scholarly journals A regional systems intervention for suicide prevention in the Netherlands (SUPREMOCOL): study protocol with a stepped wedge trial design

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Emma Hofstra ◽  
Iman Elfeddali ◽  
Margot Metz ◽  
Marjan Bakker ◽  
Jacobus J. de Jong ◽  
...  
Keyword(s):  
Mental Health ◽  
Suicidal Ideation ◽  
The Netherlands ◽  
Suicide Prevention ◽  
Study Protocol ◽  
Collaborative Care ◽  
Trial Design ◽  
Stepped Wedge ◽  
Health Institutions ◽  
Stepped Wedge Trial

Abstract Background In the Netherlands, suicide rates showed a sharp incline and this pertains particularly to the province of Noord-Brabant, one of the southern provinces in the Netherlands. This calls for a regional suicide prevention effort. Methods/design Study protocol. A regional suicide prevention systems intervention is implemented and evaluated by a stepped wedge trial design in five specialist mental health institutions and their adherent chain partners. Our system intervention is called SUPREMOCOL, which stands for Suicide Prevention by Monitoring and Collaborative Care, and focuses on four pillars: 1) recognition of people at risk for suicide by the development and implementation of a monitoring system with decision aid, 2) swift access to specialist care of people at risk, 3) positioning nurse care managers for collaborative care case management, and 4) 12 months telephone follow up. Eligible patients are persons attempting suicide or expressing suicidal ideation. Primary outcome is number of completed suicides, as reported by Statistics Netherlands and regional Public Health Institutes. Secondary outcome is number of attempted suicides, as reported by the regional ambulance transport and police. Suicidal ideation of persons registered in the monitoring system will, be assessed by the PHQ-9 and SIDAS questionnaires at baseline and 3, 6, 9 and 12 months after registration, and used as exploratory process measure. The impact of the intervention will be evaluated by means of the RE-AIM dimensions reach, efficacy, adoption, implementation, and maintenance. Intervention integrity will be assessed and taken into account in the analysis. Discussion The present manuscript presents the design and development of the SUPREMOCOL study. The ultimate goal is to lower the completed suicides rate by 20%, compared to the control period and compared to other provinces in the Netherlands. Moreover, our goal is to provide specialist mental health institutions and chain partners with a sustainable and adoptable intervention for suicide prevention. Trial registration Netherlands Trial Register under registration number NL6935 (5 April 2018). This is the first version of the study protocol (September 2019).

Tackling radicalization and terrorism in Dutch mental health institutions: Outcomes of a Dutch population survey

2021 ◽  
pp. 229-240
Author(s):  
Carl H.D. Steinmetz
Keyword(s):  
Mental Health ◽  
The Netherlands ◽  
Population Survey ◽  
Health Sector ◽  
Dutch Population ◽  
Health Institutions ◽  
Mental Health Institutions

Virtually no data are available on mental health institutions working on radicalization and terrorism. In the Netherlands we conducted a survey of all mental health institutions (n = 65) in 2016. Fifty-seven per cent responded. The result is that mental health institutions in the Netherlands have started to take small steps towards tacking radicalization and terrorism. These small steps, even by 2016, are a contrast to the reality of radicalization and terrorist incidents and attacks in the Netherlands since 2000. This outcome may have been caused by the resistance of Dutch psychiatrists in the mental health sector (often heard in the Greater Amsterdam region) to the idea that radicalisation and terrorist incidents and attacks are not their work either. For their view is, it is not our job if there is no DSM disorder.

scholarly journals Collaborative care for patients with bipolar disorder: randomised controlled trial

2015 ◽  
Vol 206 (5) ◽  
pp. 393-400 ◽  
Author(s):  
Trijntje Y. G. van der Voort ◽  
Berno van Meijel ◽  
Peter J. J. Goossens ◽  
Adriaan W. Hoogendoorn ◽  
Stasja Draisma ◽  
...  
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Medication Adherence ◽  
The Netherlands ◽  
Collaborative Care ◽  
Controlled Trial ◽  
Response To Treatment ◽  
Care Programme ◽  
Relevant Effect

BackgroundA substantial number of people with bipolar disorder show a suboptimal response to treatment.AimsTo study the effectiveness of a collaborative care programme on symptoms and medication adherence in patients with bipolar disorder, compared with care as usual.MethodA two-armed, cluster randomised clinical trial was carried out in 16 out-patient mental health clinics in The Netherlands, in which 138 patients were randomised. Patient outcomes included duration and severity of symptoms and medication adherence, and were measured at baseline, 6 months and 12 months. Collaborative care comprised contracting, psychoeducation, problem-solving treatment, systematic relapse prevention and monitoring of outcomes. Mental health nurses functioned as care managers in this programme. The trial was registered with The Netherlands Trial Registry (NTR2600).ResultsCollaborative care had a significant and clinically relevant effect on number of months with depressive symptoms, both at 6 months (z =–2.6, P = 0.01, d = 0.5) and at 12 months (z =–3.1, P = 0.002, d = 0.7), as well as on severity of depressive symptoms at 12 months (z =–2.9, P = 0.004, d = 0.4). There was no effect on symptoms of mania or on treatment adherence.ConclusionsWhen compared with treatment as usual, collaborative care substantially reduced the time participants with bipolar disorder experienced depressive symptoms. Also, depressive symptom severity decreased significantly. As persistent depressive symptoms are difficult to treat and contribute to both disability and impaired quality of life in bipolar disorder, collaborative care may be an important form of treatment for people with this disorder.

Stepped-wedge trial design to evaluate Ebola treatments

2015 ◽  
Vol 15 (7) ◽  
pp. 762-763 ◽  
Author(s):  
Jolanta Piszczek ◽  
Eric Partlow
Keyword(s):  
Trial Design ◽  
Stepped Wedge ◽  
Stepped Wedge Trial

The national strategy for suicide prevention in the Netherlands: on the road to zero suicides

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Franx
Keyword(s):  
Mental Health ◽  
The Netherlands ◽  
Suicide Prevention ◽  
Public Awareness ◽  
Vulnerable Groups ◽  
National Strategy ◽  
The Road ◽  
Public Awareness Campaign ◽  
First Results ◽  
On The Road

Abstract Background In the Netherlands, 1829 persons (11.6/100.000) ended their life by suicide in 2018. Two out of three suicides concern men, most of them in the age group of 50-55. Suicide amongst youth is rising, especially amongst youngsters between 10-25. Around 40 persons a day, predominantly young and female, are treated in Dutch hospitals after having attempted suicide. Only 40% of those who die by suicide have been in touch with healthcare professionals. These figures made the Dutch government to put in place a national strategy for suicide prevention. Methods This strategy follows the WHO's guidance and covers a range of measures in public health as well as in the health care sector. Its implementation is coordinated by “113 Suicide prevention”, the national centre of expertise on suicide prevention in the Netherlands. Results A broad package of measures is being implemented simultaneously, targeting the entire population as well as specific vulnerable groups, such as youngsters, persons with LGBT related issues and persons with mental health needs. We initiated several collective preventive measures, such as media guidelines for safe reporting, a public awareness campaign against stigma, reduction of access to deadly means or places; selective prevention initiatives, e.g. training over 3400 of gatekeepers to detect and address suicidal thoughts with desperate persons; and indicated suicide prevention strategies including screening, treatment and follow up of patients with suicidal behaviour in general practice or mental health hospitals. In this presentation the different components of the Dutch strategy for suicide prevention will be described more in detail, and experiences and first results of the different components will be addressed. Conclusions The relevance of the Dutch national strategy is related to the broad package of measures implemented simultaneously in many domains of society, but closely monitoring and evaluating the effect stays challenging.

scholarly journals Improving HIV service delivery for people who inject drugs in Kazakhstan: study protocol for the Bridge stepped-wedge trial

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Tara McCrimmon ◽  
Louisa Gilbert ◽  
Timothy Hunt ◽  
Assel Terlikbayeva ◽  
Elwin Wu ◽  
...  
Keyword(s):  
Service Delivery ◽  
Study Protocol ◽  
People Who Inject Drugs ◽  
Stepped Wedge ◽  
Stepped Wedge Trial

scholarly journals Can patient decision aids reduce decisional conflict in a de-escalation of breast radiotherapy clinical trial? The PRIMETIME Study Within a Trial implemented using a cluster stepped-wedge trial design

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Indrani S. Bhattacharya ◽  
Joanne S. Haviland ◽  
Lesley Turner ◽  
Hilary Stobart ◽  
Ada Balasopoulou ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Information ◽  
Trial Design ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Stepped Wedge ◽  
Patient Decision ◽  
Study Within A Trial ◽  
Information Group ◽  
Stepped Wedge Trial

Abstract Background For patients with early breast cancer considered at very-low risk of local relapse, risks of radiotherapy may outweigh the benefits. Decisions regarding treatment omission can lead to patient uncertainty (decisional conflict), which may be lessened with patient decision aids (PDA). PRIMETIME (ISRCTN 41579286) is a UK-led biomarker-directed study evaluating omission of adjuvant radiotherapy in breast cancer; an embedded Study Within A Trial (SWAT) investigated whether PDA reduces decisional conflict using a cluster stepped-wedge trial design. Methods PDA diagrams and a video explaining risks and benefits of radiotherapy were developed in close collaboration between patient advocates and PRIMETIME trialists. The SWAT used a cluster stepped-wedge trial design, where each cluster represented the radiotherapy centre and referring peripheral centres. All clusters began in the standard information group (patient information and diagrams) and were randomised to cross-over to the enhanced information group (standard information plus video) at 2, 4 or 6 months. Primary endpoint was the decisional conflict scale (0–100, higher scores indicating greater conflict) which was assessed on an individual participant level. Multilevel mixed effects models used a random effect for cluster and a fixed effect for each step to adjust for calendar time and clustering. Robust standard errors were also adjusted for the clustering effect. Results Five hundred twenty-one evaluable questionnaires were returned from 809 eligible patients (64%) in 24 clusters between April 2018 and October 2019. Mean decisional conflict scores in the standard group (N = 184) were 10.88 (SD 11.82) and 8.99 (SD 11.82) in the enhanced group (N = 337), with no statistically significant difference [mean difference − 1.78, 95%CI − 3.82–0.25, p = 0.09]. Compliance with patient information and diagrams was high in both groups although in the enhanced group only 121/337 (36%) reported watching the video. Conclusion The low levels of decisional conflict in PRIMETIME are reassuring and may reflect the high-quality information provision, such that not everyone required the video. This reinforces the importance of working with patients as partners in clinical trials especially in the development of patient-centred information and decision aids.

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