Sequential multiple assignment randomised trial of a brief contact intervention for suicide risk management among discharged psychiatric patients: an implementation study protocol

IntroductionThe postdischarge suicide risk among psychiatric patients is significantly higher than it is among patients with other diseases and general population. The brief contact interventions (BCIs) are recommended to decrease suicide risk in areas with limited mental health service resources like China. This study aims to develop a postdischarge suicide intervention strategy based on BCIs and evaluate its implementability under the implementation outcome framework.Methods and analysisThis study will invite psychiatric patients and family members, clinical and community mental health service providers as the community team to develop a postdischarge suicide intervention strategy. The study will recruit 312 patients with psychotic symptoms and 312 patients with major depressive disorder discharged from Shenzhen Kangning Hospital (SKH) in a Sequential Multiple Assignment Randomised Trial. Participants will be initially randomised into two intervention groups to receive BCIs monthly and weekly, and they will be rerandomised into three intervention groups to receive BCIs monthly, biweekly and weekly at 3 months after discharge according to the change of their suicide risk. Follow-ups are scheduled at 1, 3, 6 and 12 months after discharge. With the intention-to-treat approach, generalised estimating equation and survival analysis will be applied. This study will also collect qualitative and quantitative information on implementation and service outcomes from the community team.Ethics/disseminationThis study has received ethical approval from the Ethics Committee Review Board of SKH. All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations. A project report will be submitted to the National Natural Science Foundation of China as the concluding report of this funded project, and to the mental health authorities in the Shenzhen to refine and apply evidence-based and pragmatic interventions into health systems for postdischarge suicide prevention.Trial registration numberNCT04907669.

Lived Lives at Fort Dunree: a rural Irish community perspective

Background: Elevated suicide rates have alarmed policy makers and communities. In these circumstances, the value of understanding more about communities and their potential role in suicide intervention is becoming more apparent. This study involved evaluating feedback from individuals with and without previous suicidal thinking who participated in an arts-science rural community-based intervention project around suicide in County Donegal, Ireland (Lived Lives at Fort Dunree). Methods: A combined quantitative and qualitative questionnaire was used to evaluate individual and community responses to the Lived Lives project. Results: Participants (n = 83), with and without a mental health history and previous suicidal ideation, reported they believed Lived Lives could have potential to help suicide-bereaved families, people with mental illness and people with suicidal thinking. Qualitative results suggested its’ suitability for specific groups affected by suicide. Discussion: The evaluation of the Lived Lives project indicated that supervised, “safe-space” community intervention projects around suicide have inherent value with positive impacts for bereaved individuals and communities, including those who have experienced suicidal feelings. Future research should explore the transferability of these findings to other communities, and at-risk groups.

Innovating Technology-Enhanced Interventions for Youth Suicide: Insights for Measuring Implementation Outcomes

Technology is one medium to increase youth engagement, especially among underserved and minority groups, in suicide preventive interventions. Technology can be used to supplement or adjunct an in-person intervention, guide an in-person intervention, or be the stand-alone (automated) component of the intervention. This range in technological use is now called the continuum of behavioral intervention technologies (BITs). Overall, suicide intervention researchers do not use this terminology to categorize how the role of technology differs across technology-enhanced youth interventions. There is growing recognition that technology-enhanced interventions will not create substantial public health impact without an understanding of the individual (youth, families, and providers), mezzo (clinics and health systems of care), and contextual factors (society, culture, community) that are associated with their implementation. Implementation science is the study of methods to promote uptake of evidence-based practices and policies into the broader health care system. In this review, we incorporate work from implementation science and BIT implementation to illustrate how the study of technology-enhanced interventions for youth suicide can be advanced by specifying the role of technology and measuring implementation outcomes.

Validation of the Suicide Counseling Skills Inventory

Background: The self-report measures used in evaluations of the Applied Suicide Intervention Skills Training (ASIST) program have tended not to detect an improvement in a broad range of suicide counseling skills from pre- to posttraining or among trainees with better skills at pretraining. Aims: The purpose of this study was to develop and validate the Suicide Counseling Skills Inventory (SCSI), which included ten brief counselor–client scenarios and three counselor responses to each scenario. Method: Data were collected from several samples to develop and evaluate the SCSI. Trainee scores were subtracted from criterion expert scores to create discrepancy scores. Results: The SCSI detected an improvement in skills from pre- to posttraining across samples, including among trainees with better skills at pretraining. Internal consistency and test–retest reliability were good. Limitations: The results may not generalize across different training models. Conclusion: Trainee scores were more like expert scores at posttraining. The SCSI may be useful in evaluating suicide counseling competency.

Lived Lives at Fort Dunree: a rural community perspective

Background: Elevated suicide rates have alarmed policy makers and communities. In these circumstances, the value of understanding more about communities and their potential role in suicide intervention is becoming more apparent. This study involved evaluating feedback from individuals with and without previous suicidal thinking who participated in an arts-science rural community-based intervention project around suicide (Lived Lives at Fort Dunree). Methods: A combined quantitative and qualitative questionnaire was used to evaluate individual and community responses to the Lived Lives project. Results: Participants (n = 83), with and without a mental health history and previous suicidal ideation, reported they believed Lived Lives could have potential to help suicide-bereaved families, people with mental illness and people with suicidal thinking. Qualitative results suggested its’ suitability for specific groups affected by suicide. Discussion: The evaluation of the Lived Lives project indicated that supervised, “safe-space” community intervention projects around suicide have inherent value with positive impacts for bereaved individuals and communities, including those who have experienced suicidal feelings. Future research should explore the transferability of these findings to other communities, and at-risk groups.

Peer Survivors of Suicide Loss: A Phenomenological Study

The ultimate sufferers of suicide are those left behind. The present study aims to explore, describe, and interpret the lived experiences of peer survivors of suicide loss. This study utilized the phenomenological research design. The participants were selected based on their having experienced the phenomenon of being a peer survivor of suicide loss. Ten participants with low resiliency and who were severely distressed volunteered to participate. Individual narrative stories and interviews were utilized to gather the qualitative data for this study. Common themes for the lived experiences of being a peer survivor of suicide loss are: being confused about the reported suicide; being stunned by the suicide; questioning the act of suicide; accepting the truth of the suicide; grieving the loss of a friend; accepting the death of a friend; finding solace from friends; and experiencing growth after the trauma. Forging connections with other peer survivors of suicide loss are part of the healing process. Thus, this study demonstrates the possibility of this connection in providing a basis for school suicide intervention and postvention programs for peer survivors of suicide loss in a supportive environment. There is a scarcity of studies on how suicide loss affects the survivors in the Philippines, specifically on the grief of suicide-bereaved emerging adults, as most studies focus on suicidal thoughts and behaviors. This study contributes to the scarce literature on survivors of suicide loss in the country.