667981 DOI: 10.2196/50643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/27/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is free and available on app stores, and usability tests have been completed. As a next step to embed this new tool into the routine clinical workflow, research is needed to assess determinants of and design strategies for implementation with the end goal of routinization. OBJECTIVE The purpose of this 2-phased research is to implement the app in the routine clinical workflow in our local psychiatric ED. The specific objectives are as follows: (1) understanding ED clinicians' perceptions and experience of implementing the app in routine practice and identifying barriers to and facilitators of implementation (phase 1) and (2) using findings and outputs from phase 1 and collaborating with service users, families, and ED clinicians to co-design implementation strategies for the app (phase 2). METHODS We will use an integrated knowledge translation approach throughout this project. In phase 1, we will conduct interviews with ED clinicians to identify implementation determinants using a behavior change framework. In phase 2, a co-design team comprising clinicians, ED service users, and families will design implementation strategies that align with the determinants identified in phase 1. RESULTS This protocol presents detailed information about the entire structure of the 2-phased research project. Ethics approval for conducting the qualitative descriptive study (phase 1) has been obtained, and the recruitment and data collection processes will be completed no later than December 2023. Ethics approval for phase 2 is underway. CONCLUSIONS Involving multiple knowledge user groups early in the research and decision-making process is crucial for successful implementation. Although co-designing is commonly practiced during innovation development, there is often a misconception that the responsibility for implementing what has been designed falls on others. This research aims to fill this methodological gap in the health informatics literature. By the end of this project, we will have developed theory-informed implementation strategies to support Centre for Addiction and Mental Health ED clinicians in adopting the Hope app to complete safety planning intervention. These strategies, guided by a behavior change framework, will target clinicians' behavior change and seamlessly integrate the app into the routine clinical workflow. In addition, this research project will provide recommendations on how to involve multiple knowledge user groups and offer insights into how the methodology used can be adapted to other areas within the health informatics literature. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50643.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Ontario, Canada, Toronto, ON, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Gillian Strudwick
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Parrish EM, Quynh A, Scott V, Chalker SA, Chang C, Kamarsu S, Twamley EW, Depp CA. Suicide Safety Plan Self-knowledge in Serious Mental Illness: Psychiatric Symptom Correlates and Effects of Brief Intervention. Community Ment Health J 2023; 59:1639-1646. [PMID: 37340170 DOI: 10.1007/s10597-023-01155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
Psychiatric symptoms experienced by people with serious mental illness (SMI; schizophrenia, bipolar and other psychotic disorders) may impact suicide safety planning. This study examined safety plan self-knowledge, or an individual's own knowledge and awareness of their safety plan, in a sample of people with SMI. Participants (N = 53) with SMI at elevated risk of suicide completed a 4-session intervention that included safety plans, with one intervention group that included mobile augmentation. Self-knowledge was assessed from previous safety plans at 4-, 12- and 24-weeks. Fewer warning signs generated was correlated with greater psychiatric symptoms (r = - .306, p = .026) and suicidal ideation (r = - .298, p = .030). Fewer coping strategies generated was correlated with greater suicidal ideation (r = .- 323, p = .018). Preliminarily, there was greater self-knowledge of warning signs over time among participants in the mobile intervention. These preliminary findings highlight the relationship of safety plan self-knowledge to symptoms and suggest that mobile augmentation of safety planning may be beneficial. Trial Registration: NCT03198364.
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Affiliation(s)
- Emma M Parrish
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Avery Quynh
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Vanessa Scott
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Samantha A Chalker
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Cindy Chang
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Snigdha Kamarsu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
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Raciborski RA, Hamerling-Potts KK, Mitchell EL, Sullivan SR, Kapil-Pair N, Landes SJ, Jager-Hyman S, Goodman M. Cost comparison of in-person and telehealth modalities for a suicide safety planning group intervention: interim results from the "Project Life Force" randomized clinical trial. Front Psychiatry 2023; 14:1215247. [PMID: 37915795 PMCID: PMC10617511 DOI: 10.3389/fpsyt.2023.1215247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/05/2023] [Indexed: 11/03/2023] Open
Abstract
Suicide prevention is a clinical priority for the US Veterans Health Administration. Evidence-based interventions, including developing a suicide safety plan, are recommended practices and are becoming more widespread. Adaptations to further augment safety planning include a manualized group intervention (Project Life Force, PLF) that combines safety planning with the teaching of skills to maximize use of the plan. A multi-year randomized controlled trial to test efficacy of PLF compared to treatment as usual is currently in progress. However, approximately a year into the study, in-person groups were converted to telehealth groups due to the COVID-19 pandemic. This study compares the per-veteran cost of PLF when delivered in-person versus by telehealth using preliminary trial data from the first 2.5 years of the trial. Cost to deliver PLF was obtained from the Veterans Health Administration's Managerial Cost Accounting data, which relies on activity-based costing. We found no significant differences in the average number of sessions or average group size between in-person and telehealth. However, the cost per group session was lower for the telehealth modality and this led to significant overall per-veteran savings. While efficacy data comparing from the two arms is still underway and we await the ongoing RCT results, our interim cost analysis highlights potential savings with the telehealth modality.
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Affiliation(s)
- Rebecca A. Raciborski
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Evidence, Policy, and Implementation Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Kyra K. Hamerling-Potts
- VISN 2 Mental Illness, Research, Education, Clinical Center (MIRECC), James J. Peters Veteran Affairs Medical Center, Bronx, NY, United States
| | - Emily L. Mitchell
- VISN 2 Mental Illness, Research, Education, Clinical Center (MIRECC), James J. Peters Veteran Affairs Medical Center, Bronx, NY, United States
- Department of Psychology, The Catholic University of America, Washington, DC, United States
| | - Sarah R. Sullivan
- VISN 2 Mental Illness, Research, Education, Clinical Center (MIRECC), James J. Peters Veteran Affairs Medical Center, Bronx, NY, United States
| | - Nidhi Kapil-Pair
- VISN 2 Mental Illness, Research, Education, Clinical Center (MIRECC), James J. Peters Veteran Affairs Medical Center, Bronx, NY, United States
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States
| | - Sara J. Landes
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Evidence, Policy, and Implementation Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Marianne Goodman
- VISN 2 Mental Illness, Research, Education, Clinical Center (MIRECC), James J. Peters Veteran Affairs Medical Center, Bronx, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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O’Keeffe S, Suzuki M, McCabe R. An Ideal-Type Analysis of People's Perspectives on Care Plans Received from the Emergency Department following a Self-Harm or Suicidal Crisis. Int J Environ Res Public Health 2023; 20:6883. [PMID: 37835153 PMCID: PMC10572388 DOI: 10.3390/ijerph20196883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/05/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
People presenting to Emergency Departments (EDs) in a self-harm/suicidal crisis in England receive a psychosocial assessment and care plan. We aimed to construct a typology of peoples' perspectives on crisis care plans to explore the range of experiences of care plans. Thirty-two semi-structured interviews with people who presented to EDs following a self-harm/suicidal crisis in England were analysed using an ideal-type analysis. Cases were systematically compared to form clusters of cases with similar experiences of care plans. People's perspectives on care plans fitted into three types: (1) personalised care plans (n = 13), consisting of advice or referrals perceived as helpful; (2) generic care plans (n = 13), consisting of generic advice that the person already knew about or had already tried; and (3) did not receive a care plan (n = 6) for those who reported not receiving a care plan, or who were only provided with emergency contacts. Care planning in the ED following a suicidal/self-harm crisis was perceived as supportive if it provided realistic and personalised advice, based on what had/had not worked previously. However, many people reported not receiving a helpful care plan, as it was ill-fitted to their needs or was not considered sufficient to keep them safe, which may mean that these patients are at increased risk of repeat self-harm.
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Affiliation(s)
- Sally O’Keeffe
- Population Health Sciences Institute, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK
| | - Mimi Suzuki
- Unit for Social and Community Psychiatry, Queen Mary University of London, London E13 8SP, UK;
| | - Rose McCabe
- School of Health and Psychological Sciences, City, University of London, London EC1R 1UW, UK;
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25
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May AM, Al-Dajani N, Ballard ED, Czyz E. Safety plan use in the daily lives of adolescents after psychiatric hospitalization. Suicide Life Threat Behav 2023; 53:870-879. [PMID: 37605441 PMCID: PMC10592210 DOI: 10.1111/sltb.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Safety planning type interventions (SPTI's) are brief suicide-specific interventions. Little is known about safety plan use during high-risk periods, and whether safety plan use is influenced by baseline characteristics. This study examined how adolescents recently hospitalized for suicide risk use their safety plans post-discharge, tested moderators of safety plan utilization, and explored the relationship between changes in utilization and changes in suicidal ideation (SI) over time. METHODS Seventy-eight adolescents hospitalized for suicide risk who participated in a pilot trial of safety planning responded to one survey/day for 4 weeks post-discharge and completed a 1-month assessment. RESULTS Over 90% of adolescents reported having access to their safety plan during the month post-discharge. Safety plan use and SI declined over time. No baseline characteristics predicted safety plan use in the 4 weeks after discharge, or changes in safety plan use over time. However, the relationship between changes in safety plan use and changes in SI was moderated. For girls, SI and safety plan use rose and fell together; for boys, safety plan use declined regardless of changes in SI. CONCLUSIONS High-risk adolescents retain and use their safety plans. Results underscore the importance of looking at sex effects on SPTI utilization.
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Affiliation(s)
| | - Nadia Al-Dajani
- Department of Psychological and Brain Sciences, University of Louisville
| | - Elizabeth D. Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institute of Health
| | - Ewa Czyz
- Department of Psychiatry, University of Michigan
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Cassivi C, Sergerie-Richard S, Saint-Pierre B, Goulet MH. Crisis plans in mental health: A scoping review. Int J Ment Health Nurs 2023; 32:1259-1273. [PMID: 37098744 DOI: 10.1111/inm.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/27/2023]
Abstract
Crisis situations are frequent among people with mental health disorders. Several interventions have been developed to act in prevention, including crisis plans recognized as particularly effective in reducing coercive measures. In the literature, several models of crisis plans are proposed with similar aims and contents. Based on the methodology proposed by the Joanna Briggs Institute, a scoping review was conducted to map the state of knowledge on crisis plans in adult mental health settings. The literature search conducted on six databases (CINAHL, PubMed, Medline, EMBASE, PsychINFO and Cochrane) yielded 2435 articles. Of these, 122 full-text articles were assessed for eligibility, and 78 met the inclusion criteria. Studies were critically appraised using the Joanna Briggs Institute appraisal tools, and data were extracted by two independent reviewers. Content analysis identified a typology of crisis plans: (1) the legal crisis plan and (2) the formal crisis plan. Five modalities were identified for its completion: the sections, the moment, the completion steps, the people involved and the training of key actors. Most identified outcomes are consistent with the main purpose of the intervention, which is crisis prevention. However, the most identified outcomes focused on the service user's recovery and indicated that crisis plans could provide an opportunity to operationalize recovery in mental healthcare, thus suggesting an evolution in the aim of the intervention. Future research should further focus on the modalities of crisis plans to guide the implementation in clinical practice.
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Affiliation(s)
- Christine Cassivi
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Québec, Montréal, Canada
| | - Sophie Sergerie-Richard
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Institut universitaire en santé mentale de Montréal (IUSMM), Québec, Montréal, Canada
| | - Benoît Saint-Pierre
- Centre intégré universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Québec, Montréal, Canada
| | - Marie-Hélène Goulet
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Québec, Montréal, Canada
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Büscher R, Sander LB, Nuding M, Baumeister H, Teismann T. Blending Video Therapy and Digital Self-Help for Individuals With Suicidal Ideation: Intervention Design and a Qualitative Study Within the Development Process. JMIR Form Res 2023; 7:e49043. [PMID: 37733414 PMCID: PMC10557000 DOI: 10.2196/49043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Digital formats have the potential to enhance accessibility to care for individuals with suicidal ideation. However, digital self-help interventions have faced limitations, including small effect sizes in reducing suicidal ideation, low adherence, and safety concerns. OBJECTIVE Therefore, we aimed to develop a remote blended cognitive behavioral therapy intervention that specifically targets suicidal ideation by blending video therapy with web-based self-help modules. The objective of this paper is to describe the collaborative development process and the resulting intervention and treatment rationale. METHODS First, we compiled intervention components from established treatment manuals designed for people with suicidal ideation or behavior, resulting in the development of 11 drafts of web-based modules. Second, we conducted a qualitative study, involving 5 licensed psychotherapists and 3 lay counselors specialized in individuals with suicidal ideation who reviewed these module drafts. Data were collected using the think-aloud method and semistructured interviews, and a qualitative content analysis was performed. The 4 a priori main categories of interest were blended care for individuals with suicidal ideation, contents of web-based modules, usability of modules, and layout. Subcategories emerged inductively from the interview transcripts. Finally, informed by previous treatment manuals and qualitative findings, we developed the remote blended treatment program. RESULTS The participants suggested that therapists should thoroughly prepare the web-based therapy with patients to tailor the therapy to each individual's needs. Participants emphasized that the web-based modules should explain concepts in a simple manner, convey empathy and validation, and include reminders for the safety plan. In addition, participants highlighted the need for a simple navigation and layout. Taking these recommendations into account, we developed a fully remote blended cognitive behavioral therapy intervention comprising 12 video therapy sessions and up to 31 web-based modules. The treatment involves collaboratively developing a personalized treatment plan to address individual suicidal drivers. CONCLUSIONS This remote treatment takes advantage of the high accessibility of digital formats while incorporating full sessions with a therapist. In a subsequent pilot trial, we will seek input from individuals with lived experience and therapists to test the feasibility of the treatment.
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Affiliation(s)
- Rebekka Büscher
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lasse B Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mattis Nuding
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
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Lucey JV, Matti B. Suicide risk assessment: time to think again? Ir J Psychol Med 2023; 40:323-325. [PMID: 34847969 DOI: 10.1017/ipm.2021.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper considers recent research on suicide risk assessment to support calls for a 'rethink' of our assessment of the patients in our care, along with the adoption of a more collaborative approach to care planning with service users who remain at risk of self-harm and in need of a plan for their safety.
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Affiliation(s)
| | - B Matti
- Psychiatry, SPMHS, Dublin, Ireland
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29
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Zuckerman E, Fernandes SN, Sullivan SR, Ortin-Peralta A, Jeglic E, Miranda R, Baroni A. Sleep quality and in-person versus online social interaction during the early COVID-19 pandemic lockdown: Impact on affect and interpersonal needs among young adults. Psychiatry Res Commun 2023; 3:100134. [PMID: 37736570 PMCID: PMC10512736 DOI: 10.1016/j.psycom.2023.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
We examined relationships among sleep quality and forms of social interaction (in-person vs. online) as predictors of change in affect and interpersonal needs (perceived burdensomeness, thwarted belongingness) - correlates of suicidal thoughts and behaviors - during the early COVID-19 pandemic lockdown. New York City undergraduates (N = 58) from four public colleges completed a baseline survey and daily diaries up to 30 days in April-June 2020. Adjusting for relevant covariates, better sleep quality and in-person communication predicted greater positive affect and lower negative affect over time, but online social interaction only predicted greater positive affect and did not predict negative affect. Better sleep quality predicted lower perceived burdensomeness but not thwarted belongingness. Both in-person and online social interaction - but not total hours on social media - predicted lower thwarted belonging and perceived burdensomeness. Greater hours spent on social media each day lessened the relationship between in-person interaction and positive affect and lessened the buffering effect of in-person interaction on perceived burdensomeness. Improving sleep quality and increasing in-person interaction may ameliorate psychological variables that increase risk for suicidal thoughts and behaviors. However, when in-person interaction is limited, such as during the COVID-19 pandemic, online social interaction might be encouraged - depending on the nature of the interactions - to increase positive affect and buffer against suicide-related factors.
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Affiliation(s)
- Emily Zuckerman
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, USA
- Department of Psychology, Hunter College, City University of New York, USA
| | | | - Sarah R. Sullivan
- Department of Psychology, The Graduate Center, City University of New York, USA
| | - Ana Ortin-Peralta
- Department of Psychology, Hunter College, City University of New York, USA
- School-Clinical Child Psychology Program, Ferkauf Graduate School of Psychology, Yeshiva University, USA
| | - Elizabeth Jeglic
- Department of Psychology, The Graduate Center, City University of New York, USA
- John Jay College of Criminal Justice, City University of New York, USA
| | - Regina Miranda
- Department of Psychology, Hunter College, City University of New York, USA
- Department of Psychology, The Graduate Center, City University of New York, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, USA
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Chitty KM, Sperandei S, Carter GL, Ali Z, Raubenheimer JE, Schaffer AL, Page A, Buckley NA. Five healthcare trajectories in the year before suicide and what they tell us about opportunities for prevention: a population-level case series study. EClinicalMedicine 2023; 63:102165. [PMID: 37649805 PMCID: PMC10462847 DOI: 10.1016/j.eclinm.2023.102165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/16/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
Background Suicide prevention requires a shift from relying on an at-risk individual to engage with the healthcare system. Understanding patterns of healthcare engagement by people who have died by suicide may provide alternative directions for suicide prevention. Methods This is a population-based case-series study of all suicide decedents (n = 3895) in New South Wales (NSW), Australia (2013-2019), with linked coronial, health services and medicine dispensing data. Healthcare trajectories were identified using a k-means longitudinal 3d analysis, based on the number and type of healthcare contacts in the year before death. Characteristics of each trajectory were described. Findings Five trajectories of healthcare utilisation were identified: (A) none or low (n = 2598, 66.7%), (B) moderate, predominantly for physical health (n = 601, 15.4%), (C) moderate, with high mental health medicine use (n = 397, 10.2%), (D) high, predominantly for physical health (n = 206, 5.3%) and E) high, predominantly for mental health (n = 93, 2.4%). Given that most decedents belonged to Trajectory A this suggests a great need for suicide preventive interventions delivered in the community, workplace, schools or online. Trajectories B and D might benefit from opioid dispensing limits and access to psychological pain management. Trajectory C had high mental health medicine use, indicating that the time that medicines are prescribed or dispensed are important touchpoints. Trajectory E had high mental health service predominantly delivered by psychiatrists and community mental health, but limited psychologist use. Interpretation Although most suicide decedents made at least one healthcare contact in the year before death, contact frequency was overall very low. Given the characteristics of this group, useful access points for such intervention could be delivered through schools and workplaces, with a focus on alcohol and drug intervention alongide suicide awareness. Funding Australia's National Health and Medical Research Council.
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Affiliation(s)
- Kate M. Chitty
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- School of Population and Global Health, Faculty of Health and Medicine, University of Western Australia, WA, Australia
| | - Sandro Sperandei
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Gregory L. Carter
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Zein Ali
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Jacques E. Raubenheimer
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Andrea L. Schaffer
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- School of Population Health, University of New South Wales, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Nicholas A. Buckley
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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Knapp S. Lethal Means Counseling for Suicidal Firearm Owners. J Contemp Psychother 2023:1-9. [PMID: 37363717 PMCID: PMC10251328 DOI: 10.1007/s10879-023-09588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/28/2023]
Abstract
The death of a patient by suicide is one of the professional events most feared by psychotherapists and firearms are the most commonly used means of suicide. However, as the number of firearm owners within the United States has increased in recent years, so has the risk of firearm-related suicides. Suicidal patients with easy access to their firearms may give in to the wish to die and end their life with little opportunity for reflection or forethought. Furthermore, because the topic of gun control has become so polarized, patients may not always be open to discussing barriers between themselves and their firearms. Nonetheless, psychotherapists using non-judgmental, respectful, and collaborative lethal means counseling can substantially reduce patient suicides.
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Risch N, Dupuis-Maurin K, Dubois J, Courtet P, Olié E. Sensitivity to ostracism is blunted in suicide attempters only when they report suicidal ideation. J Affect Disord 2023:S0165-0327(23)00680-8. [PMID: 37230265 DOI: 10.1016/j.jad.2023.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Modified pain perception is at the core of many theories on suicide; however, studies on the relationship between pain perception and suicidal behavior (attempt) have produced contradictory results. In this experimental study, we investigated whether physical pain and social pain are concomitantly influenced by suicidal ideation (SI) and past suicidal behavior. METHODS 155 inpatients with depression (90 with and 65 without past history of suicide attempt) were included. They underwent thermal stimulation of the skin to assess physical pain tolerance and played the Cyberball game to assess their sensitivity to ostracism (social pain). Participants self-assessed current SI through the specific item in the Beck Depression Inventory. RESULTS Pain tolerance was not associated with history of suicide attempt, current SI, and their interaction. Social pain was associated with the interaction between history of suicide attempt and current SI. Social pain was decreased in suicide attempters, compared with non-attempters, only when they reported current SI. LIMITATIONS Cyberball game may not be representative of everyday stress and ecological social context. CONCLUSIONS Unlike what suggested by many theories, pain tolerance does not seem to be necessary to attempt suicide. Suicide attempters with current SI displayed blunted sensitivity to ostracism and could be less willing to restore social affiliation compared with non-attempters.
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Affiliation(s)
- Nathan Risch
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France; Clinique de la Lironde, Clinea Psychiatrie, 34980 Saint-Clément-de-Rivière, France.
| | - Kathlyne Dupuis-Maurin
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
| | - Jonathan Dubois
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
| | - Philippe Courtet
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
| | - Emilie Olié
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
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Mandel AA, Kleiman EM, Johnson S, Rogers ML, Jobes DA, Joiner T. A test of invariance of the construct of suicidal ideation across three diverse samples. J Affect Disord 2023; 329:124-130. [PMID: 36841297 DOI: 10.1016/j.jad.2023.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Suicide treatment research has placed major emphasis on preventing behavior, an observable phenomenon. Suicidal ideation (SI), however, is a distressing experience that annually impacts >15 million Americans; yet the construct validity of SI has not been well established, limiting empirical attention. METHOD We compared the coherence of three SI items (diminished wish to live, urge to die/controllability, suicide intent/expectations) and four related items across three adult samples (N = 314) that differed based on current SI severity and assessment time-scales (retrospective versus momentary). RESULTS A measurement model with scalar invariance had acceptable fit (CFI = 0.969, RMSEA = 0.076), indicating that the SI items consistently loaded onto one construct across samples. The structural model with metric invariance also had acceptable fit (CFI = 0.956, RMSEA = 0.063) and three of four related items (burdensome, hopelessness, and fatigue, but not agitation) were associated with SI across samples. LIMITATIONS Use of existing data limited the items considered. CONCLUSIONS Suicidal ideation is a coherent construct independent of the items used to assess it, the assessment's time-scale (retrospective versus momentary), or the severity of thoughts, and is worthy of greater empirical, clinical, and policy attention.
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Affiliation(s)
- Abby Adler Mandel
- Department of Psychology, The Catholic University of America, Washington, DC, USA.
| | - Evan M Kleiman
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Sheri Johnson
- Department of Psychology, University of California - Berkeley, Berkeley, CA, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Stoliker BE, Wangler H, Abderhalden FP, Jewell LM. Lifetime and Jail-Specific Suicidal Ideation: Prevalence and Correlates in a Sample of People in Jail in the United States. Int J Offender Ther Comp Criminol 2023:306624X231170112. [PMID: 37098823 DOI: 10.1177/0306624x231170112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Despite high suicide mortality in U.S. jails, there is limited research into precursors for suicide in this population, such as suicidal ideation. The current study examined the prevalence and correlates of lifetime and jail-specific suicidal ideation among a sample of 196 individuals (137 men) in custody in a U.S. jail. Nearly half the sample had reported lifetime suicidal ideation (45%), whereas 30% had reported jail-specific suicidal ideation. Adjusted correlates of lifetime suicidal ideation included a history of mental illness (OR = 2.79) and drug use (OR = 2.70). Adjusted correlates of jail-specific suicidal ideation included a history of mental illness (OR = 2.74), drug use (OR = 3.16), and a dehumanizing custodial environment (OR = 3.74). Some theoretically and empirically relevant factors were not significantly associated with suicidal ideation. Both expected and unexpected findings are discussed within the context of suicide theory and research, and practical implications are explored.
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Affiliation(s)
- Bryce E Stoliker
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, SK, Canada
| | - Haile Wangler
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, SK, Canada
| | - Frances P Abderhalden
- School of Criminal Justice and Criminalistics, California State University, Los Angeles, United States
| | - Lisa M Jewell
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, SK, Canada
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Rainbow C, Tatnell R, Blashki G, Melvin GA. Revisiting the factor structure of the suicide-related coping scale: Results from two samples of Australian online help-seekers. Psychiatry Res 2023; 324:115195. [PMID: 37058793 DOI: 10.1016/j.psychres.2023.115195] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 04/16/2023]
Abstract
The Suicide-Related Coping Scale (SRCS) measures how well a person manages suicidal thoughts through the use of internal and external coping strategies. Many studies using SRCS, including the original scale validation, used samples of treatment-engaged military veterans or personnel, which may limit the generalizability of study findings to other help-seeking and cultural contexts. The present study evaluated factor structure, internal consistency, convergent and divergent validity of SRCS in two Australian online help-seeking samples: visitors to a mental health website with experience of suicidal ideation (N = 1,266) and users of a suicide safety planning mobile app (N = 693). Factor analyses found a reduced 15-item version of the scale (SRCS-15) provided the best fit in both samples, with three factors found: Internal Coping, External Coping and Perceived Control. Internal consistency was good (α = 0.89). Strong negative associations were found between SRCS-15, recent suicidal ideation and future suicide intent. Perceived Control demonstrated the strongest associations with suicidal ideation and future suicide intent (negative) and distress tolerance (positive). External Coping demonstrated the strongest associations with help-seeking (positive). Items relating to means restriction and hospital location knowledge were dropped from SRCS-15 due to low factor loadings but may still contain clinically relevant information. SRCS-15 appears to be reliable and valid in capturing aspects of self-efficacy and belief-based barriers to coping, making it a useful additional outcome measure for suicide-related services and interventions.
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Affiliation(s)
- Christopher Rainbow
- Beyond Blue, GPO Box 1883, Melbourne VIC 3001, Melbourne, Australia; Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Level 5, Deakin University, Building BC, 221 Burwood Hwy, Burwood, VIC 3125, Melbourne, Australia.
| | - Ruth Tatnell
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Level 5, Deakin University, Building BC, 221 Burwood Hwy, Burwood, VIC 3125, Melbourne, Australia.
| | - Grant Blashki
- Beyond Blue, GPO Box 1883, Melbourne VIC 3001, Melbourne, Australia; Nossal Institute for Global Health, University of Melbourne, Level 5, 333 Exhibition Street, VIC 3000, Melbourne, Australia.
| | - Glenn A Melvin
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Level 5, Deakin University, Building BC, 221 Burwood Hwy, Burwood, VIC 3125, Melbourne, Australia.
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Pisani AR, Boudreaux ED. Systems Approach to Suicide Prevention: Strengthening Culture, Practice, and Education. Focus (Am Psychiatr Publ) 2023; 21:152-159. [PMID: 37201147 PMCID: PMC10172554 DOI: 10.1176/appi.focus.20220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Contemporary approaches to suicide prevention extend beyond an individual's interactions with care providers to seek opportunities for improvement in the wider care system. A systems-based analysis can yield opportunities to improve prevention and recovery across the care continuum. This article uses an example of an individual seeking care in an emergency department to show how a traditional clinical case formulation can be framed in terms of the outer and inner contexts of the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to illuminate the impact of systemic factors on outcomes and to identify opportunities for improvement. Three mutually reinforcing domains (a culture of safety and prevention; best practices, policies, and pathways; and workforce education and development) of a systems approach to suicide prevention are outlined, along with their defining characteristics. A culture of safety and prevention requires engaged, informed leaders who prioritize prevention; lived experience integrated into leadership teams; and adverse events review in a Restorative Just Culture focused on healing and improvement. Best practices, policies, and pathways that promote safety, recovery, and health require codesign of processes and services and evolve through continuous measurement and improvement. To support a culture of safety and prevention, and caring, competent application of policy, organizations benefit from a longitudinal approach to workforce education. This includes a common framework and language; models clinical and lived experience collaboration; and supports continuous learning, as well as onboarding of new staff, rather than following a "one-and-done" approach, so that suicide prevention training remains top of mind across the workforce.
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Affiliation(s)
- Anthony R Pisani
- Departments of Psychiatry and Pediatrics, University of Rochester Medical Center, Rochester, New York (Pisani); Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux)
| | - Edwin D Boudreaux
- Departments of Psychiatry and Pediatrics, University of Rochester Medical Center, Rochester, New York (Pisani); Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux)
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Suicide Preventive Interventions and Knowledge. Focus (Am Psychiatr Publ) 2023; 21:178-9. [PMID: 37201137 DOI: 10.1176/appi.focus.23021002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
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Bryan CJ, Carpenter KM, Pawlik TM. Evidence-Based Strategies to Reduce Suicide Mortality Among Patients With Cancer. JAMA Oncol 2023; 9:303-304. [PMID: 36633840 DOI: 10.1001/jamaoncol.2022.6373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Craig J Bryan
- Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus
| | - Kristen M Carpenter
- Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus
| | - Timothy M Pawlik
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University, Columbus
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Rodgers J, Goodwin J, Nielsen E, Bhattarai N, Heslop P, Kharatikoopaei E, O’Connor RC, Ogundimu E, Ramsay SE, Steele K, Townsend E, Vale L, Walton E, Wilson C, Cassidy S. Adapted suicide safety plans to address self-harm, suicidal ideation, and suicide behaviours in autistic adults: protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2023; 9:31. [PMID: 36855212 PMCID: PMC9972793 DOI: 10.1186/s40814-023-01264-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Suicide prevention is a national priority for the UK government. Autistic people are at greater risk of experiencing self-harm and suicidal thoughts and behaviours than the general population. Safety plans are widely used in suicide prevention but have not yet been designed with and for autistic people. We developed the first safety plan specifically targeting suicidality in autistic adults: the Autism Adapted Safety Plan (AASP). It consists of a prioritised list of hierarchical steps that can be used prior to or during a crisis to mitigate risk of self-harm and suicidal behaviour. This is a pilot study that aims to assess the feasibility and acceptability of the AASPs and the research processes, including the response rates, potential barriers and reach of AASPs, methods of recruitment, what comprises usual care, and economic evaluation methods/tools. METHODS This is an external pilot randomised controlled trial of a suicide prevention tool aimed at mitigating the risk of self-harm and suicidal behaviour in autistic adults: AASPs. Participants will be assessed at baseline and followed up 1 month and 6 months later. Assessments include questions about self-harm, suicidality, service use, and their experience of the AASP/taking part in the study. Autistic adults who have a clinical autism diagnosis and self-reported history of self-harm, suicidal thoughts, or suicidal behaviours within the last 6 months will be invited to take part in the study. Informed consent will be obtained. Participants will be recruited via community and third sector services (including community settings, autism charities, and mental health charities). They may also "self-refer" into the study through social media recruitment and word of mouth. Ninety participants will be randomised to either develop an AASP or receive their usual care in a 1:1 ratio. DISCUSSION The present study will provide an evaluation of the suitability of the processes that would be undertaken in a larger definitive study, including recruitment, randomisation, methods, questionnaires, outcome measures, treatment, and follow-up assessments. TRIAL REGISTRATION ISRCTN70594445, Protocol v4: 8/2/22.
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Affiliation(s)
- Jacqui Rodgers
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Jane Goodwin
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Emma Nielsen
- grid.4563.40000 0004 1936 8868School of Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Nawaraj Bhattarai
- grid.1006.70000 0001 0462 7212Health Economics Group, Population Health Science Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Phil Heslop
- grid.42629.3b0000000121965555Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
| | - Ehsan Kharatikoopaei
- grid.8250.f0000 0000 8700 0572Department of Anthropology, Durham University, Durham, UK
| | - Rory C. O’Connor
- grid.8756.c0000 0001 2193 314XSuicidal Behaviour Research Lab, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Emmanuel Ogundimu
- grid.8250.f0000 0000 8700 0572Department of Mathematical Sciences, Durham University, Durham, UK
| | - Sheena E. Ramsay
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Katie Steele
- grid.1006.70000 0001 0462 7212School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Ellen Townsend
- grid.4563.40000 0004 1936 8868School of Psychology, University of Nottingham, Nottingham, UK
| | - Luke Vale
- grid.1006.70000 0001 0462 7212Health Economics Group, Population Health Science Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Emily Walton
- grid.1006.70000 0001 0462 7212School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Colin Wilson
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sarah Cassidy
- grid.4563.40000 0004 1936 8868School of Psychology, University of Nottingham, Nottingham, UK
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Melia R, Francis K, Duggan J, Bogue J, O'Sullivan M, Young K, Chambers D, McInerney SJ, O'Dea E, Bernert R. Using a Safety Planning Mobile App to Address Suicidality in Young People Attending Community Mental Health Services in Ireland: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e44205. [PMID: 36809171 PMCID: PMC9993232 DOI: 10.2196/44205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Over 700,000 people die by suicide annually, making it the fourth leading cause of death among those aged 15-29 years globally. Safety planning is recommended best practice when individuals at risk of suicide present to health services. A safety plan, developed in collaboration with a health care practitioner, details the steps to be taken in an emotional crisis. SafePlan, a safety planning mobile app, was designed to support young people experiencing suicidal thoughts and behaviors and to record their plan in a way that is accessible immediately and in situ. OBJECTIVE The aim of this study is to assess the feasibility and acceptability of the SafePlan mobile app for patients experiencing suicidal thoughts and behaviors and their clinicians within Irish community mental health services, examine the feasibility of study procedures for both patients and clinicians, and determine if the SafePlan condition yields superior outcomes when compared with the control condition. METHODS A total of 80 participants aged 16-35 years accessing Irish mental health services will be randomized (1:1) to receive the SafePlan app plus treatment as usual or treatment as usual plus a paper-based safety plan. The feasibility and acceptability of the SafePlan app and study procedures will be evaluated using both qualitative and quantitative methodologies. The primary outcomes are feasibility outcomes and include the acceptability of the app to participants and clinicians, the feasibility of delivery in this setting, recruitment, retention, and app use. The feasibility and acceptability of the following measures in a full randomized controlled trial will also be assessed: the Beck Scale for Suicide Ideation, Columbia Suicide Severity Rating Scale, Coping Self-Efficacy Scale, Interpersonal Needs Questionnaire, and Client Service Receipt Inventory. A repeated measures design with outcome data collected at baseline, post intervention (8 weeks), and at 6-month follow-up will be used to compare changes in suicidal ideation for the intervention condition relative to the waitlist control condition. A cost-outcome description will also be undertaken. Thematic analyses will be used to analyze the qualitative data gathered through semistructured interviews with patients and clinicians. RESULTS As of January 2023, funding and ethics approval have been acquired, and clinician champions across mental health service sites have been established. Data collection is expected to commence by April 2023. The submission of completed manuscript is expected by April 2025. CONCLUSIONS The framework for Decision-making after Pilot and feasibility Trials will inform the decision to progress to a full trial. The results will inform patients, researchers, clinicians, and health services of the feasibility and acceptability of the SafePlan app in community mental health services. The findings will have implications for further research and policy regarding the broader integration of safety planning apps. TRIAL REGISTRATION OSF Registries osf.io/3y54m; https://osf.io/3y54m. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/44205.
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Affiliation(s)
- Ruth Melia
- Department of Psychology, University of Limerick, Limerick, Ireland.,School of Psychology, University of Galway, Galway, Ireland.,Health Service Executive Community Healthcare Mid West, Limerick, Ireland
| | - Kady Francis
- School of Psychology, University of Galway, Galway, Ireland.,Health Service Executive Community Healthcare West, Galway, Ireland
| | - Jim Duggan
- Insight Centre for Data Analytics, University of Galway, Galway, Ireland
| | - John Bogue
- School of Psychology, University of Galway, Galway, Ireland
| | - Mary O'Sullivan
- Health Service Executive Community Healthcare West, Galway, Ireland
| | - Karen Young
- College of Engineering and Informatics, University of Galway, Galway, Ireland
| | | | - Shane J McInerney
- Health Service Executive Community Healthcare West, Galway, Ireland.,Department of Psychiatry, University of Galway, Galway, Ireland
| | - Edmond O'Dea
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Rebecca Bernert
- Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, United States
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Procter N, Othman S, Jayasekara R, Procter A, McIntyre H, Ferguson M. The impact of trauma-informed suicide prevention approaches: A systematic review of evidence across the lifespan. Int J Ment Health Nurs 2023; 32:3-13. [PMID: 35938946 DOI: 10.1111/inm.13048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 01/14/2023]
Abstract
Trauma is associated with an increased likelihood of experiencing suicidality, indicating the need for and potential value of trauma-informed suicide prevention strategies. The aim of this study is to systematically review published literature regarding trauma-informed approaches for suicide prevention, and the impact on suicide outcomes. Systematic searches were conducted in eight databases (Medline, Embase, PsycInfo, Emcare, Nursing, and JBI in the Ovid platform; as well as ProQuest Psychology Database and The Cochrane Library) in March 2022, with no publication date limit. Four studies met the inclusion criteria: two randomized controlled trials and two quasi-experimental studies. Two studies reported reductions in ideation, intent, and behaviour among youth and a cultural minority group. Few studies directly reporting suicide outcomes were identified, all were quantitative, and heterogeneity prevents generalizability across population groups. Currently, there is limited evidence focusing specifically on trauma-informed suicide prevention across the lifespan. Additional research, incorporating lived experience voices, is needed to understand the potential of this approach, as well as how mental health nurses can incorporate these approaches into their practice.
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Affiliation(s)
- Nicholas Procter
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Shwikar Othman
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Rasika Jayasekara
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Alexandra Procter
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Heather McIntyre
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Monika Ferguson
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Powsner S, Goebert D, Richmond JS, Takeshita J. Suicide Risk Assessment, Management, and Mitigation in the Emergency Setting. Focus (Am Psychiatr Publ) 2023; 21:8-17. [PMID: 37205029 PMCID: PMC10172543 DOI: 10.1176/appi.focus.20220072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Suicide is a serious public health issue and is a leading cause of death worldwide. Suicidal ideation is a common presentation in emergency department (ED) settings, with many nuanced complications. Therefore, understanding screening, assessment, and mitigation is paramount to successful encounters with individuals presenting to emergency settings in psychiatric crises. Screening helps to identify the few people at risk within a large group. Assessment seeks to decide whether a specific individual is at significant risk. Mitigation aims to reduce the risk of suicide or of a serious attempt for a person at risk. These aims cannot be achieved with perfect reliability, but some approaches are more effective than others. Suicide screening specifics are important, even to individual practitioners, because a positive screen triggers assessment. Most practitioners understand assessment well: beginning with early psychiatric training, they are taught signs and symptoms suggesting that a patient might be at risk of suicide. Mitigating suicide risk is increasingly important to reduce the misery of ED boarding for patients awaiting psychiatric admission. For many patients, hospital admission is unnecessary if support, monitoring, and contingency plans are workable. For any individual patient, there may be a complicated mix of findings, risks, and interventions. Evidence-based screening and assessment tools are inadequate for the possible complexities, making care of individual patients dependent on good clinical assessment. The authors review the available evidence and offer experienced recommendations for challenges not yet thoroughly researched.
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Affiliation(s)
- Seth Powsner
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Deborah Goebert
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Janet S Richmond
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Junji Takeshita
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
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Yu T, Hu D, Jiang Y, Wang C, Liu S. Influencing factors of suicidal ideation in lung cancer patients in Midland China: A mixed-method study. Front Psychiatry 2023; 14:1072371. [PMID: 37181910 PMCID: PMC10174430 DOI: 10.3389/fpsyt.2023.1072371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction The suicide risk of lung cancer patients is higher than that of patients with other cancers. However, as China is a large country for lung cancer, there are no relevant reports on lung cancer suicides. This study aimed to investigate the prevalence of suicidal ideation and explore its influencing factors in lung cancer patients. Methods In this cross-sectional study, between July to November 2019, 366 lung cancer patients from the oncology department of a general hospital in Wuhan were chosen as participants. Of these, eight with lung cancer and suicidal ideation were selected for in-depth interviews. Results A total of 22.68% of lung cancer patients reported suicidal ideation. Sex, cancer stage, number of uncomfortable symptoms, and satisfaction with treatment were independently associated with suicidal ideation. This qualitative study found that the experience of suicidal ideation in lung cancer patients includes physiological (heavy burden of symptoms),psychological (bad mood, thwarted belongingness, perceived burdensomeness, and stigma), and social factors (high economic pressure and negative life events). Discussion These findings suggest that the incidence of suicidal ideation in lung cancer patients is higher than that of other cancers and is affected by many factors. Therefore, there should be routine screening and assessment of suicidal ideation among lung cancer patients, and related mental health and suicide prevention education should be provided.
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Affiliation(s)
- Ting Yu
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Deying Hu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yan Jiang
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yan Jiang,
| | - Cong Wang
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Liu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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de Lange J, Baams L, Bos H, Bosker R, Dumon E, Portzky G, Robinson J, van Bergen D. Moderating role of coping in the association between minority stress and suicidal ideation and suicide attempts among sexual and gender minority young adults. Suicide Life Threat Behav 2022; 52:1178-1192. [PMID: 36056550 PMCID: PMC10946947 DOI: 10.1111/sltb.12913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/11/2022] [Accepted: 08/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study examined associations of minority stressors (i.e., victimization, internalized homonegativity, and stigma consciousness), and coping styles (i.e., active, avoidant, and passive) with suicidal ideation and suicide attempts (suicidality) among sexual and gender minority (SGM) young adults, and whether coping style moderated these associations. METHODS Logistic regression analyses examined these associations among 1432 SGM young adults (ages 18-29). RESULTS Minority stressors and passive coping were associated with a higher likelihood of suicidality. Avoidant coping was associated with a lower likelihood of lifetime suicidal ideation and attempts among sexual minority participants, and active coping with a lower likelihood of past-year suicidal ideation among sexual minority participants. Moderation analyses among sexual minority participants showed that when avoidant coping was high, associations between low victimization (compared with no victimization) and lifetime suicide attempts, and stigma consciousness and lifetime suicide attempts became non-significant, and the association between internalized homonegativity and lifetime suicide attempts became significant. Among gender minority participants, when passive coping was high the association between low victimization and lifetime suicidal ideation became significant. CONCLUSION This study underlines the importance of minority stress and coping for suicidality among SGM young adults and the need for more research regarding the role of coping.
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Affiliation(s)
- Jennifer de Lange
- Department of Pedagogy and Educational SciencesUniversity of GroningenGroningenThe Netherlands
| | - Laura Baams
- Department of Pedagogy and Educational SciencesUniversity of GroningenGroningenThe Netherlands
| | - Henny Bos
- Department of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Roel Bosker
- Department of Pedagogy and Educational SciencesUniversity of GroningenGroningenThe Netherlands
| | - Eva Dumon
- Department of Head and Skin, Flemish Centre of Expertise in Suicide PreventionGhent UniversityGhentBelgium
| | - Gwendolyn Portzky
- Department of Head and Skin, Flemish Centre of Expertise in Suicide PreventionGhent UniversityGhentBelgium
| | - Jo Robinson
- OrygenParkvilleVictoriaAustralia
- Centre for Youth Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Diana van Bergen
- Department of Pedagogy and Educational SciencesUniversity of GroningenGroningenThe Netherlands
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Knapp SJ. Listen, explain, involve, and evaluate: why respecting autonomy benefits suicidal patients. Ethics & Behavior 2022. [DOI: 10.1080/10508422.2022.2152338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Marshall CA, Crowley P, Carmichael D, Goldszmidt R, Aryobi S, Holmes J, Easton C, Isard R, Murphy S. Effectiveness of Suicide Safety Planning Interventions: A Systematic Review Informing Occupational Therapy. Can J Occup Ther 2022; 90:208-236. [PMID: 36324257 DOI: 10.1177/00084174221132097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background. Suicide safety planning (SSP) is a suicide prevention approach that involves developing a collaborative plan between a service provider such as an occupational therapist and a person who is at risk of suicide. Purpose. To synthesize effectiveness studies on SSP. Method. Using the Joanna Briggs Institute methodology, we conducted a systematic review of effectiveness studies including a: (1) title and abstract screening; (2) full-text review; (3) critical appraisal; and (4) narrative synthesis. Findings. We included 22 studies. Critical appraisal scores ranged from 38.5 to 92.3 (m = 63.7). The types of interventions included were: standard and enhanced SSP (n = 11); electronically delivered SSP (n = 5); and SSP integrated with other approaches (n = 6). Only three studies identified meaningful activity as a component of SSP. Evidence across a range of studies indicates that SSP is effective for reducing suicide behavior (SB) and ideation (SI). While some studies have demonstrated effectiveness for reducing symptoms of mental illness, promoting resilience and service use, the number of studies exploring these outcomes is currently limited. Implications. Occupational therapists support individuals expressing SI, and SSP is a necessary skill for practice.
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Favril L, Yu R, Uyar A, Sharpe M, Fazel S. Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies. Evid Based Ment Health 2022; 25:148-155. [PMID: 36162975 PMCID: PMC9685708 DOI: 10.1136/ebmental-2022-300549] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
QUESTION Effective prevention of suicide requires a comprehensive understanding of risk factors. STUDY SELECTION AND ANALYSIS Five databases were systematically searched to identify psychological autopsy studies (published up to February 2022) that reported on risk factors for suicide mortality among adults in the general population. Effect sizes were pooled as odds ratios (ORs) using random-effects models for each risk factor examined in at least three independent samples. FINDINGS A total of 37 case-control studies from 23 countries were included, providing data on 40 risk factors in 5633 cases and 7101 controls. The magnitude of effect sizes varied substantially both between and within risk factor domains. Clinical factors had the strongest associations with suicide, including any mental disorder (OR=13.1, 95% CI 9.9 to 17.4) and a history of self-harm (OR=10.1, 95% CI 6.6 to 15.6). By comparison, effect sizes were smaller for other domains relating to sociodemographic status, family history, and adverse life events (OR range 2-5). CONCLUSIONS A wide range of predisposing and precipitating factors are associated with suicide among adults in the general population, but with clear differences in their relative strength. PROSPERO REGISTRATION NUMBER CRD42021232878.
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Affiliation(s)
- Louis Favril
- Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Abdo Uyar
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Michael Sharpe
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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Hawton K, Lascelles K, Pitman A, Gilbert S, Silverman M. Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management. Lancet Psychiatry 2022; 9:922-928. [PMID: 35952701 DOI: 10.1016/s2215-0366(22)00232-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/20/2022]
Abstract
Suicide prevention in psychiatric practice has been dominated by efforts to predict risk of suicide in individual patients. However, traditional risk prediction measures have been shown repeatedly in studies from high income countries to be ineffective. Several factors might contribute to clinicians' preoccupation with risk prediction, which can have negative effects on patient care and also on clinicians where prediction is seen as failing. The model of therapeutic risk assessment, formulation, and management we outline in this article regards all patients with mental health problems as potentially at increased risk of suicide. It is aimed at reducing risk through use of a person-centred approach. We describe how a move towards therapeutic risk assessment, formulation, and risk management, including collaborative safety planning, could help clinicians develop a more tailored approach to managing risk for all patients, incorporating potentially therapeutic effects as well as helping to identify other risk reduction interventions. Such an approach could lead to enhanced patient safety and quality of care, which is more acceptable to patients.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | | | - Alexandra Pitman
- UCL Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | | | - Morton Silverman
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Oates A, Gibbons R. After a patient dies by suicide: an illustrative case for trainee psychiatrists and trainers. BJPsych Bull 2022; 46:293-297. [PMID: 34782031 PMCID: PMC9768523 DOI: 10.1192/bjb.2021.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
One of the most challenging experiences psychiatrists will face in their careers may well be the death of a patient by suicide. This is likely to happen at least once during a psychiatrist's career, and often more. It can be an intensely complex and painful event with a wide range of emotional responses. Reflecting on the death and accessing good support helps clinicians process the emotional impact. It can also increase their resilience in the longer term by giving them a greater understanding of both their own and their patients' limitations, and in this way strengthen their capacity for compassion as clinicians. Using an illustrative case study, this article provides an insight into the experience of losing a patient to suicide and signposts to sources of support.
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Affiliation(s)
- Alice Oates
- Southern Health NHS Foundation Trust, Basingstoke, UK
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Nathan R, Bhandari S. Risk assessment in clinical practice: a framework for decision-making in real-world complex systems. BJPsych advances 2022. [DOI: 10.1192/bja.2022.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Risk assessment in clinical practice is often characterised as a process of analysing information so as to make a judgement about the likelihood of harmful behaviour occurring in the future. However, this characterisation is brought into question when the evidence does not support the current use of risk assessment approaches to predict, or provide probability estimates of, future behaviour in a way that is usable in single instances arising in individual cases. This article sets out a broader and more clinically applicable description of risk assessment which takes account of the wider influences on how this clinical activity takes place. In so doing, it provides a framework to guide clinicians, researchers and authors of practice guidance who are interested in improving approaches to risk assessment.
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