scholarly journals FEASIBILITY OF A MANUALIZED FAMILY-BASED SUICIDE PREVENTION STRATEGY TO REDUCE ADOLESCENT SUICIDE RISK AMONG EMERGENCY DEPARTMENT REFERRED YOUTH: A QUALITY IMPROVEMENT PROJECT

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e54-e54
Author(s):  
Matthew Tracey ◽  
Gillian Rowney ◽  
Antonio Pignatiello ◽  
Suneeta Monga ◽  
Daphne Korczak
Keyword(s):  
Emergency Department ◽  
Depressive Symptoms ◽  
Suicidal Ideation ◽  
Suicide Prevention ◽  
Controlled Trial ◽  
Standard Of Care ◽  
Improvement Project ◽  
Care Clinic ◽  
Ensure Patient Safety ◽  
Increased Risk

Abstract BACKGROUND Suicide is the second leading cause of death among Canadian children and adolescents. Youth who present at an Emergency Department (ED) for suicidal ideation and risk behaviours (SRB) are at increased risk for eventual suicide. Despite this risk, current approaches to standard of care are referral to community resources or primary care where waitlists are common, and interventions may not be evidence-based or incorporate crisis management or family participation. OBJECTIVES To determine the feasibility and acceptability of a manualized, family-centered suicide prevention intervention administered in an outpatient clinic for ED-referred youth. DESIGN/METHODS Youth (aged 12 – 18) and parents presenting to the ED for SRB and referred to the Urgent Psychiatry Care clinic were eligible for the QI program, consisting of weekly individual and family sessions delivered over a 6-week period. The therapist addressed common symptoms and concerns of suicidal youth, sources of conflict within the family, and ways to improve communication and ensure patient safety. Patients were excluded if they did not have a parent or caregiver able to participate. Suicidal ideation and behavior were assessed using youth-report measures, the Suicidal Ideation Questionnaire-Junior (SIQ-JR) and the Harkavy-Asnis Suicide Scale (HASS), at baseline and following program completion. The Mood and Feeling Questionnaire (MFQ) was used to measure depressive symptoms. Participant and therapist feedback was collected at follow-up using quantitative and qualitative measures. RESULTS Ten patients were enrolled and completed baseline measures, however four participants withdrew prior to 6 week completion: two withdrew at week 2 and one participant each withdrew at weeks 3 and 6. As such, 7/10 completed 5 weeks of the intervention. Significant improvement in both suicidal ideation (SIQ-JR, x̅ = -16.67; t(5) = 3.125, p = .026) and SRB (HASS, x̅ = -20.17; t(5) = 3.204, p = .024) were observed. Depressive symptoms also decreased (MFQ, x̅ = -15.5, t(5) = 2.724, p = .042). Youth and caregivers rated the program favorably. Improved family communication was most frequently reported by both patients and caregivers as a main benefit of the program. CONCLUSION These preliminary data indicate that SRB may be improved by a brief manualized, family-focused therapy. Early data suggest that the protocol is feasible and acceptable for adolescents presenting to the ED with safety concerns, and warrant further examination in a controlled trial.

scholarly journals Suicidal Ideation and Behaviours after Traumatic Brain Injury: A Systematic Review

2013 ◽  
Vol 14 (1) ◽  
pp. 92-112 ◽  
Author(s):  
Nazanin H. Bahraini ◽  
Grahame K. Simpson ◽  
Lisa A. Brenner ◽  
Adam S. Hoffberg ◽  
Alexandra L. Schneider
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Suicidal Ideation ◽  
Suicide Prevention ◽  
Suicide Attempts ◽  
Controlled Trial ◽  
A Priori ◽  
Increased Risk ◽  
Randomised Controlled

Traumatic brain injury (TBI) is prevalent among many populations and existing data suggest that those with TBI are at increased risk for death by suicide. This systematic review serves as an update to a previous review, with the aim of evaluating the current state of evidence regarding prevalence and risk of suicide deaths, post-TBI suicidal ideation and suicide attempts, and treatments to reduce suicide-related outcomes among TBI survivors. Review procedures followed the PRISMA statement guidelines. In all, 1014 abstracts and 83 full-text articles were reviewed to identify 16 studies meeting inclusion criteria. Risk of bias for individual studies ranged from low to high, and very few studies were designed to examine a priori hypotheses related to suicide outcomes of interest. Overall, findings from this systematic review supported an increased risk of suicide among TBI survivors compared to those with no history of TBI. Evidence pertaining to suicidal thoughts and attempts was less clear, mainly due to heterogeneity of methodological quality across studies. One small randomised controlled trial was identified that targeted suicide prevention in TBI survivors. Further research is needed to identify the prevalence of post-TBI ideation and attempts, and to establish evidence-based suicide prevention practices among TBI survivors.

756 The Moderating Influence of Depression on Insomnia and Suicidal Ideation in a Military Sample

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A294-A295
Author(s):  
Emma Palermo ◽  
Jennifer Goldschmied ◽  
Elaine Boland ◽  
Elizabeth A Klingaman ◽  
Philip Gehrman ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Suicidal Ideation ◽  
Research University ◽  
Negative Binomial ◽  
Suicide Attempts ◽  
Risk And Resilience ◽  
Depression Severity ◽  
Significant Interaction Effect ◽  
Increased Risk ◽  
The Impact

Abstract Introduction Military personnel are at an increased risk for suicide compared to the general population, making it important to develop a deeper understanding of which factors contribute to this elevated risk. Given that suicidal ideation (SI) is one of the strongest predictors of suicide attempts, understanding factors that underlie SI may improve prevention efforts. Insomnia and depression both serve as independent risk factors for SI, and therefore the aim of this study was to examine the extent to which depressive symptoms moderate the association between insomnia and SI. Methods Data were obtained from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS). Soldiers (n=21,450) completed questions related to suicidal ideation (5 items), depressive symptoms (9 items), and insomnia (5 items) based on symptom presence in the past 30 days. Items in each domain were summed to create a total severity score. GEE models using a negative binomial linking function were conducted to examine the impact of depression, insomnia, and their interaction on SI. Results Both depression (χ2 =117.56, p<0.001) and insomnia (χ2=11.79, p=0.0006) were found to have significant main effects on SI, and there was a significant interaction effect (χ2=4.52, p=0.0335). Follow up simple effects revealed that insomnia was no longer significantly associated with SI when depression severity was low, but was associated with SI in the presence of greater depression severity (χ2=2.91, p=0.0882). Conclusion In a large sample of Army soldiers, depression significantly moderated the association between SI and insomnia, such that insomnia seems to amplify the effects of depression on SI. These findings highlight the importance of addressing insomnia severity as a mean of reducing SI in those with depression, potentially allowing for intervention prior to a suicide attempt. Support (if any) Perlis: K24AG055602 & R01AG041783. This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan- http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981.

scholarly journals Depressão e ideação suicida na adolescência: implementação e avaliação de um programa de intervenção

2020 ◽  
Vol 19 (3) ◽  
pp. 1-35
Author(s):  
Ana Paula Amaral ◽  
Josiane Uchoa Sampaio ◽  
Fátima Regina Ney Matos ◽  
Margarida Tenente Santos Pocinho ◽  
Rafael Fernandes de Mesquita ◽  
...  
Keyword(s):  
Experimental Study ◽  
Depressive Symptoms ◽  
Suicidal Ideation ◽  
Suicide Prevention ◽  
Prevention Program ◽  
Intervention Program ◽  
Educational Institution ◽  
Assessment Instruments ◽  
Before And After ◽  
Quasi Experimental

Objetivo: Desarrollar, implementar y evaluar un programa de prevención del suicidio dirigido a adolescentes.Materiales y Métodos: Estudio cuasi experimental, del tipo antes y después, con adolescentes de una institución educativa en São Luís, Maranhão, Brasil. El estudio siguió las etapas de desarrollo, implementación y evaluación de un programa de intervención para la prevención del suicidio. Se administraron tres instrumentos de evaluación antes y después de la intervención: la escala de ideación suicida de Beck; el Inventario de Depresión de Beck y la Escala de Desesperanza de Beck.Resultados: Antes de la intervención, participaron 102 adolescentes, 30 (29.4%) tenían ideación suicida y síntomas depresivos. Después de la intervención, los instrumentos se aplicaron a los 30 adolescentes seleccionados, 12 (40.0%) continuaron con la ideación. Antes de la intervención, el Inventario de depresión promedio fue de 23.83 y luego de 7.17 (p <0.0001). En cuanto a la desesperanza, el promedio obtenido antes fue 7.23 y luego 2.17 (p <0.0001); Con respecto a la ideación suicida, el promedio obtenido antes fue de 10.50 y luego de 2.57 (p <0.0001).Conclusión: Hubo una disminución en los síntomas depresivos, la desesperanza y la ideación suicida después de la implementación del elaborado programa de intervención. Objective: To develop, implement and evaluate a suicide prevention program aimed at adolescents.Material and Methods: A quasi-experimental study, before and after, with adolescents from an educational institution in São Luís, Maranhão, Brazil. The study followed the stages of development, implementation and evaluation of a suicide prevention intervention program. Three assessment instruments were administered before and after the intervention: Beck's Suicidal Ideation Scale; Beck's Depression Inventory and Beck's Hopelessness Scale. Results: Before the intervention, 102 adolescents participated, 30 (29.4%) had suicidal ideation and depressive symptoms. After the intervention the instruments were applied to the 30 selected adolescents, 12 (40.0%) continued with ideation. Prior to intervention, the average Depression Inventory was 23.83 and then 7.17 (p <0.0001). As for hopelessness, the average obtained before was 7.23 and then 2.17 (p <0.0001); Regarding suicidal ideation, the average obtained before was 10.50 and then 2.57 (p <0.0001). Conclusion: There was a decrease in depressive symptoms, hopelessness and suicidal ideation after the implementation of the elaborated intervention program.

scholarly journals Treating Insomnia with High Risk of Depression Using Therapist-Guided Digital Cognitive, Behavioral, and Circadian Rhythm Support Interventions to Prevent Worsening of Depressive Symptoms: A Randomized Controlled Trial

2021 ◽  
pp. 1-12
Author(s):  
Jeanne Leerssen ◽  
Oti Lakbila-Kamal ◽  
Laura M.S. Dekkers ◽  
Savannah L.C. Ikelaar ◽  
Anne C.W. Albers ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Circadian Rhythm ◽  
Depressive Symptoms ◽  
High Risk ◽  
Depressive Symptomatology ◽  
Controlled Trial ◽  
Self Report ◽  
Cognitive Behavioral ◽  
Randomized Controlled ◽  
Increased Risk

<b><i>Introduction:</i></b> The global disease burden of major depressive disorder urgently requires prevention in high-risk individuals, such as recently discovered insomnia subtypes. Previous studies targeting insomnia with fully automated eHealth interventions to prevent depression are inconclusive: dropout was high and likely biased, and depressive symptoms in untreated participants on average improved rather than worsened. <b><i>Objective:</i></b> This randomized controlled trial aimed to efficiently prevent the worsening of depressive symptoms by selecting insomnia subtypes at high risk of depression for internet-based circadian rhythm support (CRS), cognitive behavioral therapy for insomnia (CBT-I), or their combination (CBT-I+CRS), with online therapist guidance to promote adherence. <b><i>Methods:</i></b> Participants with an insomnia disorder subtype conveying an increased risk of depression (<i>n</i> = 132) were randomized to no treatment (NT), CRS, CBT-I, or CBT-I+CRS. The Inventory of Depressive Symptomatology – Self Report (IDS-SR) was self-administered at baseline and at four follow-ups spanning 1 year. <b><i>Results:</i></b> Without treatment, depressive symptoms indeed worsened (<i>d</i> = 0.28, <i>p</i> = 0.041) in high-risk insomnia, but not in a reference group with low-risk insomnia. Therapist-guided CBT-I and CBT-I+CRS reduced IDS-SR ratings across all follow-up assessments (respectively, <i>d</i> = –0.80, <i>p</i> = 0.001; <i>d</i> = –0.95, <i>p</i> &#x3c; 0.001). Only CBT-I+CRS reduced the 1-year incidence of clinically meaningful worsening (<i>p</i> = 0.002). Dropout during therapist-guided interventions was very low (8%) compared to previous automated interventions (57–62%). <b><i>Conclusions:</i></b> The findings tentatively suggest that the efficiency of population-wide preventive strategies could benefit from the possibility to select insomnia subtypes at high risk of developing depression for therapist-guided digital CBT-I+CRS. This treatment may provide effective long-term prevention of worsening of depressive symptoms. <b><i>Trial registration:</i></b> the Netherlands Trial Register (NL7359).

scholarly journals Prediction of suicidal ideation risk in a prospective cohort study of medical interns

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260620
Author(s):  
Tyler L. Malone ◽  
Zhou Zhao ◽  
Tzu-Ying Liu ◽  
Peter X. K. Song ◽  
Srijan Sen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Depressive Symptoms ◽  
Suicidal Ideation ◽  
Medical Errors ◽  
Suicide Risk ◽  
The United States ◽  
Work Hours ◽  
Training Dataset ◽  
Data Set ◽  
Increased Risk

The purpose of this study was to identify individual and residency program factors associated with increased suicide risk, as measured by suicidal ideation. We utilized a prospective, longitudinal cohort study design to assess the prevalence and predictors of suicidal ideation in 6,691 (2012–2014 cohorts, training data set) and 4,904 (2015 cohort, test data set) first-year training physicians (interns) at hospital systems across the United States. We assessed suicidal ideation two months before internship and then quarterly through intern year. The prevalence of reported suicidal ideation in the study population increased from 3.0% at baseline to a mean of 6.9% during internship. 16.4% of interns reported suicidal ideation at least once during their internship. In the training dataset, a series of baseline demographic (male gender) and psychological factors (high neuroticism, depressive symptoms and suicidal ideation) were associated with increased risk of suicidal ideation during internship. Further, prior quarter psychiatric symptoms (depressive symptoms and suicidal ideation) and concurrent work-related factors (increase in self-reported work hours and medical errors) were associated with increased risk of suicidal ideation. A model derived from the training dataset had a predicted area under the Receiver Operating Characteristic curve (AUC) of 0.83 in the test dataset. The suicidal ideation risk predictors analyzed in this study can help programs and interns identify those at risk for suicidal ideation before the onset of training. Further, increases in self-reported work hours and environments associated with increased medical errors are potentially modifiable factors for residency programs to target to reduce suicide risk.

scholarly journals Mediators of increased self-harm and suicidal ideation in sexual minority youth: a longitudinal study

2018 ◽  
Vol 49 (15) ◽  
pp. 2524-2532 ◽  
Author(s):  
O. A. Oginni ◽  
E. J. Robinson ◽  
A. Jones ◽  
Q. Rahman ◽  
K. A. Rimes
Keyword(s):  
Depressive Symptoms ◽  
Longitudinal Study ◽  
Suicidal Ideation ◽  
Sexual Minority ◽  
Self Esteem ◽  
Gender Nonconformity ◽  
Minority Youth ◽  
Sexual Minority Youth ◽  
Increased Risk ◽  
Self Harm

AbstractBackgroundSexual minority youth have elevated suicidal ideation and self-harm compared with heterosexual young people; however, evidence for mediating mechanisms is predominantly cross-sectional. Using a longitudinal design, we investigated self-esteem and depressive symptoms as mediators of increased rates of suicidal ideation or self-harm (SISH) among sexual minority youth, and the roles of childhood gender nonconformity (CGN) and sex as moderators of these relationships.MethodIn total, 4274 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported sexual orientation at age 15 years, and past-year SISH at age 20 years. Self-esteem and depressive symptoms were assessed at ages 17 and 18 years, respectively. CGN was measured at 30–57 months. Covariates included sociodemographic variables and earlier measures of mediator and outcome variables. Mediation pathways were assessed using structural equation modelling.ResultsSexual minority youth (almost 12% of the sample) were three times more likely than heterosexual youth to report past-year SISH (95% confidence interval 2.43–3.64) at 20 years. Two mediation pathways were identified: a single mediator pathway involving self-esteem and a multiple-mediated pathway involving self-esteem and depressive symptoms. Although CGN was associated with past-year SISH, it did not moderate any mediation pathways and there was no evidence for moderation by sex.ConclusionsLower self-esteem and increased depressive symptoms partly explain the increased risk for later suicidal ideation and self-harm in sexual minority youth. Preventive strategies could include self-esteem-enhancing or protecting interventions, especially in female sexual minority youth, and treatment of depression.

scholarly journals Trajectories of change and long-term outcomes in a randomised controlled trial of internet-based insomnia treatment to prevent depression

BJPsych Open ◽  
2017 ◽  
Vol 3 (5) ◽  
pp. 228-235 ◽  
Author(s):  
Philip J. Batterham ◽  
Helen Christensen ◽  
Andrew J. Mackinnon ◽  
John A. Gosling ◽  
Frances P. Thorndike ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Suicidal Ideation ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
The Internet ◽  
Depression Symptoms ◽  
Insomnia Treatment ◽  
Trajectories Of Change ◽  
Randomised Controlled

BackgroundInsomnia treatment using an internet-based cognitive–behavioural therapy for insomnia (CBT-I) program reduces depression symptoms, anxiety symptoms and suicidal ideation. However, the speed, longevity and consistency of these effects are unknown.AimsTo test the following: whether the efficacy of online CBT-I was sustained over 18 months; how rapidly the effects of CBT-I emerged; evidence for distinct trajectories of change in depressive symptoms; and predictors of these trajectories.MethodA randomised controlled trial compared the 6-week Sleep Healthy Using the Internet (SHUTi) CBT-I program to an attention control program. Adults (N=1149) with clinical insomnia and subclinical depression symptoms were recruited online from the Australian community.ResultsDepression, anxiety and insomnia decreased significantly by week 4 of the intervention period and remained significantly lower relative to control for >18 months (between-group Cohen'sd=0.63, 0.47, 0.55, respectively, at 18 months). Effects on suicidal ideation were only short term. Two depression trajectories were identified using growth mixture models: improving (95%) and stable/deteriorating (5%) symptoms. More severe baseline depression, younger age and limited comfort with the internet were associated with reduced odds of improvement.ConclusionsOnline CBT-I produced rapid and long-term symptom reduction in people with subclinical depressive symptoms, although the initial effect on suicidal ideation was not sustained.

scholarly journals Infliximab treatment reduces depressive symptoms in patients with ankylosing spondylitis: an ancillary study to a randomized controlled trial (ASSERT)

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Casper Webers ◽  
Carmen Stolwijk ◽  
Olga Schiepers ◽  
Thea Schoonbrood ◽  
Astrid van Tubergen ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Placebo Group ◽  
Depressive Symptoms ◽  
Ankylosing Spondylitis ◽  
Controlled Trial ◽  
Trial Registration ◽  
Direct Result ◽  
Infliximab Treatment ◽  
Randomized Controlled ◽  
Increased Risk

Abstract Background Patients with ankylosing spondylitis (AS) are at increased risk of depression. This increased risk has been hypothesized to be solely secondary due to AS-related symptoms, or additionally due to a common inflammatory pathway. From a clinical perspective, it is important to know whether treatment with tumor necrosis factor alpha inhibitors reduces depressive symptoms, while from a pathophysiological point of view, it would be insightful to understand whether such an effect would be a direct result of reduced inflammation, the result of reduced AS-related symptoms, or both. The objective of this study was to evaluate the effect of infliximab on depressive symptoms in patients with AS in a randomized-controlled trial setting. Methods Data were retrieved from a subgroup of patients from the AS Study for the Evaluation of Recombinant Infliximab Therapy (ASSERT). Patients were randomly allocated to infliximab (n = 16) or placebo (n = 7) until week 24, after which all received infliximab until week 54. Associations between treatment group and depressive symptoms, measured with the Center for Epidemiological Studies Depression scale (CES-D, range 0–60 (best-worst)) at baseline and over time, were explored with generalized estimating equations (GEE). Results Mean CES-D score at baseline was 15.5 (SD 9.3) in the infliximab group and 17.3 (SD 5.7) in the placebo group. Twelve patients (52%) had a CES-D score > 16, suggestive for clinical depression. After 24 weeks, mean CES-D had decreased to 9.5 (SD 11.4) in the infliximab group, but was 18.0 (SD 6.9) in the placebo group. GEE revealed larger improvements in depressive symptoms (B = − 6.63, 95%CI − 13.35 to 0.09) and odds of possible depression (OR = 0.02, 95%CI 0.00 to 0.72) in the infliximab group, compared to the placebo group. Both associations largely disappeared when adjusted for self-reported disease activity and/or physical function. Additional adjustment for C-reactive protein (CRP) did not change results. Conclusions Depressive symptoms are common in patients with AS and active disease. Infliximab improves these depressive symptoms in AS when compared to placebo by improving disease symptoms. We did not find an indication for a direct link between CRP-mediated inflammation and depressive symptoms. Trial registration Trial registration (ASSERT): NCT00207701. Registered on September 21, 2005 (retrospectively registered).

A randomized trial of telephone-based motivational interviewing for adolescent chronic headache with medication overuse

Cephalalgia ◽  
2013 ◽  
Vol 34 (6) ◽  
pp. 446-454 ◽  
Author(s):  
Jack Stevens ◽  
John Hayes ◽  
Ann Pakalnis
Keyword(s):  
Motivational Interviewing ◽  
Medication Overuse ◽  
Controlled Trial ◽  
Medication Overuse Headache ◽  
Standard Of Care ◽  
Tension Type Headache ◽  
Headache Frequency ◽  
Care Clinic ◽  
Headache Severity ◽  
Phone Calls

Introduction Nearly 2% of youths suffer from chronic migraine or chronic tension-type headache (CTTH). A contributing factor in approximately 20%–50% of these youths is medication overuse, which involves taking analgesics three or more times per week for three months. The objective of this study was to test motivational interviewing (MI) as an approach to promote adherence to recommendations regarding not only analgesic overuse but also other aspects of treatment plans. Methods A randomized controlled trial was conducted comparing the experimental condition (standard of care clinic-based treatment with supplemental MI phone calls; n = 24) to a control condition (standard of care clinic-based treatment without these supplemental MI phone calls; n = 23). Four months after enrollment, a research assistant who was blinded to study condition telephoned adolescents inquiring about headache frequency, headache severity, and disability. Results Headache frequency was lower in the experimental condition versus control condition for those with relatively lower initial levels of headache frequency. In contrast, we did not find greater improvement in headache severity and disability for the experimental condition relative to the control condition. Discussion Our findings provided some preliminary, albeit limited, support for MI as an approach to improve outcomes for adolescent medication-overuse headache (MOH).

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